Carotid paragangliomas: case report and imaging review.

BACKGROUND: Presentation of case reviews depicting the imaging characteristics of carotid paragangliomas, associated with a thorough analysis of the anatomical morphological features and the current therapeutic strategies. MATERIALS AND METHODS: We present the cases of 3 patients diagnosed with carotid paragangliomas in our clinic, illustrating diagnostic imaging elements by computer tomography (CT) and magnetic resonance imaging (MRI), but also the postoperative aspect of the carotid system, with respective anatomical, clinical and surgical considerations. RESULTS: The imaging aspect of the carotid paragangliomas is characterised by a mass of soft tissue with intense contrast enhancement and with "salt and pepper" MRI appearance on conventional spin-echo sequences. The postoperative evolution of the patients included in the article was favourable, without any perioperative complications or signs of local tumour recurrence. CONCLUSIONS: Carotid paragangliomas are rare, often asymptomatic tumours, but with potential for increased malignancy, which raises the need for good knowledge of the cervical region pathology as well as the features of neuroendocrine tumours. CT and MRI examinations are essential for diagnosis, staging and, implicitly, for establishing the therapeutic strategy.

Anatomic-imaging correlations of lumbar disk-vertebral morphometric indices / Correlaciones anatomopatológicas de los índices morfométricos disco-vertebral lumbar

SUMMARY: This study represents a morphometric assessment of the anterior segment of the lumbar spine, focused on the vertebral body - intervertebral disk assembly, calculating some specific indicators and then completing direct morphometry data with the data resulting from the imaging interpretation and subsequently correlating the same to map an anatomic-imaging model. The study was carried out with anatomic items from personal archive and images obtained from Computer Tomography (CT) and Magnetic Resonance Imaging (MRI) assessment. The morphometric assessment was carried out for intervertebral disks, the disk height in the anterior and posterior sections and correlated with the disk angle degree. Direct morphometric data was compared and correlated with the data resulting from the imaging interpretation. Direct morphometric assessment was carried out for 11 vertebral blocks; the vertebral blocks were sectioned and turned into 22 vertebral semi-blocks allowing easy access to absolutely all dimensional values pursued, including the ones covered by the posterior arc. The assessment of imaging data was made with CT, CT 3D and MRI investigations from the 120 subjects in the study. The disk sizes were assessed by direct measurements on the anatomic items and directly measured by means of the software for modern imaging examination. In case of significant differences between the vertebral bodies, the calculation of disk sizes was made indirectly, on grounds of the geometric interpretation of the vertebral body face sizes. The vertebral body / intervertebral disk (IVD) assembly represents a dynamic structure, permanently subject to changes and adaptation, IVD being capable of incurring changes for the entire life time, including growth changes; the growth, however, is not lineal, but a succession of thickening and getting thinner, in full concordance with the structural stresses and changes occurring inside.

RESUMEN: El estudio representa una evaluación morfométrica del segmento anterior de la columna lumbar, centrado en el conjunto del cuerpo vertebral - disco intervertebral, calculando algunos indicadores específicos y completando los datos morfométricos directos. El objetivo del trabajo fue mapear un modelo de imagen anatómica con los datos de la interpretación de la imagen, posteriormente correlacionando los datos. El estudio se llevó a cabo con artículos anatómicos de archivos personales y de las imágenes obtenidas de tomografía computarizada (TC) y resonancia magnética (RM) de evaluación. La evaluación morfométrica se realizó en los discos intervertebrales, la altura del disco en las secciones anterior y posterior y se correlacionó con el grado del ángulo del disco. Se compararon los datos morfométricos directos y se correlacionaron con los datos resultantes de la interpretación de la imagen. Se realizó una evaluación morfométrica directa de 11 bloques vertebrales; Los bloques vertebrales se seccionaron y se convirtieron en 22 semibloques vertebrales permitiendo el fácil acceso a todos los valores dimensionales, incluyendo aquellos cubiertos por el arco posterior. La evaluación de los datos de imagen se realizó en 120 sujetos con CT, CT 3D y MRI. Los tamaños de los discos se evaluaron mediante medidas directas de los elementos anatómicos y se midieron con el software para la examinación de imágenes. En caso de diferencias significativas entre los cuerpos vertebrales, el cálculo de los tamaños de los discos se realizó indirectamente, debido a la interpretación geométrica de los tamaños de la cara del cuerpo vertebral. El conjunto cuerpo vertebral / disco intervertebral (CVDV) representa una estructura dinámica, permanentemente sujeta a transformaciones y adaptación, siendo (CVDV) capaz de incurrir en cambios durante toda la vida, incluyendo aquellos relacionados con crecimiento. El crecimiento, sin embargo, no es lineal, sino una sucesión de engrosamiento y adelgazamiento, en plena concordancia con las tensiones estructurales y los cambios que se producen en su interior.

Anatomo-surgical correlations in larynx cancer.

OBJECTIVE: Cancer remains a crucial problem of contemporary medicine and the principle is perfectly true regarding the laryngeal cancer. Laryngologists are constantly searching for laryngeal cancer to provide functional and oncological surgical techniques. Conservative surgery in laryngeal cancer tries to keep enough laryngeal lumen and maintain the main laryngeal functions: breath, phonation, swallowing, by using open surgical techniques. METHODS: 412 patients with larynx neoplasms were operated by open surgical techniques between 1.01.2006 and 31.12. 2008 in the ENT Clinic of "Coltea" Clinical Hospital. We selected 21 cases divided into three groups, each with 7 patients, to whom we have changed the type of surgery based on anatomical data. Careful preoperative selection is of outmost importance for the clinical outcome of the patients. Postoperative follow up was between 3 and 5 years. RESULTS: All the patients are alive, decannulated; they feed orally and are fully socially integrated. CONCLUSIONS: In the light of anatomical structures analysis, indications of partial laryngeal surgery may be extended from where it is now, to accepting only total laryngectomy.

Locally applied platelet-derived growth factor accelerates fracture healing.

Platelet-derived growth factor (PDGF) is known to stimulate osteoblast or osteoprogenitor cell activity. We investigated the effect of locally applied PDGF from poly-D,L-lactide (PDLLA)-coated implants on fracture healing in a rat model. A closed fracture of the right tibia of four-month-old Sprague-Dawley rats (n = 40) was stabilised with implants coated with a biodegradable PDLLA versus implants coated with PDLLA and PDGF. Radiographs were taken throughout the study, and a marker of DNA activity, bromodeoxyuridine (BrdU), was injected before the rats were killed at three, seven and ten days. The radiographs showed consolidation of the callus in the PDGF-treated group compared with the control group at all three time points. In the PDGF-treated group, immunohistochemical staining of BrdU showed that the distribution of proliferating cells in all cellular events was higher after ten days compared with that at three and seven days. These results indicate that local application of PDGF from biodegradable PDLLA-coated implants significantly accelerates fracture healing in experimental animals. Further development may help fracture healing in the clinical situation.

Etio-pathogenic and morphological correlations in congenital hydronephrosis.

Hydronephrosis, "distension in varying degrees of pelvis and calyces, accompanied by progressive atrophy of renal parenchyma due to obstruction in urinary flow", is an apparently simple reno-urinary disease, but, in reality, by association of its own characters with those conferred by causative lesions, becomes of a significant complexity. The purpose of this paper is to demonstrate the plurivalent character of this entity on a batch of cases with congenital hydronephrosis, by identification of lesional features correlated with cause of disease. The etiology of hydronephrosis in analyzed cases was characterized by heterogeneity: polar inferior artery, horseshoe kidney, extrarenal pelvis, transverse valves of pelviureteral junction (PUJ), adhesion of ureter to PUJ, intrinsic stenosis of PUJ, vesico-ureteral reflux, posterior urethral valves, stenosis of urethral meatus. The way of intervention of urinary obstruction and the uni- or bilateral character of damage were definitory for the macroscopical appearance of the hydronephrotic kidney, renal pelvis demonstrating its role of expansion room for kidney protection. In analyzed cases of congenital hydronephrosis, correlation specific cause-pelvic lesion evidenced histopathological differences related to etiology. Anatomical preparations obtained by injection followed by corrosion have revealed that renal vessels appear elongated, distanced from each other and even reduced in density, which explains the appearance of ischemia accompanying pathogenetic changes of obstructive uropathy. Regardless of etiology, all cases of congenital hydronephrosis were characterized by varying degrees of fibrosis in chorion of renal pelvis, accompanied by active chronic inflammation, observation that support the idea of connection between the two pathological changes.

[Anatomical considerations on the renal arterial segmentation]. / Consideratii anatomice asupra segmentarii arteriale a rinichiului.

We studied the arterial segmentation of the kidney observing the basic mode of finishing of the renal arteries and the distribution of the second order arteries in renal parenchyma. Our study was performed on 194 human kidneys resulted by evisceration and we have also analyzed the renal angiographies. As methods of study we used dissection, injection of plastic material followed by corrosion. In 10.82% of cases we found 3 arterial segments: anterior; posterior; inferior polar (basal). In 39.69% of cases au we found 4 arterial segments: apical (superior polar); middle (meso-ventral); inferior (basal or inferior polar); posterior (retro-pyelic). We found 5 arterial segments in 83 kidneys (42.78%). The 5 arterial segments are as follows: apical (superior polar); superior (meso-ventral superior); middle (meso-ventral inferior); inferior (basal or inferior polar); posterior (retro-pyelic). In 13 cases (6.7%) we found 6 renal arterial segments: superior polar (apical); superior pre-pyelic (meso-renal superior); middle pre-pyelic (middle meso-renal); inferior pre-pyelic (meso-renal inferior); inferior polar (basal); retro-pyelic (posterior).

[The origin and distribution of retro-pyelic artery]. / Originea si distributia intraparenchimatoasa a arterei retropielice.

We used as study methods of retro-pyelic artery: dissection on adult human bodies and on human fetuses, injection of plastic material followed by corrosion and the study of selective and total renal nephroangiography. We've studied the origin, the termination way and vascularization territory of retro-pyelic artery on 208 cases. We found retro-pyelic artery origin to have 3 arterial sources: as terminal branch of renal artery (58.65%); from pre-pyelic artery (40.38%) and as supplementary renal artery from aorta (0.96%). Although, usually retro-pyelic artery trajectory is arcade like, we found this aspect in 38.46% cases. In 19.71% cases the trajectory has an italic "S" or double arcade aspect, in 31.73% cases, retro-pyelic artery is terminated by bifurcation, trifurcation in 9.13% cases and ramification in four branches in only 0.96% cases. Regardless of it's aspect, in most of the cases (31.73%), retro-pyelic artery branches vascularize the posterior half of the kidney, in 28.36% cases, just the posterior middle part of the kidney and in the remaining cases does not vascularize the superior pole (18.75%) or the inferior pole (21.15%).

Double renal arteries originating from the aorta.

From a study of renal vascularization, we present 54 cases of double renal arteries supplying one kidney and originating from the aorta. Of the 54 cases, 42 were unilateral, showing a left predominance (25 cases), three of them with triple renal arteries on the opposite side. In six cases we encountered bilateral double renal arteries. Most often, the supplementary renal artery originated from the lateral side of the aorta (58%). Examination of the renal approach showed that in 28 cases the supplementary renal artery entered the kidney through the hilum (proper supplementary renal artery), in 16 cases it was inferior polar, in five cases it was superior polar and in five cases the supplementary renal artery terminated in two branches, equal in caliber, one polar and the other hilar, thus showing a combined character, identical with the manner of termination of the main renal artery. In most of the samples the supplementary renal artery ended with a bifurcation inside the kidney, either into the renal sinus (proper supplementary renal artery) or inside the renal parenchyma (polar supplementary renal artery). The course of the double renal arteries showed multiple variations: retroureteral passage of the supplementary renal artery (6 cases), right supplementary renal artery passing anterior to the inferior vena cava (5 cases), crossed course of the double renal arteries (5 cases). Double renal arteries may coexist with other uro-vascular variations, such as: double renal veins on the same side (4 cases) or on the opposite side (3 cases), double ureter on the same side (2 cases) or on the opposite side (1 case), persistence of the fetal renal lobulation on the adult kidney (3 cases) and genital artery originating from the supplementary renal artery (3 cases).

Morphological aspects of the inferior suprarenal artery.

The study was performed on 120 cases, and evaluated the origin, caliber at the origin, course, place of termination and distribution of the inferior suprarenal arteries, together with their point of entry into the glandular parenchyma. Most often, the inferior suprarenal artery originated from the trunk of the renal artery, prior to its terminal division. Other possible origins were: as a terminal branch of the renal artery, from one of the terminal branches of the renal artery (most often from the anterior division and rarely from the posterior one), as a common trunk with the superior polar renal artery, from a supplementary renal artery (more often from the superior and rarely from the inferior one), directly from the aorta, either as an individual branch, as a common trunk with the superior polar renal artery or as a common trunk with the middle suprarenal artery. Rarely the inferior suprarenal artery may originate from the genital artery or, also very rarely, from the celiac trunk, either individually or as a common trunk with the middle suprarenal artery. Usually, the inferior suprarenal arteries originating from the aorta or the renal artery have a larger caliber than those from other arterial sources. Most often, we found two or three arterial branches as inferior suprarenal arteries, so we may speak of inferior suprarenal arteries or an inferior suprarenal arterial pedicle.

"Horseshoe kidney" in an ectopic position. A case report.

We present a case study of a horseshoe kidney, harvested from a 68-year-old patient who died suddenly from rupture of an aneurysm of the ascending aorta. The kidney was ectopically placed, its isthmus corresponding to the terminal aorta. The two kidneys were unequal in size, the right kidney being larger than the left. We discovered four renal arteries, two on the right and two on the left side, and four renal veins, one left, one middle and two on the right side. The isthmus was blood supplied by the left and the right inferior renal arteries while the venous blood was collected by the left and middle renal veins.

[Anatomical study of triple renal arteries]. / Etude anatomique des artères rénales triples.

Within an 8 year study of the renal blood supply, the authors assessed 14 cases of triple renal arteries, 2 of them bilaterally (both on human fetuses), so a total of 16 triple renal arteries. Among the 14 cases of unilateral triple renal arteries, 8 were placed on the left side. In what concerns the caliber, the renal artery that enters the kidney through the hilum is usually greater than the others; in only three fetal samples the triple renal arteries were almost equal in caliber. Concerning the arterial traject, in 5 of the cases, two of the three renal arteries crossed one another; this aspect was assessed in first two arteries (2 cases) and last two arteries (3 cases). In 3 cases, the triple renal arteries were accompanied by double renal arteries on the opposite side. The almost parallel traject of the triple renal arteries was assessed in only 3 cases.

[Variations of the celiac trunk branches in the fetus]. / Variantes de ramification du tronc coeliaque chez le foetus.

The study was performed on 60 human foetuses, aged between 4 to 9 months, using as methods dissection and plastic and contrast substances injection. We studied the celiac trunk in what concerns the division into its terminal branches, insisting on the possible morphological variations, some rare collateral branches starting from the common arterial trunk, the dimensional relations between the branches at their origin and the level of the celiac trunk origin from the aorta, in relation with the vertebral column, the diaphragmatic passage of the aorta and with the superior mesenteric artery. We also assessed the dimensional relations (calibers at origin) between the branches of the celiac trunk. Ass possible variations of the division of the celiac trunk, we assessed: gastro-hepatic trunk, with the splenic artery directly from the aorta or from the hepatic artery; gastro-splenic trunk, with the hepatic artery originating from the aorta; hepato-splenic trunk, with origin of the left gastric artery either directly from the aorta or from the hepatic artery. Rare variations: celiaco-mesenteric trunk; two arterial trunks, hepato-splenic and hepato-gastric; separate aortic origin for all three "classic" branches of the celiac trunk; two hepatic arteries, one from the celiac trunk and the other from the aorta or superior mesenteric artery; celiac trunk that divides into several terminal branches; one or two suprarenal arteries originating from the celiac trunk.