White matter changes in fetal brains with ventriculomegaly.

Introduction: Ventriculomegaly (VM) is a fetal brain malformation which may present independently (isolated form) or in association with different cerebral malformations, genetic syndromes or other pathologies (non-isolated form). Methods: This paper aims to study the effect of ventriculomegaly on the internal tridimensional architecture of fetal brains by way of Klingler's dissection. Ventriculomegaly was diagnosed using fetal ultrasonography during pregnancy and subsequently confirmed by necropsy. Taking into consideration the diameter of the lateral ventricle (measured at the level of the atrium), the brains were divided into two groups: moderate ventriculomegaly (with atrial diameter between 13 and 15 mm) and severe ventriculomegaly (with atrial diameter above 15 mm). Results and discussion: The results of each dissection were described and illustrated, then compared with age-matched reference brains. In the pathological brains, fascicles in direct contact with the enlarged ventricles were found to be thinner and displaced inferiorly, the opening of the uncinate fasciculus was wider, the fornix was no longer in contact with the corpus callosum and the convexity of the corpus callosum was inverted. We have studied the prevalence of neurodevelopmental delay in children born with ventriculomegaly in the literature and discovered that a normal developmental outcome was found in over 90% of the mild VM cases, approximately 75% of the moderate and 60% in severe VM, with the correlated neurological impairments ranging from attention deficits to psychiatric disorders.

Nanomedicine and contrast enhanced imaging. Applications in cancer diagnosis and therapy.

OBJECTIVE: Nanotechnology and its applications in medicine made us live a new era of healthcare, particularly in oncology. The objective of this paper is to review the contribution of nanotechnology in clinical use of contrast agents for gastrointestinal cancer diagnosis and follow-up and to offer an overview of the impact of nanotechnology in the management of cancer. MATERIALS AND METHODS: In this regard, we reviewed the main areas of expertise where nanotechnology has contributed to the improvement of diagnostic methods (CE-US, CE-CT, MRI), along with the therapeutic applications that nanoparticles can have. Last but not least, the article highlights the potential that theragnostic molecules can have in the diagnosis and treatment of neoplasia, including those in an advanced stage. RESULTS AND CONCLUSIONS: Nanomedicine has the ability to improve the specificity and sensitivity of cancer diagnosis, together with the enhancing of the systemic cytostatic effect by developing nano bioconjugates that have a wider effect, higher tumor selectivity and thus, lower systemic toxicity. KEY WORDS: Ablative treatment, Cancer, Contrast enhanced imaging, Drug delivery, Nanomedicine.

White Matter Dissection of the Fetal Brain.

Neuroplasticity is a complex process of structural and functional reorganization of brain tissue. In the fetal period, neuroplasticity plays an important role in the emergence and development of white matter tracts. Here, we aimed to study the architecture of normal fetal brains by way of Klingler's dissection. Ten normal brains were collected from in utero deceased fetuses aged between 13 and 35 gestational weeks (GW). During this period, we observed modifications in volume, shape, and sulci configuration. Our findings indicate that the major white matter tracts follow four waves of development. The first wave (13 GW) involves the corpus callosum, the fornix, the anterior commissure, and the uncinate fasciculus. In the second one (14 GW), the superior and inferior longitudinal fasciculi and the cingulum could be identified. The third wave (17 GW) concerns the internal capsule and in the fourth wave (20 GW) all the major tracts, including the inferior-occipital fasciculus, were depicted. Our results suggest an earlier development of the white matter tracts than estimated by DTI tractography studies. Correlating anatomical dissection with tractography data is of great interest for further research in the field of fetal brain mapping.

Medicinal Plants and Natural Products Used in Cataract Management.

Cataract is the leading reason of blindness worldwide and is defined by the presence of any lens opacities or loss of transparency. The most common symptoms of cataract are impaired vision, decreased contrast sensitivity, color disturbance, and glare. Oxidative stress is among the main mechanisms involved in the development of age-related cataract. Surgery through phacoemulsification and intraocular lens implantation is the most effective method for cataract treatment, however, there are chances of serious complications and irreversible loss of vision associated with the surgery. Natural compounds consisting of antioxidant or anti-inflammatory secondary metabolites can serve as potential leads for anticataract agents. In this review, we tried to document medicinal plants and plant-based natural products used for cataract treatment worldwide, which are gathered from available ethnopharmacological/ethnobotanical data. We have extensively explored a number of recognized databases like Scifinder, PubMed, Science Direct, Google Scholar, and Scopus by using keywords and phrases such as "cataract", "blindness", "traditional medicine", "ethnopharmacology", "ethnobotany", "herbs", "medicinal plants", or other relevant terms, and summarized the plants/phytoconstituents that are evaluated in different models of cataract and also tabulated 44 plants that are traditionally used in cataract in various folklore medical practices. Moreover, we also categorized the plants according to scientific studies carried out in different cataract models with their mechanisms of action.

Intraorbital Penetrating and Retained Foreign Bodies - A Neurosurgical Case Series.

AIM: To present the particularities of the intraorbital foreign bodies from a neurosurgical perspective by summarizing the findings of a case series. MATERIAL AND METHODS: A retrospective study was conducted including a consecutive series of 30 patients with intraorbital foreign bodies treated between 1999 and 2017. Statistical analysis was performed in order to characterize the factors that influence the location of the foreign bodies and the clinical signs. RESULTS: The orbital trauma occurred mostly in working accidents. Multiple intraorbital foreign bodies were found in 23.3% of the patients. Metallic foreign bodies were seen in 66.6%, and 30% had wooden foreign bodies. Nonmetallic foreign bodies were significantly associated with displacement of the eyeball, palpebral oedema and upper lid ptosis. Posterior orbit location was associated with displacement of the eyeball and conjunctival hemorrhage. Intraconal location was associated with mydriasis and conjunctival hemorrhage. The posterior orbit was occupied by foreign bodies in 63% of the patients. The foreign bodies were in the extraconal compartment in 55.55% of the cases. Small foreign bodies tend to be retained in the anterior orbit while large ones tend to be retained in the posterior orbit. CONCLUSION: The diagnosis and management of intraorbital foreign bodies must be tailored according to their type and location and to the clinical aspect of the patient.

The Geometry of the Circle of Willis Anatomical Variants as a Potential Cerebrovascular Risk Factor.

AIM: To correlate the anatomical variants of the circle of Willis with their effects on the hemodynamic and geometrical parameters responsible for the pathogenesis of neurological diseases. MATERIAL AND METHODS: The circle of Willis and the proximal segments of the main arteries were dissected and measured on ten formalin-fixed human brains. The anatomical variants were systematized using descriptive statistics. The mathematical models for brain perfusion and wall shear stress were developed by optimally approximating resistance to flow, vascular conductance, and branching. RESULTS: Eighty percent of the brains presented asymmetries, especially in the posterior communicating (70%) and anterior cerebral (40%) arteries. The posterior circulation had more variations (65.21%). Nine hypoplastic vessels were found in 7 brains. Atypical origins were observed in eight specimens. According to the mathematical models, which integrated each anatomical change in the global circle of Willis anatomy, the circle of Willis' geometry could represent a risk factor for intracranial aneurysms and atherosclerosis, mostly when hypoplastic arteries are present, due to high resistance to flow and imbalanced bifurcation geometry. Accessory vessels are less associated with cerebrovascular risk. CONCLUSION: We described anatomical variants of both the anterior and posterior circulations and their specific effects on the hemodynamic balance of cerebral blood flow.

Short-term outcome and survival after multiorgan resection for locally advanced colo-rectal cancer. Identification of risk factors.

INTRODUCTION: Although multi-organ resections (MOR) are recommended by international guidelines for advanced colorectal cancer, the literature shows that the morbidity and mortality that accompanies these complex interventions limits the number of patients receiving this treatment. The purpose of our study was to analyse the immediate and remote results obtained after MOR and to identify potential factors that might influence the outcome. MATERIAL AND METHOD: Our study is a retrospective cohort which included patients surgically treated in our service for locally advanced colorectal cancer. We excluded patients with hepatic metastatic tumors and those who needed pelvic exenteration. Between 2006 and 2010, in our service, have been treated with MOR 146 patients, 107 being included in our study. We analysed morbidity, mortality and survival after MOR and the factors that could have influenced the postoperative course. RESULTS: Identified risk factors that negatively influenced the postoperative outcome were: diabetes, personal neoplastic pathologies, associated cardiovascular disease, history of major surgeries, intraoperative blood loss, number of resected organs. Survival was negatively influenced by positive resection margins, the presence of lymph node metastases and the presence of complications in the postoperative period. CONCLUSIONS: The data of this study support the indication for routine MOR for patients diagnosed with locally advanced colorectal cancer with the condition that R0 resection margins are achieved. All mentioned above underline the importance of the experience that the surgical team has in this type of surgeries, in order to achieve optimum results. This experience must concern the preoperative management, surgical technique and postoperative care. KEY WORDS: Colo-rectal cancer, Multi-organ resections, Risk factors.

Anatomy of the Limbic White Matter Tracts as Revealed by Fiber Dissection and Tractography.

BACKGROUND: The limbic tracts are involved in crucial cerebral functions such as memory, emotion, and behavior. The complex architecture of the limbic circuit makes it harder to approach compared with other white matter networks. Our study aims to describe the 3-dimensional anatomy of the limbic white matter by the use of 2 complementary study methods, namely ex vivo fiber dissection and in vivo magnetic resonance imaging-based tractography. METHODS: Three fiber dissection protocols were performed using blunt wooden instruments and a surgical microscope on formalin-fixed brains prepared according to the Klingler method. Diffusion tensor imaging acquisitions were done with a 3-Tesla magnetic resonance scanner on patients with head and neck pathology that did not involve the brain. Fiber tracking was performed with manually selected regions of interest. RESULTS: Cingulum, fornix, the anterior thalamic peduncle, the accumbofrontal bundle, medial forebrain bundle, the uncinate fasciculus, the mammillothalamic tract, ansa peduncularis, and stria terminalis were dissected and fiber tracked. For each tract, location, configuration, segmentation, dimensions, dissection and tractography particularities, anatomical relations, and terminations are described. The limbic white matter tracts were systematized as 2 concentric rings around the thalamus. The inner ring is formed by fornix, mammillothalamic tract, ansa peduncularis, stria terminalis, accumbofrontal fasciculus, and medial forebrain bundle and anterior thalamic peduncle, and the outer ring is formed by the cingulum and uncinate fasciculus. CONCLUSIONS: This paper proposes a fiber-tracking protocol for the limbic tracts inspired and validated by fiber dissection findings that can be used routinely in the clinical practice.

Hyperthermic intraperitoneal chemotherapy (HIPEC). Mechanisms of action and the role of HIPEC in the treatment of peritoneal carcinomatosis.

Peritoneal carcinomatosis represents the advanced, final stage of peritoneal malignancy, although it is often not accompanied by systemic neoplasia. The development of the pharmaceutical industry in combination with advanced surgery techniques has helped to improve the outcome of these patients, considered for a long time without radical resources. Tumoral cytoreduction followed by hypertermic intraperitoneal chemotherapy (HIPEC) is the treatment of choice for these patients, of course, this beeing done in a multimodal treatment, carefully chosen, following a multidisciplinary consensus. In this article we reviewed the main aspects of HIPEC procedure, describing the main chemotherapeutic agents used, highlighting the role that they play in this oncological treatment. Finally, we have pinpointed the main research lines in this field, which although have a well-established role in recent guidelines, have a great potential for development, with a maximum impact on the prognosis of patients with peritoneal metastases. KEY WORDS: Cytoreductive surgery, Hyperthermia, Intraperitoneal chemotherapy, Pharmacology, Peritoneal metastasis.

Morphometric study of the human brainstem and its neurovascular relations.

AIM: The brainstem is a very complex segment of the central nervous system because it has a high density of nuclei and tracts with vital functional roles. This explains the considerable difficulty of surgery for lesions located in or around the brainstem. Our paper aims to provide a concise description of the external configuration, its internal correspondence and the neurovascular relations of the brainstem with morphometric data that can be useful in surgical planning. MATERIAL AND METHODS: The study was conducted on formalin fixed brainstem specimens, which were harvested with respect to the topographic anatomy. Macroscopic measurements were performed with a Vernier caliper. RESULTS: The anatomical structures on the ventral and dorsal aspects of the brainstem are described and illustrated schematically. Their dimensions are also graphically represented using the mean values. Serial axial sections through the brainstem demonstrate the internal correspondence of its external features. Then there are presented the apparent origins and the proximal diameters of the cranial nerves and the arteries of the posterior circulation as well as their anatomical relations. CONCLUSION: The external morphometry of the brainstem correlated with the position of the internal structures provides landmarks with aplicability in neurosurgery especially in the fields of intrinsic brainstem lesions, posterior fossa and fourth ventricle surgery.

Solitary Langerhans histiocytosis of the orbit: case report and review of the literature.

Langerhans cell histiocytosis (LCH), previously known as "histiocytosis X", is a clinical entity characterized by abnormal proliferation of Langerhans cells, which exert a mass effect. Orbital involvement due to LCH is rare as a unifocal disease, seldom occurring outside the pediatric population. We report a case of a 21-year-old man with solitary LCH of the orbit depicted by magnetic resonance imaging (MRI) and diagnosed by histopathological examination.

Keratoacanthoma of the conjunctiva - case report and review of the literature.

INTRODUCTION: Keratoacanthoma (KA) is a relatively common, benign, rapidly growing and self-limiting squamous proliferation, which appears most frequently on the sun-exposed skin. The nature of KA and its relationship to squamous cell carcinoma (SCC) still represent one of the major debates in dermatopathology, as it is the truthfulness of such a diagnosis outside the skin. However, the tumor is now known to originate from the pilosebaceous units of the skin or from ectopic sebaceous glands of squamous mucous membranes, and to differentiate onto follicular isthmus÷infundibulum-like epithelium. CASE PRESENTATION: A 71-year-old man presented with a sore and red right eye, which on slit-lamp biomicroscopical examination revealed a dome-shaped lesion at the temporal inferior conjunctival limbus. After a thorough histopathological examination, a diagnosis of KA has been made, both after the initial tumor excision and after the relatively rapid recurrence. After the second intervention, no recurrence was observed over five years of follow-up, confirming the diagnosis. CONCLUSIONS: The peculiarity of the case stands in his exceptional rarity, being to our knowledge the first conjunctival KA reported in our country. In the light of current knowledge, the peculiar limbal location of all the conjunctival KAs reported in the literature raised the question of the possible role of limbal stem cells in the histogenesis of these tumors, similar to the pilosebaceous ones. The treatment of conjunctival KA remains the complete excision of the tumor, as it allows histopathological evaluation of the entire tumor and the exclusion of a KA-like SCCs or KAs with SCC component.

Recent achievements in colorectal cancer diagnostic and therapy by the use of nanoparticles.

Colorectal cancer is a major public health issue, being the third most common cancer in men and the second in women. It is one of the leading causes of cancer deaths. Nanomedicine is an emerging field of interest, many of its aspects being linked to cancer research. Chemotherapy has a well-established role in colorectal cancer management, unfortunately being limited by inability to have a selective distribution, by multidrug resistance and adverse effects. Researches carried out in recent years about nanotechnologies aimed, among others, to resolve the issues mentioned above. Targeted and localized delivery of the chemotherapeutic drugs, using nanoparticles, with selective destruction of cancerous cells would minimize the toxicity on healthy tissues. Also, the use of nanomaterials as contrast agent could improve sensitivity and specificity of diagnosis. The purpose of this review is to highlight the recent achievements of cancer research by use of nanomaterials, in the idea of finding the ideal composite, capable to simultaneous diagnostic and treat cancer.

[Enophthalmos in an orbital tumor]. / Enoftalmia asociata unei formatiuni tumorale iitraorbitale--prezentare de caz clinic.

Enophtalmus is an unusual sign of the orbital tumors often represented by proptosis. One patient with enophtalmus and intraorbital tumor and aplasy is presented. The treatment of choice of orbital tumor is complete surgical excision and careful follow-up. Considering the more aggressive course followed by recurrent tumor, correct diagnosis and management is essential.

[Orbit evisceration: retrospective study on a consecutive series of 10 years]. / Exenteratii de orbita: studiu retrospectiv pe o serie consecutiva de 10 ani.

Exenteration of the orbit is challenging in its anatomical, surgical and postsurgical management-related issues. We describe a surgical series of 65 patients diagnosed at Neurosurgery and Ophthal-mology departments; between 2003 and 2012, 65 cases with intraorbital tumors were identified and underwent partial or total exenteration of the orbit. The most frequent dignosticated tumor which underwent exenteration were spinous and basal carcinoma of the orbit (41.5 %) followed by neurofibroma The most common preoperative sign was proptosis (100%), followed by ocular and orbital pain (6.1%) and visual acuity loss (3.07%). Preoperatively signs included alteration of the facial aspect (96.9%), behavioural, emotional and social difficulties, especially in young people (6,9%). Although there is an extremely mutilant surgical procedure, pain is often relieved. Therefore, the surgical aim should be life preserving and relief of leading symptoms; estetic aspect of the patients was also one of postoperative aims.

[Tonic pupil, pupil Adie syndrome Adie Holmes: current reassessment of terminology -- a clinical case]. / Pupila tonica, pupila Adie sindromul Adie Holmes reevaluarea actuala a terminologiei - prezentare de caz clinic.

The benign syndrome of pupillotonia and absence of deep reflexes is not uncommon. It was clearly and accurately described by Adie (1932), although incompletely recognized many years, before. The pupillary abnormality was reported by ophthalmologists at the turn of the century (Saenger, 1902, Strasburger 1902), and the associated deep reflex change was described by Markus (1906), Roemheld (1921) and Parkes Weber (1923). Holmes (1932) was fully aware of the association of "partial iridoplegia" with diminished reflexes. Tonic pupils react poorly to light but constrict during viewing of a near stimulus. Adie's name is typically used in association with tonic pupils, but a review of Adie's articles reveals that he described the syndrome of tonic pupils and absent reflexes and not the pupillary abnormality per se. Therefore, it would be more appropriate to refer to a tonic pupil as simply a 'tonic pupil" and leave Adie's name for the syndrome. We report a typical case of tonic pupil.

[Diagnosis of orbital cysticercosis -- a challenge for ophthalmologist]. / Diagnosticul cisticercozei orbitale: o reala provocare pentru medicul oftalmolog.

Cysticercosis is a cause of serious ocular/orbital morbidity. Ocular cysticercosis can involve the anterior segment, posterior segment or adnexa. The cysticercus parasite has a predilection for subconjunctival, subretinal and intravitreal structures. Orbital involvement, in which the parasite localises within the extraocular muscle is rare. Orbital cysticercosis commonly presents with signs of inflammation, diplopia, restricted extraocular motility and proptosis. This report is of a 43-year-old woman with orbital cysticercus lying in the intraconal space, in relation with lateral rectus muscle, near to the apex of the orbit, presenting as a diplopia and painless movements of the eyeball.

Isolated neurosarcoidosis.

Sarcoidosis is an inflammatory granulomatous disease affecting multiple organ systems. Neurosarcoidosis (central nervous system involvement) is seen in approximately 25% of patients with systemic sarcoidosis, although it is subclinical in most of these cases. Clinical presentations and imaging findings in nervous system were varied. Cranial nerve abnormalities were the most common clinical presentation and involvement of the optic nerve in particular was associated with a poor prognosis for visual recovery. A patient is described who presented with decreased visual acuity, hypoesthesia of the face and multiple tumors of the eyelids on both eyes. Initial biopsy of one of the tumor of the eyelids revealed a non-caseating granulomatous inflammatory process with nodular infiltrates made up of epithelioid cells, Langhans-type giant multinucleated cells and mononuclear cells; the diagnosis of sarcoidosis was suspected. After two years of clinical and MRI (Magnetic Resonance Imaging) follow up, the diagnosis of isolated neurosarcoidosis was confirmed by histology. In this study, we analyzed clinical and radiologic records of this patient with biopsy proven and clinically diagnosed neurosarcoidosis for the following reasons: (1) to assess the concordance between abnormalities noted on MRI with neurologic symptoms at presentation; (2) to correlate changes in imaging findings during follow-up with clinical worsening; and (3) to show up the characteristic feature of this case with no general sign/symptoms of sarcoidosis.

Idiopathic orbital inflammatory pseudotumor: case report and review of the literature.

Idiopathic orbital inflammatory pseudotumor is a chronic neoplasm-like inflammatory reaction, usually affecting the orbital tissues of both eyes and orbit. Isolated optic nerve involvement by the idiopathic inflammatory process is a rare finding and very few reports are available. Here a case of an isolated orbital nerve inflammatory pseudotumor presenting with gradually progressive unilateral loss of vision is described. It showed dramatic response to surgery and steroid treatment and its differential diagnoses are discussed.

[Pneumosinus dilatans--general considerations and a case report]. / Pneumosinus dilatans consideratii generale. Prezentare de caz clinic.

The term "pneumosinus dilatans" was coined by Benjamin in 1918 in his description of ballooning hyperpneumatization of the frontal sinus. The term was use later on for excessive pneumatization of individual or several paranasal sinuses, with or without local compressive signs. Inspite of numerous publications, the phenomenon of pneumosinus dilatans of paranasal sinuses never became particularly popular. The diagnosis of sphenoid pneumosinus dilatans in particular was difficult to establish by conventional radiological methods and demonstration of the indirect signs of a compressive mechanism was almost impossible prior to the introduction of thin section CT. The etiology and pathogenesis of pneumosinus dilatans were a matter of speculation and remained unsatisfactory to researches and clinicians. A 28-year-old male had a six-year history of scotoma and loss of the temporal visual fields for both eyes; he was admitted to Ophthalmological Department with visual loss of the right eye. The section CT was performed and revealed massive hyperpneumatization of the sphenoethmoidal sinusal complex, extending into the right anterior clinoid process, causing narrowing of the optic canal, more marked on the right than on the left side. The final diagnosis was: Right eye - Vitreous hemorrhage. Pneumosinus dilatans.