Histopathologie de la cysticercose cérebrale

Resumé Revue générale et critique sur l'histopathologie de la cysticercose du systéme nerveux, affection très fréquente en Amérique du Sud, surtout au Brésil, Chili et Pérou. Le travail est basé sur 25 cas de neurocysticercoses vérifiées histologiquement. L'affection intéresse également les deux sexes et son incidence se fait remarquer à partir de la deuxième décade; la forme anatomique qui prédomine c'est la kystique, avec un degré massif d'infestation à vésicules jeunes, localisées fondamentalement au niveau cérébro-méningé. On décrit un cas, extraordinairement rare de localisation intra-médullaire.On fait d'abord l'étude minutieuse de la fine structure de la membrane vésiculaire de la forme kystique et racémeuse, en décrivant des nouveaux détails histologiques qui jouent un rôle fondamental dans la biologie du parasite et dans l'interprétation physiopathologique des lésions du tissu nerveux. Quant aux lésions mêmes, elles intéressent aussi bien les méninges que le parenchyme nerveux.On observe dans la méninge le compromis prévalent de la leptoméninge; l'intensité et l'extension des lésions est beaucoup plus grande dans la cysticercose racémeuse. L'existence des lésions vasculaires n'est pas discutable: les gros vaisseaux ainsi que les petits sont lésés, généralement dans les territoires localisés, mais en certains cas les altérations peuvent se généraliser. Les lésions épendymaires sont fréquentes, elles ont l'aspect d'une épendymite granuleuse et déterminent des bouleversements dans l'hydraulique du L.C.R. Les altérations de la névroglie sont marquées et intéressent tous ses trois éléments, quoique avec une plus grande prédilection, l'astroglie. Les lésions ganglionnaires sont le résultat de l'action toxique et compressive des éléments parasitaires.On insiste sur la structure de la membrane parasitaire, à laquelle les auteurs classiques assignent seulement une fonction limitante, mais après une analyse minutieuse, les auteurs péruviens montrent clairement la couche ciliaire, l'extrême richesse de cette membrane en canaux et canicules, avec des ampoules digestives qui indiquent que cette riche formation est dédiée à des fonctions plus actives: la nutrition du kyste, et joue un rôle fondamental dans la biologie du parasite et dans le mécanisme pathogénique de la maladie.

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Zusammenfassung Allgemeine und kritische Übersicht der Histopathologie der Cysticercose des Nervensystems, einer sehr häufigen Erkrankung in Südamerika, besonders in Brasilien, Chile und Peru. Die Arbeit stützt sich auf 25 histologisch verifizierte Fälle von Neurocysticercose. Die Erkrankung betrifft beide Geschlechter im gleichen Maße; ihre Häufigkeit nimmt ab dem 2. Lebensjahrzehnt zu. Die vorwiegende anatomische Form ist eine cystische mit reichlicher Bildung junger Bläschen, die vorzugsweise im Gehirn und in den weichen Häuten gelegen sind. Ein seltener Fall von intramedullärer Lokalisation wird beschrieben.Es wird eine ausführliche Untersuchung der Feinstruktur der Blasenmembran der cystischen und racemösen Form durchgeführt, wobei neue histologische Einzelheiten beschrieben werden, die eine wichtige Rolle in der Biologie des Parasiten sowie für die pathophysiologische Deutung der nervösen Gewebsläsionen spielen.Die Veränderungen des ZNS betreffen die Meningen sowie das nervöse Parenchym. In den Hüllen des ZNS besteht eine vorwiegende Beteiligung der Leptomeningen. Schwere und Ausdehnung der Läsionen sind bei der racemösen Cysticercose wesentlich größer. Die Existenz vasculärer Läsionen ist unbestreitbar: große und kleine Gefäße sind vorwiegend in umschriebenen Abschnitten geschädigt, doch können die Läsionen in einzelnen Fällen auch generalisiert auftreten. Läsionen des Ependyms sind häufig. Sie entsprechen dem Bild der Ependymitis granularis und bedingen Störungen der Liquorzirkulation. Die Gliaschäden sind ausgeprägt und betreffen alle drei Elemente mit erheblicher Bevorzugung der Astroglia. Die nervösen Zellschäden sind die Folge toxischer Wirkung und Kompression seitens der Parasiten.Besondere Beachtung verdient die Parasitenmembran, der von den klassischen Autoren nur eine Kapselfunktion zugeschrieben worden war. Auf Grund genauer histologischer Untersuchungen konnten peruanische Autoren jedoch in der Ciliarschicht einen extremen Reichtum an Kanälen und Kanälchen mit Verdauungsampullen nachweisen, welche auf aktivere Funktionen dieser reichen Formation hinweisen: sie dient der Ernährung der Cyste und spielt eine grundlegende Rolle in der Biologie des Parasiten sowie im pathogenetischen Mechanismus der Erkrankung.

     

Laser resurfacing today and the ‘cook book’ approach: a recipe for disaster?

Background Laser ablative skin resurfacing achieves skin rejuvenation by precise ablation of photoaged skin and subsequent re‐epithelialisation and dermal remodelling. Carbon dioxide (CO₂) and Erbium:YAG (Er:YAG) lasers are the established choice. A wide range and many sets of parameters have been proposed as the gold standard for each system but results have varied. Aims To show that this single system ‘cook book’ approach must be rejected in favour of a more comprehensive approach. Subjects and methods The author has experience of ablative skin resurfacing in over 1200 patients and has used both systems. A more flexible approach, using a combined wavelength system, is presented. It comprises precise ablation of the epidermal with the Er: YAG (to create an epidermal window), followed instantaneously with subablative heating of the exposed dermis with the CO₂ laser. Results Since adopting the dual wavelength/dual modality approach, more than 600 patients have been treated, with excellent results and a very high patient satisfaction index, currently around 90%, obtained from the sum of the very satisfied and satisfied patients using a five‐grade scale. Possible resurfacing‐related complications have included prolonged erythema, hyper or hypopigmentation, scarring and viral infections, which were more common with single system resurfacing. The author's complication rate remains under 1%, without any prophylactic use of antiviral agents. Conclusions The cook book approach, whereby a particular set of fixed laser resurfacing parameters for a specific single laser system are adopted and rigidly applied in all patients, will not achieve the best treatment effects and may even produce a bad result and dissatisfied patients. The dual modality approach allows a combination of the favourable elements of each of the two wavelengths with excellent and consistent results.     

New operative technique for treatment of xanthelasma palpebrarum: laser-inverted resurfacing: preliminary report

Xanthelasma palpebrarum lesions are benign but present cosmetic problems to the patient. Their surgical removal has also presented problems to the surgeon. A new laser operative technique for xanthelasma palpebrarum is introduced to avoid the risk for scarring and pigmentary changes after vaporization of eyelid tissue to remove benign lesions, for example, xanthelasma. The authors propose pulsed erbium yttrium aluminum garnet (Er:YAG) vaporization of the lipomatous tissue off the inner surface of the eyelid after incision and eversion of the incised tissue to expose the xanthelasma. The Er:YAG is the laser of choice because of its high absorption in water and thus its self-limiting depth of penetration coupled with extremely precise tissue ablation. Two illustrative case reports are presented, with no recurrence seen in a maximum of 1 year of follow-up. This technique offers the following advantages: no excision of tumor tissue is required (bearing in mind the high rate of recurrence of this lesion) and this wavelength allows good control of tissue removal and accurate recognition of the end point.     

The filtrum remodelling with combined Er:YAG CO 2 laser resurfacing

BACKGROUND: Upper lip wrinkles develop with aging and they can be successfully treated with laser resurfacing. The treatment eliminates the wrinkles and, ideally, should also recover the aesthetic configuration. METHODS: This report includes 32 patients treated for wrinkles of the upper lip with the Derma? K. The first pass was done using 29 J/cm 2 , 5 Hz, 3 mm collimated spot size, plus the CO 2 laser 5 W, 50% duty cycle, 50% overlapping. Following this pass, Derma? K was reprogrammed to emit only with the Er:YAG at 1.4 J/cm 2 , 10 Hz, approximately 50% overlapping and with a beam diameter of 3 mm. Then, several passes were done where wrinkles could still be seen, focusing on the area corresponding to the filtrum . Biopsies were taken to examine possible particular implications of underlying muscle and its role in the recovery of anatomic aesthetics of young lip characteristics when using the proposed technique. RESULTS: Using Derma? K resurfacing with extra passes of the Er:YAG at relatively low density, at the aforementioned area, it was possible to achieve the recovery of the aesthetic youthful appearance of the upper lip. Also, the shape of the filtrum recovered its youthful appearance together with the cupid's bow shape. Histology samples collected at the end of resurfacing showed that the laser thermal effect was also related to muscle fibres due to the proximity of this layer to the dermis because of the narrow subcutaneous fat layer. CONCLUSION: The combination of Er:YAG and CO 2 laser of Derma? K has potential to enhance the results of resurfacing for elimination of wrinkles of the upper lip. Moreover, the fact that only one laser pass of high energy density is used permits clear and secure control of treatment, preventing complications and obtaining good results.     

Endometrial histology in long-term users of the once-a-month injectable contraceptive Cyclofem

This study evaluated endometrial histology in women using the once-a-month injectable contraceptive Cyclofem for one year or more. The study received IRB approval. Seventeen Cyclofem users accepted to be submitted to an endometrial biopsy. All the samples were collected with an endometrial suction curette (Z-Sampler, ZSI Gynecological Product, Chasworth, CA, USA) in an outpatient clinic, 27–33 days after the last injection. The material was fixed immediately in Bouin solution prior to wax embedding and screened as a routine histological examination by a senior pathologist. The pathologist did not know the bleeding status of each woman or the number of injections each woman had received before the biopsy. All women recorded bleeding and spotting for the last 60 days prior to the biopsy. The mean age of volunteers was 25.9 years (range 21–32) and the mean number of injections received was 24.8 (range 14–47). The results were: 4 out of 17 biopsies were found to be inadequate for diagnosis because they consisted of only blood and mucus. Two of these women were bleeding regularly and the other 2 had amenorrhea. Eight endometrial samples presented a proliferative pattern and, in this group, 3 women had amenorrhea and 5 were bleeding regularly. The other 5 biopsies were reported as secretory endometrium, and 4 of them showed pseudodecidual reaction compatible with the administration of progestin. All of these women were bleeding regularly. The results of the biopsies were not related to the number of injections received nor to the age of the women. In conclusion, long-term administration of the injectable contraceptive Cyclofem did not produce adverse alterations in the endometrium as hyperplasia.