Transforaminal Endoscopic Lumbar Diskectomy versus Open Microdiskectomy for Symptomatic Lumbar Disk Herniation: A Comparative Cohort Study on Costs and Long-Term Outcomes

BACKGROUND

 Transforaminal endoscopic lumbar diskectomy (TELD) is considered an effective treatment for lumbar disk herniation (LDH). There is a paucity of studies comparing in detail the costs and long-term clinical outcomes of TELD and open microdiskectomy (MD), especially in developing countries. Thus, we sought to provide a multidimensional insight into this matter by comparing the direct costs and long-term outcomes of TELD with those of MD.

METHODS

 The electronic health records of 434 patients with LDH who underwent either TELD or MD were collected from February 2011 to October 2014. Within a 7-year follow-up period, 412 patients, comprising 203 patients treated with TELD and 209 patients treated with MD, were fully evaluated. Patient characteristics, operative time, intraoperative blood loss (IBL), postoperative hospital stay, time to return to work (RTW), perioperative complications, and direct costs were collected. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria.

RESULTS

 The postoperative ODI and VAS scores improved significantly in both groups (p < 0.001). In accordance with the modified MacNab criteria, the rate of excellent and good outcomes was 88.67 and 88.03% in the TELD and MD groups, respectively. There were no significant differences between the groups in the clinical outcomes and perioperative complications. However, IBL, hospital stay, and RTW were significantly reduced in the TELD group (p < 0.05). Twenty-one cases in the TELD group and nine in the MD group underwent reoperation due to recurrence (p < 0.05). Total inpatient cost per patient was $1,596 in the TELD group and $1,990 in the MD group (p < 0.05).

CONCLUSION

 TELD for the treatment of symptomatic LDH could be an affordable strategy, providing certain advantages of minimally invasive procedures such as shorter hospital stay and earlier recovery along with comparable clinical outcomes to the conventional surgical method.

Intraparenchymal Schwannoma of Temporal Lobe: A Case Report and Review of the Literature

Intracranial schwannomas (ISs) account for approximately 8% of intracranial tumors, while IS, a rare entity, is responsible for roughly 1% of IS. A 33-year-old man with a 3-month headache and sudden onset seizure was referred to our clinic. Preoperative magnetic resonance imaging revealed a contrast-enhancing mass accompanied by cystic components in the right temporal lobe. Ganglioglioma, metastasis, or glioblastoma multiforme was suspected, and surgery was advised. During surgery, gross total resection of a noninvasive tumor was conducted. Postoperative recovery was uneventful. Based on histopathological examination and confirmatory immunohistochemistry, the intraparenchymal temporal tumor was diagnosed as schwannoma. ISs are extremely scarce brain tumors mainly located on the surface of the brain or adjacent brain ventricles. The definite preoperative diagnosis of schwannoma cannot be readily established due to radiologically indistinguishable features from metastasis and gliomas; however, histopathology and immunohistochemistry are of great assistance. Complete surgical removal is the most preferred treatment alternative with a long-term favorable prognosis without adjuvant and neoadjuvant chemotherapy requirements.

Prevalence and pathological study of Paramphistomum infection in the small intestine of slaughtered ovine

Paramphistomiasis, a trematode infectious disease in ruminants, has been neglected but has recently emerged as an important cause of productivity loss. The small intestine of slaughtered sheep was collected weekly from abattoirs (Kermanshah, Sanandaj, Tabriz and Urmia Slaughterhouses) to monitoring the seasonal occurrence of Paramphistomosis, 2,421 sheep carcasses (743 male (30.69 %) and 1,678 female (69.31 %)) were examined, out of which 0.041 % were positive for Paramphistomum infestation. Furthermore, upon evaluation Paramphistomum termatodes, Gastrothylax crumenifer and Cotylophoron detected as well. Overall, the small intestinal infestation by such parasite was 0.041 % which contained hyperemia, severe congestion and haemorrhage. The highest infection in the sheep infected with Paramphistomum spp. was found during the summer (July to August) (6.7, 2 %) and followed by the autumn seasons (November to October) (3.8, 2.3 %). Microscopic study of the small intestine revealed dilatation of intestinal glands, destruction of superficial glands, replacement of fibrin, diffuse infiltration of inflammatory cells and fibrinonecrotic enteritis. Other changes as congestion hemorrhage and nodules of Ostertagia were observed in total examination of small intestines. According to statistical analysis by SPSS software and Chi square test revealed that there is significant difference between pathologic changes, seasons and ecological situations of the region (p < 0.05). There was no significant difference between age, gender and sample pH of examined sheep (p > 0.05).According to the results of pathologic changes of sheep small intestines, preventive measurements in the area should be taken to decrease the damages, so applying a parasitic control program is recommended.

Cyto-histopathological and outcome features of the prepuce squamous cell carcinoma of a mixed breed dog

Abstract

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Metastatic ovarian papillary cystadenocarcinoma to the small intestine serous surface: report of a case of high-grade histopathologic malignancy

Ovarian cystadenocarcinoma is characterized by marked heterogeneity and may be composed of an admixture of histologic growth patterns, including acinar, papillary and solid. In the present study, a case of isolated small intestine metastasis of ovarian papillary cystadenocarcinoma was reported. A 7-year-old female mixed-breed dog presented with a mass in the left upper quadrant with progressive enlargement of the abdomen, periodic bloody discharge from the vulva and incontinence. The tumor was histologically characterized by the presence of cysts and proliferation of papillae, both lined by single- or multi-layered pleomorphic epithelial cells. Furthermore, the mass was composed by intense cellular and nuclear pleomorphism and numerous mitotic figures. These findings indicate a tumor of high-grade malignancy with infiterative tumor cells resembling the papillary ovarian tumor in the serosal surface of the small intestine along with an intact serosa. Immunohistochemically, tumor was positive for CK7 and negative immunoreactivity for CK20. The histopathologic features coupled with the CK7 immunoreactivity led to a diagnosis of high grade ovarian papillary cystadenocarcinoma. To the best of our knowledge, this is the first case of small intestine serousal surface metastasis from ovarian papillary cystadenocarcinoma.

Neuroprotective effects of Nigella sativa extract on cell death in hippocampal neurons following experimental global cerebral ischemia-reperfusion injury in rats

BACKGROUND

Global cerebral ischemia followed by reperfusion, leads to extensive neuronal damage, particularly the neurons in the hippocampal CA region. Recent studies have demonstrated that pharmacological agents, such as Nigella sativa L. (Ranunculaceae) that is an annual herbaceous flowering plant, given at the time of reperfusion afforded protection against ischemia, which is referred to as pharmacological post conditioning.

OBJECTIVES

The aim of this study was to evaluate the neuroprotective effects of Nigella sativa in the hippocampus neurons of rats exposed to global ischemia/reperfusion.

METHODS

In the present study 30 Wister rats (200-250 g) were divided into 5 groups namely sham (operated without treatment), control (operation with normal saline treatment), and 3 treatment groups with Nigella sativa 1mg/kg, 10mg/kg and 50mg/kg. Firstly, the animals were anesthetized by ketamin and xylazine, and then the right carotid artery was operated upon dissection of the soft tissues around it and ligation by a clamp for 20 min. The Nigella sativa extraction was used during surgery through IP route and after 72 h the animals were euthanized and their brain removed, fixed and prepared for histopathological examinations.

RESULTS

In treatment group (1mg/kg) the interstitial neuron frequency which contains cytoplasmic edema, along with CA, was 28 cells, whereas the edematous astrocyte number along with CA in this group was 115 cells. In the treatment group (10mg/kg) the interstitial neurons of cornua ammonis (CA) were 15 and the edematous astrocytes were 122 cells and in the treatment group (50mg/kg) the number of edematous interstitial neurons was 7 cells in distance of 2900 μ of CA. In such group the number of edematous interstitial neurons was less as well. In this group the appearance of CA cells was more similar to control group, not only the edema decreased in interstitial and astrocyte cells, but it dramatically decreased in pyramidal cells. Our study revealed that the Nigella sativa extraction could prevent intracellular edema of interneurons in 50mg/kg group significantly compared to sham group (91.6%) and the extraction (50mg/kg) decreased edematous astrocytes 67.1% dramatically compared to sham group. Furthermore there was no significant difference between control and two treatment groups (1 and 10mg/kg) (P>0.05), CONCLUSION: Our finding suggested that the N. sativa extraction could prevent the cerebral edema which the best result was obtained in 50mg/kg group; consequently such extraction is able to prevent ischemia/reperfusion in the hippocampus tissue of the brain.

Protective and antidiabetic effects of extract from Nigella sativa on blood glucose concentrations against streptozotocin (STZ)-induced diabetic in rats: an experimental study with histopathological evaluation

Background

Diabetes in humans induces chronic complications such as cardiovascular damage, cataracts and retinopathy, nephropathy and polyneuropathy. The most common animal model of human diabetes is streptozotocin (STZ)-induced diabetes in the rat. The present study investigated the effects of Nigella sativa hydroalcholic extract on glucose concentrations in streptozotocin (STZ) diabetic rats.

Methods

In this study Twenty-five Wister-Albino rats (aged 8-9 weeks and weighing 200-250 g) were tested. Rats were divided into five experimental groups (control, untreated STZ-diabetic (60 mg/kg B.W., IP), treated STZ-diabetic with hydroalcholic extract of Nigella Sativa (NS) (5 mg/kg B.W, IP), treated STZ-diabetic with hydroalcholic extract of NS (10 mg/kg B.W., IP) and treated STZ-diabetic with hydroalcholic extract of NS (20 mg/kg B.W., IP and 32 days were evaluated to assess its effect on fasting blood glucose (FBG), and in different groups fasting blood glucose (FBG) and body weight (BW) were measured in the particular days (1, 16 and 32). At the end of the study, the animals were fasted overnight, anaesthetized with an intraperitoneal injection of sodium pentobarbital (60 mg/kg), and sacrificed for obtaining tissues samples (liver, pancreases). The number of islets and cells were counted and the islet diameters were determined by calibrated micrometer. The glycogen content in the liver was examined by Periodic Acid-Schiff (PAS) staining.

Results

Treatment with NS (5 mg/kg b.w.) markedly increased BW gain and the FBG level was significantly (p<0.001) reduced when compared to the control. Histopathological examination showed that the NS (5 mg/kg b.w.) partially recovered hepatic glycogen content and protected the great deal of the pancreatic islet cells. The number of islets, cells and islets diameter were found statistically significant when compared to the control (p<0.01, p<0.05).

Conclusions

Higher doses of NS did not exhibit any therapeutic effect. These results showed that hydroalcholic extract of NS at low doses has hypoglycemic effect and ameliorative effect on regeneration of pancreatic islets and may be used as a therapeutic agent in the management of diabetes mellitus. The hypoglycemic effect observed could be due to amelioration of β-cell, thus leading to increased insulin levels. Consequently, N. sativa may prove clinically useful in the treatment of diabetics and in the protection of β-cells against streptozotocin.

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Comparative value of clinical, cytological, and histopathological features in feline mammary gland tumors; an experimental model for the study of human breast cancer

Background

The diagnosis of breast lesions is usually confirmed by fine-needle aspiration cytology (FNAC) or histological biopsy. Although there is increasing literature regarding the advantages and limitations of both modalities, there is no literature regarding the accuracy of these modalities for diagnosing breast lesions in high-risk patients, who usually have lesions detected by screening. Moreover, few studies have been published regarding the cytopathology of mammary tumors in cats despite widespread use of the animal model for breast cancer formation and inhibition. The objective of the present study was to evaluate the diagnostic interest of cytological and histopathological analysis in feline mammary tumours (FMTs), in order to evaluate its possible value as an animal model.

Methods

The study was performed in 3 female cats submitted to surgical resections of mammary tumours. The mammary tumours were excised by simple mastectomy or regional mastectomy, with or without the superficial inguinal lymph nodes. Female cats were of different breeds (1 siamese and 2 persians). Before surgical excision of the tumour, FNA cytology was performed using a 0.4 mm diameter needle attached to a 8 ml syringe held in a standard metal syringe holder. The cytological sample was smeared onto a glass slide and either air-dried for May-Grünwald-stain and masses were surgically removed, the tumours were grossly examined and tissue samples were fixed in 10%-buffered-formalin and embedded in paraffin. Sections 4 μm thick were obtained from each sample and H&E stained.

Results

Cytologically, atypical epithelial cells coupled to giant nucleus, chromatin anomalies, mitotic figures, spindle shape cells, anisocytosis with anisokaryosis and hyperchromasia were found. Histologically, these tumors are characterized by pleomorphic and polygonal cell population together with mitotic figures, necrotic foci and various numbers inflammatory foci. Also, spindle shaped cells, haemorrhage localized in the different regions, local invasiveness and enlarged nuclei were observed. The samples included 3 tumors of mammary glands mammary tumors were complex carcinomas (n = 2) and adenocarcinoma (n = 1). The histological grades of the 3 cases were as follows: grade II, (1/3); grade III, (2/3) with high mitotic index. The preferential localization of mammary neoplasms was in the inguinal lobe (1/3 case) and abdominal lobes (2/3 cases). Furthermore, 1case of the inguinal mass affected the left caudo-inguinal lobe and 2cases right cranio and caudo abdominal lobes.

Conclusion

The study concluded that cytology could be used as a quick, rapid, field diagnostic technique in combination with histopathology for the diagnosis of feline mammary tumors (FMTs). Our findings in feline MTs indicate that FMTs could be useful as an animal model of human breast cancer. Moreover, because of the similarity of the cytohistopathological findings in the human and feline mammary gland tumours, it is possible to use the same cytopathological criteria applied in human pathology for the diagnosis of feline mammary gland tumours.

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Diagnosis, classification and grading of canine mammary tumours as a model to study human breast cancer: an Clinico-Cytohistopathological study with environmental factors influencing public health and medicine

BACKGROUND

The human "Elston and Ellis grading method" was utilized in dogs with mammary tumor to examine its relation to prognosis in this species, based on a 2-year follow-up period. Although cytopathology is widely used for early diagnosis of human neoplasms, it is not commonly performed in veterinary medicine. Our objectives in this study were to identify cytopathology criteria of malignancy for canine mammary tumors and the frequency of different types of mammary lesions and their relationship with histologic grade was investigated. Another aim of this study was to differentiate the simple and adenocarcinoma tumors from the complex or mixed tumor described by Elston and Ellis grading method.

METHODS

The study was performed in 15 pure or mixed-breed female dogs submitted to surgical resections of mammary tumours. The mammary tumours were excised by simple mastectomy or regional mastectomy, with or without the superficial inguinal lymph nodes. Female dogs were mainly terriers (9 dogs) or mixed (3 dogs), the 3 other animals were a German shepherd, Dachshund and Pekingese. Before surgical excision of the tumour, FNAC was performed using a 0.6 mm diameter needle attached to a 10 ml syringe held in a standard metal syringe holder. The cytological sample was smeared onto a glass slide and either air-dried for May-Grünwald-stain, or ethanol-fixed for Papanicolaou stain and masses were surgically removed, the tumours were grossly examined and tissue samples were fixed in 10%-buffered-formalin and embedded in paraffin. Sections 4 μm thick were obtained from each sample and H&E stained.

RESULTS

We obtained a correct cytohistological correlation in 14/15 cases (93.3%) when all cytopathological examinations were considered. Of the 15 cases examined, 2(13.3%) had well-differentiated (grade I), 6(40%) had moderately differentiated (grade II) and 7(46.7%) had poorly differentiated (grade III) tumours. Classification of all canine mammary gland lesions revealed 13(86.7%) malignant and 2(13.3%) benign tumors. The histological examination showed that the most common tumor types of mammary glands in bitches were: complex carcinoma, adenocarcinoma, malignant mixed tumour, benign mixed tumour, simple carcinoma- (5/15; 33.3%), (3/15; 20%), (3/15; 20%) and (2/15;13.3%), respectively. Simple carcinoma and cystic hyperplasia were less common - (1/15; 6.7%), and (1/15; 6.7%), respectively. Moreover, the most often tumors occur in inguinal mammary (60%) and abdominal (27%) glands.

CONCLUSIONS

Our results demonstrate that, because of the similarity of the cytohistopathological findings in the human and canine mammary gland tumours, it is possible to use the same cytopathological criteria applied in human pathology for the diagnosis of canine mammary gland tumours. Furthemoer, routine use of this human grading method would help the clinician to make a more accurate prognosis in the interests of post-surgical management in dogs with mammary carcinomas. Furthermore, this research will allow a more discriminating classification of mammary tumors and probably has a bearing on cytohistopathology, epidemiology, pathogenesis and prognosis. The most often tumors occur in inguinal mammary (60%) and abdominal (27%) glands. This interesting regional difference may be due to a) the duration of the growth before the diagnosis; b) the age of the dogs; and c) high prevelance of unspayed animals. Moreover, the most common type of tumor was complex carcinoma - 33.3% (5 cases).

Blood electrolytes changes in peritonitis of cattle

Peritonitis is an inflammation of the peritoneal cavity and is one of the main causes of animal deaths. It has been reported that many diseases such as peritonitis cause electrolyte imbalance in the body. The present study has been conducted to evaluate the serum electrolyte concentration in cattle with peritonitis. In order to perform this study, 45 cattle with peritonitis were selected in the Karaj area, and 20 healthy cattle were used as the control group. After diagnosis of peritonitis in the infected cattle, 10-ml blood samples were taken from the jugular vein, the concentrations of calcium, phosphorus, magnesium, and chloride were estimated using the spectrophotometric method, and sodium and potassium concentrations were assessed by a flame photometer device. The results showed that the concentrations of calcium, magnesium, sodium, potassium, and chloride in cattle affected with peritonitis were reduced compared with the control group, but the differences were not statistically significant. The concentration of phosphorus in the peritonitis-infected cattle was significantly higher than in the healthy cattle. On the basis of the results of the present study, it can be concluded that inflammation of the peritoneal cavity in cattle causes blood electrolyte deterioration, and more attention needs to be focused on this factor in the treatment of infected animals.