[Systemic manifestations of idiopathic inflammatory myopathies--part one]. / Sistemske manifestacije idiopatskih inflamatornih miopatija--prvi deo.

Dermatomyositis and polymyositis are the idiopathic inflammatory myopathies of autoimmune origin. Apart from muscle weakness, general symptoms such as the affection of visceral organs and altered indicators of humeral immunity occur in a minority of patients. The aim of the study was to establish whether the systemic manifestations of the disease, altered immunoserologic parameters and findings of muscle vasculitis occurred more frequently in patients with dermatomyositis or polymyositis. The frequency of clinic, serologic and histopathologic alterations in the groups of patients with dermatomyositis and polymyositis was determined. In order to determine the degree and importance of the frequency, the following parameters were calculated: the relative rations of frequencies and the importance of the difference in frequencies of particular alterations between the groups of patients. It was found that extramuscular manifestations of the disease such as arthritis, pulmonary, cardiac and renal changes, the increased activity of C3 and C4 complement components as well as vasculitis of muscle and skin tissue occurred more frequently in patients with dermatomyositis. This finding indicates that patients with DM, regardless of the degree of muscular affection, may have a more severe clinical course of the disease and a poor prognosis.

[Successful surgical removal of a cardiac myxoma from the left ventricular outflow tract]. / Uspesno hirurski odstranjen miksom srca u izlaznom trakty leve komore.

The precondition for successful, exclusively surgical treatment in the extracorporeal circulation, is the precise diagnosis of heart myxoma, particularly in rare locations such as the left ventricle. We present a case of myxoma in the outflow tract of the left ventricle as the exceptionally rare location, successfully diagnosed and surgically treated at the Clinic for Cardiac and Thoracic Surgery of the Military Medical Academy. A female patient, aged 46 years, was sent from another hospital with misdiagnosis of idiopathic hypertrophic subaortic stenosis. The patient was successfully operated after transthoracic and transesophageal echocardiography as the main diagnostic procedures. Myxoma that completely obstructed the aortic opening if pulled, was completely removed through aortic valve in the extracorporeal circulation. Its pedicle was arising from the ventricular side of the great mitral cusp. Postoperative course was uneventful and the patient was released from the hospital on the tenth postoperative day.

[Primary liposarcoma of the pericardium]. / Primarni liposarkom perikarda.

A case of primary liposarcoma of the pericardium, an exceptionally rare localization, has been presented. The tumor localized in the region of the left ventricle and connected to the visceral wall of the pericardium was diagnosed in a 38-year old male. Histological, histochemical and immunochemical findings confirmed the diagnosis of the liposarcoma of the pericardium.

[Primary liposarcoma of bone]. / Primarni liposarkom kosti.

A case of 75-year-old man with extremely rare primary liposarcoma of the bone was presented. Stains for lipid, Sudan III, Sudan IV, and Oil Red "O", demonstrated the presence of intracellular lipid in the lipoblasts. Similarly, the S-100 immunoreactivity and electron microscopic findings of tumor cells confirmed the diagnosis of liposarcoma. Histochemical stains for PAS, Alcian-blue, mucikarmin, Toluidin-blue and Coloidal Iron were negative.

[Detection of B-lymphocyte clonality in samples of salivary gland tissue in patients with primary Sjogren syndrome]. / Detekcija klonalnosti B limfocita u uzorcima tkiva pljuvacnih zlezda bolesnika sa primarnim Sjegrenovim sindromom.

Intensive lymphoplasmocytic infiltration with atrophy of glandular tissue structures is the dominant patohistological feature found in exocrine glands of patients with Sjögren syndrome (SS). The infiltrates consist of T and B lymphocyte clusters that make the structures resembling germinal centers, and numerous plasmocytes that are secreting imunoglobulines locally, including autoantibodies. By applying the polymerase chain reaction (PCR) in our study we have shown the existence of dominant B cell clone in salivary glands samples of 4 out of 6 patients with SS, in the absence of clinical, routine laboratory, and patohistological signs of the lymphoma. B lymphocyte clones were detected upon the amplification of gene segment that encoded variable heavy chain immunoglobulin CDR3 region. Finding of single, dominant B lymphocyte clone could be of predictive significance, because these patients are predisposed to non-Hodgkin lymphoma (NHL) for which there is an assumption that it originates out of salivary glands from one of the clusters of proliferating B lymphocytes.

[Systemic manifestations of idiopathic inflammatory myopathies--part two]. / Sistemske manifestacije idiopatskih inflamatornih miopatija--drugi deo.

The aim of the investigation was to establish if the finding of immunoserologic and pathohistologic parameters of the altered humoral immune response in patients with dermatopolymyositis was associated with the occurrence of more severe clinical patterns of the diseases followed by general symptoms and the affection of visceral organs. Sensitivity, specificity, accuracy, positive and negative prediction of immunologic parameters of the disease were determined compared to the occurrence of certain systemic manifestations of the disease. Significant (80-100%) correlation of systemic manifestations with the altered immunoserologic and histopathologic parameters of the disease was confirmed, so that it could be assumed that pathologic humoral response had a significant role in the onset of systemic manifestations during dermatopolymyositis. Predictive value of indicators was of the utmost importance. If the increased values of immune complexes, vasculitis in the muscle and the other cited indicators of the altered humoral response were confirmed in a patient, more severe course of the disease could be expected, which was of practical value for the planning of therapeutic approach, estimation of the disease course and its prognosis.

[Myositis ossificans in recurrent synovial hemangioma of the knee]. / Myositis ossificans nastao u recidivantom hemangiomu sinovije kolena.

A case of myositis ossificans in 15-year old boy that occurred as a complication of the recurrent synovia hemangioma of the left knee was presented. The alteration was diagnosed as: osteosarcoma, chondrosarcoma and chondromyxoid fibroma by the pathologists from other institutions. The diagnosis of myositis ossificans was established using numerous histochemical and immunochemical methods (PAS, PAS diastasis, Alcian blue, Masson trichrom, von Kossa, Azur A, Toluidin blue, Goldner, method by Peris, Citokeratin, S-100, NSE and Vimentin). The presence of zonal phenomenon, as the one observed in the presented case, is one of the most significant criteria for differentiation of myositis ossificans from osteosarcoma.

[Ameloblastic fibro-odontoma]. / Ameloblastni fibroodontom.

Ameloblastic fibro-odontoma is a rare malformation which is classified in group of odontomas, such as simplex and compound odontomas. A lesion usually develops asymptomatically in the first or the second decade of life, near the non-erupted or displaced tooth, consisting of numerous small tooth-like components. This is a case report of a 10 years old boy with tumor-like lesion in the angle of mandibula in whom was confirmed ameloblastic fibroodontoma after the operation and histological examination. Considering the growth potential and its clinical features, ameloblastic fibroodontoma requires adequate surgical treatment.

[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.

[Pigmented villonodular synovitis--analysis of 50 patients]. / Pigmentni vilonodularni sinovitis--analiza 50 bolesnika.

Fifty patients with pigmented villonodular synovitis (PVNS) were examined and treated in the Military Medical Academy in twenty-year period (1977-1996). Among them, 32 were male and 18 female (2:1), of average age from 6 to 72 years. Articular disease localization was 2.5 times more frequent compared to the non-articular. The rate of circumscribed in relation to diffuse form was 1.5:1. The ankle joint was most frequently involved (94%). In one patient, PVNS was proved in both ankle joints. The disease was clinically expressed as chronic, and 4 times more frequently as chronic recurrent synovitis. The data of previous injury were known in 14 patients. Associated rheumatic disease or injury was found in more than a half patients (53%). For the disease diagnosis there were used: physical examination, standard laboratory tests, radiography, ultrasonographic and magnet resonance examination and histopathologic examination of synovia obtained by open or arthroscopic biopsy. Surgical methods, such as total or partial synovectomy were applied in the therapy. Chemical synovectomy was performed in one patient, 6 months after the diagnostic arthroscopy due to disease recurrence. Therapeutic effect was estimated in 22 patients, from 3 months to 11 years after the surgery on the basis of disease recurrence. Except for the cited one patient, none other had the disease recurrence. It was concluded that timely diagnosis of PVNS offered more adequate treatment and conditions for complete recovery. In the disease limited just in the ankle joint, arthroscopic synovectomy would be the therapy of choice. In advanced diffuse form, total synovectomy should be performed for all the disease localizations.

[Histopathologic changes in the skin of transplanted microvascular flaps]. / Histopatoloske promene u kozi transplantiranih mikrovaskularnih reznjeva.

During the microvascular transfer, the free flaps tissue is exposed to series of pathophysiological changes (tissue anoxia, tissue acidosis, anaerobic metabolism, wound healing and cicatrisation, degeneration of nerves fibers in the free flaps tissue, etc.) In 1993-1998 period, at the Clinic for Plastic Surgery and Burns at the Military Medical Academy, we analyzed histopathologic changes in the skin taken from the transferred flaps and from the recipient region surroundings of 31 patients with microvascular tissue transfer. The bioptic materials were taken between 6 and 36 months following the free tissue transfer--average 23.6 months. By light microscopy we analyzed histopathologic changes of the epidermis, collagen's fibers, skin adnexa, blood vessels and nerve fibers. The data obtained showed considerable difference in the histopathology test results of the epidermis, collagen's fibers, the skin adnex and the nerve fibers in the transferred free flaps compared to the results obtained from testing recipient region surroundings. The histopathologic tests of the blood vessels did not show considerable comparative difference.

Morphologic characteristics of primary nonperforative intestinal blast injuries in rats and their evolution to secondary perforations.

Five hundred and fifty Wistar rats were investigated to determine the frequency of secondary intestinal perforations after exposure to nonperforating blasts and the evolution of the morphological changes from hematoma through to necrosis and gangrene. The animals were observed at different times for a period of 14 days from the moment that the injury was inflicted. Microscopic findings showed that alterations began in the mucosal layer where they were most extensive, then spread to the submucosal layer, muscular layer, and serosal layer, respectively. Examination of the intestinal wall revealed an evolution of the injury from hematoma to necrosis to gangrene, resulting in secondary intestinal perforation. The secondary wounds had centrifugal patterns, opposite those of the original wound pathways. Based on these observations, the mechanism of evolution of primary nonperforating intestinal blast injury into secondary intestinal perforations is presented.

Morphological analysis of saphenous vein used for aortocoronary graft.

Histological, histochemical, immunohistochemical and ultrastructural analyses of 120 saphenous veins (of 120 patients) prepared for aortocoronary graft, revealed in 57 cases lesser or larger morphological changes, such as endothelial damage, hyperplasia of t. intima, or t. media, and fibrosis of t. adventitia that could be the result of postoperative complications (thrombosis of the graft lumen, or its occlusion due to progressive hyperplasia of t. intima). The analyses have proved significantly increased number of smooth muscle cells and fibroblasts in t. intima of the damaged veins in relation to t. media, contrary to the findings in normal veins, and it was suggested that these smooth muscle cells in the damaged veins migrated from t. media to t. intima causing hyperplasia, as was confirmed by histochemical, immunohistochemical and ultrastructural findings. Since in 57 of 120 analyzed veins morphological changes were found which developed before the implantation of vein and which could compromise the vein function as the aortocoronary graft and cause severe postoperative complications, forming of vein banks is recommended from the chosen donors to avoid vein implantation with the already existent morphological changes, that could be proven by their immediate histological examination.

Histopathological evaluation of the carbon fibers application for the substitution of the anterior cruciate ligament--an experimental study on dogs.

The application of allograft-carbon fibers on the experimental group of 15 dogs (German Shepherd race) was histopathologically investigated after the artificial lesion of anterior cruciate ligament (ACL). In definite time intervals (1, 2, 4, 6 months) pathoanatomic and histopathologic findings were analyzed and the proliferation of new connective tissue of predominantly elastic type, between carbon fibers was observed. Beside the lymphocyte infiltration around torn carbon fibers giant cells of a foreign body type were found, and on the surface the epithelium similar to synovial was observed. It was concluded that carbon fibers could not be considered as the ideal artificial ligament.

The use of autografts and synthetic carbon fibers in reconstruction of the anterior cruciate ligament--an experimental study on dogs.

Biological characteristics and strength of the anterior cruciate ligament (ACL) after replacement by an artificial carbon fibers ligament--(group 1) and autograft--fascia lata (group 2) were investigated. These two methods were compared in four periods of time by means of clinical course, laboratory parameters, histopathological analysis and biomechanical testing on an Instron apparatus. Strength of neoligament in both examined groups has never achieved the strength of natural, unaffected ACL, and there was no significant difference between two observed groups in relation to clinical and laboratory parameters. Histopathological examination showed the presence of ingrowing of the connective tissue between carbon fibers, but in bone tunnels inside the fibers there was no ingrowing between bone trabeculae. In the group 2, collagenic fibers of the fascia lata were substituted with predominantly elastic connective tissue, with epithelium, similar to synovial, on the surface. No absolute superiority of carbon fibers to fascia lata as a substituent of the anterior cruciate ligament of a dog knee, as an experimental analog, was proved in this study.

[Anatomic characteristics and clinical signs of congenital anomalies in the circle of Willis]. / Anatomske karakteristike i klinicki znacaj kongenitalnih anomalija Willis-ovog sestougla.

Anatomical characteristics and clinical importance of congenital anomalies of cerebral arteries were examined based on the results obtained by dissection of the circle of Willis blood vessels of 70 native cadaveric brains. Anomalies were most frequently found in posterior communicant artery and their most frequent type was hypoplasia of the blood vessel. Multiple anomalies of the circle of Willis were found in 3 cadavers. Premortal neurological symptomatology (PNS) existed in 5 cadavers. There was no significant difference in PNS occurrence at autopsy in cases with or without anomalies. Association of aneurisms with anomalies of the circle of Willis was found in two cases, but it was not significant in comparison to the control group with no anomalies.