Immunohistochemical and electron microscopic morphometric image analysis of hepatocellular carcinoma in association of HCV infection

Early detection of hepatocellular carcinoma (HCC) is crucial for successful therapy. The present work examined the value of ultrastructural morphometric image analysis of hepatocyte nuclei in patients with chronic hepatitis C virus (HCV) versus HCC cases with chronic HCV and the corresponding surgical tumor-free safe margins (TFMs), to highlight any early predictive signs of neoplastic cellular transformation. This work also performed an immunohistochemical assessment of cytokeratin 19 (CK19) and Ki-67-positive cells to visualize any associated proliferative activity in the examined groups. The results showed significant decrease in the hepatocyte nuclear surface areas in the HCC and TFMs versus those in the HCV cases. The hepatocyte nucleolar surface area was significantly increased in the HCC cases versus that in the HCV cases. This increase was associated with a significant increase in Ki-67-positive cells in the HCC cases compared to those in the other groups. Conversely, the mean number of CK 19-positive cells was significantly reduced in the HCC cases compared to the cell numbers in TFMs and HCV cases with severe hepatic fibrosis. Liver progenitor cells (LPCs) were discerned in the reactive ductules and canaliculo-ductular junctions that characterized TFMs. LPCs were sporadically distributed in the liver lobules and reactive bile ductules in the HCC samples. In conclusion, CK 19 represents an important marker for distinguishing between dysplastic and malignant liver nodules. Electron microscopic morphometric image analysis may be considered as adjunct factor for assessing hepatocyte malignant transformation. Wider scale studies are needed to authenticate these results.

Potential ultrastructure predicting factors for hepatocellular carcinoma in HCV infected patients

Hepatitis C virus represents one of the rising causes of hepatocellular carcinoma (HCC). Although the early diagnosis of HCC is vital for successful curative treatment, the majority of lesions are diagnosed in an irredeemable phase. This work deals with a comparative ultrastructural study of experimentally gradually induced HCC, surgically resected HCC, and potential premalignant lesions from HCV-infected patients, with the prospect to detect cellular criteria denoting premalignant transformation. Among the main detected pathological changes which are postulated to precede frank HCC: failure of normal hepatocyte regeneration with star shape clonal fragmentation, frequent elucidation of hepatic progenitor cells and Hering canals, hepatocytes of different electron density loaded with small sized rounded monotonous mitochondria, increase junctional complexes bordering bile canaliculi and in between hepatocyte membranes, abundant cellular proteinaceous material with hypertrophied or vesiculated rough endoplasmic reticulum (RER), sequestrated nucleus with proteinaceous granular material or hypertrophied RER, formation of lipolysosomes, large autophagosomes, and micro-vesicular fat deposition. In conclusion, the present work has visualized new hepatocytic division or regenerative process that mimic splitting or clonal fragmentation that occurs in primitive creature. Also, new observations that may be of value or assist in predicting HCC and identifying the appropriate patient for surveillance have been reported. Moreover, it has pointed to the possible malignant potentiality of liver stem/progenitor cells. For reliability, the results can be subjected to cohort longitudinal study.

Management of pilonidal sinus using fibrin glue: a new concept and preliminary experience

BACKGROUND

There is a multiplicity of treatment techniques described for pilonidal sinus. However none of the methods has emerged as being superior to the others. A ideal treatment should be simple, lead to minimal disability and a rapid return to normal activity. We present the preliminary finding an operative technique using fibrin glue in patents with pilonidal sinus.

PATIENTS AND METHODS

The study was carried out in the surgical unit of the Armed Forces Hospital, Khamis Mushayt, Kingdom of Saudi Arabia. From September 2001 to February 2004, 25 consecutive patients with primary pilonidal sinus, were prospectively submitted to tension free excision and fibrin glue injection under local anaesthesia as day surgery cases. There were 23 males and 2 females with a mean age of 26.4 years (range 17-50 years). The data recorded included the duration of the disease symptoms, operative time, duration of hospital stay, postoperative analgesia, and return to work. All excised specimens were sent to histopathology. The postoperative disability and the social disruption were evaluated by indirect questions about the ability to drive a car and the position assumed while at home in the outpatient follow-up.

RESULTS

The mean duration of the symptoms was 15.4 months (range 4-36 months). Mean operative time including local anaesthetic time was 19.3 min (range 15-50 min). The mean hospital stay was 7.5 h (range 6-10 h). All patients were discharged home on the day of surgery. Mean follow-up was 10.8 months (range 4-36 months). Primary healing was achieved in 24 (96%) patients within two weeks. One (4%) patient had a breakdown of the fibrin glue and the open wound managed with daily betadine dressings.

CONCLUSION

The management of pilonidal sinus with excision under local anesthesia and application of a fibrin glue is simple and reduces postoperative disability and disruption of patient social life.

Delayed presentation of traumatic rupture of the diaphragm

Diaphragmatic injuries occur frequently after penetrating rather than blunt trauma and account for 8% of all organ injuries from penetrating trauma. Motor vehicle accidents account for approximately 50% of blunt injuries, followed in frequency by falls from height. The mechanism of injury in these accidents is that the body quickly decelerates while the organs continue to move downward or forward at maximal velocity, tearing vessels and tissues from their points of attachment. In this paper we are presenting 3 cases of traumatic diaphragmatic rupture due to motor vehicle accidents and fall from height, in which the diagnosis was delayed. Patient one was initially diagnosed with hemorrhagic pleural fluid for investigation, patient 2 was diagnosed 4 months later and patient 3 presented 7 years after the initial trauma. All were successfully treated surgically once the diagnosis was established.

An unusual case of acute urinary retention in young females

Urinary retention is an unusual problem in females and may be psychogenic, especially in the young. However it is important to remember that there are also organic causes for retention. We present 2 cases of an uncommon cause of urinary retention in the young female, namely hematocolpos.

Trichobezoar: a rare cause of acute bowel obstruction

A surgically successfully treated case of (2.8 kg) Trichobezoar presenting with severe epigastric pain, vomiting, associated with anemia and dark stool of one days duration. Complicated on admission by an acute intestinal obstruction. There has been no report of such a case from Saudi Arabia up to the present time. The presenting symptoms and signs, and management strategies are discussed.