Pulmonary sequestration in adulthood: clinical-morphological study.

OBJECTIVES: The aim of the study was to evaluate pulmonary sequestration (PS). We report on location, blood supply, histology, clinical manifestation, and surgical treatment of PS, as well as on postoperative course in patients with PS. BACKGROUND: PS is a rare congenital defect of the lower respiratory tract, it represents locus minoris resistentiae of the body. Occasionally, PS is diagnosed for the first time in adulthood. METHODS: We evaluated 7 cases of PS treated at the Centre of Thoracic Surgery in Vysné Hágy, Slovakia, between years 2013 and 2020. RESULTS: Four of our seven patients were asymptomatic; the PS was found incidentally upon chest imaging. Three patients had recurrent bronchopneumonia related specifically to the intralobar type of sequestration. The most significant complication, observed in a singular patient, was a life-threatening episode of haemoptysis, requiring urgent surgical intervention. In the other 6 cases, the sequestra were surgically resected during the period when they were asymptomatic. and their sputum was confirmed negative upon microbiological examination. Anatomical resection of the affected pulmonary lobe by thoracotomy was the most common type of operation performed (4 cases, n = 7). There was no surgical mortality. CONCLUSION: To prevent complications, it is crucial to perform surgical treatment for pulmonary sequestration in patients who have sufficient functional capacity (Tab. 2, Fig. 4, Ref. 30). Text in PDF www.elis.sk Keywords: pulmonary sequestration, anatomic lobectomy, haemoptysis.

A report on accessory renal arteries incidence in Slovak adults: Cadaveric study and surgical correlation.

OBJECTIVES: The aim of the study was to evaluate renal arterial variations in Slovak context. METHODS: Forty cadavers (80 formalin-fixed cadaveric kidneys) were included in the study. The accessory renal arteries (ARAs) were evaluated on the basis of point of origin, termination in the kidney (superior pole, hilum, inferior pole), and symmetry. RESULTS: The incidence of ARAs was detected in 20 % (8/40) of the cadavers. Double renal arteries were observed in 9 (11.25 %, n = 80) of kidneys. Among 8 cadavers with ARAs, the unilateral presence of ARA was found in 7 cadavers and bilateral presence in 1 cadaver. Among 9 ARAs, polar artery was the most common anomaly seen in 7 (78 %) kidneys (inferior polar artery 5, superior polar artery 2) followed by the hilar artery in 2 kidneys. CONCLUSIONS: This is the first cadaveric study on the incidence and morphology of ARAs in Slovakia. The study has shown that the variations in renal arterial anatomy are a frequent finding (20 % of cadavers) while all of the described variants have significant implications for a variety of surgical procedures in the retroperitoneal space. The variations in renal arteries should be considered an integral part of anatomy teaching as they point to the diverse clinical reality of anatomy (Tab. 1, Fig. 1, Ref. 35). Text in PDF www.elis.sk Keywords: renal artery, variation, polar artery, double renal artery, cadaver.

Combined unusual origin and course of the right vertebral artery and right inferior thyroid artery: a case report.

PURPOSE: An unusual unilateral origin and course of the prevertebral part of the right vertebral artery and anomalous course of the right inferior thyroid artery was observed during dissection of the neck of a cadaver. METHODS: An accidental finding in the cadaver within the anatomical dissection was assessed. RESULTS: The right vertebral artery originated a nonstandard from brachiocephalic trunk and travelled in the anterior cervical region, along the longus colli muscle in front of the transverse processes from C7 to C4, and it entered the transverse foramen of C3. During its course, the position of the right inferior thyroid artery varied: it turned medially and passed posterior to the vertebral vessels and later curved inferomedially to its termination. Additionally, the left vertebral artery of the same cadaver arose directly from the subclavian artery and entered the transverse foramen at C6, and the left inferior thyroid artery passed anterior to the vertebral artery. CONCLUSION: Variation in the vertebral artery and inferior thyroid artery alone have been reported, but a combined variation is rare. The anatomical information from this study will be useful during dissection, angiography, endovascular surgery, thyroidectomy and non-invasive procedures in the cervical region.

Investigation of tumour supressor protein p53 in renal cell carcinoma patients.

BACKGROUND: Investigation of p53 immunoreactivity in formalin-fixed paraffin-embedded tissues of normal renal tissue and renal cell carcinoma with respect to histopathologic subtype and nuclear grade of RCC. METHODS: 42 tissue sections of RCC and 5 samples of normal renal tissue were stained for p53 expression using immunohistochemical assay. The results were analyzed in relation to nuclear grade and histopathologic subtype. RESULTS: In total, p53 expression was found to be 4 to 5 times higher (30.8%) in other types of RCC than in the clear-cell type of RCC (6.9%). Further, there was no statistically significant difference in p53 overexpression among the histopathologic subtypes (P>0.05, P=0.063). No association was found between the expression of p53 and nuclear grade (P>0.05, P=0.17). Interestingly, our study also showed weak cytoplasmic positivity in renal tubular epithelium. CONCLUSION: Our findings suggest that p53 might play an important role in tumour development or progression and it might be used as a new predictor and therapeutic target for RCC.

Relation between expression pattern of wild-type p53 and multidrug resistance proteins in human nephroblastomas.

One of the best characterized resistance mechanisms of human cancer is multidrug resistance (MDR) mediated by P-glycoprotein (Pgp/MDR1) and multidrug-resistant related protein (MRP1). In addition to Pgp/MDR1 and MRP1, p53 inactivation or mutation might play a relevant role in therapeutic failure. This study involved 25 children (17 girls and 8 boys) aged 7 months to 10 years treated for unilateral Wilms' tumor. 25 tissue samples of Wilms' tumor and 5 samples of normal human kidneys were obtained from the Department of Pathological Anatomy, Jessenius Faculty of Medicine in Martin, Slovak Republic. We used an indirect immunohistochemical method to determine expression of Pgp/MDR1, MRP1 and wild-type p53 in 25 tissue samples of nephroblastoma. The minority of nephroblastoma specimens showed positivity for both MDR proteins, as well as for wild-type p53. 24% of tissue samples revealed positive results for Pgp/MDR1, 48% for MRP1 and 8% for wild-type p53. Furthermore, our study showed a statistically significant difference between p53 and MRP1 protein expression (p<0.01), but not between p53 and Pgp/MDR1 (p>0.05). No correlation was found between the expression of both multidrug resistance proteins (Pgp/MDR1 and MRP1) and the expression of wild-type p53. Immunohistochemical detection of the expression of MDR proteins and wild-type p53 at the time of diagnosis might assist in choosing specific chemotherapeutics to improve prognosis and therapy.

Comparison of expression pattern of monoamine oxidase A with histopathologic subtypes and tumour grade of renal cell carcinoma.

BACKGROUND: Studies of the biochemical properties of MAO-A (monoamine oxidase) are numerous, but the information about determination of MAO-A in human normal and tumour renal tissue is limited. Our objectives in the present study were to determine the localization of MAO-A in normal kidney and level of expression of this protein in tumour kidney. MATERIAL/METHODS: Enzyme immunohistochemical method was chosen for detection of MAO-A in 63 clinical samples of all histopathological types of RCC (renal cell carcinoma). Our results were compared to basic clinical and histopathological parameters such as histopathological type and tumour grade. We also compared MAO-A expression between normal and tumour tissue samples. RESULTS: We confirmed the elevated expression of MAO-A in high-grade tumours of renal cell carcinoma specimens. The percentage of MAO-positive samples progressively increased from 9% in grade 2 to 45% in grade 3. We also noted high levels of MAO-A immunoreactivity in epithelial cells of proximal tubules in normal renal tissue. MAO-A was absent or very low in epithelial cells of distal tubules and glomerular capsule, as well as in endothelial cells of renal vessels. CONCLUSIONS: Taken together, our results and findings of other studies show that MAO-A expression in high-grade tumours may have a direct role in maintaining a dedifferentiated phenotype and promoting aggressive behaviour. The ability of clorgyline (an MAO-A inhibitor) to counteract oncogenic pathways and promote differentiation suggests that MAO-A inhibitors, which have been used for many years in clinical practise for treating neurological disorders, could be therapeutic options for advanced stages of tumours.

Association between polymorphisms of XRCC1, p53 and MDR1 genes, the expression of their protein products and prognostic significance in human breast cancer.

BACKGROUND: This study aimed to examine the relationship between XRCC1, p53 and MDR1 protein, along with polymorphisms of their genes and their prognostic values in breast cancer. The following clinical and pathological parameters were evaluated: histopathological type of tumor, grade, stage, Her2/neu expression, ER, PR positivity and involvement of regional lymph nodes. MATERIAL/METHODS: Expression of proteins was determined in 39 samples of breast cancer by immunohistochemistry. Nucleotide polymorphisms were analyzed by PCR-RFLP. For statistical analysis, chi-square test (Yates), Fisher's exact test, and correlation test were used to analyze the data. RESULTS: The highest protein expression was immunohistochemically found in MDR1 protein, with 54% of samples testing positive. In addition, the evaluation of MDR1 expression revealed higher positive immunoreactivity in lobular (LIC) and other types of tumor in comparison to ductal (DIC) type. The expression of p53 and XRCC1 protein was equal, but lower compared to MDR1, both testing positive in 36% of all tissue samples. Comparison of XRCC1 protein and histopathological type of tumor revealed that DIC and LIC types were mostly XRCC1-negative, while other types, papillary and mucinous were more likely to be XRCC1-positive. Interestingly, when evaluating LIC samples separately, a negative correlation between the Her2/neu and expression of XRCC1 was detected. Apparently, all Her2/neu-positive samples were XRCC1-negative (6/86%). The correlation test indicated a negative correlation between Her2/neu-positive samples and XRCC1-negative specimens (r = 1, p < 0.05). Statistical analysis did not reveal a correlation of p53 expression with clinical and pathological parameters. Similarly, no statistically significant difference was found between the tested polymorphisms and protein expression. CONCLUSIONS: We did not find statistically significant correlation between tested polymorphisms and their protein expression.