[Anatomo-clinical studies in post-extraction alveolitis].
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Biomedical subjects
Publications and source records attributed to D Laky.
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The author discusses problems of morphological diagnosis and pathogenesis with reference to a case of sarcoma of the urinary bladder presenting the following particularities: exulcerated pedunculate macroscopic aspect, histological leiomyo- and myxosarcomatous differentiation, angiomatous hyperplasia and a late favourable course after partial cystectomy.
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The authors carried out experimental and clinical studies in an attempt to explain the causes leading to anastomotic dehiscences, a major complication of exeresis surgery of the left colon and of the rectum. In this view they have performed in dogs incomplete stenoses at the level of the sigmoid and also made parallel studies of the morphological and histochemical changes occuring in the supra-stenosis colon wall, with those of the supra-tumoral colon wall found in human colo-rectal carcinomas, in the "sub-occlusion" stage. Histological alterations are presented, characterized by marked edema in all the layers of the wall, leading to evidently hampered colon vascularization. From the enzymological viewpoint there was noted an intensive phosphatasic and ATP-ase reaction in all the layers of the colon wall. These studies led to the conclusion that it is necessary to evaluate the degree and the duration of the supra-tumoral colic distension before a decision is taken to carry out primary colectomy or rectal resection (single-step procedure), and not to avoid the practice of a seriated intervention when necessary. The reversibility of the lesions noted by the authors allows for the possibility to perform a resection after the colic wall to be anastomosed has returned to an almost normal condition, thus avoiding the dehiscence of the sutures.
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In acute experimental intoxication with 3 indigenous pesticides (Tripinacloraz, Lemax and Maleic Hydrazide-Na salt) the changes of some biochemical parameters, reflecting the degree of hepatic structural alterations, were studied. The pesticides were administered by gastric gavage in a single dose close to DL50 to Wistar male rats. The morphological alterations were in good correlation with a different hepatocellular levels localization. Reversible morphological lesions (granulovascuolar like dystrophy and circulatory disorders) without any pathological significance on dose-effect correlation induced a progressive response especially on serum ceruloplasmine, leucinaminopeptidase and lactatdehydrogenase.
The case of a 78-year old man with a non adherent subcutaneous tumour in the right iliac fossa was presented. In about one year and a half it stretched on the third superior part of the fore right thigh and appeared under the shape of a hard plate free from the osseous tissue. Microscopically, besides some fibrosarcomatous proliferations or very slightly differentiated ones with osteoid structures, the predominance of the osteosarcomatous images was found. The problems of pathogenesis and diagnosis of extraskeletal osteosarcomas were discussed.
Some biochemical parameters were simultaneously investigated in serum and hepatic homogenate in acute experiment with three pesticides in rat. The one-dose exposure response was relatively well correlated with the chemical toxicity and showed the statistically significant values, preferentially placed 48 hours after dosing. The liver morphological alteration might be associated with the serum and tissue comportment of the bioenzymological factors. The various genotoxicity induced by the three pesticides, appreciated by the frequency of micronucleus induction in the bone marrow cells, completes the data about the one-dose exposure effects of the chemical in rat.
It was reported a case of a 55-year-old woman with giant uterine polylobated leiomyofibromatosis with an albescent-reddish fluctuating nodule, of a mesodermal heterologous mixed tumour aspect. The origin of these sarcomas from müllerian pluripotent mesenchymal cells is discussed. The particularity of this case is underlined by the association of two distinct types of benign and malignant tumours.
A study was carried out on the evolution of histological and ultrastructural lesions of liver fragments harvested at different time intervals in the course of extracorporeal circulation in 62 patients operated for acquired and congenital heart disease, as well as that of serologic tests, pre-, intra- and postoperatively up to seven days. Morphologically, it is only the ultrastructural examination that detects the accentuation of preexisting hypoxic lesions within the framework of a state of "controlled shock", noting especially accentuated dilation of the endoplasmic reticulum, lysosomal activation, mitochondrial lesions and a tendency to ribosomal and glycogenic depletion. The lesions did not exceed the limits of reversibility, excepting the cases with advanced heart failure and cardiac cirrhosis. Lending support to these data is the decrease of proteinemia and the dynamics of LDH, SDH, G1DH, gamma GT and transaminases increase after 24 h, then fall to normal values within seven days.
A case of a 55 year old patient with a tumour in the inguino-scrotal region infiltrating into the depth of the thigh was reported. The most tumoral cells appeared clear, rich in glycogen and in melanic pigment, with positive reaction for S-100 protein; between tumoral cells fine vasculo-conjunctival axes were observed. Excluding a Grawitz tumour metastasis one made the differential diagnosis with synovial sarcoma, epitheloid form of malignant schwanomas, spindle cell melanomas, liposarcoma, fibrosarcoma, the tumour was included in the distinct oncologic entity described by Enzinger, with neuroectodermal origin. This case is the first published in Romania.
The electron microscopic aspect of the myocard fragments was examined during surgical extirpation and prosthesis of some septic valvulopathies. Various and disseminated lesions were observed. We remarked the range of mitochondrial lesions, glycogenic deletions, lysosomal activations, the intensity of interstitial and intrasarcoplasmatic oedema that disintegrate sarcolemal structures and intercalary disks. The difficulties concerning the surgical valve prosthesis on the severe toxicoseptic and hypoxic myocardial alterations were mentioned.
A case of a 56 years old female patient with a giant tumour of the left pectoral region developed in a 2 years time was reported. The tumour, free from skin and pectoral muscles, was after mammectomy 25 x 15 x 5 cm, 2.200 grs, multilobaed, albescent with hemorrhages zones and predominantly hard, the rest of the breast being extremely reduced in comparison with the volume of the tumour itself. The initial histological aspect was that of a benign spindle cell tumour and only after some neurohistological techniques the diagnosis established was neurofibroma. The literature data and the exceptional mammary localization of this tumour were reviewed.
Localization of primary solid tumors on the omentum is rare and of leiomyoblastoma exceptional. A 57-year-old patient presented on the omentum an encapsulated, lumpy tumoral formation, 9 x 4.5 x 2.5 cm, with whitish-grey and hemorrhagic cystic zones. Predominant histopathologically were images of leiomyoblastoma infiltrated with fascicular and pleomorphic zones, recent thrombosis and hemorrhage. The postoperative evolution was satisfactory after three years.
Histochemical analysis of some lysosomal and sarcoplasmic proteolytic enzymes was assayed in human myocardial biopsies taken from 26 cardiopathic patients subjected to open heart operations, under extracorporeal circulation and protection with cardioplegic solution and hypothermia. The investigated myocardial proteases were: cathepsin B, cysteine aminopeptidase, acid gelatinases, trypsin-like endopeptidase, chymotrypsin-like endopeptidase and neutral gelatinases. The effects of surgical interventions appreciated by comparing the myocardium fragments harvested before, and at various intervals after aorta clamping (6-90 minutes) revealed disorders in the activity and compartmentalization of all the investigated proteases, whose histochemical reactions increased between 10 and 20 minutes after aorta clamping and manifested a lowering tendency with sarcoplasmic diffusion and extracellular release at longer periods than 20 minutes. The early activation of the neutral proteases and their sarcolemmal expression even before 10 minutes after aorta clamping, suggested the involvement of the nonlysosomal proteases in the first proteolytic events implied in the molecular membrane damage of the myocardial fibre. Sequential proteolytic cascades of abnormal neutral and acid proteases were emphasized as possible mediators and effectors of molecular and subcellular damages suffered by the myocardial fibers during the open heart operations, even under cardioplegic and hypothermic protection.
A study was carried out on the histological and ultrastructural aspects of liver fragments harvested from 62 patients with acquired or congenital heart disease before open heart surgery under extracorporeal circulation. Against a background of passive congestion in the pericentrolobular and mediolobular areas, various mitochondrial lesions and dilation of the endoplasmic reticulum with a reduced number of ribosomes, the presence of microbodies, biliary pigments, lipid vacuoles, lysosomol hyperplasia and activation, glycogen depletion could be seen, as well as extensive collagenization of Disse's spaces, fibroblast hyperplasia and Kupffer cell activation. These lesions are more reduced in the periportal zones. In the advanced stages of heart failure, there appeared a cirrhogenic organization due to extensive pericentrolobular and periportal fibrosis.