Isolated "Tillaux" fracture in adulthood: rarity where the key of success is not to miss it.

BACKGROUND: Fracture of the lateral border of the distal tibia is often referred as Tillaux fracture. It is an avulsion fracture due to the tension of the anteroinferior portion of the anterior tibiofibular ligament (1). This type of fracture is scarce in adulthood and can be easily overlooked. METHODS: From 2006 to the present day, 7 case reports describing the Tillaux fracture were found in the PubMed and Web of Science database, to which one case from our set of patients was added. Our goal was to focus on the diagnostic and a selected treatment described in each published case. RESULTS: We found no gender difference. The injury mechanism was mostly an external rotation. Treatment and diagnosis were, in all cases differentiated at specific points. Fixation and load reduction were indicated at least for six weeks in all of the patients. After three months, in almost all cases, a return to full function was achieved. CONCLUSION: Our assessments are not statistically significant, but our goal was to point out the existence of such a rare type of fracture. At the same time, based on previous publications, we developed an algorithm of diagnosis and treatment to facilitate the management of this type of fracture (Tab. 1, Fig. 5, Scheme 1, Ref. 21).

Short-term effect of the demonstration of human dissection and excursion on students´ ideas about the human organ systems: a Slovak experience.

BACKGROUND: Excursions in natural sciences education are justified in the current school system and within the scope of subject focus. The research aimed to observe the immediate impact of demonstration of the human dissection and excursion on the formation of ideas of students about the human body systems. METHODS: The experiment involved the first Slovak demonstration of a real human autopsy for students of the Biology Teaching Department (PdF TU in Trnava). Concepts of the structure of the human body were analyzed before and after experimental impact by a projective technique. The evaluation included the representation, description, and abundance of organs in the view of various systems. The subject of the research were also the questions focused on the use of illustrative procedures and tools in the educational process. RESULTS: Significant statistical differences were found in the group affected by human autopsy in understanding of the digestive, urinary, and locomotor systems. Conversely, the skin, endocrine glands, and lymphatic system were the least represented by the experimental groups. CONCLUSION: Considering the presented results, using different organizational forms and aids (real and virtual) is essential for bringing a positive educational effect on the studied problem (Tab. 1, Fig. 5, Ref. 20).

The vascular patterns of the posterior part of the circulus arteriosus cerebri (Willisi).

BACKGROUND: Various authors defined three patterns of the posterior part of the circulus arteriosus cerebri Willisi (CW) according to the diameter of the posterior communicating artery (PCoA) and the precommunicating segment of the posterior cerebral artery (P1). In the adult pattern, the P1 has a diameter larger than the non-hypoplastic PCoA. In the transitional pattern, the diameter of the PCoA is equal to that of the P1. In the fetal pattern, the diameter of the P1 is smaller than the diameter of the PCoA. The study was aimed to evaluate the configurations and calibers of the posterior part of the CW. METHODS: The work was conducted on 185 adult post-mortem brains. The CW and its branches were photographed by a digital camera. We used the software Image J to evaluate and process the gained images. RESULTS: The fetal pattern was found unilaterally in 8.37 %, and bilaterally in 4.86 %. The transitional pattern was observed unilaterally in 6.47 %, and bilaterally in 1 %. The prevalence of the unilateral and bilateral adult patterns was equal (21.62 % for each configuration). The hypoplastic PCoA was found unilaterally in 17.57 %, and bilaterally in 16.76 %. CONCLUSION: Various factors including genetic and environmental may affect the development of the cerebral vessels and their dimensions. The distinguishing of the vascular dimensions in vivo can help in the expectation and may be the avoidance of possible cerebrovascular disturbances in the future. Correlation and interdisciplinary cooperation of the studies dealing with morphology, radiology, and hemodynamics of the cerebral vessels are becoming an urgent need. The assumed results of this cooperation can be used in tabulating the calibers of the cerebral vessels and determining the threshold dimensions under which failure of hemodynamics and collateral function may appear (Tab. 2, Fig. 5, Ref. 28).

Subserosal localization of myenteric ganglia in normal human appendix: immunostaining with neuronal and glial markers.

OBJECTIVES: Visualization of unexpected distribution of myenteric ganglia in normal human appendiceal wall by immunofluorescence. BACKGROUND: The myenteric plexus is located between the longitudinal and circular muscle layers of the GIT. However, recently the irregular distribution of myenteric ganglia was revealed in human appendix. METHODS: The cryosections prepared from normal human appendices were examined by immunofluorescence methods using antibodies to neurofilaments (NF) and glial fibrillary acidic protein (GFAP). RESULTS: Indirect immunofluorescence revealed the positive staining of myenteric ganglia with both neuronal and glial marker antibodies. Double labeling for NF/GFAP staining showed close assotiation between glia and neurons inside ganglia. GFAP-positive cells were often observed as the cells surrounding myenteric ganglia. The staining confirmed the irregular distribution of myenteric ganglia in human appendiceal wall and revealed the small ganglia in the subserosal area. CONCLUSION: Our results showed that localization of myenteric ganglia in human appendix differs from other parts of GIT. GFAP immunostaining is available for visualization of smaller myenteric ganglia located mainly in the subserosal area. Our studies may find application in current HIV research focused on enteric neuropathogenesis and in diagnostic laparoscopy for chronic abdominal pain: to detect the irritation of subserosal ganglia (Fig. 2, Ref. 26).

Biological aspects of appendix pathology: irregular distribution of myenteric ganglia in human appendiceal wall.

OBJECTIVES: Although appendicitis is a common disease, basic questions about risk factors and its etiology remain unexplained. BACKGROUND: An obstruction of the appendix lumen is usually considered to be the main cause of acute appendicitis. However, more studies are currently dealing with neuroimmune appendicitis. METHODS: We studied samples of human appendices with the histological diagnosis of chronic appendicitis. Fixed cryosections of appendiceal walls were examined by immunofluorescence methods using neuronal anti-neurofilament antibody markers and beta III tubulin. RESULTS: The immunostaining revealed an irregular distribution of myenteric ganglia in inflamed appendiceal walls and unexpected groups of large ganglia unequally distributed in the subserosal area. The comparative analysis of normal and inflamed appendix samples showed differences in the occurrence of myenteric ganglia in the subserosal area. They appeared more frequently on cryosections prepared from the inflamed appendiceal wall. CONCLUSION: We propose that the high variability and irregular location of myenteric ganglia in the appendiceal wall are due to an alteration in the motility which results in flaccid appendix emptying. In addition, superficially located myenteric ganglia are exposed to abdominal irritation and may explain the chronic abdominal pain which is often considered to be a sign of chronic appendicitis (Fig. 2, Ref. 23).

Omphalocele with ectopic liver forming a mesodermal cyst.

BACKGROUND: Congenital anomalies of the abdominal wall are classified as anomalies with the abdominal wall defect (omphalocele, gastroschisis) and without the defect (umbilical hernia, persistent ductus omphaloentericus or urachus). Clinical presentations of these conditions are different, and so is the timing of surgical intervention and approach with or without the exploration of the peritoneal cavity. CASE: The presented case report refers to a rare finding of ectopic liver forming mesodermal cyst within the umbilical region. Full term neonate girl with 5 cm spheroid tumor in umbilicus was otherwise without problems. Ultrasonography (USG) of the lesion detected a tissue with good vascularization and a cystic cavity. There was no flow in the umbilical vessels and no evidence of intestinal loop in the sac. USG of the liver was normal. During surgery an additional narrow canaliculus was identified connecting the spheroid along with umbilical vessels to the liver. The whole spheroid together with the canaliculus was surgically removed without exploration of the abdominal cavity. Histological evaluation of the surgical specimen discovered liver tissue with a mesodermal cyst in the center. The sphere was connected to the liver by a bile duct. Six months after the operation the child is in a good clinical condition. CONCLUSION: In conclusion omphalocele may contain liver. Ectopic liver is an extremely rare condition. Surgical treatment in the presented case focused only on umbilicus without exploration of the abdominal cavity and appeared to be sufficient. Long-term postoperative follow up typical in pediatrics will be applied also in this patient (Fig. 3, Ref. 25).