Development of neuromuscular spindles in the muscles of the floor of the human oral cavity during intrauterine development]

By means of histological, neurohistological, histochemical and morphometrical techniques the development, number and histotopography of neuromuscular spindles have been studied in 860 muscles of the mouth cavity fundus obtained from 108 human embryos, fetuses and newborns. In genioglossal and in geniohyoid muscles, the spindles are layed down at the 7th week of gestation. Their differentiation starts at the 9th week -- with forming the first sensitive endings, nuclear bursa and cellular elements of the spindle capsule. By the 14th week, the subcapsular space becomes evident, and by the 20th week of embryogenesis neuromuscular spindles resemble definitive structures. In the anterior belly of the digastric muscle, the foundation and initial differentiation of the spindles is retarded. The mylohyoid muscle has no spindles. Morphogenesis of neuromuscular spindles has been studied with special reference to the beginning of functional activity of the fundal muscles in the mouth cavity during embryogenesis in view of the theory of systemogenesis.     

Innovative surgical approach for the Pierre Robin anomalad: subperiosteal release of the floor of the mouth musculature

The Pierre Robin anomalad presenting with severe respiratory distress is a difficult situation still associated with a significant mortality rate. A surgical approach based on a new idea is described. The concept is that the musculature of the floor of the mouth is under increased tension and pushes the tongue upward and backward with secondary respiratory obstruction. The surgical approach consists of a subperiosteal release of the musculature of the floor of the mouth through a 2-cm submental incision. So far this procedure has been used in four patients with severe obstruction, and marked improvement has occurred postoperatively in all cases. This surgical technique is simple and is associated with little morbidity. It should lessen the need for tracheostomy, which carries a greater morbidity, especially in newborns. We think that this new surgical approach can significantly improve the outcome of the severe form of Pierre Robin anomalad.     

THE CYST-THECA RELATIONSHIP IN CALCIODINELLUM OPEROSUM EMEND. (PERIDINIALES, DINOPHYCEAE) AND A NEW APPROACH FOR THE STUDY OF CALCAREOUS CYSTS

The paratabulate calcareous cyst of Calciodinellum operosum Deflandre was recorded in a sediment trap sample collected in the Bay of Naples (Tyrrhenian Sea, Italy). The germination of this resting stage produced a phototrophic vegetative cell that had the typical plate pattern of a Scrippsiella species. The cyst morphotypes, observed in a clonal culture of this species, ranged from cysts with well-developed paratabulation to cysts in which the paratabulation was barely visible, to cysts covered by irregularly shaped crystals. The analysis of thin sections of the calcareous cysts using the polarized light microscope equipped with crossed nicols and a gypsum plate showed that the optical orientation of the calcite crystals was tangential in all the morphotypes examined. We suggest that the crystallographic method we describe might provide insights for calcareous cyst taxonomy and phylogeny .     

Analysis of some variables in patients with hydatidosis surgically treated at the Regional Hospital of Valdivia, Chile, 1976-1986

A survey of surgically treated cases of hydatidosis in the province of Valdivia, Chile, was done. Data were provided by the Regional Hospital of Valdivia, and a period of eleven years was covered (1976-1986). Disease, treatment and related data from each patient were consigned. For the analysis, the information was grouped according to: sex, age, cyst location, condition of the cyst, concomitance with another pathology, condition at time of discharge, hospitalization period and number of repeat hospitalizations. In the period studied, 197 cases of hydatidosis were surgically treated. The sex distribution was 53.3% for males and 46.7 for females; the age group 10-19 years was the most affected by the disease (19.3%). The most frequent locations of hydatid cysts were the liver (58.9%) and lungs (36.5%); the 38.6% of the patients showed complicated cysts, mainly with bacterial infections (11.7%); also, 20% of the cases presented a concomitant liver-related pathology. After the operation, 153 (77.7%) clinically recovered and 27 (13.7%) non-recovered patients left the hospital and 7 (3.5%) cases died while hospitalized. The average hospitalization period was 29 days. During 1976-1986, 24 patients were rehospitalized.     

Unusual abdominal cysts in infants and children

In a 20-year period at the Los Angeles Children's Hospital, 46 infants and children have had operation for cysts within the abdomen. The age range of patients was from newborn to 13 years. Most of them were under four years old. There were four general groups of these cysts. (1) About one-half were cysts of the ovary, some of them serous and some dermoid. These cysts are attached by a stalk that often twists, causing gangrene or rupture with acute symptoms simulating appendicitis. (2) Next in frequency were cysts arising in the mesentery of the intestine. They usually caused little trouble until by their size (up to a 2-quart capacity) they created pressure and obstruction in the intestine. (3) Enteric cysts were found in four patients. (4) Cysts of the pancreas were present in three of the children.X-ray examination was helpful in diagnosis. Usually the type of cyst was not determined until operation was done. Transection of the intestinal tract sometimes was necessary for removal of the cyst. Surgical correction was satisfactory in 44 of the 46 cases.     

腹腔镜手术治疗妇科57 例卵巢囊肿的临床分析

目的:探讨腹腔镜下手术治疗妇科卵巢囊肿的临床应用价值和手术要点。方法:对2009年5月～2011年5月期间我院57例进行腹腔镜手术的卵巢囊肿患者(巧克力囊肿32例,单纯性浆液性囊腺瘤19例,良性畸胎瘤6例)的手术资料进行回顾性分析。结果:57例腹腔镜手术全部成功,无中转开腹手术,平均手术时间58min,平均术中出血48ml,术后平均住院2.4d,无病理性恶变。结论:腹腔镜手术治疗妇科卵巢囊肿具有术后恢复快、住院时间短,微创、并发感染率低及其他并发症少、安全有效等明显优势,是妇科手术治疗卵巢囊肿的首选术式。     

MASSIVE AND RECURRENT HERNIAS—Use of Dermal Grafts in Carrying Out Repair

Graft of dermis is clinically and experimentally superior to graft of whole skin for use as reinforcement at the site of repair of hernia, for gross cysts do not form and it fuses better with the surrounding tissues than does whole skin. Placing either dermis or skin under tension helps prevent cyst formation and aids fusion with surrounding tissues. Dermal grafts are less liable to infection than are whole skin grafts, either at the time of operation or later.A split-split flap dermatome technique is presented as a preferred technique for obtaining a dermal graft from the thigh in cases of ventral hernia in which the abdominal skin is stretched, attenuated and inelastic because of the massive size of the hernia. This technique was used in 27 cases of massive hernia. There was infection in one case of the 27 and subsequent healing was satisfactory. One patient died of spontaneous rupture of an intracranial carotid aneurysm. Hernia did not recur in any patient.A split-split free graft dermatome technique is presented for use in cases in which an elliptical segment of normal skin can be removed adjacent to an inguinal or thoracic incision for repair of a hernia or other use. This technique was used in seven cases of inguinal hernia and in one of diaphragmatic hernia with satisfactory results.     

Postrhinoplasty nasal cysts and the use of petroleum-based ointments and nasal packing

Nasal cysts are rare complications of rhinoplasty, and numerous theories exist regarding their cause. The term "paraffinoma" has been used to describe cyst formation observed after topical antibiotic ointment application with nasal packing in the immediate postoperative period. Such complications are rare but may occur because of the inherent properties of the agent used or a lack of meticulous technique (in the placement of incisions and nasal packing). Three cases of postrhinoplasty cysts with a variety of presentations, including incidental intraoperative findings, bilateral medial canthal masses, and a draining dorsal cyst, are described. Although such cysts are uncommon, techniques to prevent these unwanted sequelae should routinely be used, with the judicious application of non-petroleum-based topical antibiotic preparations.     

Portable Cyst Extractor: Detecting Cyst Nematodes in the Field

For on-site detection of cysts, a portable cyst extraction kit was constructed from nine readily available items. The portable cyst extractor detected cysts in a range of 1-117 cysts/100 g soil from 42 fields. Samples processed by this kit in fields were clean and easy to examine, possibly because the kit is a compact version of the standard wet-sieving technique used in the laboratory. The portable cyst extractor has several advantages over traditional survey methods: i) diagnosis of cyst infestations in the field accurately and rapidly most of the year and ii) reduction in the labor of samplings and transportation of soil samples.     

The detection of Giardia muris and Giardia lamblia cysts by immunofluorescence in animal tissues and fecal samples subjected to cycles of freezing and thawing

The effects of freezing and thawing on the detection of selected Giardia spp. cysts were investigated using immunofluorescence, bright field microscopy, and low voltage scanning electron microscopy (SEM). Giardia muris cysts were obtained from either animal carcasses, fecal pellets, or isolated cyst preparations, whereas Giardia lamblia cysts were isolated from fecal samples. These samples were stained using an immunofluorescence technique after 1-3 freezing (-16 C) and thawing (20 C) cycles. Cysts were detected successfully by immunofluorescence in all samples. However, in those samples subjected to freeze-thawing, the cyst walls often became distorted and then were not detectable by bright field microscopy. Low voltage SEM demonstrated that the filaments in the distorted cyst wall underwent rearrangements of interfilament spacing. Quantitation of cyst recovery after freezing and thawing demonstrated that a substantial loss occurred after 1 cycle of alternating temperature when low concentrations of cysts were used, but not with high concentrations of cysts. Cyst recovery, after 3 freezing and thawing cycles, was dramatically lowered irrespective of the initial cyst concentration. These results demonstrated that immunofluorescence was an effective technique for the detection of Giardia spp. cysts in frozen samples and would suggest that freezing and thawing of fecal samples could prevent the detection of cysts when only bright field microscopy was employed.     

Lymphangioma of the pancreas: a multimodal approach to pre‐operative diagnosis

Background: Lymphangioma of the pancreas is an extremely rare benign tumour of lymphatic origin, with only four cases diagnosed by EUS‐FNA reported to date. Methods and materials: Five cases of either cytologically or histologically diagnosed pancreatic lymphangioma with pre‐operative cytological analysis by EUS‐FNAC were reviewed. Results: All patients were female, with a mean age of 56.4 years. By imaging, the cystic lesions ranged in size from 2 to 7 cm (mean 4.5 cm) and were mainly located in the head of the pancreas. All cysts had thin walls and no cyst demonstrated a mural nodule. Diagnosis based on imaging features was benign in all cases due to the absence of high‐risk features. Four samples were sent for biochemical analysis, which showed low CEA levels (range, <0.5–19.4 ng/ml; mean, 5.45 ng/ml) and CA 19.9 and CA 72.4 levels within normal range. All cyst fluids showed numerous small lymphocytes with no atypia; no epithelial cells were present, including no gastrointestinal contamination. Flow cytometry in two cases showed T lymphocytes with a mature phenotype. Surgical resection in two patients confirmed the cytological diagnosis. Benign clinical follow‐up was available in three patients at 2, 3 and 3.5 years. Conclusion: A multimodal approach to cytological diagnosis (combining clinical, radiological and cyst fluid gross, biochemical and cytological characteristics) can lead to the diagnosis of this cystic neoplasm and distinguish it from other more common cysts in the pancreas, potentially avoiding the need for unnecessary surgery.     

A comparison of Giardia microti and Spironucleus muris cysts in the vole: an immunocytochemical, light, and electron microscopic study

We have shown that cysts of the genus Spironucleus share many common morphological features with Giardia cysts including: 2-4 nuclei, flagellar axonemes, a distinct cyst wall, and they even display the same immunostaining as Giardia cysts when labeled with antibodies specific for Giardia cyst wall. A direct comparison of Spironucleus muris and Giardia microti cysts have revealed that cysts of S. muris are significantly smaller than cysts of G. miroti. At the ultrastructural level, the cyst walls are similar in fibrillar appearance, but the width of the S. muris cyst wall is significantly less than that of G. microti. The cysts of S. muris also differ from G. microti in that they contain a striated rootlet fiber, flagellar sheath, and numerous glycogen rosettes. Characteristic features of Giardia include the adhesive disc and median body. Although the cysts of Spironucleus and Giardia are similar in appearance, these unique morphological features can be used to distinguish between the 2 protozoa and should be employed in the detection of Giardia cysts in water samples.     

Different excystment patterns in two calcareous cyst-producing species of the dinoflagellate genus Scrippsiella

Scrippsiella rotunda and Scrippsiella trochoidea var. aciculifera (order Peridiniales, subfamily Calciodinelloideae) are autotrophic orthoperidinioid dinoflagellates producing calcareous resting cysts which are at times abundant in coastal marine sediments. We have carried out laboratory experiments to investigate features of cyst germination in the two species, including dormancy length, germination pattern and germination success, over an annual cycle and under different light and temperature conditions. The maturation period for S. rotunda cysts was between 17 and 24 weeks, while that of S. trochoidea var. aciculifera was much shorter, ranging between 2 and 5 weeks. Both species required exposure to light for germination, while temperature shifts (from 14 to 20C) in the dark did not induce excystment of mature cysts. In both species, germination was not synchronous, but distributed over a variable time interval, suggesting a high physiological diversity within the cyst pool. Moreover, exposure to light of S. rotunda cysts that had not completed maturation impaired the germination of a great percentage of the cysts. Differences in dormancy length may partially explain the distinct cyst production patterns observed for the two species in the Gulf of Naples.      

Les kystes intraprostatiques: à propos de trois observations

Introduction

Intraprostatic cysts are considered to be rare. Some forms may be responsible for male infertility. The authors study the various clinical aspects, with the aim of defining guidelines for the exploration and treatment of different types of intraprostatic cysts.

Materials and methods

Between 2002 and 2007, we studied 3 cases of intraprostatic cyst in 3 men aged between 32 and 39 years.

Results

The clinical presentation was primary infertility (2 cases) and pelvic pain (2 cases). Digital rectal exam revealed prostate mass in 2 cases. Spermogram results were abnormal in 2 cases. The diagnosis was confirmed by prostate ultrasound. Trans-rectal ultrasound guided needle aspiration was performed in one case with secondary recurrence. Two patients had urethroscopy showing an absence of communication between the cyst and urethral channel. Transurethral incision of the cyst was made with resection of the protruding dome. Progress was favourable in all cases with improvement of semen and dissipation of symptoms without recurrence.

Conclusion

Intraprostatic cysts are benign lesions, often of congenital origin. Imaging is an essential component of diagnosis and can sometimes guide therapeutic procedures. The treatment is not yet codified, but symptomatic and/or complicated cysts can be treated by effective and minimally invasive endoscopic methods.     

Cohort study of association of risk of breast cancer with cyst type in women with gross cystic disease of the breast.

OBJECTIVE: To assess correlation between type of breast cyst and risk of breast cancer in women with gross cystic disease of the breast. DESIGN: Cohort study of women with breast cysts aspirated between 1983 and 1993 who were followed up until December 1994 for occurrence of breast cancer. SETTING: Major cancer prevention centre. SUBJECTS: 802 women with aspirated breast cysts. MAIN OUTCOME MEASURES: Type of breast cyst based on cationic content of cyst fluid: type I (potassium:sodium ratio > 1.5), type II (potassium:sodium ratio < 1.5), or mixed (both types). Subsequent occurrence and type of breast cancer. RESULTS: After median follow up of six years (range 2-12 years) 15 cases of invasive breast cancer and two ductal carcinomas in situ were diagnosed in the cohort: 12 invasive cancers (and two carcinomas in situ) among the 417 women with type I cysts, two cancers among the 325 women with type II cysts, and one among the 60 women with mixed cysts. The incidence of breast cancer in women with type I cysts was significantly higher than that in women with type II cysts (relative risk 4.62 (95% confidence interval 1.26 to 29.7)). These results were confirmed after adjustment for several risk factors for breast cancer (relative risk 4.24 (1.12 to 27.5)). CONCLUSIONS: The increased risk of breast cancer of women with breast cysts seems to be concentrated among women with type I breast cysts.     

肾囊肿腹腔镜手术后复发原因分析与对策

目的:分析肾囊肿腹腔镜手术后复发原因并提出相应对策。方法:回顾性分析我院2006年1月至2011年1肿)的诊疗过程和复发情况,分析复发原因并提出需要重视的相关技术细节。结果:325例病人复发28例,其中囊壁游离不充分,囊壁切除不够7例,占复发病例25.0%;手术清除2月采用腹腔镜技术治疗的325例单纯性肾囊肿患者(412个肾囊不够16例,占复发病例57.1%;术后尿性囊肿形成误判为囊肿复发2例,占复发病例7.1%,其他3例,占10.7%。结论:腹腔镜技术是一种安全、有效的单纯性肾囊肿治疗方法,选择合理的手术入路,同时对某些技术环节合理运用和改良,有助于降低术后复发率。     

Incidence of Spinal Perineurial (Tarlov) Cysts among East-European Patients

The spinal perineurial cyst (Tarlov) is a dilatation between the perineurium and endoneurium of spinal nerve roots, located at level of the spinal ganglion and filled with cerebrospinal fluid but without communication with the perineurial subarachnoid space. The aim of the study was to evaluate it incidence among East-European patients. The retrospective data collected during various magnetic resonance spinal examinations and stored on the picture archiving and communication system was analyzed for an incidence of perineurial cysts. From among 842 patients that underwent examination, 75 cases perineurial cysts were revealed. In 22 cases single anomalies were found. In remaining 53 cases, multiple uni- or less frequently bilateral changes were noted. The most common position was the sacral canal, particularly the level of S2 and S3. Occasionally, cysts were also visible on the cervical, thoracic and lumbar level. Incidence of sacral perineurial cysts was significantly higher in females than in males. Similar data was found for single and multiple changes despite of their localization. Insignificant changes were seen for patient age and cyst size. Perineurial spinal cysts were the most frequently observed on the sacral level and such changes were more common in females.     

Modelling the age variation of larval protoscoleces of Echinococcus granulosus in sheep

In autumn 2006, a study of the age-dynamics of Echinococcus granulosus cyst abundance was undertaken from an abattoir study of 1081 sheep slaughtered in Naryn Province in central Kyrgyzstan, an area endemic for echinococcosis. The results demonstrated approximately 64% of sheep were infected with the prevalence increasing markedly with age. The mean abundance was 3.8 cysts per sheep. From established models, an infection pressure of 1.33 cysts per year was estimated. In addition all cysts were recovered from infected sheep and the numbers of protoscoleces was evaluated in each cyst. A new model was developed that examined the variation in numbers of protoscoleces per infected sheep with age. This demonstrated that young sheep aged 1-2 years had very few protoscoleces, but there was a massive increase as the sheep aged. The best-fitting model assumed that the number of protoscoleces in a sheep was proportional to the volume of the cysts. In this model, the radius of the individual cyst increased linearly with the age of the cyst and hence the volume increased with the cube of the cyst age. This combined with the linear increase in numbers of cysts with age resulted in a massive accumulation of protoscoleces with the age of sheep. When the model was parameterised it demonstrated that 80% of protoscoleces were present in sheep aged 4 years and older and this represented just 28% sheep slaughtered. An average sheep at 6 or more years of age has an abundance of over 9700 protoscoleces, whilst in a young sheep of 1 year of age an average of just 16 protoscoleces could be found. The average for the sampled population across all ages was 1562 protoscoleces per sheep. The maximum number of protoscoleces in a single cyst was just 482 for sheep aged 1 year rising to 92,000 for sheep aged 6 years or older. The mean volume of cysts containing protoscoleces increased from approximately 0.7 ml at 1 year of age to 8.8 ml at 6 years of age. Cysts containing protoscoleces ranged from a diameter of 0.5-8 cm with a volume of fluid ranging from 0.2 to 50 ml. It is hypothesised that removal of old sheep through a culling programme could substantially improve the control of cystic echinococcosis.     

Determination of cell fate along the anteroposterior axis of the Drosophila ventral midline

The Drosophila ventral midline has proven to be a useful model for understanding the function of central organizers during neurogenesis. The midline is similar to the vertebrate floor plate, in that it plays an essential role in cell fate determination in the lateral CNS and also, later, in axon pathfinding. Despite the importance of the midline, the specification of midline cell fates is still not well understood. Here, we show that most midline cells are determined not at the precursor cell stage, but as daughter cells. After the precursors divide, a combination of repression by Wingless and activation by Hedgehog induces expression of the proneural gene lethal of scute in the most anterior midline daughter cells of the neighbouring posterior segment. Hedgehog and Lethal of scute activate Engrailed in these anterior cells. Engrailed-positive midline cells develop into ventral unpaired median (VUM) neurons and the median neuroblast (MNB). Engrailed-negative midline cells develop into unpaired median interneurons (UMI), MP1 interneurons and midline glia.     

Factors influencing regional patency and configuration of the human infant upper airway

To study factors influencing patency and configuration of the upper airway, we studied 11 infant cadavers using endoscopy and photography. In most cases, studies were performed shortly after death. The naso-, oro-, and hypopharynx and the larynx were studied. The upper airway was sealed at the nose and mouth so that transmural airway pressure could be raised or lowered. As pressure was lowered airway closure was seen in each of the four regions studied. With respect to closing pressure, the oropharynx was the most compliant region and the larynx the least compliant. In the naso-, oro-, and hypopharynx, lowering the transmural pressure was associated with inward movement of the anterior, posterior, and lateral airway walls. In the larynx, closure occurred by vocal cord opposition in the midline. Tension applied to the genioglossus and geniohyoid tongue muscles had an effect opposite to that of airway suction, causing a more or less symmetrical dilation of the naso- and oropharynx. When the airway was closed, additional tension was needed to produce airway reopening, suggesting that adhesion forces act to maintain airway closure. Neck flexion caused pharyngeal closure, and neck extension caused pharyngeal dilation. Secretions adherent to the walls of the airway visibly narrowed its lumen. The relevance of these findings for the obstructive sleep apnea and laryngomalacia syndromes is discussed.