Biomedical subjects
Publications and source records attributed to R Kubale.
This is a case report on a 21-year old woman patient having an asymptomatic, mainly cystic tumour of 25 cm size. Microscopic examination after removal revealed a tumour belonging to the APUD cell system. The clinical symptoms and pathology of this unusually large tumour are discussed.
Because of the risk of carcinoma, choledochal cysts always should be completely removed. If the cyst is extrahepatic, this should not offer any problem. Radical excision of an intrahepatic cyst, however, can present as a major problem and is in fact not always achievable. The anatomical situation (involvement of both lobes of the liver) or the general condition of a patient can force us to limit the surgical procedure. We report our experience with 5 cases of intrahepatic choledochal cyst, emphasizing the difficulties of achieving the before mentioned therapeutic goal. Details on today's pathogenetic theories and classification of choledochal cysts are reported from the literature.
Adenoma sebaceum, also known as Pringle's tumour, is frequently associated with tuberous sclerosis (Bourneville's disease); if the lungs are involved, however, the clinical course is different from that of the "classical" type of the combination of these two diseases without lung involvement. The case record of a woman patient in whom the lung was affected, is presented with a brief discussion of the x-ray and pathological changes and their differential diagnosis.
A congenital portacaval shunt was discovered in five rats. In these animals the hepatic artery was the only blood vessel perfusing the liver; the portal vein was absent. The livers were small and mainly hypoplastic, but light microscopy revealed the occurrence of focal hyperplastic alterations and occasional hyperplastic nodules. TEM and SEM showed these areas to be composed of clustered hepatocytes, separated by widened intercellular spaces. The cell membranes carried numerous pleomorphic microvilli, and the cytoplasma contained densely packed mitochondria, some of which were giant sized. Liver cells in the centrilobular region were hypoplastic. Comparison with findings of experimental portacaval anastomosis suggest that in congenital-shunt animals, the overall hypoplasia of the liver with the formation of hyperplastic areas is a consequence of the lack of portal blood.
The diagnostic significance of enzyme and isoenzyme ratios in serum relies on their different distribution at various levels: from organs to subcellular structures. Factors which modify the ratios are the molecular properties of enzymes and isoenzymes and their turnover in the cells and in the extracellular space. These pathophysiological principles are considered with respect to the Szasz ratio CK/GOT and its application for the differential diagnosis of acute myocardial infarction.
BACKGROUND: Primary leiomyosarcoma of bone is a very rare malignant tumor with uncertain pathogenicity. METHODS: The authors studied five cases of surgically treated primary leiomyosarcoma of bone. Clinical histories and radiographic findings were recorded. Regular clinical and radiographic controls were obtained postoperatively. In all cases, immunohistochemical studies were used to confirm the diagnosis. Molecular biologic examinations, using the polymerase chain reaction technique with microsatellite DNA markers from regions of tumor-relevant genes, were performed to determine the stability of the genome or to detect some typical genomic changes. RESULTS: The study included three women and two men, with an average age of 42 years. The tumor was located in the pelvis in two patients, in the femur in two patients, and in the proximal tibia in one patient. All tumors were classified as high-grade tumors (four stage IIB, one stage IIA). Radiographically, all tumors appear as purely osteolytic lesions, with a geographic or moth-eaten appearance and without any sclerotic margin. Three patients underwent limb salvage surgery followed by endoprosthetic replacement. The other two patients required amputation. The mean follow-up was 19 months (range, 8-29 months). Three patients died of disease, with a mean postoperative survival period of 18 months (range, 6-27 months). Four patients developed diffuse pulmonary metastases after an average of 10.5 months. One of those patients responded well to chemotherapy. In all cases, immunohistochemistry showed strong reactivity of the tumor cells for (alpha-SMA and vimentin. Molecular biologic investigations revealed a high rate of genomic instabilities in all of the stage IIB tumors. CONCLUSION: Clinical follow-up suggests that primary osseous leiomyosarcoma has an aggressive biologic behavior. The immunohistochemical studies are useful tools and suggest that osseous leiomyosarcoma arise from the vascular smooth muscle cells within the bone. The molecular biologic findings of a high rate of genomic instability confirm the hypothesis that this rare entity is of an aggressive nature.
In this study, we tested the stability of the xenograft SURGIBONE and of human iliac crest graft depending on the donor's bone density. The mean load bearing capacity of SURGIBONE was 4816 N, the compressive strength 32.8 N/mm2. This even exceeds the values given by the producer. Yet in clinical use the material caused problems by collapses or lysis of the graft. According to our results, those failures can not be explained by missing primary stability. Perhaps there is a immunogenic reaction of the host against the remaining protein as it once was proved for the "kielspan"-graft. The iliac crest grafts of donors with normal bone density had a load bearing capacity of 3397 N. Grafts of donors with reduced bone density of less than 60 mg/ml Ca-Equivalent showed reduced load bearing capacities of 2265 N. DEXA (Dual-Energy X-Ray Absorptiometry) seems to be suitable to scan preoperatively the iliac crest graft stability in order to recognize the danger of reduced stability by osteoporosis.
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