[Call attention to the overall benefit of digital pathology and promote its development].

The successful operation of the complete digital pathology(CDP) in foreign countries indicates that the full digital pathology process has entered the full implementation stage. Digital pathology in China started late and progressed slowly, so far there has not been a truly meaningful CDP. The pathologist's understanding of digital pathology is not comprehensive enough, and there are still doubts about the time efficiency and cost effectiveness of digital pathology processes. Therefore,a comprehensive analysis of the process, overall advantages and cost-effectiveness of CDP was made by drawing on international successful experience and hands-on practice experience, in order to promote the construction and development of the CDP in our country.

[Clinical significance of HER2 positivity in gallbladder adenocarcinoma].

Objective: To study the clinical significance of HER2 overexpression and/or amplification in gallbladder adenocarcinoma. Methods: HER2 staining was performed on 123 cases of gallbladder adenocarcinoma specimens by IHC using scoring criteria for gastric cancer. FISH test was performed on the IHC score 2+ and 3+ cases and the results were correlated with clinicopathological findings. Results: In total of 123 cases of gallbladder adenocarcinomas, HER2 amplification detection rate was 22.0%(27/123). Among 27 cases with HER2 gene amplification, 5 cases were IHC 2+ (5/12) and 22 cases were IHC 3+ (91.7%, 22/24), and the concordance rates between IHC and FISH were 41.7%and 91.7% respectively. The heterogeneity of HER2 expression was observed in 3 cases with complete strong cell membrane staining but the number of stained cells of<10%.Among them, 1 case showed HER2 gene amplification. The difference of HER2 gene amplification in well, moderately and lowly differentiated tumors has statistical significance(χ2=24.4, P<0.01), and its detection rate was related to the degree of tumor differentiation (C=0.45). Conclusions: About 20% gallbladder adenocarcinomas have HER2 positivity, providing the targeted therapy implicationfor these patients.IHC HER2 scoring system for gastric carcinoma is suitable for gallbladder carcinoma. However, the cases with complete strong membrane staining but in <10% tumor cells should be included in the 2+ score IHC group.

[Invasive micropapillary carcinoma of gallbladder: a clinicopathologic study].

Objective: To study the clinicopathologic features of invasive micropapillary carcinoma (IMPC) of the gallbladder. Methods: Among 160 resected cases of gallbladder adenocarcinomas, the clinical and histological features of gallbladder adenocarcinomas with invasive micropapillary components (IMPC≥5%) were studied. Results: The detection rate of IPMC among gallbladder adenocarcinomas was 19.4% (31/160). Among these 31 cases, the patients' age ranged from 42 to 84 years (mean 64.8 years). The male-to-female ratio was 1∶4.Histologically, 19 cases were characterized by small papillary tufts lacking central fibrovascular cores, lying freely within the clefts of fibrous tissue, resembling IMPC of the breast; in five cases, the micropapillary tufts floated within cystic spaces lined by tumor cells, resembling IMPC of the lung; in four cases, slender, delicate filiform processes on the tumor surface with classic IMPC in the depth of gallbladder was observed; and in three cases mixed features were seen. Small cluster invasion (SCI) was seen adjacent to the IMPC. The lymph node metastatic rate, the lymphovascular invasion rate, and the SCI detection rate were significantly higher in the IMPC group (P=0.000). The IMPC detection rate was related to poorer histological differentiation and increased T stage (P=0.012, C=0.67; P=0.011, C=0.68). The two-year survival rate of IMPC (4/18) was significantly lower than usual gallbladder carcinoma (54.8%, 23/42). Conclusions: Compared to conventional adenocarcinoma of the gallbladder, IMPC has a more advanced tumor status and is prone to lymphovascular invasion and lymph node metastasis, which thus leads to short-term survival. Moreover, SCI may play an important role in the invasion of the IMPC of the gallbladder.

Curative effect and safety of intrathecal transplantation of neural stem cells for the treatment of cerebral hemorrhage.

In this study, we aimed to explore the curative effect and safety of neural stem cell intrathecal transplantation for the treatment of cerebral hemorrhage. We transplanted 4.0 x 10(8) neural stem cells per procedure into the subarachnoid space by lumbar puncture 7 days after cerebral hemorrhage, twice a week, a total of 4 times. NIHSS scores and brain CT scans were conducted to assess neural functions and the volume of perihematoma lesions in patients on days 1, 7, 14, 21, and 28. We found that the NIHSS scores and the volume of the perihematoma lesions were significantly reduced after day 14. The differences before and after treatment were highly significant in intra- and between-group comparisons (P < 0.05). There were no adverse reactions, except for transient fever and shivering in a few patients. Our data suggest that the use of neural stem cells in intrathecal transplantation for the treatment of cerebral hemorrhage is safe and effective.

Systemic embolism: a serious complication after cardiac transplantation avoidable by bicaval technique.

OBJECTIVE: Systemic embolism is a serious complication after classical orthotopic transplantation, presumably originating from enlarged left atrium. We specifically studied this problem after classical and modified bicaval transplantation. METHODS: Between December 1985 and March 1999 we consecutively performed 72 classical and 106 modified heart transplantation. Modification included bicaval anastomosis and recipient left atrium maximal reduction. Mean age was 47 years. All the patients received an antiplatelet therapy and were routinely followed. When clinical signs of systemic embolism were present, a neurological evaluation and transesophageal echocardiography were done. Sixty matched patients (30 of each group) had comparative transesophageal echocardiography study, at least 6 months after transplantation. RESULTS: Perioperative mortality was 17.4%. Mean follow-up was 6.8 2+/47 years. All patients were in sinus rhythm. Among 147 survivors, 11 patients who underwent classical transplantation had a systemic embolism, 1 month to 12 years after transplantation, 15.3%, (11/72). Two limb ischemia and one mesenteric ischemia (needing surgery), seven strokes (one death, two permanent neurological deficit). There was no systemic embolism in the modified technique group (P=0.013). Left atrial comparative transesophageal echocardiography study showed a larger left atrial surface in classical transplantation. 33+/-4 cm(2) versus 20+/-3 cm(2) in a modified technique, P=0.01. Spontaneous echo contrast was present in 56% of classical technique group associated with atrial thrombosis in nine patients, there were no atrial thrombosis in modified technique group and spontaneous echocontrast was present in 0.5% (P=<0.001). CONCLUSION: The occurrence of systemic embolism, left atrial spontaneous echocontrast and thrombosis when using classical technique, and the absence of these complications with the bicaval technique justified the use of this method. Our experience with atrial thrombosis and spontaneous echocontrast rises the question of anticoagulation in classical transplantation.

A telomeric satellite in Drosophila virilis and its sibling species.

Telomere elongation by telomerase is the most widespread mechanism among eukaryotes. However, alternative mechanisms such as homologous recombination between terminal satellite DNAs are probably used in lower dipteran insects and in some plants. Drosophila melanogaster uses the very unusual telomere elongation pathway of transposition of telomere-specific retrotransposable elements. The uniqueness of this telomere elongation mechanism raises the question of its origin. We, therefore, analyzed sequences located at telomeres of fairly distantly related Drosophila species, and in this paper we describe the characterization of complex satellite DNA sequences located at the telomeres of D. virilis and other species in the virilis group. We suggest an involvement of these DNA satellites in telomere elongation by homologous recombination similar to that found in lower dipterans. Our findings raise the possibility that telomere elongation by specific retrotransposons as found in D. melanogaster and its sibling species is a recent event in the evolution of dipteran insects.

Moose, a new family of LTR-retrotransposons in the mosquito Anopheles gambiae.

A novel LTR retrotransposable element called moose has been cloned and characterized from the malaria transmitting mosquito, Anopheles gambiae. This element has all the characteristic features of LTR retroelements and is related to retroelements from other insects and nematodes, belonging to a subgroup of retroelements distinct from the copia/Ty1 and gypsy/Ty3 groups. The moose element appears to be active in A. gambiae, and strong RNA expression is detected in the male and female gonads. The use of this retroelement as a potential vector for germ line transformation is discussed.

Extending the concept of the autograft for complete repair of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction: a report of ten cases of a modified procedure.

BACKGROUND: In most cases of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction, a Lecompte procedure (réparation à l'étage ventriculaire) is possible without interposition of a conduit between the right ventricle and pulmonary artery. However, the anterior location of the pulmonary arteries after the Lecompte maneuver may be a potential cause for right ventricular outflow obstruction, which continues to be reported in 5% to 25% of cases. We have used a tubular segment of aortic autograft to connect the pulmonary artery, left in the orthotopic posterior position (without the Lecompte maneuver), to the right ventricle in 10 consecutive patients with transposition, ventricular septal defect, and left ventricular outflow tract obstruction. METHODS: Ten consecutive patients aged 2 months to 11 years (mean 32 months) have undergone a modified Lecompte operation. Eight had severe pulmonary stenosis, two had pulmonary atresia, and four had a restrictive ventricular septal defect at the time of the operation. Two had multiple ventricular septal defects. Seven had undergone one (n = 5) or two (n = 2) previous modified Blalock-Taussig shunts. All patients underwent a total correction with left ventricular-aortic intraventricular connection (four needed a ventricular septal defect enlargement), connection between the right ventricle and pulmonary arteries with a tubular segment of autograft aorta, without the Lecompte maneuver (anterior location of the bifurcation of the pulmonary arteries) on the right (n = 6) or the left (n = 4) of the aorta. No valvular device was used for the right ventricular outflow repair. RESULTS: No early or late deaths occurred. One patient with multiple ventricular septal defects needed an early (2 weeks) reoperation for a residual muscular ventricular septal defect. All patients are currently in New York Heart. Association class I, without medications, in sinus rhythm, at a mean follow-up of 30 months. Late results up to 3.6 years show no calcification on the chest roentgenogram, and at the most recent echocardiogram, right ventricular pressures were low (25 to 40 mm Hg, mean 33 mm Hg) and no significant gradient (over 10 mm Hg) was found between the right ventricle and pulmonary arteries. Left and right ventricular function was satisfactory. CONCLUSION: This modification of the Lecompte operation using a segment of autograft allows an excellent early and late result, with no danger of compression of anteriorly placed pulmonary arteries, no significant right ventricular outflow obstruction, and normal appearance of the tubular autograft. In view of laboratory and clinical evidence, normal growth of the autograft can be anticipated. It allows an elective correction of transposition, ventricular septal defect, and left ventricular outflow tract obstruction without a previous Blalock-Taussig shunt (three patients) and correction at a young age (three patients younger than 1 year).

False aneurysm: a rare and potentially severe complication after pulmonary autograft operation.

A case of a false aneurysm arising at the proximal suture of an aortic root replacement with a pulmonary autograft is presented. This complication did not occur in the first postoperative month but was discovered late, and the female eight-year-old patient was in an extremely serious condition. She was reoperated on an emergency basis but died of acute pulmonary artery hypertension. The mechanism of the occurrence of such a case is discussed. In the absence of infection, structural weakness of the right ventricular muscle with progressive tearing is suggested. Strict and prolonged echocardiographic surveillance after the Ross procedure and early reoperation are mandatory.

[Ano-rectal injuries in civilian practice in Cameroon. 10 case reports]. / Les plaies ano-rectales en pratique civile camerounaise. A propos de 10 cas.

At the Central Hospital of Yaoundé, Cameroon, 10 ano-rectal injuries were treated over a period of 5 years. There were the same number of men and women and all patients were young (range: 7 to 35 years). The cause was illegal abortion in 2 cases and impalement following a fall from a tree in 3. The time lapse between injury and treatment was longer than 24 hours in 5 patients. In 2 cases the lesions were minor and simple debridement was possible. In the remaining 8 cases, construction of a colostomy was required using either the Hartmann terminal-type technique (n = 5) or the exclusion technique (n = 3). Three patients died: one from traumatic shock and two from septic shock. Complications were observed in 4 patients: 2 infections and 2 mechanical complications. Two patients presented permanent sequels including one with partial fecal incontinence. This study confirms the difficulty in management of ano-rectal injuries with limited facilities and reveals the variety of situations that can lead to these injuries especially in children in Africa.

[Typhoid perforations: experiences in a surgical setting in Cameroon. Apropos of 49 cases]. / Perforations typhiques: expérience en milieu chirurgical Camerounais. A propos de 49 cas.

Over a period of 3 years, 49 typhoid perforations of the small intestine were treated at Yaoundé Central Hospital. These 34 men and 15 women with a mean age of 29.6 years presented sthenic peritonitis in 20 cases and more difficult to diagnose asthenic peritonitis in 29 cases. The perforation was always located at the end of the ileum and was single in 40 cases, double in 6 cases and triple in 3 cases. Surgical management in association with intensive care and multiple agent antimicrobial therapy consisted in sleeve resection in 29 cases, resections with an exteriorized anastomosis in 15 cases, and ileocolonic intubation in 5 cases. The postoperative complications were suppuration of the wall (n = 4), intestinal fistula (n = 3), evisceration, and residual abscess. There were 9 deaths (18.4%) including 4 after sleeve resection and 5 after resection with an exteriorized anastomosis. On the basis of this experience, the authors describe the diagnostic difficulties posed by typhoid perforations, discuss surgical techniques proposed in the literature, and emphasize the value of sleeve resection.

[3 new cases of internal male pseudohermaphroditism]. / Trois nouvelles observations de pseudohermaphrodisme mâle interne.

The authors report 3 new cases of Male Internal Pseudohermaphrodism. It is a scarce entity. The discovery is fortuous during the cure of hernia or cryptorchidism. The family history has nothing particular. The main problem of this syndrome is its treatment. Our attitude consisted in conserving the mullerian derivatives and treating the hernia or the cryptorchidism. Hysterectomy is not justified for the following reasons; no case of cancerisation of the mullerian derivatives has not yet been reported. The vasa deferens and uterus are in intimate relationship; the dissection is therefore dangerous. We did not perform systematic castration in order to protect fertility. The removal of the testis is performed only when the gland is intraabdominal and undescendable considering the major risk of cancerisation.

[The value of metronidazole in the indications for appendicectomy in a tropical environment. Apropos of 183 cases]. / Intérét du métronidazole dans l'indication d'une appendicectomie en milieu tropical. A propos de 183 cas.

This work was carried out consequently to three observations followed up by regrettable consequences: one right hemicolectomy about acute perforated typhlitis, two post-operative fistulae about clinical feature of pseudo-appendicitis. A study was undertaken on 183 patients; 160 patients complained of chronic in right iliac fossa, 23 of acute or subacute pain. Out of the 160 chronic patients, treated by metronidazole did not show symptoms anymore. Out of the 23 acute patients, 14 were cured thanks to the amebicide test-treatment and the 9 others showed during surgical intervention: 4 phlegmonous appendicitis, 3 appendicitis with inflammation of the mucous membrane, 2 appendicitis with abscess. In the acute cases, the duration of the therapeutic test was 10 ho. In the operated chronic cases (37 out of 160), histology substantiated surgery in revealing typical lesions of chronic appendicitis sometimes associated to anatomical deformity such as diverticulum. The authors strongly suggest such a test-treatment by metronidazole. It is well accepted and has enabled to get rid of post-operative morbidity of appendicectomy in tropical milieu.