Harmonic Scalpel and Electrothermal Bipolar Vessel Sealing System in Head and Neck Surgery: A Prospective Study on Tissue Heating and Histological Damage on Nerves.

OBJECTIVES: Define and compare the thermal nerve injury caused by 3 different vessel sealing and dissection devices: the harmonic scalpel (HS), the electrothermal bipolar vessel sealing system (EBVS), and the bipolar electrosurgery unit (BE). METHODS: First we recorded the heating variations in pig tissue caused by a BE unit, HS, and EBVS after an activation for 5, 10, and 15 seconds at minimum and at maximum power. In the second part, we evaluated the histological damage caused by HS and EBVS on 20 in vivo human nerves, 10 per device. The 2 scalpels were placed and activated at 3 different distances from the nerve (1, 3, and 5 mm). The extension and the degree of the nerve lesion was then calculated. RESULTS: The instrument determining the highest rise in temperature was the BE unit, followed by HS and then EBVS. Comparison between the extension and degree of nerve injury caused by the 2 scalpels showed no statistically significant differences. Based on these evaluations, we established a relative safety limit at 3 mm and an absolute safety limit at 5 mm for both scalpels. CONCLUSIONS: Our data suggest EBVS and HS can be considered valid and safe devices for ENT surgery.

Russell body gastritis: expanding the spectrum of Helicobacter pylori - related diseases?

We report a new case of Helicobacter pylori gastritis showing plasma cell infiltrates with extensive formation of Russell bodies (Mott cells) within the lamina propria of the antral mucosa. The patient was a 60-year-old woman with a history of epigastric pain. Endoscopy revealed non-specific congestion of the mucosa. Microscopically, the intracytoplasmic inclusions were homogeneous, mainly round to oval, and pushed the nucleus toward the periphery. They were intensely PAS-positive and reacted to antibodies against polytypic light chains, CD79a, and anti-plasma cell antibody. Because of the accumulation of intracytoplasmic inclusions, Russell body gastritis is a potential source of diagnostic difficulties in endoscopic biopsy specimens that can be confused with immunocytic neoplasms, such as lymphoplasmacytic lymphoma or plasmocytoma, or signet-ring cell carcinoma. In the light of similar cases published previously, it seems as if the association between Russell body gastritis and Helicobacter pylori infection is not merely coincidental.

Increased myocardial apoptosis in patients with unfavorable left ventricular remodeling and early symptomatic post-infarction heart failure.

OBJECTIVES: The purpose of this study was to evaluate a potential correlation between apoptotic rate (AR), post-infarction left ventricular (LV) remodeling, and clinical characteristics in subjects who died late (>or=10 days) after an acute myocardial infarction (AMI) with evidence of persistent occlusion of the infarct-related artery at autopsy. BACKGROUND: Apoptosis contributes to myocardiocyte loss in cardiac disease and may have a pathophysiologic role in post-infarction LV remodeling. METHODS: The AR was calculated at the site of infarction and in remote unaffected LV regions, using co-localization of in situ end labeling for deoxyribonucleic acid fragmentation and immunohistochemistry for caspase-3, in 14 subjects who died within two months after AMI. Correlation between AR and clinical characteristics such as age, site of AMI, transmural extension, multivessel coronary disease, and signs and/or symptoms of heart failure (HF), at the time of initial hospitalization for AMI or subsequently before death, was assessed using non-parametric statistical tests. Parameters of LV remodeling including diameters, free wall thickness, diameter-to-wall-thickness ratio, and mass were measured at gross examination at autopsy. Values are expressed as median (interquartile range). RESULTS: Among clinical variables, early symptomatic post-infarction HF (9 cases, 64%) was associated with nearly fourfold increased AR at the site of infarction (26.2% [24.5% to 28.8%] vs. 6.4% [1.9% to 13.3%], p = 0.001). Moreover, AR both at the site of infarction and in unaffected regions was significantly correlated with parameters of progressive LV remodeling (p < 0.05). CONCLUSIONS: Our data show that in patients dying >or=10 days after AMI, myocardial apoptosis is strongly associated with and may be a major determinant of unfavorable LV remodeling and early symptomatic post-infarction HF.

Extensive metastatic leptomeningeal melanomatosis as the first clinical sign of a cutaneous melanoma: morphological correlations between magnetic resonance imaging and autopsy findings. A case report.

In recent years, the diagnosis and management of leptomeningeal carcinomatosis have gained increased attention as patients with neoplasms live longer and the condition becomes more common. Conclusive hallmarks of this disease have yet to be identified. We report and discuss a case of massive invasion of the cerebral leptomeninges by neoplastic cells from a malignant melanoma in a shoulder. Symptoms of cerebral dysfunction were the first indication of neoplasm. The onset of symptoms, magnetic resonance imaging, and patient death all occurred within a brief time span. To our knowledge, this is the first case of meningeal melanomatosis in a patient not treated with chemotherapeutic drugs in which the radiologic evidence is virtually synchronous with direct anatomic observation. Thus the images provided with this report may be of use in the radiographic diagnosis of cerebrospinal metastatic colonization.

Chance diagnosis of low stage non-metastasized adrenal cortical carcinoma in a young woman with retroperitoneal hemorrhage.

Adrenal cortical carcinoma (ACC), a rare and highly malignant neoplasm of the cortical tract of the adrenal gland, is usually diagnosed at an advanced stage of development and often when metastatic spread already has begun. We report a very rare case of low-stage, non-metastasized ACC, the first clinical appearance of which was a large retroperitoneal hemorrhage caused by the rupture of the neoplastic mass. To the best of our knowledge, this is the third reported case of ACC rupture.

Cutaneous pseudolymphoma following tattoo application: report of two new cases of a potential lymphoma mimicker.

The authors report 2 cases of cutaneous pseudolymphoma that occurred in 2 young adult patients who referred for relentlessly growing nodules that appeared within 4 to 5 months after the application of a mercury-based tattoo. Systemic symptoms were not present and there was no evidence of lymph node enlargement. Clinically, both lesions were limited to the red, mercury-based areas of the tattoo. Microscopic examination featured a dense cellular infiltrate composed of polytypic T cells in the upper to mid-dermis, coupled with focal interface tissue reaction. Scattered macrophages contained finely granular particles in their cytoplasm. In addition, extracellular pigment particles were also recognized. Collections of epithelioid macrophages were present in both cases and were reminiscent of epithelioid granulomas. This study confirms evidence that, among skin diseases featuring a dense lymphoid infiltrate, cutaneous pseudolymphoma secondary to tattooing is a rare but not exceptional source of diagnostic challenges.

Intravesical botryoid adenocarcinoma of the prostate: report of an unusual growth pattern of prostatic carcinoma simulating a urinary bladder tumor.

We report on 3 cases of prostatic carcinoma presenting with a predominant intravesical mass as to simulate clinically and macroscopically a primary tumor of the urinary bladder. The patients were 65, 66, and 68 years old and presented with dysuria and micturition. All patients had a medical history of a prostatic adenocarcinoma diagnosed between 5 and 7 years earlier and treated conservatively. Because of instrumental evidence of a large urinary bladder mass, 2 patients underwent radical cystoprostatectomy based on suspicions for a primary urothelial tumor. Either cystoscopic or direct specimen inspection revealed a lobulated, yellow-tan, and polypoid lesion with a broad implant in the trigonal bladder area in 1 case and a mixed, polypoid, and diffuse linitis plastica-like infiltration of the bladder wall in the other 2 cases. Microscopically, sections of tumor mass as well as from the prostate featured a poorly differentiated adenocarcinoma compatible with the prostatic origin. Tumor cells were positive for prostate-specific antigen and prostatic acid phosphatase. Our cases suggest that an extensive polypoid growth pattern may be added to those patterns customarily observed in presenting prostatic carcinomas, raising treatment and diagnostic challenges.