Intrauterine diagnosis and pathology of fetal choroid plexus carcinoma – A case study

This is a case report of a 39-year-old pregnant woman whose fetus was found to have a large hydrocephalus on routine prenatal ultrasound at the 29th gestational week. A 56 mm × 73 mm mass was detected in the fetal brain arising from the brainstem and invading the third cerebral ventricle. On the subsequent fetal cranial MRI, T2-weighted image the tumor measured 55 mm × 50 mm × 48 mm and had a non-homogeneous consistency and irregular contours. Elective cesarean section was performed during gestational week 32, delivering a male fetus with a cranial circumference of 46 cm (normal circumference, 30 cm) and a birth weight of 2920 g. The infant expired 4 h following delivery. Autopsy revealed a carcinoma of the choroid plexus. Our case, like others, suggests that MRI is more accurate than prenatal ultrasound in prenatal brain tumor diagnosis. More precise morphological detail is provided by MRI, which improves surgical planning and survival.     

A four trunked brachial plexus and a post fixed brachial plexus: A conjunction or a co‐incidence?: Report of three cases

The anatomical variations of the brachial plexus in humans have clinical significance for surgeons, radiologists, and anatomists. In a study of 60 brachial plexuses, four trunked brachial plexuses were encountered in three limbs (two female and one male), all of them being post fixed and on left side of cadavers. The third trunk in all these limbs gave rise to two anterior divisions (upper and lower) and one posterior division. In two limbs belonging to the female sex, the upper anterior division joined with the anterior division of the second trunk to form the lateral cord while its lower anterior division joined with the anterior division of the fourth trunk to form the medial cord. In the sole male limb, along with the third trunk, the fourth trunk also divided into upper and lower anterior divisions. Upper anterior divisions of the third and fourth trunks joined to form the medial root of the median nerve while lower anterior divisions joined to form the ulnar nerve. No medial cord was formed as such. Further, it is inferred that in postfixed brachial plexus, there is a tendency to failure on part of T1 and T2 to join C8 which continues as the third trunk while T1 and T2 continue as the fourth trunk. Since it was seen in all postfixed brachial plexuses of the present study, it is emphasized to be given a place in the textbooks of anatomy or to conduct a study on a larger database.     

Loss of glia and neurons in the myenteric plexus of the aged Fischer 344 rat

Over the normal lifespan, a subpopulation of myenteric neurons in the small and large intestines dies. This loss is one possible mechanism for the disruptions of gastrointestinal function seen in the elderly. Little, however, is known about how the glia constituting the supportive cells of the myenteric plexus may change with aging and the losses of the enteric neurons. The goal of the present study, therefore, was to determine what, if any, changes occur in the glia associated with myenteric neurons in the aged gut. Two experimental groups, consisting of adult (5–6 months of age, n=8) or aged (26 months of age, n=8) virgin male Fischer 344 rats, fed ad libitum, were examined. The duodenum, jejunum, ileum, colon, and rectum from each rat were prepared as whole mounts, and indirect immunofluorescence was used to visualize the myenteric glia and neurons (antibodies to S-100 and the HuC/D protein, respectively). Separate counts of glia and neurons from the same specimens were determined, and these counts were expressed both as per ganglionic area and as per ganglion to correct for “dilution” effects resulting from age-associated changes in tissue area. Significant reductions in both the numbers of glia as well as neurons occurred in every region of the small and large intestine sampled from aged rats, except for the rectum, where a nonsignificant decrease was observed. Glial loss was proportional to neuronal death, suggesting an interdependency between the two cell types. Thus, an understanding of the nature of the neuron-glia interaction in the enteric nervous system may provide insight into the deterioration of function seen in the aged gut.     

Are routine breast and pelvic examinations necessary for women starting combined oral contraception?

Millions of women worldwide use combined oral contraception (COC). Most of them are in good health and have no contraindications to using any contraceptive method. Although extremely safe for the vast majority of women and even though the absolute risk of complications is very small, COC is associated with an increased relative risk of serious conditions including cardiovascular disease and breast and cervical cancer. In many countries, breast and pelvic examinations are routinely undertaken annually for all women using hormonal contraception. Breast and pelvic examination have low detection rates for abnormality and may yield clinically irrelevant results, causing anxiety and inconvenience to the patient for no obvious gain. There is no good evidence to support routine breast or pelvic examination either for women starting hormonal contraception or for monitoring long-term use.     

What has changed in brachial plexus surgery?

Brachial plexus injuries, in all their severity and complexity, have been extensively studied. Although brachial plexus injuries are associated with serious and often definitive sequelae, many concepts have changed since the 1950s, when this pathological condition began to be treated more aggressively. Looking back over the last 20 years, it can be seen that the entire approach, from diagnosis to treatment, has changed significantly. Some concepts have become better established, while others have been introduced; thus, it can be said that currently, something can always be offered in terms of functional recovery, regardless of the degree of injury. Advances in microsurgical techniques have enabled improved results after neurolysis and have made it possible to perform neurotization, which has undoubtedly become the greatest differential in treating brachial plexus injuries. Improvements in imaging devices and electrical studies have allowed quick decisions that are reflected in better surgical outcomes.In this review, we intend to show the many developments in brachial plexus surgery that have significantly changed the results and have provided hope to the victims of this serious injury.     

Is there a correlation between pelvic incidence and orientation of the acetabulum? An analysis based on a three‐dimensional statistical model of the pelvic ring

The pelvic ring is a complex anatomical structure building up the connection between the trunk and the legs. Whilst there is a broad discussion in the literature about the dynamic interaction between spine, pelvis and the hip joints, there is still little information about the relation and interaction of the constant pelvic parameters. Based on a three‐dimensional (3D) statistical model consisting of 150 uninjured and bony healthy pelves (100 Europeans, 50 Japanese; 81 males, 69 females; average age 74.3 years ± 17.5 years) an evaluation of pelvic incidence (PI) and acetabular orientation in anteversion and inclination was performed and potential correlations of these intraindividual constant parameters were investigated. Pelvic incidence is defined as the angle between the perpendicular to the sacral plate at its midpoint and the line connecting this point to the middle axis of the femoral heads. Acetabular anteversion is defined as the angle between the perpendicular to the best‐fit plane on the acetabular rim and the coronal plane measured in strict lateral view. Acetabular inclination is defined as the angle between the perpendicular to the best‐fit plane on the acetabular rim and the sagittal plane in strict frontal view. Data were further analysed with regard to different subgroup''s age, sex and ethnicity. A positive correlation between PI and acetabular anteversion could be demonstrated. Further, PI and also the acetabular parameters anteversion and inclination were found to be significantly higher in the European individuals than in the Asian. The results of the present study demonstrate a relation between the anatomical configuration of the constant pelvic parameters building up the connection points to the next proximal respectively caudal skeleton section. The findings might lead to more comprehensive treatment strategies in case of trauma or degenerative pathologies of the pelvis in the future.     

Hypothesis: Role for the circadian Clock system and sleep in the pathogenesis of adhesions and chronic pelvic pain?

Intra-peritoneal adhesions ensuing from surgery or infection may lead to chronic pelvic pain, bowel obstruction, infertility and additional invasive surgery to resolve adhesion-related complications. As a result adhesions are a major clinical, social and economic concern. The cumulative year-on-year direct costs of adhesion-related readmissions for a 10-year period are more than ￡ 569 million. The degree of intra-abdominal adhesion formation in an individual patient after a surgical or infective insult remains difficult to predict. This reflects a lack of understanding as to the underlying aetiologies. Several different mechanisms leading to adhesion formation and re-formation have been proposed. These include abnormal modulations in inflammatory status, fibrinolytic pathways and matrix remodelling. A number of preventative strategies have been designed accordingly. However, although each individual model offers specific insights into the aetiology of adhesion formation, none have been shown to provide the basis for a highly effective clinical intervention. A unifying fundamental mechanism remains elusive. In this article we propose that such a mechanism can be found within the molecular control of circadian rhythms and "Clock" gene biology. A number of physiological processes demonstrating circadian variation have been shown to involve 'Clock genes' in the suprachiasmatic nucleus (SCN), which then entrains a similar set of Clock genes in peripheral tissues such as the heart, brain, spleen, lung, liver, skeletal muscle and kidney. The intrinsic time-keeping system influences activity, such as sleep, temperature regulation, rates of metabolism, immune responses, blood pressure and hormone secretion. The function and availability of mediators involved in the inflammatory response, fibrinolytic and anti-coagulation pathways are all under the tight control of the molecular Clock system. These include IL-6, PAI-1, fibrinogen, fibroblasts and TNF-α. We hypothesise that disruptions in the 'Clock system' are central to the causal pathway of adhesion formation. Our hypothesis takes into consideration and utilises current understanding in the field uniting individual principles. Moreover; this hypothesis suggests strategies for optimising existing therapeutic interventions.     

Morphology and immuno-distribution of the histamine H4 receptor and histamine – releasing factor in choroid plexus of patients with paraneoplastic cerebellar degeneration

Objective and Design:  The study was aimed at screening out the mimetic peptides from the binding site of lipopolysaccharide binding protein and CD 14, and then observing if the mimetic peptide will inhibit in vitro LPS-induced inflammatory reaction and function as an anti-endotoxin in the model of LPS-induced acute lung injury. Material and Methods:  Human monocytic cell line (U937) was used in vitro. Thirty three-month-old SD rats were used. Phage display peptide library was adapted to screen mimetic peptide sequences. Treatment:  U937 cells were exposed to treatment with LPS and rhLBP and then were incubated with MP12 at three different concentrations after they were induced and differentiated by PMA. LPS intravenous injection was used to establish a model of rat acute lung injury which was later treated with intravenous injection of MP12. Results:  We successfully obtained the mimetic peptide of lipopolysaccharide-binding protein and CD 14 binding site, the gene sequence of which is FHRWPTWPLPSP (MP12). MP12 can markedly inhibit LPS induced TNF-α expression. MP12 can evidently increase PaO₂ of rats with acute lung injury and also increase the survival rate of these rats. Conclusions:  MP12 (FHRWPTWPLPSP) has the same function as mimetic of lipopolysaccharide-binding protein and CD 14 binding site. The application of MP12, both in vitro and in vivo, confers the biological activity required to antagonise LBP/CD14 and block LPS inflammatory signals, and it can markedly enhance PaO₂ of rats suffering from acute lung injury and also enhance their survival rate. Received 28 April 2008; returned for revision 2 June 2008; received from final revision 4 October 2008; accepted by A. Falus 7 October 2008     

Does hyperbaric oxygen administration decrease side effect and improve quality of life after pelvic radiation?

AIM: to evaluate the influence of HBOT to the side effect and quality of life after pelvic radiation. METHODS: this is an open randomized, parallel, prospective study conducted in Department of Obstetrics and Gynecology, Oncology Division and Department of Radiotherapy. Endoscopy procedure was performed in Department of Internal Medicine and tissue biopsy in Department of Pathology Anatomy. The hyperbaric oxygen therapy (HBOT) was done in Dr. Mintohardjo, Navy Seal Hospital Jakarta. The side effect was measured using LENT SOMA scale ratio, the quality of life used the Karnofsky score. The difference of two mean was analyzed using student t test. RESULTS: of 32 patients undergoing HBOT and 33 patients as control, the ratio of ASE of control group was 44.1+/-28.2%, HBOT group was 0.7+/-30.1%; p<0.001; the LSE of control group was 33.6+/-57.6%, HBOT group was -19.6+/-69.4%; p=0.008. Quality of life of control group after intervention was 4.5+/-10.7%; HBOT group was 19.7+/-9.6%; p <0.001. After 6 months of intervention the quality of life was 2.5+/-16.1% in the control group, and HBOT group was 15.2+/-14.7%; p =0.007. CONCLUSION: the study showed that HBOT decreased acute and late side effect, also improved the quality of life of patients with proctitis radiation.     

ACTH-secreting pancreatic neuroendocrine carcinoma with ovarian and pelvic metastases causing Cushing’s syndrome: a case report

Adrenocorticotropin hormone (ACTH)-secreting pancreatic neuroendocrine carcinoma (NEC) with ovarian and pelvic metastases causing Cushing’s syndrome is very rare and might be misdiagnosed. We describe a case of ACTH-secreting pancreatic poorly differentiated NEC developing bilateral ovarian and pelvic metastases. A 27-year-old woman presented with thirst, polydipsia, fatigue and poorly controlled hyperglycemia. Laboratory and imaging investigations revealed hypokalemia, hyperglycaemia, ACTH-dependent hypercortisolemia and a 12-cm mass at the junction of body and tail of the pancreas with ovarian and pelvic nodules. The patient underwent partial pancreatectomy and splenectomy, uterectomy, bilateral oophorectomy, and excision of peritoneal nodules. Tumors in pancreas, ovaries and pelvis were diagnosed as poor-differentiated NEC. After 19-month chemotherapy, she developed pelvic metastasis. The tumor in our case is a large, poorly differentiated NEC secreting ACTH and causing CS, with ovarian metastases. To our knowledge, this new additional case of ACTH-secreting pancreatic NEC with ovarian metastases would add to the better understanding of this tumor.     

Properties of the inward-rectifying Cl– channel in rat choroid plexus: regulation by intracellular messengers and inhibition by divalent cations

The properties of the inward-rectifying Cl- conductance in rat choroid plexus epithelial cells were investigated to allow comparisons to be made with ClC-2. All experiments were performed using the whole-cell configuration of the patch-clamp method. The conductance was transiently activated using an electrode solution which contained 375 nM catalytic subunit of protein kinase A (PKA). PKA failed to activate the conductance, however, when cells were pre-incubated with phorbol esters, which activate protein kinase C [1 microM phorbol 12-myristate 13-acetate (PMA) and 1 microM phorbol 12,13-dibutyrate (PDBu)]. Sustained activation of the conductance by PKA was observed in Ca2+-free conditions (5 mM BAPTA in the electrode solution), or when 100 nM calphostin C, a PKC inhibitor, was added to the electrode solution. The inward-rectifying Cl- conductance in choroid plexus is therefore similar to ClC-2 in that it is inhibited by PKC. The inward-rectifying conductance was blocked when Cd2+ (30 and 300 microM) and Zn2+ (1, 30 and 300 microM) were added to the bath solution. ClC-2 channels are also blocked by Zn2+ and Cd2+. The magnitude of the inward conductance was dependent on the concentration of ATP in the electrode solution. The conductance was not observed when ATP in the electrode was replaced with non-hydrolysable ATP analogues [adenosine 5'-O-(3-thiotriphosphate) (ATP[gamma-S]) and 5'-adenylylimidodiphosphate (AMP-PNP)), but it was supported by UTP and GTP. These data contrast with those of previous studies in which ClC-2 channels were activated in the absence of ATP. In conclusion, the inward-rectifying Cl- channel in rat choroid plexus shares some properties with ClC-2 (inhibition by PKC and block by divalent cations), but differs in that it depends on intracellular ATP.     

Prevalence and conditions associated with chronic pelvic pain in women from S?o Luís,Brazil

The objective of the present study was to estimate the prevalence of chronic pelvic pain in the community of São Luís, capital of the State of Maranhão, Northeastern Brazil, and to identify independent conditions associated with it. A cross-sectional study was conducted, including a sample of 1470 women older than 14 years predominantly served by the public health system. The interviews were held in the subject''s home by trained interviewers not affiliated with the public health services of the municipality. The homes were visited at random according to the city map and the prevalence of the condition was estimated. To identify the associated conditions, the significant variables (P=0.10) were selected and entered in a multivariate analysis model. Data are reported as odds ratio and 95% confidence interval, with the level of significance set at 0.05. The prevalence of chronic pelvic pain was 19.0%. The independent conditions associated with this diagnosis were: dyspareunia (OR=3.94), premenopausal status (OR=2.95), depressive symptoms (OR=2.33), dysmenorrhea (OR=1.77), smoking (OR=1.72), irregular menstrual flow (OR=1.62), and irritative bladder symptoms (OR=1.90). The prevalence of chronic pelvic pain in Sao Luís is high and is associated with the conditions cited above. Guidelines based on prevention and/or early identification of risk factors may reduce the prevalence of chronic pelvic pain in São Luís, Brazil.     

High prevalence of chronic pelvic pain in women in Ribeirão Preto, Brazil and direct association with abdominal surgery

INTRODUCTION:

Chronic pelvic pain is a disease that directly affects the social and professional lives of women.

OBJECTIVE:

To estimate the prevalence of this clinical condition and to identify independent factors associated with it in women living in Ribeirão Preto, Brazil.

METHODS:

A one-year cross-sectional study was conducted in a population sample of 1,278 women over the age of 14 years. The target population was predominantly composed of women who are treated by the public health system. The questionnaire was administered by interviewers who were not linked to the city health care programs. The prevalence of the morbidity was estimated. First, we identified the significant variables associated with pelvic pain (p<0.10) and then we attributed values of 0 or 1 to the absence or presence of these variables. Logistic regression analysis was used to identify and estimate the simultaneous impact of the independent variables. The results were expressed by odds ratio and their 95% confidence interval with p<0.05.

RESULTS:

The disease was found in 11.5% (147/1,278) of the sample. The independent predictors were dyspareunia, previous abdominal surgery, depression, dysmenorrhea, anxiety, current sexual activity, low back pain, constipation, urinary symptoms, and low educational level.

CONCLUSION:

The prevalence of chronic pelvic pain in Ribeirão Preto is high and is associated with conditions that can usually be prevented, controlled, or resolved by improvement of public health policies and public education.     

Can application of a pelvic belt change injured hamstring muscle activity?

Hamstring injuries are commonly reported in various sports involving sprinting, high-velocity running and kicking. Aberrant biomechanics and neuromotor control of the lumbopelvic and thigh segments have been reported to play a significant role in hamstring injury incidence and recurrence. Recent evidence suggests that external pelvic compression (EPC) applied with a pelvic belt can augment the stability of the pelvic joints, and alter neuromotor control of the lumbopelvic and thigh muscles in individuals with and without (somatic) lumbopelvic and groin dysfunction. However, the effects of EPC on neuromotor control of injured hamstring muscles remain unknown. We have explored the putative neuromotor link between the lumbopelvic segment and hamstring muscles, and generated hypotheses based on plausible mechanisms through which EPC could affect injured hamstring muscle strength and recruitment. Recent guidelines argue that rehabilitation of hamstring injuries should follow a multi-modal approach and include strategies to improve stability and neuromotor control of the lumbopelvic segment. Further investigations exploring these hypotheses would confirm whether EPC could be recommended as an assessment, intervention and rehabilitation tool for hamstring injury.     

Evidence for opioid-induced release of glutamate in guinea pig longitudinal muscle–myenteric plexus strip

By the use of longitudinal muscle–myenteric plexus (LMMP) strips of the guinea pig ileum it should be investigated whether opioids can contribute to an excitatory component of the intestinal smooth muscle contractions. LMMP preparations were set up in Tyrode solution with 1 μmol/l naloxone present or without naloxone from the beginning of tissue preparation. After a 30-min equilibration period the twitch contractions evoked by the first and the fifth electrical 3-s-stimulus in an 80-s-sequence were significantly higher in the tissues prepared and tested without naloxone present. When after continuous electrical twitch responses (+) MK-801, an NMDA receptor antagonist (10–100 μmol/l) was added to the Tyrode solution, the electrically evoked contractions were reduced. The inhibition of the twitch response by (+) MK-801 was less pronounced in the preparations treated continuously with naloxone as compared to the otherwise untreated LMMP preparations. Morphine, (1 and 5 μmol/l), evoked a release of glutamate from this nerve–muscle-preparation. In conclusion these experiments provide evidence that endogenously released opioids or exogenously applied morphine can release glutamate as an excitatory component within the LMMP preparation.     

What is the pelvic lymph node normal size? Determination from normal MRI examinations

Purpose

There are few previous reports on maximal pelvic lymph node sizes and no data on normal mesorectal nodes. Therefore, the aim of the study was to estimate the normal size of pelvic lymph nodes and to determine the upper limits of the normal range.

Materials and methods

Pelvic magnetic resonance imaging (MRI) examinations were prospectively carried out using a Intera 1.5 T magnet (Philips, the Netherlands), on 36 healthy volunteers (22 females, 14 males, mean age 25 years). A balanced fast field echo (b-FFE) sequence was used with the following parameters: 3-mm-thick contiguous slice, matrix 512 × 512. Short axis diameters of pelvic and inguinal lymph nodes were measured in each anatomic territory (internal iliac, external iliac, common iliac, mesorectum and inguinal). After normalization of the measurements, the influences of age, gender, laterality and territory were evaluated. Upper limits (95th percentile) were then calculated.

Results

A total of 1147 lymph nodes were measured. Age, gender and side (right/left) had no significant influence on size. The upper limits of the normal range were, respectively, 5.3, 4.4, 6.3 and 3.9 mm for the external and common iliac, internal iliac, inguinal and mesorectum nodes.

Conclusion

This work presents maximal normal values for each pelvic area, and the values for mesorectum nodes are reported for the first time.

Advances in knowledge

The mesorectum nodes should be considered as abnormal when they are over 4 mm in short diameter. For the other node areas, the upper limits of the normal range were, respectively, 6, 6, 5, 7 mm for the external and common iliac, internal, iliac and inguinal nodes for the short axis.