The natural history of nephrogenic adenoma of the urinary bladder.

The nephrogenic adenoma is a peculiar lesion of the urinary bladder characterized partly by villous and partly by gland-like structures. The two layered surface epithelium consists of an eosinophilic cell layer, which covers a clear cell layer, the latter resting upon a delicate basal layer. The clear cells disappear when approaching the tip of the villi. There exists a 200 micron wide zone of transition between the urinary bladder epithelium and that of the neprogenic adenoma. At the base of the villi there are scattered nodules of gland-like structures lined either by eosinophilic cells or by clear cells. These epithelial cells are derived from the corresponding surface epithelial cells from which they had separated by active downwards growth.     

The neuroanatomical correlates of route learning impairment

Recent functional imaging studies of topographical learning point to the participation of a large network of cortical and subcortical regions. Nevertheless, areas which are crucial remain poorly specified due to the absence of group studies of subjects with focal lesions distributed throughout the brain. We assessed the ability of 127 subjects with stable, focal lesions to learn a complex real-life route, a critical aspect of topographical functioning. Results indicated that impairment in route learning was highly associated with damage to medial occipital and posterior parahippocampal cortices in either hemisphere, the right hippocampus, and the right inferotemporal region. Impairment was seen among 86% of the subjects with damage to any these regions, in contrast to impairment among 31% of subjects with lesions in other regions. The importance of medial occipitotemporal cortices bilaterally and right inferotemporal cortex likely reflects the critical role of the ability to quickly and accurately perceive and learn multiple topographical scenes. The importance of the right (and probably left) posterior parahippocampal gyrus and of the right hippocampus likely reflects their critical, distinctive roles forming an integrated representation of the extended topographical environment (i.e., the appearance of places and spatial relationships between specific places), and consolidating that representation into multifaceted contextual knowledge of the environment.     

Significance of plasma tissue polypeptide antigen determination for diagnosis and follow-up of urothelial bladder cancer

Summary Plasma concentrations of tissue polypeptide antigen (TPA) were determined in 104 patients with all stages and grades of urinary bladder cancer. Patients with evidence of bacterial or virus infections were excluded. In addition, follow-up controls after treatment were performed. At a rate of 5% false positive values, the diagnostic sensitivity for the tumour stage pTis/pT1 was 63% and for the stages pT2-4 it was 76%. Patients with proved lymph node or distant metastases showed elevated values in 100% of cases. A positive correlation was found between the 3 grades of malignancy and the TPA concentrations. Except for the tumour diagnosis, TPA is a valuable parameter for followup controls. Our results show a very good correlation of the plasma TPA concentration with tumour progression as well as with stabilisation and regression after treatment.     

Cytomorphological and histological studies on the urothelium during and after chemoimmune prophylaxis

Summary During and after chemoimmune prophylaxis with i.v. cyclophosphamide (CTX) and both intravesical and systemic BCG-treatment, the bladder mucosa is prone to morphological changes which might resemble tumor recurrences. Therefore, morphological parameters which can discriminate between treatment effects and tumor recurrences are of interest. In a prospective study, routine cytology, determination of granulocytes, lymphocytes, and macrophages in the urine sediment as well as flow-cytophotometry (FCM) for DNA analysis were performed before, during, and after chemoimmune prophylaxis. In addition, bladder biopsies and all recurrent tumors were histologically analysed. Our results show that FCM is the best method for monitoring the bladder mucosa for recurrent tumors during treatment. After termination of BCG, it takes at least 4 months for cytological normalization to take place. Urine excretion of granulocytes, lymphocytes, and macrophages does not correlate with this process. Histological alterations during treatment are demonstrated; their normalization requires at least 3 months. In 10% of the patients chronic inflammatory lesions (pseudotumors) develop.     

Asymmetric, disproportionate craniofacial hyperostoses of mosaic pattern in a patient not meeting Proteus syndrome criteria

A 34-year-old patient with asymmetric hyperostosis of the craniofacial skeleton much more pronounced on the right side is presented. A long-term follow-up of 16 years showed progression of overgrowth even after skeletal maturity and despite repeated surgical corrections focusing on regional reduction of the hyperostoses. Clinical situation during infancy, adolescence, and adulthood is documented. Although the craniofacial hyperostosis in the patient was indicative of the Proteus syndrome, the applicable criteria were not met. Proportionate mild hemihypertrophia/hyperplasia of the patient's right extremities also exclude an oligosymptomatic variant of the Proteus syndrome limited to the skull. Both surgical strategies and difficulty of a diagnostic classification are discussed.     

Dentoalveolar injury related to general anaesthesia: a 14 years review and a statement from the surgical point of view based on a retrospective analysis of the documentation of a university hospital

Abstract – Introduction: Damage to dentoalveolar structures related to general anaesthesia is a well‐known complication and may represent a relevant morbidity for affected patients. Central documentation of perioperative dentoalveolar injuries was performed since 1990 in the Department of Anaesthesiology and Intensive Care Medicine in cooperation with the Department of Oral and Maxillofacial Surgery at the Charité Universitätsmedizin Berlin, Campus Virchow‐Klinikum. Documentation of perioperative dentoalveolar injury consisted of anaesthesia charts, reports of the anaesthesiologists and consultant maxillofacial surgeons. Materials and methods: Retrospective analysis of the data from 1990 to 2004 was performed according to this documentation with respect to incidence, matter, distribution of dental injury and therapeutic consequences. Results: Within 14 years 82 ‘dental injuries’ with 103 affected teeth were documented in calculated 375 000 general anaesthesias. Incidence of 0.02% was very constant with an average of 5.5 events/year. Eighty‐nine percent of the documented injuries occurred during scheduled operative procedures. Only 32.9% of the injuries took place during endotracheal intubation. In about 50% the injury was not related to intubation or extubation but happened during general anaesthesia. In 80% the dental injury was estimated by the anaesthesiologist as ‘not avoidable’. In 83% pre‐existing affection or structural injury of intraoral tissues was documented, in 32.7% of the affections sufficient therapy could be provided already during inhospital stay. Conclusion: Perioperative dentoalveolar injury is surely an annoying complication of general anaesthesia. However incidence is rare and seems to be unavoidable. Pre‐existing damage to dentoalveolar structures is the main risk for additional injuries related to general anaesthesia. Adequate therapy can be provided by interdisciplinary concepts. There should be a fair balance between the benefit of the surgical procedure and the risk of dental injury related to general anaesthesia. Awareness of the problem and proper documentation are important factors for adequate management in liability cases.     

Changes in cortical morphology resulting from long-term amygdala damage

The amygdala's contribution to emotion, cognition and behavior depends on its interactions with subcortical and cortical regions. Amygdala lesions result in altered functional activity in connected regions, but it is not known whether there might be long-term structural sequelae as well. We hypothesized that developmental bilateral amygdala lesions would be associated with specific gray matter morphometric abnormalities in the ventromedial prefrontal cortex (vmPFC), anterior cingulate cortex (ACC) and the ventral visual stream. We conducted regions of interest and vertex-based analyses of structural MRI data acquired in two patients with long-standing focal bilateral amygdala lesions (S.M. and A.P.), compared to gender- and age-matched healthy comparison subjects. Both patients showed significant proportional increases in gray matter volume of the vmPFC. Cortical thickness was increased in the vmPFC and ACC and decreased in the ventral visual stream. There were no morphometric changes in dorsolateral prefrontal cortex or dorsal visual stream cortices. These findings support the hypothesis that cortical regions strongly connected with the amygdala undergo morphometric changes with long-standing amygdala damage. This is the first evidence in humans of the remote alteration of brain morphology in association with amygdala lesions, and will help in interpreting the structural and functional consequences of amygdala pathology in neuropsychiatric disorders.     

Processing of facial emotion in the human fusiform gyrus

Electrophysiological and fMRI-based investigations of the ventral temporal cortex of primates provide strong support for regional specialization for the processing of faces. These responses are most frequently found in or near the fusiform gyrus, but there is substantial variability in their anatomical location and response properties. An outstanding question is the extent to which ventral temporal cortex participates in processing dynamic, expressive aspects of faces, a function usually attributed to regions near the superior temporal cortex. Here, we investigated these issues through intracranial recordings from eight human surgical patients. We compared several different aspects of face processing (static and dynamic faces; happy, neutral, and fearful expressions) with power in the high-gamma band (70-150 Hz) from a spectral analysis. Detailed mapping of the response characteristics as a function of anatomical location was conducted in relation to the gyral and sulcal pattern on each patient's brain. The results document responses with high responsiveness for static or dynamic faces, often showing abrupt changes in response properties between spatially close recording sites and idiosyncratic across different subjects. Notably, strong responses to dynamic facial expressions can be found in the fusiform gyrus, just as can responses to static faces. The findings suggest a more complex, fragmented architecture of ventral temporal cortex around the fusiform gyrus, one that includes focal regions of cortex that appear relatively specialized for either static or dynamic aspects of faces.     

Looking you in the mouth: abnormal gaze in autism resulting from impaired top-down modulation of visual attention

People with autism are impaired in their social behavior, includingtheir eye contact with others, but the processes that underliethis impairment remain elusive. We combined high-resolutioneye tracking with computational modeling in a group of 10 high-functioningindividuals with autism to address this issue. The group fixatedthe location of the mouth in facial expressions more than didmatched controls, even when the mouth was not shown, even infaces that were inverted and most noticeably at latencies of200–400 ms. Comparisons with a computational model ofvisual saliency argue that the abnormal bias for fixating themouth in autism is not driven by an exaggerated sensitivityto the bottom-up saliency of the features, but rather by anabnormal top-down strategy for allocating visual attention.