Porcelain gallbladder and its relationship to cancer

Summary Background Porcelain gallbladder (PGB) is defined as calcium deposits encrusting the internal visceral layer, which becomes hard, brittle, and bluish. Porcelain gallbladder is rare and has been found in less than 1% of routine cholecystectomy specimens. Several studies report an incidence of gallbladder carcinoma (GBC) associated with gallbladder calcification varying between 12.5 and 61%, data which have been known for 60 years. There is a lack of information concerning PGB and its association with GBC, and the aim of this study is to better define this relationship. Methods A total of 10 patients were found to have PGB in 1050 consecutive routine surgical cholecystectomies. Clinical and laboratory findings, gallbladder histologic examination, bile culture, and bile pH were related to stone composition analysis performed by X‑ray diffraction using Perkin–Elmer (Perkin Elmer Corp. Norwalk, CT, US) 1625 FTIR. Results Among the 10 patients with PGB, complete calcification of the entire gallbladder wall was present in six cases, while four patients had partial calcification. Gallstones were present in all cases of PGB, multiple stones in nine cases and a single stone in one case. Bile culture was performed in all patients of the series. Among the 10 cases with PGB, culture was positive in two cases. Conclusion PGB is a disease as rare as it is subtle. Moreover, the chronic stimulation by stones can generate an initial dysplasia that will subsequently turn into a neoplasm: the cancerization risk is probably no different from long-standing cholesterol or combined stones, but as risk factor for cancer it requires early cholecystectomy.

Acute-on-chronic subdural cranial hematoma in a dog: case report

ABSTRACT A ten-month-old male Yorkshire terrier dog was evaluated via CT four months after traumatic brain injury. The head CT scan showed dilated ventricles associated with a peripheral crescent-shaped collection of blood near the right parietal bone with a mineralized area. The visceral layer of the hematoma was hyperattenuating on the native scan and showed moderate contrast enhancement after administration of intravenous iodinated contrast medium. No fractures were identified in the calvarium. These findings were compatible with acute-on-chronic calcified subdural hematoma, which have been described with more detail in humans. This is the first report to include the description of the imaging findings related to this condition using computed tomography in a dog.

Management of pericarditis

Pericarditis is an inflammatory syndrome involving pericardium, which is a double-walled sac consisting of two leaves, a serous visceral layer in contact with the myocardium (pericardium) and a parietal fibrous one, delimiting a cavity (pericardial cavity) containing pericardial fluid. Pericarditis may occur isolated or as a manifestation of a systemic disorder. Diagnosis and correct management of pericarditis can be difficult and its natural history is often characterized by a lot of relapses. Treatment of acute pericarditis should target the underlying etiology. The diagnosis is based on characteristic clinical findings, electrocardiogram, and echocardiography. The goals of treatment are relief of pain, resolution of inflammation (and, if present, pericardial effusion), and prevention of recurrence. Despite a significant impairment of the quality of life, pericarditis usually has good long-term outcomes.

KARAKTERISTIK MORFOLOGI DAN DISTRIBUSI KARBOHIDRAT NETRAL PADA UTERUS KELELAWAR BUAH (Pteropus vampyrus) ASAL PULAU TIMOR

Timorese fruit bat(Pteropusvampyrus)is the only fly mammalian with its unique behavior which hanging upside down inspite of its pregnancy. This research is aimed to reveal the morphology of the Timorese fruit bats and the distribution of neutral carbohydrate within this organ. Three uterus samples derived from three different Timorese fruit bats were used in the research.Both macroscopical and microscopical examinations using H&E and PAS methods were applied. Macroscopically, Timorese fruit bats showedsoft reddish white duplex uterus. Meanwhile microscopically, endometrium consisted of epithelial layer and lamina propria and was the place where simple tubular glands located. The epithelial layer comprised of simple cylindric secretory cells and ciliated cells. Neutral carbohydrate distribution was seen within this epithelial layer. Myometrium was a thick circular smooth muscle layer which consisted of smooth muscle separated by collagen and elastic fibre. Perimetrium was a visceral layer and consisted of mesothelial cells.

Epicardial Adipose Tissue and Renal Disease

Epicardial adipose tissue (EAT) is derived from splanchnic mesoderm, localized anatomically between the myocardium and pericardial visceral layer, and surrounds the coronary arteries. Being a metabolically active organ, EAT secretes numerous cytokines, which moderate cardiovascular morphology and function. Through its paracrine and vasocrine secretions, EAT may play a prominent role in modulating cardiac function. EAT protects the heart in normal physiological conditions by secreting a variety of adipokines with anti-atherosclerotic properties, and in contrast, secretes inflammatory molecules in pathologic conditions that may play a dynamic role in the pathogenesis of cardiovascular diseases by promoting atherosclerosis. Considerable research has been focused on comparing the anatomical and biochemical features of EAT in healthy people, and a variety of disease conditions such as cardiovascular diseases and renal diseases. The global cardiovascular morbidity and mortality in renal disease are high, and there is a paucity of concrete evidence and societal guidelines to detect early cardiovascular disease (CVD) in this group of patients. Here we performed a clinical review on the existing evidence and knowledge on EAT in patients with renal disease, to evaluate its application as a reliable, early, noninvasive biomarker and indicator for CVD, and to assess its significance in cardiovascular risk stratification.

An anatomical hypothesis: a “concentric-structured model” for the theoretical understanding of the surgical anatomy in the upper mediastinum required for esophagectomy with radical mediastinal lymph node dissection

SUMMARY Understanding the surgical anatomy is the key to reducing surgical invasiveness especially in the upper mediastinal dissection for esophageal cancer, which is supposed to have a significant impact on curability and morbidity. However, there is no theoretical recognition regarding the surgical anatomy required for esophagectomy, although the surgical anatomy in abdominal digestive surgery has been developed on the basis of embryological findings of intestinal rotation and fusion fascia. Therefore, we developed a hypothesis of a ‘concentric-structured model’ of the surgical anatomy in the upper mediastinum based on human embryonic development. This model was characterized by three factors: (1) a concentric and symmetric three-layer structure, (2) bilateral vascular distribution, and (3) an ‘inter-layer potential space’ composed of loose connective tissue. The concentric three-layer structure consists of the ‘visceral layer’, the ‘vascular layer’, and the ‘parietal layer’: the visceral layer containing the esophagus, trachea, and recurrent laryngeal nerves as the central core, the vascular layer of major blood vessels surrounding the visceral core to maintain the circulation, and the parietal layer as the outer frame of the body. The bilateral vascular distribution consists of the inferior thyroid arteries and bronchial arteries originating from the bilateral dorsal aortae in an embryo. This bilateral vascular distribution may be related to the formation of the proper mesentery of the esophagus and frequent lymph node metastasis observed in the visceral layer around recurrent laryngeal nerves. The three concentric layers are bordered by loose connective tissue called the ‘inter-layer potential space’. This inter-layer potential space is the fundamental factor of our concentric-structured model as the appropriate surgical plane of dissection. The peripheral blood vessels, nerves, and lymphatics transition between each layer, thereby penetrating this loose connective tissue forming the inter-layer potential space. Recurrent laryngeal nerves also transition from the vascular layer after branching off from the vagal nerves and then ascend consistently in the visceral layer. We investigated the validity of this concentric-structured model, confirming the intraoperative images and the surgical outcomes of thoracoscopic esophagectomy in a prone position (TSEP) before and after the introduction of this hypothetical anatomy model. A total of 226 patients with esophageal cancer underwent TSEP from January 2015 to December 2016. After the introduction of this model, the surgical outcomes in 105 patients clearly improved for the operation time of the thoracoscopic procedure (160 min vs. 182 min, P = 0.01) and the incidence of recurrent laryngeal nerve palsy (19.0% vs. 36.4%, P = 0.004). Moreover, we were able to identify the concentric and symmetric layer structure through surgical dissection along the inter-layer potential space between the visceral and vascular layers (‘viscero-vascular space’) in all 105 cases after introduction of the hypothetical model. The concentric-structured model based on embryonic development is clinically beneficial for achieving less-invasive esophagectomy by ensuring a theoretical understanding of the surgical anatomy in the upper mediastinum.

The lower respiratory tract and its role in ventilation

The two lungs occupy the right and left pleural cavities in the thoracic cavity. They are separated by the central mediastinum containing the heart and the great vessels, the trachea, and other structures passing through the thorax to the abdomen. The left and right pleural cavities are entirely separate from each other. Figure 11.1 shows how they are formed as the developing lung buds invade part of the coelomic cavity by pushing a layer of the wall before it. This is analogous to pushing your finger into a partially inflated balloon. Your finger is the equivalent of the lung bud, the wall of the balloon it is pushing into is the inner layer of pleura, and the far wall of balloon is the outer layer of pleura. The pleura are thus divided into outer and inner layers. As outlined in Figure 11.1D, the outer parietal layer lines the inner surface of the thoracic wall, the thoracic surface of the diaphragm, and the medial wall of the mediastinum. The inner visceral layer closely covers all surfaces of the lungs. The pleural cuff is formed where the two layers become continuous at the junctional region, surrounding the root (hilus) of the lung. A fold in the pleural cuff called the pulmonary ligament allows some space for movement of the lungs relative to the mediastinum during ventilation. The pleural cavity separates the two layers of pleura, but is normally a potential space over most of the lung surface. The visceral and parietal pleurae are in virtual contact, separated by only a thin layer of pleural fluid. Pleural fluid has two important functions. • It lubricates movement of the lungs and their attached visceral pleurae against the parietal pleurae. • It also adheres the two pleural layers to each other, thus maintaining the inflation of the lungs. The parietal pleura is often described as having costal, diaphragmatic, and mediastinal surfaces; this is useful when considering their nerve supply. The costal pleura is supplied segmentally by intercostal nerves, the mediastinal pleura by the phrenic nerves, and the diaphragmatic pleura centrally by the phrenic and peripherally by the lower five intercostal nerves.

The Glomerulus-Revisited

In the embryologic development of the nephron, the glomerular tuft (renal corpuscle) and the excretory tubules develop from two distinct embryologic origins or anlagen. Nephrotomes constitute the earliest formation of the excretory tubules and appear first as segmentally arranged cell clusters, which grow and become canalized, forming nephric tubules. Formation of the glomerulus begins when the dorsal aorta gives rise to small branches, consisting of tufts of capillaries. Bowman’s capsule forms as a blind terminal expansion at the proximal end of the nephron. in the final stage of development, Bowman’s capsule becomes deeply indented by the glomerular tuft. Which leads to a differentiation of it into 2 layers: 1) an inner, visceral layer and 2) an outer, or external, parietal layer. The two layers are separated by a crescent shaped space, known as Bowman’s or the urinary space.The inner, visceral layer encloses, and, comes into close apposition with the glomerular capillaries. At the vascular pole of the glomerulus, the visceral layer is reflected off these vessels and becomes continuous with the external, or parietal layer of Bowman’s capsule, which is lined by a very flat polygonal epithelium. Traditionally, it has been depicted that there is a direct opening of the urinary space into the tubule and that the flat cells of the parietal layer of Bowman’s capsule become continuous with the cuboidal epithelium in the neck of the proximal convoluted tubule.This investigation shows that the junction of the renal corpuscle and the proximal convoluted tubule is a more complicated one. Scanning electron microscopic studies of microdissected nephrons enabled the visualization of the glomerulus, with the two vessels at the vascular pole and the proximal convoluted tubule at the urinary pole. An unexpected finding, was the presence of a gourd-like out-pouching at the urinary pole. (Fig. 1, “A”) Higher magnification showed a saucer shaped depression (50 μm × 25 μm) on its free border. (Fig. 2). This was a consistent finding in the material that was studied.

The effect of cathepsin inhibitor on rat embryos grown in vitro

The addition of leupeptin to New cultures of rat embryos produces growth retardation and abnormalities of embryonic development. The effect is probably due to inhibition of the maternal protein breakdown necessary for embryonic growth. This function is carried out by the visceral layer of the yolk sac which shows distinct morphological changes akin to storage disease when leupeptin is added to the culture medium. We have not found it possible to reverse the effects of leupeptin by addition of amino acids to the culture medium.