The vascular stem cell niches and their significance in the brain.

AIM: This cytohistopathological study was performed for a better knowledge of phenotypes derived from pluripotent stem cells, as well as for precise location of stem cells within the vascular niche in the brain. METHODS: We used light and transmission electron microscopy to demonstrate the presence of stem cells in the vascular wall of microvessels in the cerebral and cerebellar cortex, pia mater (considered by us a cordocytic-vascular tissue), adventitia of larger cortical arteries and veins, and around vessels. We investigated multiple vascular segments and brain tissue in a variety of clinical cases, such as cerebral tumors, cerebrovascular malformations, thromboses in the carotid system, and direct laceration. RESULTS: Our morphological and ultrastructural observations pointed out many changing phenotypes, as well as cell interrelationships within the vascular niche, both for repair processes when cordocytes cooperate with mesenchymal stem cells, and pathological processes such as atherogenesis, tumorigenesis, and neurotrauma. Our results underlie the important roles of cordocytes in their interrelations with precursor/stem cells in the arterial adventitia. CONCLUSION: The cells derived from pluripotent stem cells along different lineages have had different phenotypes as they derived from hematopoietic stem cells or mesenchymal stem cells, with or without epigenetic disregulations or depending on different microenvironments. Cell interactions, phenotypes, and underlying mechanisms, as well as biological responses to different small molecules or compounds, remain to be determined by future molecular insights within the vascular niche.

Idiopathic granulomatous mastitis: a rare entity with a variable presentation.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a rare, chronic benign breast disease which may mimic a breast abscess or malignancy. It is a diagnosis of exclusion, and requires a high index of suspicion. Most patients present in the third or fourth decade of life. CASE SERIES: We present a case series of IGM with varied presentation, as a non-resolving abscess and as a lump, clinically appearing to be malignant. Patients required repeated drainage and/or lumpectomy. CONCLUSION: Although IGM is considered to be autoimmune in aetiology, however other infectious aetiologies causing granulomatous mastitis and malignancy have to be ruled out by histopathology. In the event of relapse immunosuppression may be required.

[Bicycle accidents treated in emergency departments. A multicentre study]. / Accidentes de bicicleta atendidos en los Servicios de Urgencias. Estudio multicéntrico.

OBJECTIVES: To describe epidemiological characteristics, types of injury, prognosis and medical management of bicycle-related Paediatric Emergency Department (ED) visits and to identify potential preventive measures. PATIENTS AND METHODS: This multicentred, observational prospective study included all children between 3 and 16 years of age treated for bicycle-related injuries in the Emergency Departments of 15 Spanish Hospitals belonging to the «Unintentional Paediatric Injury Workshop¼ of the Spanish Paediatric Emergency Society between the 1(st) of June 2011 and the 31(st) of May 2012. Characteristics of all ED visits, as well as epidemiological data and accident-related information, were collected. RESULTS: A total of 846 patients were included in the study, with a male predominance (72.9%) and a median age of 9.6 ± 3.6 years. Head injury was the third most common injury (22.3%) and the main cause of admission to the Pediatric Intensive Care Unit (PICU) (68.4%). More than three-quarters (77.9%) of the patients did not wear a helmet, which was significantly associated to a higher incidence of head injury and admission to PICU. Older children (OR 1.063) and bicycle injuries involving motor vehicles (OR 2.431) were identified as independent risk factors for worse outcomes. CONCLUSIONS: Since helmet use reduces up to 88% of central nervous system lesions secondary to head injury, promotion of its use should be the main preventive measure, followed by restriction of bike-riding to cycling areas.

Apoptosis, paraptosis, necrosis, and cell regeneration in posttraumatic cerebral arteries.

This study is to understand the nature and functional significance of the activated cell death programs and rehabilitation signs during late vascular changes after brain injury. We used light and transmission electron microscopy to describe changes of cells within the vascular endothelium and tunica media of the cortical arteries four weeks after craniocerebral traumatism. Within tunica media of the posttraumatic damaged artery, apoptotic and paraptotic phenotypes were identified as well as some early ultrastructural signs of smooth muscle cells regeneration, these cell highlighting a remarkable degree of plasticity. Surprisingly, some endothelial cells showed an extensive rough endoplasmic reticulum development, whereas other endothelial cells showed typical necrosis. In conclusion, two groups of suicidal cells apoptotic and paraptotic cells were encountered in the same lesional vascular wall after neurotrauma, showing also signs of cell regeneration. The pathophysiologic significance of the coexisting double cell death programs and cell regeneration seems to be in relation with late cell survival, after arterial damage when some cells disappear and other cells try to survive undergoing reversible injury.

Evaluating the definition of "stone free status" in contemporary urologic literature.

OBJECTIVE: There is no standardized definition of stone free after renal stone surgery. The lack of standardization prompted a review of the current urologic literature, to assess the definitions of stone free status, and how imaging is used to determine stone free status. METHODS: A literature search on PubMed for the MeSH terms for percutaneous nephrolithotomy (PCNL), ureteroscopy with lithotripsy, shock wave lithotripsy (SWL), and laser lithotripsy, published in English between January 2007 and January 2010 was performed. Case reports, articles not evaluating stone free outcomes, and review articles were excluded. Articles were evaluated for the treatment modality, definition of stone free status, and the imaging modality employed to determine stone free status. RESULTS: This search yielded 417 articles of which 249 met inclusion criteria. Stone free was defined in 169 articles (68%). The most common definition of stone free was "no stones" (47%), but a total of seven different definitions were encountered. The most common treatment modality was PCNL (47%), followed by SWL (33%), and URS (13%). The most common detection modality was KUB alone (28%), the second most common being KUB and US combined (22%). CONCLUSIONS: Nearly one-third of articles evaluating surgical management of urinary calculi do not define stone free status; when stone free is defined, there is wide variation as to that definition. Furthermore, vast differences exist in the type of imaging used to define stone free status. The urologic community should standardize the reporting of stone free outcomes in the urologic literature.

The thread-protective cell, a new cell performing multiple tasks.

Our research work, which has led us to discovering the new cerebral cell, has started 30 years ago. An important moment was the year 1986, when we have highlighted it for the first time, during a study upon the clarification of some undiscovered aspects of cerebral atherosclerosis. In 2006 we have initiated the publishing of our results at three congresses (Cape Town - 2006; San Diego - 2009 and Los Angeles - 2011) as well as in three Atlases, form 2006, 2008 and 2010. By means of the electronic microscope we have analyzed to this purpose alone, a number of neurosurgery patients, with 1176 cerebral, vascular, tumoral, cortical, choroid plexus tumor and infectious biopsies. The cell in question was named cordocit-protectocit (thread-protective cell) in order to highlight its morphological aspect of a belt band and its functional one, of protective element of the noble substance of the brain, acting for its defense against various aggressions, especially hemorrhagic. On this occasion we have discovered that the pia mater is made up of such protective cells, which also play a role in preventing the neuroblasts from migrating. When the chemotactants of our cells are not numerous enough, subcortical cell heterotopias will occur, at the level of the corona radiata, double cortex and other neuronal migration disorders which may generate epilepsy. Therefore, the pia mater should be considered from a cytodynamic perspective. The telocyte at the internal organs level (intestine, heart etc.) is nothing else but the interstitial cell of Cajal (ICC), described by Cajal more than 100 years ago. The ICC spontaneously initiate rhythmic electrical activity, much like the peacemaker cells of the heart.

Monitoring the serological proteome: the latest modality in prostate cancer detection.

PURPOSE: Various strategies have recently emerged to improve the diagnostic prediction of prostate cancer (CaP). One such strategy includes the mass profiling of serum protein fractions selectively adsorbed onto chemically modified probes. In the current study we further validated this approach, while offering a more versatile, less expensive and yet equally predictive alternative to existing technologies. MATERIALS AND METHODS: A solid core lipophilic C-18 resin was used to extract and enrich the low molecular weight protein fraction from patient serum for further analysis by mass spectrometry. Mass spectra generated from a 48 patient training set were data mined using multivariate analysis to identify diagnostically significant protein peaks. These peaks were then used to test a blinded study set comprising 168 patients with common statistical algorithms and commercially available software packages. RESULTS: A total of 36 peaks generated from the training set were used to test the combined set of 168 serum samples obtained from 98 healthy individuals and 70 patients with CaP. We report a sensitivity of 94.1% and a specificity of 99.0% with 1 false-positive, 4 false-negative and 5 nondiagnosed cases. CONCLUSIONS: Our results further indicate that mass profiling of serological proteins provides a means for the accurate detection of CaP. In addition, our approach was found to be superior to chip based protocols, generating rich, sharp, highly reproducible spectra attainable in a high throughput manner and at minimal cost. This technique is also scaleable for subsequent protein characterization using multidimensional protein identification technologies. Finally, analyses of mass spectra with commercially available statistical applications was found to be highly effective in generating highly discriminatory m/z values for CaP diagnosis.

Parallelisation and application of a multi-layer atmospheric transport model to quantify dispersion and deposition of ammonia over the British Isles.

An atmospheric transport model, FRAME (Fine Resolution AMmonia Exchange), has been used to model the spatial pattern of ammonia concentrations and deposition over the British Isles for the first time. The model uses a multi-layer approach with diffusion through 33 layers to describe vertical concentration profiles in the atmosphere explicitly. Together with the necessary description of atmospheric reactions with sulphur and oxidised nitrogen, this imposes a major computational requirement, with the model having a run-time of 8.5 days on a mid-range workstation. Improvement in the model run-time was sought by developing a parallel implementation coded in a data-parallel approach using High Performance Fortran. Running the code on a Cray T3E with 128 processors provided a speedup by a factor of 69. The code's portability, its validation with measurements and new maps of its application to the British Isles, are presented. Good agreement is found with measured NH3 concentrations, while wet de-position is underestimated. In addition to model uncertainties, this may be due to an underestimation of the NH3 emissions input data.

Priapism from quetiapine overdose: first report and proposal of mechanism.

We report a case of priapism occurring after an overdose of the newly approved atypical antipsychotic quetiapine. A review of its previously published receptor-binding studies suggests that alpha-adrenergic blockade may be the responsible mechanism. To our knowledge, this is the first report of priapism associated with quetiapine, and we recommend the inclusion of priapism in its list of potential adverse effects in cases of overdose.

Adenocarcinoma of the urachus associated with elevated levels of CA 125.

Adenocarcinoma of the urachus is a rare genitourinary tumor with a poor prognosis. The treatment of choice is en bloc surgical resection, although combination therapy with surgery and chemotherapy has been used with mixed results. We describe a 69-year-old woman with adenocarcinoma of the urachus and elevated serum levels of CA 125 tumor marker. She was treated with resection plus 5-fluorouracil, doxorubicin and mitomycin, alternating with platinum-based chemotherapy. The serum CA 125 level decreased precipitously after the operation and became normal after 2 months of chemotherapy. The patient remained free of disease 1 year postoperatively. Serum CA 125 may be a useful tumor marker for urachal carcinoma and adjuvant chemotherapy may be effective in treating the disease.

Plasmacytoma of the urethra treated with transurethral resection and radiotherapy.

Plasmacytoma, which is a localized malignant plasma cell tumor, occurs rarely and is found mostly in the upper airways of older patients. Two urethral plasmacytomas have been reported, 1 of which was a primary lesion. We describe a primary plasmacytoma of the urethra in a 23-year-old woman who had been exposed to diethylstilbestrol in utero. The patient underwent transurethral resection of the tumor and radiation therapy and has been free of disease for more than 10 years.

Infertility in an XX male.

A case of an infertile male subject with 46XX female karyotype is reported. A testicular biopsy revealed hyalinized tubules with Sertoli cells and marked interstitial cell hyperplasia. Chromosomal studies showed the presence of 46 chromosomes with an XX sex chromosome constitution, confirmed with trypsin banding. XX male subjects present an interesting diagnostic problem and need to be differentiated from XXY male subjects with Klinefelter's syndrome. The clinical features of this rare syndrome are discussed and the literature is reviewed.

Idiopathic pelviureteric varices.

Pelviureteric varices are well-documented sequelae of renal vein thrombosis, but there have been only 10 prior reports of idiopathic renal vein varicosities. Herein we report 3 more cases and review the literature. Two thirds of the patients presented with hematuria; one-fourth had flank pain, and one-third had saphenous vein varicosities. Pyelographic findings include scalloped deformities of the upper ureter and pelvis with displacement and intraluminal filling defects. The diagnosis may be suspected from the excretory urogram, but venography is definitive. Excision and ligation of the varicose veins were curative in all but 3 patients who required nephrectomy for life-threatening hemorrhage.

Radiolucent defects within renal pelvis.

Radiolucent filling defects within the renal pelvis are common findings in diagnositc urography, and because of their myriad causes the diagnostician is often faced with a challenging problem. Several of the more unusual causes of renal pelvis filling defects are described and their diagnosis, pathophysiology, and therapy discussed.

Paraurethral cysts in female neonate.

Paraurethral cysts in the female neonate are uncommon lesions. All reported cases have either ruptured spontaneously or responded to simple marsupialization. However, complete urologic evaluation is mandatory because they simulate ectopic ureteroceles in appearance. Herein is reported our experience with 5 patients. The etiology, embryogenesis, natural history, differential diagnosis, and treatment are discussed.

Arteriovenous aneurysm of kidney after open renal biopsy.

Renal arteriovenous fistula following percutaneous renal biopsy is being reported frequently in the literature. For this reason, open renal biopsy has gained popularity as a safer alternative procedure. We present a case of a large arteriovenous fistula seen two years after open renal biopsy. The presentation was highly atypical, mimicking an acute gastrointestinal event, rather than sudden hemorrhage in a previously asymptomatic fistula.

Chemolysis of residual stone fragments after extensive surgery for staghorn calculi.

Chemical dissolution of residual stone fragments was attempted in twelve instances via nephrostomy tube irrigation. Appropriate solutions containing either hemiacidrin or sodium bicarbonate were used for struvite and uric acid stones, respectively. Precautions were taken to prevent and recognize outflow obstruction and urinary infection. Seventy-five per cent of the stones so treated were completely dissolved, and there were no major complications. The incidence of retained stones, natural history, and indications for chemical dissolution are reviewed.