Perigraft seroma following axillofemoral bypass: Report of three cases

One hundred and twenty-three axillofemoral or bifemoral bypasses were performed in the Department of Cardiovascular and Thoracic Surgery of the Catholic University of Louvain, Belgium between 1975 and 1986. Three cases of perigraft seroma were noted. A polytetrafluoroethylene (PTFE) graft had been inserted in all three cases. In one case, the seroma recurred rapidly after surgical drainage. The two others were not drained. In all three cases appearance remained unchanged throughout the observation period. The three bypasses are patent at 5, 14 and 24 months. Observation is advocated for this complication especially in high risk patients.     

Adrenal myelolipoma: clinical, radiologic, and histologic features

The adrenal myelolipoma is a benign, endocrinologically inactive tumor whose histologic structure consists of mature adipose tissue with foci of hematopoietic cells. A case is presented of a seventy-one-year-old woman in whom the diagnosis was established preoperatively by means of sonography, computerized tomography, and magnetic resonance tomography. In a review of the literature, the radiologic profile is discussed, and based on the analysis of 59 surgically treated cases a therapy recommendation is given.     

Perigraft reaction: Incompatibility of synthetic vascular grafts? new aspects on clinical manifestation,pathogenesis, and therapy

Perigraft reaction can be defined as an aseptic biological incompatibility of synthetic vascular prostheses. The clinical picture is characterized by an indolent fluctuating swelling around the prosthesis, consisting of sterile fluid surrounded by a fibrous capsule. Since 1979, a total of 22 perigraft reactions in 2,554 implanted vascular grafts were observed and analyzed. The incidence of this complication is about 8/1,000 both for Dacron ® double-velour and expanded polytetrafluoroethylene (PTFE). Including 306 reports from the literature, prostheses in the extraanatomical position comprise nearly 75% of the material analyzed. The time interval between graft implantation and clinical manifestation is, on average, 25 months. Although the etiology is still unclear, the pathogenesis is supposed to be multifactorial: (a) there is mechanical trauma due to continuous shifting of the prosthesis in the surrounding tissue (especially in the case of extraanatomic grafts), (b) there is physicochemical irritation of the tissue bed by the graft material (velour surface, organic solvents), and (c) poor incorporation of the graft may lead to periprosthetic gap formation and fluid accumulation around the prosthesis. Infections, or immunologic or allergic causes can be excluded. Therapy includes total or partial replacement of the affected portion of the graft and cyst wall with substitution by a prosthesis of a different synthetic material. Repeated aspiration of the periprosthetic cyst should be avoided because of the high failure rate and danger of secondary infection.

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Resumen La reacción periprotésica puede ser definida como una incompatibilidad biológica aséptica de las prótesis vasculares sintéticas. El cuadro clínico se caracteriza por inflamación fluctuante e indolente alrededor de la prótesis, constituída por líquido estéril rodeado de una cápsula fibrosa. A partir de 1979, hemos observado 22 reacciones periprotésicas en 2,554 injertos vasculares, las cuales han sido estudiadas y analizadas. La incidencia de esta complicacíon es de alrededor de 8/1,000 tanto para el Dacron^® double-velour como para el politetrafluoroetileno expandido. Incluyendo 306 reportes de la literatura, las prótesis en posiciones extraanatómicas comprenden el 75% del material analizado.El intervalo promedio entre la implantación del injerto y la manifestación clínica fue de 25 meses. A pesar de que la etiología aún no está aclarada, su patogénesis parece ser multifactorial: (a) aparece el trauma mecánico debido a un movimiento continuo de la prótesis en los tejidos vecinos (especialmente en el caso de injertos extraanatómicos), (b) aparece la irritación físicoquímica del lecho tisular por el material protésico mismo (superficie de velour, solventes orgánicos), y (c) la pobre incorporacíon del injerto puede dar lugar a la formación de un espacio periprotésico libre con acumulación de líquido a su alrededor.El tratamiento consiste en el reemplazo total o parcial de la porción afectada del injerto y de la pared del quiste periprotésico por una prótesis de diferente material sintético. La aspiration repetida del quiste periprotésico debe ser evitada por su escasa tasa de éxito y por el peligro de infeccíon secundaria.

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Résumé La réaction périprothétique se définit comme une incompabilité biologique aseptique avec la prothèse vasculaire synthétique. Le tableu clinique se caractérise par une tuméfaction indolore et fluctuante autour de la prothèse; il s'agit de la collection d'un liquide stérile entouré d'une capsule fibreuse. Depuis 1979, on a observé et analysé 22 réactions périprothétiques survenues après l'implantation de 2,554 prothèses vasculaires. L'incidence de cette complication est donc d'environ 8/1,000, que la prothèse soit en Dacron^® double-velours ou en polytétrafluoroéthylène expansé. De l'analyse de notre série et de celle de la littérature, il ressort que presque 75% des cas étaient des prothèses placées en position extra-anatomique.Le délai moyen entre l'implantation de la prothèse et les premiers signes cliniques était de 25 mois. Bien que l'étiologie exacte ne soit pas encore établie, la pathogénèse dépend probablement de multiples facteurs: (a) traumatismes dus aux mouvements continus de la prothèse dans les tissus environnants, surtout en cas de pontage extra-anastomotiques, (b) irritation physiochimique du lit tissulaire par le matériau de la prothèse (surface en velours, solvants organiques), et (c) mauvaise incorporation de la prothèse susceptible de provoquer la formation d'une cavité périprothétique et l'accumulation de liquide autour de la prothèse. Les causes infectieuses, immunologiques ou allergiques semblent avoir été éliminées.Le traitement consiste à remplacer complètement ou en partie la prothèse et a la remplacer par une prothèse d'un autre matériel synthétique at à pratiquer l'exérèse de la coque. Il faut proscrire les ponctions répétées en raison des taux élevées d'échecs et d'infections secondaires.

     

Rheumatoid arthritis in beta-thalassemic trait: clinical, serologic and immunogenetic profile

OBJECTIVES: To investigate the clinical, serologic, radiologic and immunogenetic characteristics of rheumatoid arthritis (RA) occurring in patients with beta-thalassemic trait as compared with RA in control patients from the same geographical area. MATERIALS AND METHODS: Twenty-eight patients with beta-thalassemic trait fulfilling the American College of Rheumatology (ACR) criteria for RA were compared with a control group of twenty-eight RA patients matched for age, sex, disease duration and place of birth. Clinical and routine laboratory assessment, including anti-keratin antibodies and anti-citrullinated peptide antibodies, was carried out in the two groups. The patients were also evaluated for HLADRB1 alleles and radiologic damage. RESULTS: No differences were found with regard to clinical indexes of disease activity, laboratory parameters, and joint erosions. The immunogenetic analysis did not show any significant difference, the percentage of patients with alleles encoding for the shared epitope being similar in the two groups (61% vs. 57%). As for the extra-articular features, we found a trend for a lower prevalence of sicca syndrome in the beta-thalassemic group (14% vs. 39%; P = 0.06). Rheumatoid nodules were not found in beta-thalassemic patients while they were present in two RA patients in the control group. CONCLUSIONS: The chronic polyarthritis occurring in beta-thalassemic trait carriers can be regarded as a true RA similar to that found in Mediterranean countries, possibly characterized by a low prevalence of extra-articular features.     

Electrosurgical resurfacing: a clinical,histologic, and electron microscopic evaluation

BACKGROUND: Radiofrequency resurfacing is a new technology for ablative facial resurfacing. OBJECTIVES: To evaluate the efficacy of radiofrequency resurfacing in reduction of perioral and periorbital rhytides, and to assess it's effects on collagen remodeling by electron microscopic evaluation. RESULTS: Fourteen of the fifteen subjects (93%) were 100% re-epithelialized by day 7. All 15 patients (100%) had resolution of post-treatment erythema by 3 months. Clinical investigator assessment evaluation revealed mild to moderate improvement in 100% of patients. Histologic changes were consistent with new upper papillary dermal collagen formation. Post-treatment ultrastuctural changes showed either new Type III or mature Type I collagen formation. CONCLUSIONS: Radiofrequency resurfacing is an effective ablative resurfacing method for mild to moderate improvement of Fitzpatrick Type I-III rhytides. It is a low risk procedure with potentially shorter periods of post-operative re-epithelialization and erythema as compared to standard ablative laser procedures.     

The pathophysiology of Hirschsprung's-associated enterocolitis: importance of histologic correlates

To more clearly define the pathophysiology of Hirschsprung's-associated enterocolitis (HAEC), this study comprehensively evaluates the gastrointestinal tissue of a group of infants with clinical HAEC. A pathologic grading system that demonstrates a progressive sequence of histologic changes specific for HAEC is established. The grading system correlates closely with clinical enterocolitis and may prove to be a useful method for early detection of infants at risk for the development of clinical HAEC. A significant alteration of intestinal mucins with an increase in neutral mucins and a decrease in acidic-sulfomucins was identified in HAEC tissue specimens. Enterocyte-adherent organisms were present in 39% of HAEC tissue specimens. The pathogenesis of HAEC may result from an alteration in intestinal mucins that may allow for the subsequent adherence of enteropathogenic organisms to enterocytes. The enterocyte-adherent organisms have the potential to induce an enterocolitic process and may contribute to both the intestinal and systemic manifestations of HAEC.     

Zirconia as a sliding material: histologic, laboratory, and clinical data

Zirconia ceramics have been introduced in orthopaedic surgery as prosthetic femoral heads to solve the critical issue of femoral head fractures sometimes observed with alumina ceramics. In addition to outstanding mechanical properties, zirconia ceramics have, similar to other surgical grade ceramics, a high biocompatibility and a high resistance to scratching. The radioactivity of zirconia ceramic, which has been the subject of contradictory data, now is well understood and managed with appropriate standards. The long-term stability of zirconia ceramics recently has been studied extensively and precise models allow a good prediction of their long-term behavior. In vitro wear tests against polyethylene and clinical data confirm the low wear rate associated with the use of ceramic femoral heads. The use of zirconia femoral heads in ceramic-on-ceramic total hip prostheses also has been investigated and now is clinically effective.     

Hemodialysis bone disease: correlation between clinical, histologic, and other findings

This paper explores in patients with dialysis osteodystrophy the relationship between clinical features and histological, radiological, and biochemical findings. Eighty-five patients treated by hemodialysis for more than 6 months were studied. The following conclusions were drawn: 1) Bone pain in patients on regular hemodialysis is usually a symptom of developing osteomalacia but not of hyperparathyroidism or osteoporosis. 2) Many patients with histological osteomalacia and radiological features of osteomalacia, such as fractures or Looser zones, have no symptoms. 3)In dialysis patients, biochemical and radiological abnormalities are not a reliable means of predicting the presence of osteomalacia, but a raised serum alkaline phosphatase is a good indicator of the presence of osteitis fibrosa. For early detection of osteomalacia, bone biopsy in necessary. 4)A number of our dialysis patients develop an unusual form of osteomalacia characterized by absent or minimal histological osteitis fibrosa, a normal serum alkaline phosphatase, and a high incidence of myopathy and fractures.     

Pseudoxanthoma elasticum: clinical, histologic, and genetic studies--a report of two sisters

CASE 1: A 24-year-old black woman was referred to our clinic in September 1999 by the department of dermatology. She was referred to confirm the diagnosis of pseudoxanthoma elasticum (PXE). Her medical history was normal. Dermatologic examination revealed confluent papules that gave the skin a "plucked chicken" appearance on the flexural surfaces in the neck, axillae, clavicle, thigh, and periumbilical area (Figure 1). The patient stated that the changes in her skin had begun in the periumbilical region at about 5 years of age and had since been slowly progressive. Physical examination showed brownish black pigmentation on the left side of the face, left eyelid, and left sclera, which was diagnosed as Nevus of Ota (Figure 2). Her visual acuity was 20/10 in both eyes, with no afferent pupillary defect. Intraocular pressure in both eyes was normal. Slit lamp examination showed no abnormalities. Findings from fundus examination revealed angioid streaks that formed an incomplete ring around the optic disc and anteriorly radiated toward the equator of the globe, multiple calcified drusen-like structures, and "peau d'orange" changes. Skin biopsy (skin tissue from the neck) was taken and the diagnosis of PXE was confirmed. Histopathologic findings revealed calcification of the elastic fibers and abnormalities of the collagen (Figure 3). The patient was not known to have sickle cell anemia or sickle cell trait, and her blood pressure levels had never elevated. Other systemic causes of angioid streaks were excluded by findings from extensive laboratory examination. Her relatives were asked to come in for examination but lived far away. One of the patient's sisters lived in Kinshasa, Africa, however, and is presented in case 2. CASE 2: The 27-year-old sister of the previous patient was examined on April 19, 2000. At examination, she was found to have PXE. Her medical history was significant for systemic hypertension since 1998 and genital hemorrhage. She underwent an ablation of a cyst of her left ovary in 1988. Her ocular history was unremarkable. On physical examination, raised (yellow) papillary lesions, typical of pseudoxanthoma, were found on the neck, axillae, clavicle, thigh, and periumbilical regions. External and anterior segment examinations (of her eyes) were unremarkable. She was found to have a best-corrected visual acuity of 20/10 in both eyes. Intraocular pressure was normal. Funduscopy revealed bilateral angioid streaks, crystalline bodies, and "peau d'orange," but to a lesser extent than in her sister. In both cases, after informed consent, peripheral blood cells were taken and sent for extraction of DNA. Analysis was performed but could not demonstrate the known gene defects of PXE.     

Oral hairy leukoplakia: clinical aspects, histologic morphology and differential diagnosis.

Clinical and histologic morphology of oral hairy leukoplakia in 85 HIV-positive patients were studied. Differential diagnosis of oral hairy leukoplakia in comparison with the normal lingual and buccal epithelium from both HIV-positive and HIV-negative patients, and with other tongue conditions was also examined. Oral hairy leukoplakia lesions were located on the lateral borders of the tongue and showed a corrugated/hairy aspect in the majority of cases. Hyperparakeratosis, hyperplasia/acanthosis, and a papillated epithelial surface were common findings. A parakeratin band and ballooning cells were present in 60% and 99% of the cases, respectively. Some of the histologic features of oral hairy leukoplakia were present in the normal lingual epithelium of both HIV-negative and HIV-positive patients as well as in other tongue conditions. Thus, many histologic features of oral hairy leukoplakia appear not to be specific.     

Radiofrequency-assisted laparoscopic partial nephrectomy: clinical and histologic results

PURPOSE: To evaluate a surface conductive radiofrequency (RF) coagulation instrument (Tissuelink FB3.0) in laparoscopic and open partial nephrectomy (PN) in hereditary kidney cancer. The lesion depth and viability in the pathologic specimens from a surgical series and an acute porcine model were characterized under conditions of vascular perfusion and occlusion. MATERIALS AND METHODS: A total of 19 patients underwent 20 laparoscopic and open procedures with the device. Data were acquired on tumor number, size, operative time, blood loss, length of stay, renal function, complications, pathologic diagnosis, and surgical-margin status. Renal lesions were created in pigs with the device, ultrasonic shears, and a standard electrocautery for specified time intervals and operative energy settings. These lesions were analyzed for depth, diameter, and tissue viability. RESULTS: In 20 separate (14 laparoscopic; 6 open) procedures in 19 patients, a total of 112 tumors were removed (range 1-31 tumors per procedure). The median operative time, blood loss, and length of stay were 310 minutes, 250 mL, and 4 days, respectively. There were no positive surgical margins. Median preoperative and postoperative creatinine concentrations were similar (1.0 v 1.0 mg/dL). The average treatment margin depth was 3 mm. In the porcine experiments, the treatment depth in the unclamped vascular model was significantly less in than the clamped model (4.0 +/- 1.7 mm v 7.0 +/- 1.6 mm; P < 0.05). Lesion depth and diameter increased with treatment time. Viability depth correlated well with the depth of the visible thermal lesions (Pearson correlation 0.989). CONCLUSIONS: This RF energy device can provided adequate and uniform hemostatic control without hilar clamping during laparoscopic and open PN for hereditary renal tumors. Gross measures of renal function after surgery appeared clinically unchanged. Coagulation depth is dependent on both tissue perfusion and time in the porcine model.     

Adenomyoepithelioma: clinical, histologic, and immunohistologic evaluation of a series of related lesions

Adenomyoepithelioma, strictly defined, is a proliferation of both epithelial and myoepithelial elements. The broad range of lesions that may fall under this umbrella, however, may be quite diverse. The diagnostic confusion surrounding this entity and its prognostic implications have led to a diagnosis by default as malignant and to overtreatment of some patients. We evaluated available material from a series of 35 women whose slides were seen in consultation and who were diagnosed with adenomyoepithelioma or a closely related lesion. This comprehensive review of the varied histology of adenomyoepithelioma and similar lesions and their immunohistochemical properties will assist general pathologists in evaluating these sometimes difficult lesions. Follow-up and treatment information demonstrates their benignity. Architecture and histologic features should be combined with immunohistochemistry when determining categorization.     

Mucoepidermoid penile carcinoma: clinical, histologic, and immunohistochemical characterization of an uncommon neoplasm

We report a case of a mucoepidermoid penile carcinoma. The specimen was studied by immunohistochemistry and DNA cytometry. Mucoepidermoid and adenosquamous penile carcinoma are exceedingly rare variants of penile cancer, with very little follow-up data available. To evaluate the possible prognostic significance of these differentiation patterns, it is necessary to document more cases of this unusual tumor entity.