RESUMEN
The 'optical fold' of Evermanella balbo covers the ventro-lateral cornea and is presumed to capture illumination that would otherwise remain undetected by the tubular eye of this mesopelagic teleost. It contains alternating bands of cellular and acellular material, running approximately perpendicular to the lateral surface of the eye. Only parts of this lamellar body lie within the eyelid-like structure. The cellular lamellae are 2-2.5 µm thick centrally and composed of fibroblast-like cells. The extracellular bands (4.5-5 µm thick) contain regular arrays of collagen fibrils, with layers of thin fibrils sandwiching a region of thicker fibrils. The thin fibrils are organised in alternating sheets where fibrils, although all parallel, change their orientation by 90° between each sheet. All thick fibrils are oriented parallel to the lateral surface of the 'optical fold'. In the main retina, small bundles of rod inner/outer segments are separated by the processes of the retinal pigment epithelium (rpe) laterally. Centrally, the length of tightly packed rods increases, but rpe processes no longer divide them into bundles. Medially, rod length increases further, but packing is less dense. The accessory retina is significantly thinner, and less well-developed than the main retina. Ventrally, the rods show no regular arrangement and are not grouped. Dorsally, however, rods are arranged into bundles, separated by melanosome-filled rpe processes. The thickness of the retina increases as it approaches the crystalline lens. It is on this dorsal accessory retina that light traversing the 'optical fold' most likely falls, facilitating the detection of moving objects in the ventro-lateral field of view.
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Peces/fisiología , Fenómenos Fisiológicos Oculares , Visión Ocular/fisiología , AnimalesRESUMEN
BACKGROUND: In the autonomic nerve system most sympathetic neurons synapse peripherally in the ganglia of the sympathetic trunk. A reduction in sympathicotonia by partial elimination of these ganglia is a therapeutic approach that has been used for more than 100 years. In the early 1920s the first attempts at percutaneous sympathicolysis (SL) were carried out. Nowadays, minimally invasive image-guided SL has become an integral part of interventional radiology. Established indications for SL are hyperhidrosis, critical limb ischemia and the complex regional pain syndrome. METHODS: The standard imaging guidance modality in SL is computed tomography (CT) which allows the exact placement of the puncture needle in the target area under visualization of the surrounding structures. Ethanol is normally used for chemical lysis, which predominantly eliminates the unmyelinated autonomic axons. In order to visualize the distribution of the ethanol during application, iodine-containing contrast medium is added. RESULTS: The sympathetic nervous system (SNS) controls sweat secretion via the efferent neurons; therefore, effective therapy of idiopathic palmar, axillary and plantar hyperhidrosis can be achieved when SL is performed at the corresponding level of the sympathetic trunk. Furthermore, due to the vasomotor innervation of most blood vessels, by reduction of the sympathicotonus an atony of the smooth muscles and therefore vasodilatation occurs, which is used as a palliative therapeutic option in patients with critical limb ischemia. By elimination of the afferent sensory fibers this also results in pain relief. This principle is also used in the SL therapy of the complex regional pain syndrome. CONCLUSION: After the introduction of CT guidance, major complications have become rare events. In addition to the usual risks of percutaneous interventions there are, however, a number of specific complications, such as syncope caused by irritation of cardiac sympathetic nerves in thoracic SL and ureteral injury in lumbar SL.
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Dolor Crónico/tratamiento farmacológico , Etanol/administración & dosificación , Radiografía Intervencional/métodos , Sistema Nervioso Simpático/efectos de los fármacos , Sistema Nervioso Simpático/diagnóstico por imagen , Dolor Crónico/diagnóstico por imagen , Humanos , Inyecciones/métodos , Soluciones Esclerosantes/administración & dosificación , Tomografía Computarizada por Rayos X/métodosRESUMEN
We describe the bi-directed eyes of a mesopelagic teleost fish, Rhynchohyalus natalensis, that possesses an extensive lateral diverticulum to each tubular eye. Each diverticulum contains a mirror that focuses light from the ventro-lateral visual field. This species can thereby visualize both downwelling sunlight and bioluminescence over a wide field of view. Modelling shows that the mirror is very likely to be capable of producing a bright, well focused image. After Dolichopteryx longipes, this is only the second description of an eye in a vertebrate having both reflective and refractive optics. Although superficially similar, the optics of the diverticular eyes of these two species of fish differ in some important respects. Firstly, the reflective crystals in the D. longipes mirror are derived from a tapetum within the retinal pigment epithelium, whereas in R. natalensis they develop from the choroidal argentea. Secondly, in D. longipes the angle of the reflective crystals varies depending on their position within the mirror, forming a Fresnel-type reflector, but in R. natalensis the crystals are orientated almost parallel to the mirror's surface and image formation is dependent on the gross morphology of the diverticular mirror. Two remarkably different developmental solutions have thus evolved in these two closely related species of opisthoproctid teleosts to extend the restricted visual field of a tubular eye and provide a well-focused image with reflective optics.
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Ojo/anatomía & histología , Peces/anatomía & histología , Fenómenos Ópticos , Animales , Peces/fisiología , Océanos y Mares , Visión Ocular , Campos VisualesRESUMEN
We report a case of false-positive metabolic screening for isovaleric acidemia in a newborn due to treatment of the mother with pivalic acid containing antibiotics before delivery. By using a recently established second-tier test based on the tandem-MS technique, we could identify pivalic acid in a dried blood sample taken during routine neonatal screening. Before this second-tier test was initiated, diverse analytical procedures were performed in the baby to rule out isovaleric acidemia and carnitine supplementation was started. This caused additional psychological burden to the family. The direct use of the second-tier test would have avoided these negative consequences of a false-positive screening result.
RESUMEN
Despite the rapid rise of integrated curricula, the teaching of gross anatomy by traditional dissection remains a central element in most medical programs worldwide. However, modern didactic concepts demand the integration of clinical content in preclinical settings. The implementation of interdisciplinary tools often leads to a reduction in teaching of comprehensive anatomy. 'Tübingen's Sectio chirurgica' (TSC) introduces a concept of a teaching activity in which surgical prosection is performed in addition to the traditional dissection course. TSC is designed to integrate clinical and preclinical content in a traditional medical curriculum without affecting the systematic presentation of anatomical content. In the past 2 years, about 10,000 medical students have participated in the use of telemedical transmissions of 'live surgery' in a total of 25 sessions of TSC. Here we describe the organisational plan of TSC and the results of an evaluation which was performed to monitor the influence of TSC on student motivation for surgical disciplines as well as for the learning of anatomical factual content. We demonstrate that additional surgical prosection is a valuable tool in increasing the coherence between preclinical and clinical parts of medical education programs.
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Anatomía/educación , Disección/educación , Especialidades Quirúrgicas/educación , Enseñanza/métodos , Cadáver , Curriculum/normas , Curriculum/tendencias , Alemania , Humanos , Aprendizaje Basado en Problemas/normas , Aprendizaje Basado en Problemas/tendencias , Telemedicina , Comunicación por VideoconferenciaRESUMEN
Inflammatory myofibroblastic tumors (IMT) are a rare entity. Localization in the stomach is extremely seldom and almost exclusively seen in children. Invasive growth of IMT may lead to irresectability or recurrence. In an 8-month-old girl presented with repetitive vomiting for several days. Complete surgical resection of a gastric IMT was possible.
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Obstrucción de la Salida Gástrica/etiología , Neoplasias de Tejido Muscular/complicaciones , Neoplasias Gástricas/complicaciones , Biomarcadores de Tumor/análisis , Diagnóstico Diferencial , Gastroenterostomía , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Neoplasias de Tejido Muscular/diagnóstico , Neoplasias de Tejido Muscular/cirugía , Estómago/patología , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirugía , UltrasonografíaRESUMEN
AIMS: To provide evidence for a novel route of gene administration to normal and diseased retinas, we performed systemic transplantation of genetically engineered bone marrow-derived cells (BMDCs) to wild-type mice and to mutant mice with retinal degeneration. METHODS: Lethally irradiated recipient mice-C57BL/6 (wild-type), SCA7 (spinocerebellar ataxia type 7) and FVB/N (rd1 mutant)-were transplanted intravenously with 5x106 BMDCs, which were transduced with a retroviral vector to express the enhanced green fluorescent protein (GFP). Chimeras were killed at 1, 3, 8, 11, 12 and 15 months (wild-type) or at 8 and 12 months (mutants) after transplantation. Eyes were enucleated, and the retinas were analysed using immunohistochemistry. RESULTS: In wild-type retinas, BMDCs preferentially engrafted in the inner and outer plexiform layers, the ganglion cell layer and the optic nerve. No BMDCs were found in the photoreceptor layer. BMDCs were more common in the degenerating retinas of the mutant mice. The majority of BMDCs in the retina were identified as microglia based on morphology and immunophenotype. Approximately 8-16% of all CD11b(+) cells in the retina expressed GFP. None of the BMDCs expressed neuronal cell markers. GFP-expressing BMDCs were found to persist for more than 1 year after transplantation. CONCLUSIONS: We demonstrate that gene-modified BMDCs show long-term engraftment and stable expression of GFP from a retrovirus in both wild-type and mutant mouse retinas. Thus, BMDCs may be used as vehicles for gene delivery to the retina.
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Trasplante de Médula Ósea/métodos , Técnicas de Transferencia de Gen , Ingeniería Genética/métodos , Degeneración Retiniana/terapia , Animales , Supervivencia de Injerto , Proteínas Fluorescentes Verdes/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Retina/metabolismo , Degeneración Retiniana/metabolismo , Transducción GenéticaRESUMEN
PURPOSE: To evaluate whether catheter-related infections after radiologically placed port catheters can be reduced by single-shot periinterventional antibiosis. MATERIALS AND METHOD: Between January and September 2002, 164 consecutive patients with indication for central venous port catheter implantation were included in the present study. During implantation the interventional radiologist was responsible for deciding whether to administer a prophylactic single-shot antibiosis. The prophylactic antibiosis entailed intravenous administration of ampicillin and sulbactam (3 g Unacid, Pfizer) or 100 mg ciprofloxacine (Ciprobay, Bayer) in the case of an allergy history to penicillins. Catheter-related infection was defined as a local or systemic infection necessitating port catheter extraction. RESULTS: Indication for port catheter implantation was a malignant disease requiring chemotherapy in 158 cases. The port catheter (Chemosite [Tyco Healthcare] [n = 123], low-profile [Arrow International] [n = 35], other port system [n = 6]) was implanted via sonographically guided puncture of the right jugular vein in 139 patients, via the left jugular vein in 24 cases and via the right subclavian vein in one patient. 75 patients received periinterventional prophylactic antibiosis (Unacid [n = 63] Ciprobay [n = 12]) and 89 patients did not receive antibiosis. The prophylactic antibiosis caused a minor allergic reaction in one patient that improved with antihistamic and corticoid medication. A total of 7 ports, 6 without prophylactic antibiosis versus one with periinterventional prophylaxis, were extracted due to infectious complications. CONCLUSION: Single-shot periinterventional prophylactic antibiosis can reduce early and late infectious complications after radiological-interventional placement of central venous port catheters.
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Antibacterianos/administración & dosificación , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/métodos , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/prevención & control , Radiografía Intervencional/métodos , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the technical success rate, procedure-related complications, and clinical long-term results for patients who underwent infrapopliteal angioplasty. MATERIALS AND METHODS: We retrospectively evaluated all patients who underwent infrapopliteal angioplasty to treat critical chronic limb ischemia or severe claudication from 1/1997 to 12/1999. We excluded patients with acute (< 2 weeks) limb ischemia. Procedure-related data were prospectively documented in a database and analyzed with a focus on the technical success rate and procedure-related complications. In addition all clinical documents were analyzed, and a follow-up examination was performed or telephone interviews were conducted with patients, relatives and referring doctors for follow-up. The primary end points were the limb salvage rate and patient survival rate. The secondary end points included the complication rate, technical success rate, and walking distance. RESULTS: 112 patients with a mean age of 72 years (41 women, 71 men) underwent crural angioplasty on 121 limbs. Four patients suffered from severe claudication (Rutherford category 3) and all others had critical chronic limb ischemia (category 4 to 6). The complication rate was 2.7 %. The technical success rate was 92 %. The ankle brachial index increased from 0.59 to 0.88. The mean walking distance increased significantly from 52 +/- 66 to 284 +/- 346 meters at the time of follow-up. The limb salvage rate was 83.6 % after one year and 81.1 % after three years. The mean survival rate according to Kaplan-Meier was 79.4 %, 69.2 %, and 54.2 % at 1, 2, and 3 years, respectively. Patients with at least one patent run-off vessel after angioplasty had a significantly better limb salvage rate. Diabetes was not a risk factor for limb salvage. CONCLUSION: Infrapopliteal angioplasty shows a high technical success rate with an acceptable complication rate. The clinical long-term success seems favorable if a least one open run-off vessel was able to be achieved. However, the survival rate was limited by the co-morbidity in this patient group.
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Angioplastia de Balón/mortalidad , Isquemia/mortalidad , Isquemia/cirugía , Pierna/irrigación sanguínea , Pierna/cirugía , Medición de Riesgo/métodos , Anciano , Femenino , Alemania/epidemiología , Humanos , Isquemia/diagnóstico por imagen , Pierna/diagnóstico por imagen , Estudios Longitudinales , Masculino , Prevalencia , Pronóstico , Radiografía , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
In this article, current evidence-based treatment recommendations for acute and chronic lower limb ischemia will be presented considering the varied possibilities of endovascular techniques and open surgical vascular strategies. Beside presentation of the different therapeutic possibilities, advantages of the combination of both techniques will be described. Despite the BASIL trial, there are no prospective randomised controlled trials comparing endovascular and open surgical interventions. Different therapeutic rules along the different vascular segments will be discussed for both acute and chronic peripheral arterial disease. Generally it can be stated that aortoiliac revascularization for chronic obstructions is increasingly being carried out by endovascular means or hybrid procedures using a minimally invasive femoral approach, whereas acute occlusions in this vascular segment are still treated with open surgical techniques (Fogarty balloon thrombectomy). In the infrainguinal region, endovascular therapeutic strategies are gaining favor. However, multilevel occlusions and long-segment obstructions in the femoral and popliteal segment are still treated by bypass procedures. Acute ischemia in the infrainguinal segment is increasingly treated with endovascular methods (local thrombolysis and percutaneous thrombectomy).
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Angioplastia de Balón , Arteriopatías Oclusivas/cirugía , Arteriopatías Oclusivas/terapia , Isquemia/cirugía , Isquemia/terapia , Pierna/irrigación sanguínea , Enfermedades Vasculares Periféricas/cirugía , Enfermedades Vasculares Periféricas/terapia , Stents , Enfermedad Aguda , Angiografía , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/tratamiento farmacológico , Implantación de Prótesis Vascular , Embolectomía , Humanos , Isquemia/tratamiento farmacológico , Pierna/diagnóstico por imagen , Estudios Multicéntricos como Asunto , Enfermedades Vasculares Periféricas/diagnóstico por imagen , Enfermedades Vasculares Periféricas/tratamiento farmacológico , Enfermedades Vasculares Periféricas/etiología , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Trombectomía , Terapia Trombolítica/métodos , Tomografía Computarizada por Rayos XRESUMEN
We studied seroprevalence and concentrations of Epstein-Barr virus (EBV) antibodies in 147 pediatric patients with multiple sclerosis (MS) and paired controls. The children with MS showed a near-complete seropositivity for EBV antibody against virus capsid antigen (98.6% vs 72.1% in controls, p = 0.001) but did not display serologic evidence for a recent EBV infection. EBV antibody concentrations of pediatric patients with MS were significantly higher vs controls.
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Herpesvirus Humano 4/aislamiento & purificación , Esclerosis Múltiple/virología , Adolescente , Adulto , Anticuerpos Antivirales/sangre , Niño , Preescolar , Estudios de Cohortes , Infecciones por Virus de Epstein-Barr/epidemiología , Infecciones por Virus de Epstein-Barr/virología , Femenino , Alemania/epidemiología , Herpesvirus Humano 4/metabolismo , Humanos , Estudios Longitudinales , Masculino , Esclerosis Múltiple/epidemiología , Estudios SeroepidemiológicosRESUMEN
BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) may lead to dysphagia caused by osteophytes of the cervical spine. Osteophytes can be resected transorally or transcervically, but operative ablation should not be indicated generously because of the threat of severe complications. PATIENT: A fifty-year-old man with dysphagia and loss of weight of 15 kg in the last three months is presented. He also suffered from a brain damage during infancy which caused grand-mal-seizures. One seizure lead to cardiac arrest which required cardio-pulmonary resuscitation and subsequent tracheostomy. A spheric tumor of the posterior pharyngeal wall could be seen endoscopically, it appeared radiologically as an osteophytic formation of the segments C (3) - C (5). Ossification of the anterior longitudinal ligament was also seen. Diagnosis of DISH was made on the basis of these results. Contrast imaging of the esophagus and videofluoroscopy showed aspiration in terms of neurogenic disorders. The patient received a percutaneous gastrostomy after his case was discussed with neurologic and orthopaedic colleagues, because a causal therapy of the combined disease seemed to be impossible. CONCLUSION: Dysphagia in the presented case was caused by a combination of neurogenic deglutition disorders and oropharyngeal obstruction through osteophytes. Surgical removal of the osteophytes was not indicated because it would have put the patient at a certain risk, but only a part of the underlying problem would have been removed. Symptomatic therapy with a gastrostomy secures normocaloric diet. The patient's weight remained stable and he can follow his habitual daily routine.
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Trastornos de Deglución/etiología , Hiperostosis Esquelética Difusa Idiopática/complicaciones , Vértebras Cervicales , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/diagnóstico por imagen , Trastornos de Deglución/cirugía , Fluoroscopía , Gastrostomía , Humanos , Hiperostosis Esquelética Difusa Idiopática/diagnóstico , Hiperostosis Esquelética Difusa Idiopática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Factores de Tiempo , Grabación en VideoRESUMEN
HISTORY AND CLINICAL FINDINGS: A 41-year-old man with known Klippel-Trenaunay syndrome was admitted to hospital because of progressive dyspnea on exertion. Examination on admission revealed the typical signs of Klippel-Trenaunay syndrome, predominantly of the left leg. INVESTIGATIONS: D-dimers were significantly increased. Contrast-enhanced computed tomography of the chest revealed multiple small pulmonary arterial emboli in subsegmental arteries on both lungs. Pulmonary arterial digital subtraction angiography revealed extensive peripherally localized perfusion defects. Pulmonary artery pressure measurement demonstrated bilateral pulmonary artery hypertension. Phlebography of the left lower leg showed marked varices in the calf. There was also a persisting sciatic vein. DIAGNOSIS, TREATMENT AND COURSE: The recurrent peripheral pulmonary emboli with pulmonary arterial hypertension was a complication of a Klippel-Trenaunay syndrome. Another rare entity of this syndrome was a persisting sciatic vein. Heparinization was initiated, followed by oral anticoagulation. As the patient had not been anticoagulated before, implantation of an inferior vena cava filter was not deemed appropriate. CONCLUSIONS: Recurrent peripheral pulmonary emboli leading to chronic pulmonary artery hypertension is a rare but typical complication of Klippel-Trenaunay syndrome. Early recognition of this syndrome and any complications as a separate entity, as well as initiation of therapeutic measures, like anticoagulation or early pulmonary thrombendarterectomy for chronic pulmonary artery emboli, are of prognostic importance.
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Anticoagulantes/uso terapéutico , Heparina/uso terapéutico , Hipertensión Pulmonar/etiología , Síndrome de Klippel-Trenaunay-Weber/complicaciones , Embolia Pulmonar/etiología , Adulto , Enfermedad Crónica , Disnea/etiología , Humanos , Hipertensión Pulmonar/diagnóstico , Masculino , Pronóstico , Embolia Pulmonar/diagnóstico , RecurrenciaRESUMEN
PURPOSE: Are implanted central venous port catheters suitable for contrast media pressure (power) injection in computed tomography? MATERIAL AND METHODS: In an in vitro study 100 ml of contrast medium (Ultravist 370, Schering, Berlin, Deutschland) was injected through 20 different port catheter systems using a power injector (Stellant, Medrad, Inianola, USA) with a pressure limit of 325 PSI. The injection rate was increased from 2 ml/s to 10 ml/s in increments of 2 ml/s. The maximum injection pressure and maximum injection rate were assessed. RESULTS: An injection rate of 2 ml/s was possible in all catheter systems. Injection rates of 4 ml/s in 18 systems, 6 ml/s in 13 systems and 8 ml/s in 6 systems were achieved. With a given pressure limit of 325 PSI an injection rate of 10 ml/s was not possible in any of the port catheter systems. There were no catheter ruptures, catheter disconnections or contrast extravasations noted. CONCLUSION: Power injection of contrast media with a pressure limit of 325 PSI seems to be tolerated by port catheter systems. Most of the evaluated port systems allow flow rates suitable for multislice computed tomography requiring rapid contrast injection.
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Cateterismo Venoso Central/instrumentación , Medios de Contraste/administración & dosificación , Inyecciones Intravenosas/instrumentación , Yohexol/análogos & derivados , Tomografía Computarizada por Rayos X/instrumentación , Tomografía Computarizada por Rayos X/métodos , Cateterismo Venoso Central/métodos , Diseño de Equipo , Análisis de Falla de Equipo , Humanos , Técnicas In Vitro , Inyecciones Intravenosas/métodos , Yohexol/administración & dosificación , PresiónRESUMEN
The solid-pseudopapillary tumor (SPT) is a very rare pancreatic neoplasm that predominantly affects young females. About 450 cases have been described in the world literature and approximately 20% of the reported patients were children. The occurrence of SPT with distant metastases in children is extremely rare with only two previously reported cases. We now report a 16-year-old Asian girl with a large SPT and synchronous multiple liver metastases who was successfully treated in a 2-step strategy, including initial pylorus-preserving partial duodenopancreatectomy, right hemicolectomy, resection and allografting of the portal vein and secondary resection of 12 liver metastases. The patient is disease free after a follow-up of 18 months after resection of the primary tumor, suggesting that an aggressive surgical treatment might also be justified for metastasized SPT.
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Carcinoma Papilar/secundario , Carcinoma Papilar/cirugía , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Adolescente , Femenino , Humanos , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
This paper provides the first detailed description of the time courses of light-evoked pupillary constriction for two species of cephalopods, Sepia officinalis (a cuttlefish) and Eledone cirrhosa (an octopus). The responses are much faster than hitherto reported, full contraction in Sepia taking less than 1 s, indicating it is among the most rapid pupillary responses in the animal kingdom. We also describe the dependence of the degree of pupil constriction on the level of ambient illumination and show considerable variability between animals. Furthermore, both Sepia and Eledone lack a consensual light-evoked pupil response. Pupil dilation following darkness in Sepia is shown to be very variable, often occurring within a second but at other times taking considerably longer. This may be the result of extensive light-independent variations in pupil diameter in low levels of illumination.
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Luz , Moluscos/fisiología , Reflejo Pupilar/fisiología , Animales , Océano Atlántico , Especificidad de la Especie , Factores de TiempoRESUMEN
Hemangioendotheliomas of the thyroid are neoplasms that are rarely encountered in the Alpine region in Europe. The endemic goiter in this iodine-deficient region can be considered as a predisposing factor. We report the second case of an epithelioid hemangioendothelioma (EHE) of the thyroid gland and the first clinical case with malignant behavior. A 73-year-old woman with a long history of multinodular goiter presented with a rapidly growing thyroid mass, free of distant metastases. A total thyroidectomy was performed. Histologically the lesion had characteristic epithelioid and spindle cell proliferation in a background of chondromyxoid stroma. Cytoplasmic vacuolization in the epithelioid and spindle cells were present. Tumor cells were positive for factor VIII-related antigen, MNF116, PAN-ceratin, CD 34, and CD 31 and negative for cytokeratin allowing the diagnosis of EHE. Nine months after the primary resection the tumor locally recurred. A palliative resection was performed in a second operation followed by interferon-alpha therapy. The patient rapidly developed a second local relapse and died 13 months after the diagnosis of an EHE had been made. An improvement of the very poor prognosis of this rare tumor may depend on early tumor diagnosis and surgery combined with a multimodal treatment.
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Hemangioendotelioma Epitelioide/patología , Neoplasias de la Tiroides/patología , Anciano , Femenino , Hemangioendotelioma Epitelioide/diagnóstico , Humanos , Imagen por Resonancia Magnética , Neoplasias de la Tiroides/diagnósticoRESUMEN
The vertebrate retina receives efferent input from different parts of the central nervous system. Efferent fibers are thought to influence retinal information processing but their functional role is not well understood. One of the best-described retinopetal fiber systems in teleost retinae belongs to the terminal nerve complex. Gonadotropin-releasing hormone (GnRH) and molluscan cardioexcitatory tetrapeptide (FMRFamide)-containing fibers from the ganglion of the terminal nerve form a dense fiber plexus in the retina at the border of the inner nuclear and inner plexiform layer. Peptide-containing fibers surround and contact perikarya of dopaminergic interplexiform cells in teleost retina. In vitro experiments demonstrated that exogenously supplied GnRH mediates dopaminergic effects on the membrane potential and on the morphology of dendritic tips (spinules) of cone horizontal cells. These effects can be specifically blocked by GnRH-antagonists, indicating that the release of dopamine and dopamine-dependent effects on light adaptation of retinal neurons are affected by the terminal nerve complex. Recent data have shown that olfactory information has an impact on retinal physiology, but its precise role is not clear. The efferent fiber of the terminal nerve complex is one of the first retinopetal fiber systems for which the sources of the fibers, their cellular targets, and several physiological, morphological, and behavioral effects are known. The terminal nerve complex is therefore a model system for the analysis of local information processing which is influenced by a distinct fiber projection.
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Dopamina/fisiología , Terminaciones Nerviosas/fisiología , Retina/fisiología , Visión Ocular/fisiología , Animales , FMRFamida/fisiología , Humanos , Neuropéptidos/análisis , Neuropéptidos/inmunología , Nervio Óptico/citología , Retina/citología , VertebradosRESUMEN
BACKGROUND: Pulmonary arteriovenous malformations (PAVM) can be found in approximately 20 % to 35 % of patients with hereditary hemorrhagic telangiectasia (HHT). PAVM should be treated since they are a source of paradoxical embolization, potentially resulting in severe neurologic complications. The treatment of choice is the endovascular embolization with coils. PATIENTS AND METHODS: Seven patients with HHT underwent superselective embolization of PAVM detected during screening for PAVM. Four patients had a single PAVM and one patient 3, 4 and 5 PAVMs, respectively. Electrolytically detachable coils were used for embolization. In addition, coils with synthetic fibers were used during 6 embolizations for completion of embolization. RESULTS: Embolization was technically successful in all patients. Complete primary occlusion was achieved in all PAVM. No coil migration or occlusion of unaffected pulmonary arteries was observed. After embolization, one patient developed a small pleural effusion, which was treated symptomatically. CONCLUSION: As a minimally invasive procedure, superselective embolization is the treatment of choice in treating PAVM in patients with HHT. With the use of electrolytically detachable coils, the ideal coil size can be chosen and exact placement achieved without the risk of coil migration or occlusion of unaffected pulmonary arteries.
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Malformaciones Arteriovenosas/terapia , Embolización Terapéutica/instrumentación , Arteria Pulmonar/anomalías , Venas Pulmonares/anomalías , Telangiectasia Hemorrágica Hereditaria/terapia , Adolescente , Adulto , Anciano , Angiografía , Malformaciones Arteriovenosas/diagnóstico , Malformaciones Arteriovenosas/diagnóstico por imagen , Embolización Terapéutica/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía Torácica , Tomografía Computarizada Espiral , Tomografía Computarizada por Rayos XRESUMEN
Primary intimal sarcomas of the aorta are extremely rare and aggressive tumors metastasizing into bones and visceral organs including liver, kidneys, adrenal glands, and lung. The first symptoms are often nonspecific and often caused by arterial embolism. We report a case with an incidental finding of primary intimal sarcoma in an aneurysm of a patient with claudication due to tumor embolization.