Romanian Journal of Morphology and Embryology最新文献

Inverted papilloma (IP) is a non-cancerous tumor that develops from the paranasal sinuses. Identifying and diagnosing an IP is vital for an ear, nose and throat specialist, due to its high recurrence rate and ability to transform into malignant carcinoma. Diagnosis is based on endonasal flexible endoscopy, preoperative biopsy, and imaging methods. Treatment is exclusively surgical, and its aim is the complete resection of the tumor to prevent further recurrences. The success of surgery depends on employing the most appropriate surgical technique. The choice should be tailored to the tumor's location, size, and the patient's specific anatomy. Endoscopic, open, or even combined approaches may be considered. Notably, attachment-oriented surgery is the cornerstone in endoscopic endonasal approaches. Regardless of the chosen approach, long-term surveillance is vital, as early detection provides the benefit of easier re-resection.

The oral mucosa can suffer a series of traumatic injuries from various causes (bacterial plaque, tartar, fillings, incorrectly adapted prosthesis). A risk factor generating periodontal diseases is represented by fixed orthodontic therapy, if the forces exerted on it are excessive. These forces cause more or less extensive injuries both on the surface and in depth. One of these lesions is gingival hypergrowth. Early injuries concern only the superficial periodontium and are represented by mild or moderate inflammation, gingival hypergrowth, which can be reversible after removing the irritating factor (bacterial plaque, tartar). Advanced injuries are characterized by major clinical, radiological and tissue changes that cause the destruction of the deep periodontium (alveolar bone, deep ligament). Hypergrowth changes may occur at the epithelial level with reduced conjunctival reaction or may predominantly involve fibro-connective structures of the chorion with insignificant reaction in the epithelial component. Through this study, we highlight superficial and deep changes at the gingival and periodontal level.

The paper overviews the uniquely intricate and distinct perineurium that envelops nerve fibers in bundles. It consists of perineurial cells (PCs), connective tissue, and blood vessels. The perineurium creates a microenvironment for efficient signal transmission, protects and maintains neuronal structure and function, and facilitates neuronal repair. PCs are a unique type of myofibroblasts essential for maintaining nerve homeostasis. They act as an effective blood-nerve barrier (BNB), protecting against toxins, infections, and mechanical trauma. Despite their crucial function, the origin, ultrastructure, molecular structure, and functional roles of PCs remain a mystery, making them a fascinating area of study.

Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) play an important role in the pathophysiology of chronic glaucoma, as they are involved in extracellular matrix (ECM) remodeling in the trabecular meshwork (TM), affecting its ability to efficiently regulate intraocular pressure (IOP). Ensuring the balance between MMPs and TIMPs helps to maintain homeostasis in ocular tissues, which is essential to avoid glaucomatous lesions. Elevated levels of MMPs and increased degradation of the ECM, ultimately affecting aqueous humor outflow and increasing IOP, characterize glaucoma. In the current literature review, the impact and interactions of MMPs and TIMPs in chronic glaucoma have been emphasized, with multiple but still unelucidated roles in the mentioned pathology including their clinical implications, future research directions, and therapeutic approaches. Research to date indicates that the expression of TIMPs is altered in patients with chronic glaucoma, suggesting a compensatory response to increased MMPs activity. Certain drugs can influence the expression levels of MMPs and TIMPs, therefore therapeutic strategies can be developed to restore the balance between tissue enzymes and their inhibitors. Therefore, understanding the relationship between MMPs and TIMPs is a key factor in the pathogenesis of chronic glaucoma. Understanding the interplay between the two provides interesting insights into ECM remodeling in ocular tissues, highlighting the potential of targeted therapies to restore the balance between proteolytic enzymes and their inhibitors.

Background/objectives: Despite the efficacy of endovascular approaches for most secondary interventions post-endovascular aortic aneurysm repair (EVAR), a small proportion of patients need open conversion (OC) procedures. We shared our experience regarding patient outcomes after late OCs post-EVAR. We also performed a literature review of data published on this topic.

Patients, materials and methods: Medical records of patients who underwent late OCs post-EVAR at a Public Hospital in Germany (2017-2019) were retrospectively analyzed. OC involved total or partial endograft removal followed by aortic reconstruction. Preoperative patients' characteristics, indications for OC, and intra-∕post-operative outcomes were assessed. Studies published in English (2014-2024) on OCs post-EVAR complications were descriptively analyzed.

Results: Six patients underwent late OCs throughout the study (males: 66.67%; age [mean±standard deviation]: 66.50±2.89 years). Grafts were excised after a median of 72 months (range: 24-132 months), with 2∕6 (33.33%) urgent removals and 4∕6 (66.67%) elective. 4∕6 (66.67%) patients underwent complete removal, and 2∕6 (33.33%) were partial. Clamping site was suprarenal in 3∕6 (50.00%) patients, supraceliac in 2∕6 (33.33%), and infrarenal in 1∕6 (16.67%). Technical success was 100%, with 32 minutes mean clamping time and 1.67 L blood loss. Median follow-up was 13 months. No aneurysm growth was observed, and implanted grafts functioned well. 1∕6 (16.67%) patients died during the postoperative intensive care unit stay. Seven studies were included in our review. The 30-day mortality post-OCs was 6.2-10.0% in elective setting and up to 40% in urgent.

Conclusions: Late OC can be a reliable procedure for managing endoleak post-EVAR. Its success relies on accurate preoperative assessment and surgical expertise.

Cardiac myxoma (CM) is the most common benign tumor of the heart and an important etiology of stroke in young adults. The study aimed to provide the latest literature data on CMs and, in particular, on the association between CM and cardioembolic ischemic stroke. It also discussed a specific instance of atrial myxoma (AM) in a young patient who suffered an ischemic stroke linked with familial cavernomatosis. The case presentation focuses on a 43-year-old woman showed up at the hospital's Emergency Room for transient speech disorders lasting about 15 minutes. The physical examination revealed preserved mental and cognitive status. Cranial magnetic resonance imaging (MRI) showed three areas of microvascular ischemia (frontal, parietal, and left occipital), in addition to multiple cavernomatous lesions. Because these microvascular ischemias were located in different vascular territories, we considered the cause to be embolic and completed the investigation with a transesophageal cardiac ultrasound that revealed a mobile and heterogeneous tumor mass in the left atrium. Histopathological investigation with immunohistochemistry proved the tumor to be a CM. The patient therapy included a multidisciplinary approach, which led to surgical excision of the tumor. The co-existence of cerebral cavernous malformations (CCMs) and AM might thus be coincidental or induced by a common genetic component. More cases are needed to verify or disprove the concept of a shared genetic basis for CCMs and myxoma.

Aim: Tuberculosis (TB) came back in the top of causes for infectious disease-related deaths and its pleural involvement is still in the top two extrapulmonary sites. The authors continued their studies on TB pleural effusions (Pl-Effs) with the assessment of biological and cytological variable of pleural fluid (PF), introducing in the investigation algorithm and testing a new tool, the computer-assisted evaluation of cell populations on PF smears.

Patients, materials and methods: A series of 85 patients with TB pleurisy (PLTB) were selected from a larger group of 322 patients with different types of Pl-Effs. The algorithm of investigation included. clinical variables, biological assays of PF, gross aspects including imagistic variables and PF cytology on May-Grünwald-Giemsa (MGG)-stained smears. All the data obtained were entered into and processed using Microsoft Excel module of the 2019 Microsoft Office Professional software along with the 2014 XLSTAT add-in program for MS Excel. The PF cellularity was assessed qualitatively by a cytologist and quantitatively with in-house software. Continuous variables were compared using Pearson's correlation test, while categorical variables were compared using χ² (chi-squared) test.

Results: Our analysis showed that patients were usually males, aged between 25 and 44 years with Pl-Eff discovered at clinical imagistic examination, almost always one-sided and free in the pleural cavity. Its extension was either moderate or reduced. The PF had a serous citrine appearance in most of the cases, and biological characteristics pleaded for an exudate [high levels of proteins and lactate dehydrogenase (LDH)], with elevated adenosine deaminase (ADA) values and rich in lymphocytes (Ly). The attempt to identify the pathogen in PF was not of much help. Apart from Ly, neutrophils [polymorphonuclear neutrophils (PMNs)] were a rare presence and their amount had only a trend of direct correlation with Ly. The same situation was encountered in the case of mesothelial cells (MCs). The comparison between the qualitative and the quantitative, computer-assisted evaluations of cytological smears showed that the results of the two methods overlapped in less than one third of the cases, although the sensitivity and specificity values as well as the two calculated predictive values of the qualitative method were encouraging.

Conclusions: The assessment of biological variables and cell populations of the PF are basic tools in the diagnosis of pleural TB. The assessment of PF cell population could be improved by the use of computer-assisted quantitative analysis of the PF smears, which is simple to design, easy to introduce and handle and reliable.

Various electrophysiological abnormalities are noted in patients with cirrhosis, the most prevalent consisting of QT prolongation and autonomic dysfunction. This study aims to thoroughly evaluate these abnormalities in cirrhotic patients by utilizing various parameters and compare them with healthy individuals. We evaluated 60 patients with hepatic cirrhosis using a resting electrocardiogram (ECG), ECG during and after the Valsalva maneuver, 24-hour ambulatory ECG monitoring and a standardized ECG stress test. We then compared these results with a group of 50 patients who had no hepatic cirrhosis or other significant known pathologies and were not on any medical treatment. At rest, cirrhotic patients had a reduced Valsalva index compared to the control group, but no statistical differences were noted in comparing resting heart rate (HR) values. At Holter monitoring, although there was a trend toward increased corrected QT (QTc) intervals in cirrhotic patients, it did not reach statistical significance, indicating no difference between the two groups. Reduced standard deviation of normal-to-normal (NN) intervals (SDNN) values, statistically significant, were noted in cirrhotic patients compared to the control group, indicating autonomic dysfunction. At stress test, there was no statistically significant difference in the results obtained for maximum HR during exercise between the two groups. Also, the results showed that cirrhotic patients had statistically significantly higher HR values after exercise compared to the control group. In conclusion, cirrhotic patients presented an increased grade of autonomic dysfunction compared to healthy patients, but no differences were noted regarding QT interval abnormalities.

Pindborg tumor is a calcifying epithelial odontogenic tumor possibly arising from developmental disturbances in dental lamina remnants. It predominantly affects individuals in their third decade of life, with women also experiencing later onset. The tumor exists in two forms, namely intraosseous (central) and extraosseous (peripheral), with the former showing higher post-surgery recurrence rates of about 14%. Despite its rarity, the tumor can be misdiagnosed due to symptoms resembling dental issues and headaches, or it may even be asymptomatic. Radiologically, it presents a mix of radiolucent and radiopaque areas, sometimes unilocular or multilocular. Histopathologically, it is characterized by nests and sheets of polygonal epithelial cells with eosinophilic cytoplasm and prominent nucleoli. The presence of eosinophilic amyloid-like material and calcifications is distinctive, ranging from small concretions to larger aggregates. The exact origin of amyloids is unknown, but they are thought to derive from degraded keratin filaments. Treatment varies by tumor location, with more invasive procedures required for jaw tumors, including bone resection, due to their aggressive growth and invasion of the surrounding tissues. Accurate, individualized treatment is crucial for patient outcomes, particularly in cases where the tumor's calcification is absent, indicating a severe impact on health. Our study included a case report of a 12-year-old patient who presented to the dental clinic complaining of sporadic pain in the area of the lower right front teeth. During a clinical examination of the area, we noticed a deformation of the alveolar bone, with a depressed mucosa. We followed the chronological steps of radiological examination, lesion excision, and histopathological examination to obtain a definitive diagnosis.

Adenocarcinoma (ADK) of the ileum is an infrequent cancer that poses significant diagnostic and treatment difficulties. This article analyses the existing case literature to investigate the correlation between pyloric gland metaplasia (PGM) and the onset of ileal ADK. PGM, defined by the atypical transformation of intestinal epithelial cells into gastric-type mucosa, has been recognized as a possible precursor lesion in the spectrum of several gastrointestinal malignancies. We intend to clarify the clinical characteristics, histological results, and outcomes linked to ileal ADK originating from PGM through an exhaustive examination of recorded cases. Our findings indicate that early identification of metaplastic alterations may be essential for enhancing prognosis and informing therapeutic choices. This study emphasizes the need for additional research to elucidate the mechanisms driving this transition and to improve diagnostic precision in clinical practice.