Pelvic organ venous communications. Anatomy and role in urogenital diseases; a new technique of cystovaginohysterography

Could postmortem hemorrhage occur in the brain?: a preliminary study on the establishment and investigation of postmortem hypostatic hemorrhage using rabbit models

OBJECTIVE

The aim of this study was to explore whether postmortem hemorrhage can occur in brain tissue using rabbit models.

METHODS

The rabbits killed by air embolism were randomly divided into the horizontal-position group and the upside-down group. Autopsy was performed after 48 hours, and the brains were investigated with macroscopic assessment and histologic examination.

RESULTS

Macroscopically, congestion of vessels on the surface of the brain was identified in all the subjects in both groups. Microscopically, the presence of multifocal extravascular red blood cell aggregation was observed in brain parenchyma and subarachnoid space in the upside-down group. In contrast, no leakage of extravascular red blood cells was observed in the brain parenchyma and the subarachnoid space in the horizontal-position group.

CONCLUSIONS

Hypostatic and leakage bleeding can occur in sites of subarachnoid space and brain parenchyma of rabbits after death by nonforce with a certain period and certain position of the placement. This type of hemorrhage is challenging to differentiate from traumatic hemorrhage in pathologic practice. To avoid misdiagnosis, the clinical pathologists should keep in mind that the possibility of postmortem hypostatic hemorrhage needs to be ruled out when the diagnosis of subarachnoid hemorrhage or cerebral hemorrhage is established.

Hemorrhagic lividity of the neck: controlled induction of postmortem hypostatic hemorrhages

Postmortem hypostasis (livor mortis or lividity) is classically defined as the intravascular pooling of blood in gravitationally dependent parts of the body after death. However, intense lividity can be associated with small hemorrhages in the skin, so-called postmortem hypostatic hemorrhages (Tardieu spots). Postmortem hypostatic hemorrhages seem to contradict the usual understanding of lividity, since hemorrhage is by definition an extravascular phenomenon. Substantive medicolegal difficulties can arise if such hemorrhagic lividity develops in the necks of bodies that have ventral lividity due to prone position at the death scene. To study this phenomenon, we have developed a model for the controlled formation of hypostatic hemorrhages in human cadavers. In this model, extensive hypostatic hemorrhages or hemorrhagic lividity could be reproducibly but not universally induced in the soft tissues of the anterior neck and strap muscles. Histologic examination revealed hemorrhage that was microscopically indistinguishable from the acute hemorrhages observed in contusions. In addition, some larger areas of interstitially extravasated blood showed "buffy coat"-sedimentation separation of neutrophils that closely mimicked acute inflammation, further confounding the correct diagnosis. This research implies that hypostatic hemorrhages form after the progressive development of increasing gravitational hydrostatic pressure in an autolysing venous plexus. Thus, this phenomenon can mimic soft tissue injury ("pseudo-bruising") and the internal injuries related to strangulation. Caution must be exercised when diagnosing strangulation in bodies with anterior neck lividity.

Anal submucosal injection: a novel modality for the treatment of advanced rectal cancer

AIMS

To investigate the efficacy of methotrexate (MTX) submucosal anal injection in the treatment of advanced rectal cancer.

METHODS

Thirty-six patients (age 36-66 years; 21 men, 15 women; 20 patients with stage T3N1M0 and 16 with T4N1M1 rectal cancer) were injected with MTX in the anal submucosa. A comparative group of eight patients (age 38-62 years: five men, three women; four with T3N1M0 and four with T4N1M1 rectal cancer) was injected with MTX intravenously. The dose in both groups was 100 mg every 5 days for five consecutive doses and the course was repeated at 3-week intervals. MTX serum and tumour concentrations were estimated 30 and 60 min after MTX injection. The patients received MTX as outpatients.

RESULTS

In the anal group, six of 20 patients with T3 tumour showed complete tumour regression and were alive 28-46 months after the start of the treatment. Partial response occurred in 25 patients: 14 of stage T3 and 11 of T4. The 14 T3 patients underwent combined excision operation and 9/14 were alive 26-68 months from the time of operation. Five of the 16 T4 patients showed tumour and metastatic progression. Mild toxicity occurred in six of 36 patients while the haematological reserve was unchanged in all the patients. All eight patients in the parenteral group showed progress of the malignant lesions under treatment and toxic manifestations were so severe that the treatment had to be interrupted. The MTX concentration in serum was significantly higher after parenteral than after anal injection, while in tumour tissue it was higher after anal administration.

CONCLUSIONS

The results show that MTX submucosal anal injection is effective in treatment of T3 rectal cancer due to high MTX concentration in the tumour. Toxicity was mild owing to low level of serum MTX. The anal route of administration is safe, well tolerated and can be used on an outpatient basis.

Anal submucosal injection: a new route for drug administration. VI. Chronic prostatitis: a new modality of treatment with report of eleven cases

The anal submucosal route was used for the treatment of chronic bacterial prostatitis in 11 patients. Prior to presentation, the patients had received different antimicrobial agents; the symptoms disappeared only to recur whenever the drug was discontinued. After repeated failure, the patients were treated with gentamicin to which the organisms were sensitive, via the anal submucosal route. A daily injection was given for ten days on an outpatient basis. The technique of injection is described. The patients were followed up clinically and by segmented cultures for three years. No anorectal complications were encountered as had been demonstrated experimentally. The symptoms of chronic prostatitis disappeared, and culture was negative by the end of treatment and for two to three years thereafter in all patients. It appears that the antimicrobial agent, via anal route, reaches the prostatic tissues at a higher concentration than that of the serum. The route adopted by the drug to reach the prostate from the anal submucosa is presented.

Anal submucosal injection: a new route for drug administration in pelvic malignancies. IV. Submucosal anal injection in the treatment of cancer of uterine cervix--preliminary study

Seven patients with advanced cancer of the uterine cervix were treated by anal submucosal injection of methotrexate. Each course consists of five injections, one every 5 days; each injection contains 100 mg of methotrexate. The course was repeated at 3-week intervals and was given on an outpatient basis. Investigations were performed before, during, and after treatment. Methotrexate blood level was measured 4 and 24 hours after administration. Complete response occurred in all seven patients. Relapse occurred in four but could be controlled by further methotrexate administration. Average duration of survival is 46 1/2 months. No side effects were encountered as a result of a low methotrexate serum level that was recorded 4 hours after administration, 0.82 mumol after anal injection compared with 2.8 mumol for the intravenous route. The beneficial effect seems to be the result of the high methotrexate concentration in uterine and tumor tissue. The route adopted by the drug to reach the uterus from the anal submucosa is through the hemorrhoidogenital communicating veins. This preliminary study demonstrates that anal injection of methotrexate is effective in the treatment of advanced cancer. It is safe, well tolerated, and can be used as an outpatient treatment.