Autolysis: a plausible finding suggestive of long ESD procedure time.

Autolysis is the enzymatic digestion of cells by the action of its own enzymes, and it mostly occurs in dying or dead cells. It has previously been suggested that prolonged procedure time could lead to autolytic changes from the periphery of the endoscopic submucosal dissection specimens. Recently, the authors have experienced a case of autolysis; due to the presence of ulcer, fibrosis, and frequent bleeding from the cut surface, it took 6 hours to complete the resection. More than halfway through the resection; bluish purple discoloration of the part of the dissected flap where the dissection was initiated was noticed. Histologic examination of this site showed diffuse distortion of epithelial lining and cellular architectures along with loss of cell components, compatible with autolysis. Because autolysis could theoretically pose a potential problem regarding the evaluation of resection margin, endoscopists and pathologists should communicate with each other for a reliable pathologic decision.

Asociación de meningitis tuberculosa y meningitis criptocócica en un paciente infectado por el VIH / Meningitis simultaneously due to Cryptococcus neoformans and Mycobacterium tuberculosis inapatient with HIV infection

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Autolisis: cuerpo extraño intracraneal / Autolysis: intracranial foreign body

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[Chronic hepatic cytolysis syndrome in southern Africa]. / Le syndrome de cytolyse hépatique chronique en Afrique Noire.

Accidental discovery of a moderate and durable increase of transaminases in an asymptomatic patient is a more frequent possibility thanks to the development of methodological case findings activities. Most of the time, it is an isolated anomaly of which import and consequences have been already reviewed and published. Steatosis and chronic hepatitis are, by far, the most frequent etiologies in Western Countries. But the right importance of that syndrome in tropical hepatology has not been yet described. If we want to transpose results and what has to be done namely liver biopsy, to African medical practice, we have to take into due consideration local pathology, diagnosis facilities and/or therapeutic possibilities. The present article reviews the present knowledge on chronic liver cytolysis syndrome and discusses its interest in tropical Medicine.

[The morphogenesis of pancreonecrosis]. / Morfogenez pankreonekroza.

Pancreas was studied histologically, histochemically and electron microscopically in 117 autopsy cases and in the experiment (25 dogs and 60 white rats). Morphogenesis of pancreonecrosis proceeds through certain stages. The initial stages of an acute pancreatic edema is characterized by degenerative and necrotic changes of pancreocytes with parapedesis of pancreatic enzymes into the interstitium and a reactive stromal edema. The following stages are distinguished in the progressing phase of pancreonecrosis: hemorrhagic pancreonecrosis when the proteolytic enzymes provoke a colliquation necrosis of the acinar tissue, fibrinoid necrosis of vascular walls and disturbances of the intravascular hemorheology resulting in the enhancement of destructive processes and hemorrhagic inhibition of tissues; fat pancreonecrosis in which lipolytic enzymes lead to the coagulation necrosis of the acinar and fat tissue while a non-completed proteolysis of necrotic tissues stipulates the intensity of the reactive inflammation.

Autodigestion of the glans penis and urethra by activated transplant pancreatic exocrine enzymes.

A case of synchronous kidney and pancreas transplantation in which a whole pancreas graft had been drained to the urinary bladder is discussed. On the 137th postoperative day, the patient presented with symptomatic balanitis and urethritis. Documented enzymatic activation of the trypsinogen/chymotrypsinogen, which is not present in symptom-free control patients, was thus thought to be responsible for these symptoms. Conversion to enteric drainage by means of a Roux-en-Y loop resulted in resolution of both symptoms and urinary enzymatic activation. Recurrent urinary tract infections were thought to be the most likely mechanism responsible for these findings.

Autolysis of the granular layer of the cerebellar cortex in brain death.

In a study of duration of brain death, granular layer autolysis (GLA) of the cerebellar cortex was analyzed in 45 patients who died of acute cerebrovascular diseases (CVDs). Twelve patients who died of causes other than intracranial disease served as controls. Tonsillar herniation occurred in all who died of acute CVDs. More advanced GLA was seen in the central folia adjacent to the central white medullary body of the cerebellum as compared with the peripheral folia. Widespread GLA involving the most of the peripheral folia was found solely in patients in whom brain death had been present over 18 h. Of the 12 control patients, 4 showed GLA only in the central folia. Although GLA of the central folia might develop during immersion fixation of the brain, the alteration of the peripheral folia is assumed to develop in the period of brain death. Widespread GLA extending to the peripheral folia could be a pathological finding characteristic of brain death, where intracranial blood flow could be absent or significantly reduced. Brain death for little less than 1 day would be necessary for GLA to develop.