[Diagnostic conization of the portio vaginalis uteri. Surgical technic, histological diagnosis and clinical results].
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The authors explored the possibility of using isobutyl-2-cyanoacrylate, a fast-setting plastic adhesive, for controlling parenchymal bleeding after resection of the upper pole of the kidney in rats and rabbits. They describe the immediate results of this technic and histological findings elicited at various removes after experimental surgery.
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Lymph nodes in breast cancer have been examined by two histological techniques in 324 patients who underwent axillary node dissection. A routine pathologic examination consisted in the examination of only one pathological section while in the other, the lymph nodes were macroscopically serially sectioned. With the latter, an increase of 18.8 per cent in the number of detected metastases was noted. However this increase can be considered of prognostic and therapeutic importance only in 8.6 per cent of cases: half corresponding to those cases in which more than the initial threshold number of three lymph nodes were found, the other half corresponding to those cases in which one lymph node was found while the initial examination was negative. In the latter case, the increase of lymph node involvement was mainly due to "clandestine" metastases, i.e. lymphatic embolisation of micrometastases.
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OBJECTIVE AND IMPORTANCE: This case report details the unexpected surgical difficulty encountered in treating a recurrent aneurysm after coil embolization and presents the histological findings of the resected aneurysm. This is only the second reported case of histological description of an aneurysm after coil embolization in a human. CLINICAL PRESENTATION: A 60-year-old woman experienced a 3-month history of chronic headache. Neuroimaging studies demonstrated a 2-cm anterior communicating artery aneurysm. The aneurysm was treated with a two-stage endovascular coil embolization, resulting in almost complete occlusion of the aneurysm. A cerebral angiogram at 6-month follow-up demonstrated slight refilling of the aneurysm, and angiography at 18 months showed a marked increase in the size of the small remnant. Therefore, the patient was referred for direct surgical repair of the aneurysm. INTERVENTION: The distal aneurysm dome, which had been packed with the coils and thrombus, was resected under temporary arterial trapping. An intra-aneurysmal endarterectomy was required, because the aneurysm wall developed intimal dissection that extended to the orifices of afferent and efferent arteries. The aneurysm was then obliterated with multiple clips, reconstructing the patent vessel lumen. However, the patient awoke from surgery with left hemiparesis. A postoperative angiogram disclosed occlusion of the right anterior cerebral artery. An histological study of the thrombosed aneurysm showed that the luminal surface of thrombus was not lined by endothelium. CONCLUSION: This case demonstrated not only the limited efficacy of coil embolization treatment for wide-necked aneurysms but also the potential difficulty in the direct surgical repair for such recurrent aneurysms.
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Sonographically guided puncture of intra-abdominal and retro-peritoneal masses for cytological diagnostic is widely employed. However, processing of cytological material may result in artifacts and in the case of certain malignant tumours, of benign tumours or diffuse organ changes, cytology is only relatively reliable. Special experience on the part of the investigato is therefore required. Hence, in far-reaching therapeutic decisions such as operation, cytostatic therapy or radiotherapy, diagnosis based on histological findings is preferred. Preliminary experience with a new type of fine needle (Schneidbiopsiekanüle) suitable for obtaining histological material is presented.
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