Laparoscopic management of ovarian benign masses.

PURPOSE: To determine whether the presence of normal ovarian tissue could assist in the diagnosis of large benign ovarian neoplasms in young females and in choosing the laparoscopic treatment. MATERIALS AND METHODS: A prospective study of 25 patients treated surgically for a cystic ovarian neoplasm measuring diameter more than ten cm or volume more than 500 ml and having normal ovarian tissue or ovarian crescent sign (OCS). Ultrasonography was performed at six weeks, then at three, six, nine, and 12 months postoperatively. RESULTS: The mean age of patients was 15.3 +/- 3.6 years, ranging between 6.5 and 19 years. The mean preoperative volume of the ovarian neoplasm was 1,686 +/- 1,380 cm3, ranging between 550 and 6,000 cm3. The presence of OCS was visualized by ultrasonography in all 25 patients and serum tumor markers were negative in 22. No borderline tumors or malignancies were identified. There was a statistically significant difference between the volume of the affected ovary and the contralateral ovary during the first six weeks follow-up, but without significant difference after three months. CONCLUSIONS: Postoperative ultrasound revealed that the affected ovary resumed its normal volume within three months after surgery, despite the thinned appearance of the ovarian cortex present on ultrasound as the OCS. Laparoscopic ovarian preservation should be the preferred surgical approach for adolescents to ensure the conservation of the entire ovarian tissue.

Giant Gartner duct cyst and elevated CA-125.

BACKGROUND: Gartner duct cysts represent vestigial remnants of the caudal end of the mesonephric (Wolffian) ducts. They are often associated with ureteral and renal abnormalities. In most cases they are solitary, less than 2 cm in diameter. Giant Gartner duct cysts are extremely rare. CASE: We present a girl with a giant Gartner duct cyst, without notable associated abnormalities or pathology, successfully treated by surgical excision. Preoperative aspiration revealed elevated level of CA-125 in the cyst fluid, with normal serum level of the same marker. CONCLUSION: Analyzing the aspirated fluid for CA-125 may be a useful tool for evaluation of cystic lesions in this region.

Ovary-preserving tumorectomy for immature teratoma in an adolescent--case report.

The authors present a case of a 14-year-old premenarchal girl with a large solid tumor of the left ovary. The rim of normal ovarian tissue was visible around the tumor on ultrasonography scan. Although the levels of two tumor markers, LDH and CA125, were elevated, the authors performed an organ-sparing tumorectomy. The final pathology report revealed foci of immature neural tissue, with a final diagnosis immature teratoma Stage Ia.

A 7-year prospective study of routine histopathological evaluation of the lacrimal sac wall incisional biopsy specimens obtained during external dacryocystorhinostomy in adults and a review of the literature.

The most common lacrimal sac pathology is chronic inflammation with or without occlusive fibrosis. However, a substantial number of lacrimal sac-specific pathologies were reported throughout the literature which may mimic chronic inflammation and be misdiagnosed. From a tertiary ophthalmic care centre in Serbia, in a single ophthalmic pathology laboratory, during a 7-year period (January 2004 to October 2010), a 599 consecutive lacrimal sac wall biopsy samples routinely obtained during external dacryocystorhinostomy in adult patients with clinically presumed primary acquired lacrimal drainage system obstruction were analysed. Although non-specific lacrimal sac pathology was present in the vast majority of cases (578 biopsy specimens; 96.49%), this report also reveals a relatively substantial number (21 biopsy specimens; 3.51%) of clinically non-suspected or intraoperatively unexpected primary lacrimal sac-specific pathology--among them, six lesions with malignant biological behaviour were identified: one microinvasive squamous cell carcinoma and five malignant lymhoproliferative lesions. Usefulness of routine lacrimal sac wall biopsy during surgery for primary acquired lacrimal drainage system obstruction is undoubtful and commensurate with the constant need for better understanding of the pathological processes that involve lacrimal drainage system.

Value of ultrasonographic detection of normal ovarian tissue in the differential diagnosis of adnexal masses in pediatric patients.

OBJECTIVE: The aim of the study was to evaluate whether the presence of normal ovarian tissue, the 'ovarian crescent sign' (OCS), could assist in the differential diagnosis between benign and malignant adnexal masses in young patients. METHODS: This was a prospective observational study, from March 2004 to January 2006, which included 98 patients younger than 20 years of age (including two with bilateral tumors) with an ultrasonographic diagnosis of an adnexal mass. Morphological assessment using the Ueland index was performed in each case. Patients were also systematically examined for the presence of the OCS and a comparison was made with the Ueland index. All findings in surgically treated patients were compared with the final histological diagnosis. RESULTS: There were 100 adnexal masses: 90 were benign and 10 were malignant. Forty-eight were managed expectantly and 52, including 17 cases of adnexal torsion, underwent surgical treatment. The OCS was found in 65 (72%) benign adnexal masses and in one (10%) non-invasive malignant tumor. A Ueland index score of < 7 was found in 85 (94%) benign masses and in one (10%) non-invasive malignancy. The OCS was seen in 15 (45%) of 33 masses in premenarchal patients and in 51 (76%) of 67 masses in postmenarchal patients. The OCS was absent in 15 (88%) of the torsioned adnexal masses. CONCLUSIONS: The presence of normal ovarian tissue adjacent to an ovarian mass is a useful morphological feature that can assist exclusion of a malignant tumor in pediatric and adolescent patients. When compared with the Ueland index, diagnostic sensitivity of the OCS is similar, but specificity is lower. The presence of the OCS is significantly less frequent in premenarchal patients than in postmenarchal patients.

Primary extranodal marginal zone lymphoma of the uvea associated with massive diffuse epibulbar extension and focal infiltration of the optic nerve and meninges, clinically presented as uveitis masquerade syndrome: a case report.

To report a clinical, histopathological and immunohistochemical findings in a case of primary extranodal marginal zone lymphoma of the uvea associated with massive diffuse extraocular episcleral extension and focal infiltration of the optic nerve and meninges, clinically presented as longstanding uveitis masquerade syndrome. Interventional case reports with histopathological correlation. We describe a 80-year-old male patient with a 3-year history of chronic recurrent hypertensive (pan) uveitis associated with ocular pain, unresponsive to topical and systemic anti-inflammatory, immunosuppressive, antibiotic/antiviral and antiglaucomatous therapy. Because the eye was not salvageable with conservative treatment, enucleation of blind and painful eye was performed. Findings from histopathological and immunohistochemistry examination of the enucleated eye showed an extranodal marginal zone lymphoma of the uveal tract with massive epibulbar extension and optic nerve and meningeal penetration. During almost 3 years of clinical course and 6 months after the enucleation, there were no systemic manifestations of lymphoma, and patient has not required subsequent treatment. Primary lymphoproliferative lesions of the uvea, comprising the iris, ciliary body and choroid are very rare, associated with epibulbar extension extremely and with optic nerve and menigeal penetration exceptionally. Despite its rarity, primary lymphoma of the uvea should be included in the differential diagnosis particularly in older patients with longstanding recurrent uveitis.

[What is the value of the whole body spiral CT in the primary radiological imaging of severely injured children?]. / Welchen Stellenwert hat das Ganzkörper-Spiral-CT in der Primärdiagnostik polytraumatisierter Kinder?

AIM: Whole body spiral CT scans have become a routine method in the radiological imaging of severely injured patients in emergency rooms of an increasing number of hospitals. The routine use of CT scans is, however, still discussed controversially, especially with regard to its use in children. This is mainly due to the reportedly higher level of exposure to radiation of CT scans as compared to plain radiographs. The aim of the present study was to compare the dose of exposure to radiation of a whole body CT scan to that of a plain radiograph protocol in an animal model for severely injured children. MATERIAL AND METHODS: We chose 3 female pigs of different weights to serve as a model for children at different ages. 4 film radiation dosimeters (positioned on the eye, under the breast, paravertebrally on the thoracic spine and in the small pelvis, respectively) were implanted into every pig for each examination. Plain radiographs of the chest and the pelvis in one plane and of the skull and the complete spine in two planes were performed. The CT scan included skull, cervical spine and the whole body from the thorax to pelvis. RESULTS: The radiation dose of CT scans was 7 times higher as compared to the X-ray protocol, but the performance of CT scans was faster (8 vs. 18 min). The radiation dose of the whole body CT scan was at about 15 mSv. CONCLUSION: Based on our data and a review of the literature we will use whole body spiral CT scans as the preferred method in the primary radiological imaging of severely injured patients. In our opinion, the evident benefit of a reduced time of imaging in combination with superior image information outweighs the higher level of exposure to radiation.

Minimal invasive treatment of cervical rhabdomyosarcoma in an adolescent girl.

Rhabdomyosarcomas are the most common soft tissue sarcomas in childhood and adolescence. In cases of minimal cervical invasion, less invasive local excision in combination with adjuvant chemotherapy has resulted in excellent survival rates with complete preservation of the bladder, rectum, uterus and vagina. Herein we present the case of an adolescent girl with a large rhabdomyosarcoma of the uterine cervix treated with minimal invasive therapy.

[Injuries of the midfoot in children]. / Mittelfussverletzungen im Kindesalter.

Midfoot injuries of children are rare entities and often caused by high energy trauma mechanisms. Foot fractures in children may pose a diagnostic challenge but they usually have a good prognosis. In special cases computed tomography is necessary to find the right diagnosis in addition to plain X-rays. Based on two cases of midfoot injuries, a type II open Lisfranc fracture dislocation and a dislocation of a Chopart's joint, we describe the causes, diagnosis, and possibilities for treatment of juvenile midfoot injuries.

Validation of a high-performance liquid chromatographic method for the simultaneous determination of tramadol and its impurities in oral drops as a pharmaceutical formulation.

The novel, rapid high performance liquid chromatographic method for the determination of tramadol hydrochloride and its three impurities was developed and validated. The method can simultaneously assay potassium sorbate, used as preservative, and saccharin sodium, used as sweetener in tramadol pharmaceutical formulation. The separation was carried out on a C(18) XTerra (150 mm x 4.6 mm, 5 mm) column using acetonitrile-0.015 M Na(2)HPO(4) buffer (2:8, v/v) as mobile phase (pH value 3.0 was adjusted with orthophosphoric acid) at a flow rate 1.0 ml min(-1), temperature of the column 20 degrees C and UV detection at 218 nm. The method was found to be linear (r > 0.999) in the range of 0.05-0.8 mg ml(-1) for tramadol hydrochloride, 0.1-1.2 mg ml(-1) for impurities B and C and for impurity A (r > 0.995) in the range 0.15-2.4 mg ml(-1). The low RSD values indicate good precision and high recovery values indicate excellent accuracy of the HPLC method. Developed method was successfully applied to the determination of tramadol hydrochloride, its investigated impurities and potassium sorbate in commercial formulation. The recovery of tramadol hydrochloride was 98.25% and RSD was 1.80%. The method is rapid and sensitive enough to be used to analyse Trodon oral drops.

Epithelial ovarian tumors and CA125 in premenarchal girls.

PURPOSE: This is a review of our 18-year experience with premenarchal girls with epithelial ovarian tumors. Special attention was focused on the predictive value of CA125 serum levels. METHODS: Analysis of premenarchal patients with resected or biopsied ovarian masses from 1988 to 2005 was performed. Patient age, clinical presentation, operative procedures, histologic type of tumor, treatment and outcome were obtained. RESULTS: Six premenarchal girls (aged from 6 to 14 years) were surgically treated for epithelial tumors, representing 13% of all ovarian tumors at this age. Histological findings revealed cystadenoma in four girls, one with a mucinous borderline tumor and one with undifferentiated carcinoma. Tumor volume was higher than 400 cm3 in four girls. Sensitivity, specificity and positive predictive value of CA125 level for ovarian malignant epithelial tumors were 0.50, 0.50, and 0.33, respectively. The premenarchal girl with undifferentiated carcinoma in Stage III died after six months in spite of chemotherapy. CONCLUSION: Ovarian epithelial tumors in premenarchal girls show important growth potential and a relatively high malignancy rate with great influence of borderline neoplasms. CA125 is a tumor marker with low sensitivity and specificity for detection of epithelial ovarian malignancy in this age group.

[Ochronosis--an autopsy case report]. / Ohronoza--autopsijski prikaz slucaja.

The authors have presented a case of ochronosis, as the incidental finding during the autopsy of a female patient, aged 59 years. It was the case of suicidal drug poisoning. Ochronosis is a rare disease, with chronic benign course, but frequently followed by complications. Histopathological criteria for the diagnosis of this disease are described in detail.

[Correlation of clinical and autopsy diagnosis during a 10-year period at the Institute for Pathology and Forensic Medicine at the Military Medicine Academy in Belgrade]. / Korelacija klinickih i autopsijskih dijagnoza na desetogodisnjem materijalu Instituta za patologiju i sudsku medicinu Vojnomedicinske akademije u Beogradu.

The comparison between the clinical and pathohistoanatomic diagnosis of 3.929 autopsied cases is performed. In 82.5% of cases the clinical and pathohistoanatomic diagnosis were in the absolute correlation; in 8% of cases the clinical diagnosis of the basic disease has no adequate pathoanatomic characteristics, while in 4.5% of cases the clinical diagnosis of the basic disease, immediate cause of death and condition which was important for the course and outcome of the treatment were not adequate. Among the pathologic states diagnosed as: pulmonary thromboembolism, myocardial infarction and cerebrovascular insult--pulmonary embolism most often was not confirmed by autopsy (47%), while in 58% of cases it remained clinically unrecognized. Malignant tumours of the liver, pancreas and kidneys have been most frequently clinically unrecognized compared to other malignancies. Duration of hospitalization has not had the essential influence on correct establishment of the clinical diagnosis.

Forensic-medical expertise of twenty four murdered citizens from Gospic and its surroundings.

The forensic-medical expertise of 24 predominantly carbonized bodies, that were found at Kukin Do was reported. The victims were from Gospic and its surroundings, who disappeared between October 16-18, 1991. The expertise involved the identification of bodies, injury classification, determination of tools by which injuries were inflicted as well as time when injuries were inflicted, and whether it was when the victims were alive or dead. At the time of expertise all bodies were in the state of advanced putrification, frozen and burned. In 18 cases, the larger or smaller parts of bodies lacked as the consequence of fire. Eleven persons were identified as the Serbs from Gospic and for thirteen persons the procedure of identification is still in process. In 21 persons while they were alive, injuries were done with: bullets, blade, pointed and blunt mechanical tools. In three persons, injuries were not found due to missing of the larger parts of bodies. After their death all corpses were burned, and in two persons bites of rodents were evident.

[Morphologic characteristics of persons killed in armored vehicles]. / Morfoloske karakteristike blast povreda poginulih u oklopnim vozilima.

The authors have analysed macroscopic and microscopic changes in tissues and organs of 8 members of the Y.P.A. killed by granate explosion in the armoured vehicles. In all the analysed cases multiple mechanic injuries were found as well as combined mechanothermal injuries. Injuries caused by the blast wave were mainly found in the internal air-containing organs and three cases of solid blast injury were described too.

[Morphologic damage in internal organs in miners caused by explosions of methane gas in mines]. / Morfoloska ostecenja unutrasnjih organa rudara izazvana eksplozijom metana u rudniku.

Four cases of blast injuries in miners caused by methane explosion in the mine are described. In all cases besides burns, changes in tissues and organs, according to their microscopic and macroscopic characteristics, corresponded to blast type injuries described in the literature.

[Malignant transformation in bone cysts]. / Maligna transformacija kostane ciste.

Bone cysts are often found on x-ray examinations of patients in their first two decades of life. We present an extremely rare case of cystically changed first metatarsal bone of the left foot. The content of the cyst was histopathologically verified as consisting of a mixture of echinococcal scolexes and chondrosarcomatous tissue.

Abnormal megakaryocytopoiesis in the Belgrade laboratory rat.

The Belgrade laboratory rat (b/b rat) has hereditary, hypochromic, microcytic anemia with a variety of red cell abnormalities. Although this anemic syndrome has been recently ascribed to the defective delivery of iron to the developing red cell, the basic hematopoietic defect is still unknown. In this article we present evidence that the b/b rat has an additional hematologic defect. We have found that the megakaryocyte number in the marrow of the b/b rat is decreased to one half that of the normal rat, but the maturation rate of recognizable megakaryocytes is accelerated and the size is increased. The platelet count is moderately reduced. These findings indicate that megakaryocytopoiesis in the anemic b/b rat is abnormal and suggest that the genetic defect may involve the progenitors of the megakaryocyte cell lineage. Alternatively, the megakaryocytic abnormalities may be secondary to the severe anemia.