Further observation on the fine structure of a colloid cyst of the third ventricle

Summary The fine structure of a surgically excised colloid cyst is described. The cyst was lined by ciliated and nonciliated columnar cells. The nonciliated cells contained secretory material and had a surface coating. In addition, a third type of smaller cell was seen wedged between the columnar cells and abutting on the basement membrane. These cells contained abundant free ribosomes and tonofilaments and displayed well developed desmosomes and half desmosomes. The cyst lining closely resembled the upper respiratory epithelium rather than neuroepithelium, thus supporting the contention that colloid cysts are derived from an endodermal source.     

Glial outgrowth along spinal nerve roots in amyotrophic lateral sclerosis

Formation of glial bundles in the proximal portion of the ventral nerve roots is described in a 51-year-old patient with the sporadic form of amyotrophic lateral sclerosis (ALS). Although the bundles were relatively fewer, they were identical in morphology and distribution to those consistently found in Werdnig-Hoffmann disease (WHD). The occurrence of glial bundles in ALS, albeit rare, indicates that this phenomenon is not a unique feature of WHD. Similar changes have been observed in several other unrelated conditions, always in association with degeneration of neurons or axons. Thus, outgrowth of astrocytes in the form of glial bundles should be considered a special type of astrocytic reaction at the interface of the central and peripheral nervous systems.     

Extracranial meningioma presenting as lytic skull lesion.

A meningioma that had replaced the outer table of the skull and thinned the inner table but had no intracranial extension appeared as a solitary lytic lesion on routine roentgenograms of the skull. It was removed without complications.     

Chondrosarcoma of the arytenoids- a rare laryngeal malignancy

Even though laryngeal malignancies are the most frequent primary malignancies of the upper aero digestive tract except for oral cavity cancers, laryngeal chondrosarcomas are rare tumors, constituting less than 1% of all laryngeal tumors. We present a rare case of chondrosarcoma arising from the right arytenoid cartilage with sub glottic extension. The mode of presentation and management of the case is presented along with a review of the literature.     

Pexelizumab and its role in the treatment of myocardial infarction and in coronary artery bypass graft surgery: a review

Monoclonal antibodies are antibodies that are identical because they were produced by one type of immune cell, all clones of a single parent cell. This has become an important tool in biochemistry, molecular biology and medicine. The role of complement system in inflammation has been well established. Inflammation is a cornerstone of the post-myocardial infarction. Also, during a heart bypass procedure, the "complement activation" causes an inflammatory response that can lead to side effects such as chest pain, heart attack, stroke, heart failure, or death. One such agent which causes complement inhibition is pexelizumab. Pexelizumab (Alexion Pharmaceuticals), a recombinant humanized single chain monoclonal antibody to C5, blocks the conversion of C5 to C5a and C5b-9. Pexelizumab is an Alexion-engineered monoclonal antibody fragment designed to inhibit complement-mediated tissue damage associated with reperfusion injury and inflammation that occurs during open heart surgery. Recent Phase III trials have evaluated the role of pexelizumab in patients undergoing coronary artery bypass graft surgery and also in the treatment of acute myocardial infarction. In the ischemia/reperfusion setting of cardiopulmonary bypass surgery, pexelizumab appears to reduce cardiac enzyme release and possibly mortality. Pexelizumab can also be used as adjunctive therapy to fibrinolysis and primary percutaneous coronary intervention. If approved, pexelizumab would represent not only the first of a new class of therapeutics called terminal complement inhibitors for the reduction of death and peri-operative myocardial infarction in patients undergoing CABG-CPB surgery but also a new approach to improving outcomes for patients undergoing CABG surgery. Present article also includes relevant patents on the topic.     

Appropriateness criteria are an imprecise measure for repeat echocardiograms

Background: Previous studies have reported that most transthoracic echocardiograms meet current ACC/ASE appropriateness criteria, but efficacy of appropriateness criteria for repeat echocardiograms has not been investigated. We sought to prospectively determine whether current appropriateness criteria accurately assess the need for repeat echocardiograms in a consecutive series of inpatients in a tertiary care community teaching hospital. Methods and Results: Appropriateness criteria were assessed for consecutive echocardiograms ordered over 30 days. Ordering clinician specialty and level of training were recorded. For repeat echocardiograms, change in clinical status between first and second echocardiogram and any change in echocardiographic findings were documented. Out of 574 echocardiograms analyzed, 143 repeat studies were performed in 104 patients. Level of appropriateness for first time studies was estimated at 84.6% and for repeat studies at 73.4% (x²= 7.71, P = 0.005). Of those patients receiving at least 1 repeat echocardiogram 42 patients (40%) experienced no detectable change in clinical status or other reason that would justify a repeat study. New echocardiographic findings were found in slightly more than half (52%) of patients receiving repeat studies. Conclusions: Inappropriate repeat echocardiograms are ordered more frequently than first time studies. A significant proportion of repeat echocardiograms do not appear to be justified, and often yield no new echocardiographic findings. Our data suggest that current appropriateness criteria might benefit from further revision with particular regard to justification for repeat studies. (Echocardiography 2011;28:131‐135)     

Splenectomy and proximal lieno-renal shunt in a factor five deficient patient with extra-hepatic portal vein obstruction

Background  

The clinico-surgical implication and successful management of a rare case of factor five (V) deficiency with portal hypertension and hypersplenism due to idiopathic extra-hepatic portal venous obstruction is presented.