[Successful surgical removal of a cardiac myxoma from the left ventricular outflow tract]

The precondition for successful, exclusively surgical treatment in the extracorporeal circulation, is the precise diagnosis of heart myxoma, particularly in rare locations such as the left ventricle. We present a case of myxoma in the outflow tract of the left ventricle as the exceptionally rare location, successfully diagnosed and surgically treated at the Clinic for Cardiac and Thoracic Surgery of the Military Medical Academy. A female patient, aged 46 years, was sent from another hospital with misdiagnosis of idiopathic hypertrophic subaortic stenosis. The patient was successfully operated after transthoracic and transesophageal echocardiography as the main diagnostic procedures. Myxoma that completely obstructed the aortic opening if pulled, was completely removed through aortic valve in the extracorporeal circulation. Its pedicle was arising from the ventricular side of the great mitral cusp. Postoperative course was uneventful and the patient was released from the hospital on the tenth postoperative day.

[Primary liposarcoma of the pericardium]

A case of primary liposarcoma of the pericardium, an exceptionally rare localization, has been presented. The tumor localized in the region of the left ventricle and connected to the visceral wall of the pericardium was diagnosed in a 38-year old male. Histological, histochemical and immunochemical findings confirmed the diagnosis of the liposarcoma of the pericardium.

[Primary liposarcoma of bone]

A case of 75-year-old man with extremely rare primary liposarcoma of the bone was presented. Stains for lipid, Sudan III, Sudan IV, and Oil Red "O", demonstrated the presence of intracellular lipid in the lipoblasts. Similarly, the S-100 immunoreactivity and electron microscopic findings of tumor cells confirmed the diagnosis of liposarcoma. Histochemical stains for PAS, Alcian-blue, mucikarmin, Toluidin-blue and Coloidal Iron were negative.

[Ameloblastic fibro-odontoma]

Ameloblastic fibro-odontoma is a rare malformation which is classified in group of odontomas, such as simplex and compound odontomas. A lesion usually develops asymptomatically in the first or the second decade of life, near the non-erupted or displaced tooth, consisting of numerous small tooth-like components. This is a case report of a 10 years old boy with tumor-like lesion in the angle of mandibula in whom was confirmed ameloblastic fibroodontoma after the operation and histological examination. Considering the growth potential and its clinical features, ameloblastic fibroodontoma requires adequate surgical treatment.

[Histopathologic changes in the skin of transplanted microvascular flaps]

During the microvascular transfer, the free flaps tissue is exposed to series of pathophysiological changes (tissue anoxia, tissue acidosis, anaerobic metabolism, wound healing and cicatrisation, degeneration of nerves fibers in the free flaps tissue, etc.) In 1993-1998 period, at the Clinic for Plastic Surgery and Burns at the Military Medical Academy, we analyzed histopathologic changes in the skin taken from the transferred flaps and from the recipient region surroundings of 31 patients with microvascular tissue transfer. The bioptic materials were taken between 6 and 36 months following the free tissue transfer--average 23.6 months. By light microscopy we analyzed histopathologic changes of the epidermis, collagen's fibers, skin adnexa, blood vessels and nerve fibers. The data obtained showed considerable difference in the histopathology test results of the epidermis, collagen's fibers, the skin adnex and the nerve fibers in the transferred free flaps compared to the results obtained from testing recipient region surroundings. The histopathologic tests of the blood vessels did not show considerable comparative difference.

[Myositis ossificans in recurrent synovial hemangioma of the knee]

A case of myositis ossificans in 15-year old boy that occurred as a complication of the recurrent synovia hemangioma of the left knee was presented. The alteration was diagnosed as: osteosarcoma, chondrosarcoma and chondromyxoid fibroma by the pathologists from other institutions. The diagnosis of myositis ossificans was established using numerous histochemical and immunochemical methods (PAS, PAS diastasis, Alcian blue, Masson trichrom, von Kossa, Azur A, Toluidin blue, Goldner, method by Peris, Citokeratin, S-100, NSE and Vimentin). The presence of zonal phenomenon, as the one observed in the presented case, is one of the most significant criteria for differentiation of myositis ossificans from osteosarcoma.

[Ochronosis--an autopsy case report]

The authors have presented a case of ochronosis, as the incidental finding during the autopsy of a female patient, aged 59 years. It was the case of suicidal drug poisoning. Ochronosis is a rare disease, with chronic benign course, but frequently followed by complications. Histopathological criteria for the diagnosis of this disease are described in detail.

[Pigmented villonodular synovitis--analysis of 50 patients]

Fifty patients with pigmented villonodular synovitis (PVNS) were examined and treated in the Military Medical Academy in twenty-year period (1977-1996). Among them, 32 were male and 18 female (2:1), of average age from 6 to 72 years. Articular disease localization was 2.5 times more frequent compared to the non-articular. The rate of circumscribed in relation to diffuse form was 1.5:1. The ankle joint was most frequently involved (94%). In one patient, PVNS was proved in both ankle joints. The disease was clinically expressed as chronic, and 4 times more frequently as chronic recurrent synovitis. The data of previous injury were known in 14 patients. Associated rheumatic disease or injury was found in more than a half patients (53%). For the disease diagnosis there were used: physical examination, standard laboratory tests, radiography, ultrasonographic and magnet resonance examination and histopathologic examination of synovia obtained by open or arthroscopic biopsy. Surgical methods, such as total or partial synovectomy were applied in the therapy. Chemical synovectomy was performed in one patient, 6 months after the diagnostic arthroscopy due to disease recurrence. Therapeutic effect was estimated in 22 patients, from 3 months to 11 years after the surgery on the basis of disease recurrence. Except for the cited one patient, none other had the disease recurrence. It was concluded that timely diagnosis of PVNS offered more adequate treatment and conditions for complete recovery. In the disease limited just in the ankle joint, arthroscopic synovectomy would be the therapy of choice. In advanced diffuse form, total synovectomy should be performed for all the disease localizations.

Morphologic characteristics of primary nonperforative intestinal blast injuries in rats and their evolution to secondary perforations

Five hundred and fifty Wistar rats were investigated to determine the frequency of secondary intestinal perforations after exposure to nonperforating blasts and the evolution of the morphological changes from hematoma through to necrosis and gangrene. The animals were observed at different times for a period of 14 days from the moment that the injury was inflicted. Microscopic findings showed that alterations began in the mucosal layer where they were most extensive, then spread to the submucosal layer, muscular layer, and serosal layer, respectively. Examination of the intestinal wall revealed an evolution of the injury from hematoma to necrosis to gangrene, resulting in secondary intestinal perforation. The secondary wounds had centrifugal patterns, opposite those of the original wound pathways. Based on these observations, the mechanism of evolution of primary nonperforating intestinal blast injury into secondary intestinal perforations is presented.

Morphological analysis of saphenous vein used for aortocoronary graft

Histological, histochemical, immunohistochemical and ultrastructural analyses of 120 saphenous veins (of 120 patients) prepared for aortocoronary graft, revealed in 57 cases lesser or larger morphological changes, such as endothelial damage, hyperplasia of t. intima, or t. media, and fibrosis of t. adventitia that could be the result of postoperative complications (thrombosis of the graft lumen, or its occlusion due to progressive hyperplasia of t. intima). The analyses have proved significantly increased number of smooth muscle cells and fibroblasts in t. intima of the damaged veins in relation to t. media, contrary to the findings in normal veins, and it was suggested that these smooth muscle cells in the damaged veins migrated from t. media to t. intima causing hyperplasia, as was confirmed by histochemical, immunohistochemical and ultrastructural findings. Since in 57 of 120 analyzed veins morphological changes were found which developed before the implantation of vein and which could compromise the vein function as the aortocoronary graft and cause severe postoperative complications, forming of vein banks is recommended from the chosen donors to avoid vein implantation with the already existent morphological changes, that could be proven by their immediate histological examination.

Histopathological evaluation of the carbon fibers application for the substitution of the anterior cruciate ligament--an experimental study on dogs

The application of allograft-carbon fibers on the experimental group of 15 dogs (German Shepherd race) was histopathologically investigated after the artificial lesion of anterior cruciate ligament (ACL). In definite time intervals (1, 2, 4, 6 months) pathoanatomic and histopathologic findings were analyzed and the proliferation of new connective tissue of predominantly elastic type, between carbon fibers was observed. Beside the lymphocyte infiltration around torn carbon fibers giant cells of a foreign body type were found, and on the surface the epithelium similar to synovial was observed. It was concluded that carbon fibers could not be considered as the ideal artificial ligament.

The use of autografts and synthetic carbon fibers in reconstruction of the anterior cruciate ligament--an experimental study on dogs

Biological characteristics and strength of the anterior cruciate ligament (ACL) after replacement by an artificial carbon fibers ligament--(group 1) and autograft--fascia lata (group 2) were investigated. These two methods were compared in four periods of time by means of clinical course, laboratory parameters, histopathological analysis and biomechanical testing on an Instron apparatus. Strength of neoligament in both examined groups has never achieved the strength of natural, unaffected ACL, and there was no significant difference between two observed groups in relation to clinical and laboratory parameters. Histopathological examination showed the presence of ingrowing of the connective tissue between carbon fibers, but in bone tunnels inside the fibers there was no ingrowing between bone trabeculae. In the group 2, collagenic fibers of the fascia lata were substituted with predominantly elastic connective tissue, with epithelium, similar to synovial, on the surface. No absolute superiority of carbon fibers to fascia lata as a substituent of the anterior cruciate ligament of a dog knee, as an experimental analog, was proved in this study.

[Anatomic characteristics and clinical signs of congenital anomalies in the circle of Willis]

Anatomical characteristics and clinical importance of congenital anomalies of cerebral arteries were examined based on the results obtained by dissection of the circle of Willis blood vessels of 70 native cadaveric brains. Anomalies were most frequently found in posterior communicant artery and their most frequent type was hypoplasia of the blood vessel. Multiple anomalies of the circle of Willis were found in 3 cadavers. Premortal neurological symptomatology (PNS) existed in 5 cadavers. There was no significant difference in PNS occurrence at autopsy in cases with or without anomalies. Association of aneurisms with anomalies of the circle of Willis was found in two cases, but it was not significant in comparison to the control group with no anomalies.

[Immediate results of surgical treatment of intracardiac myxomas in 45 patients]

Between 1961 and 1992, 45 patients with intracardiac myxomas localised in the left ventricle--40 (89%) and in the right ventricle--5 (11%) were operated on. There were 27 women and 18 men, aged 15-63, mean age, 46.5 years. Three patients were asymptomatic while in other dominated different degree of malfunction of the corresponding atrioventricular valve, mainly with dominant symptoms and signs of stenosis. In 5 patients (11%) myxoma of the left atrium was in question together with systemic embolization. The diagnosis was established both by invasive and noninvasive methods and the method of choice, very reliable and easy, has proved to be echocardiography. All patients were operated on with the use of the total cardiopulmonary bypass and induced heart arrest. The histologic verification of all excised myxomas was performed. Three early deaths occurred (6.6%), while in other patients no postoperative complications developed. It has been concluded that echocardiography is very safe diagnostic procedure and results of surgical treatment are very good.

[Hemangiopericytoma of the lungs]

Six patients, three women and 3 men with lung hemangiopericytoma treated at the Military Medical Academy in the period 1971-1991 are reported. The youngest patient was 20 years, the oldest 69 years. Surgical treatment was performed in all patients, 3 lobectomies, one bilobectomy, one wedge resection and one extirpation. Multiple hemangiopericytoma was found in one patient which consisted of three separate tumours in the right lung. The other had solitary lesions. Malignant hemangiopericytoma, was found in 4 patients, one of them had metastases in the mediastinal lymphatic glands. Four patients are alive and are under control for nine years in the average without signs of recurrence.

[Analysis of intracranial aneurysms from autopsy material]

The analysis of 44 intracranial aneurysms found at 7.687 autopsies is performed. The largest number of aneurysms was of congenital (secular) type, then, of arteriosclerotic type while inflammatory and traumatic aneurysms were very rare. The elastic and reticular fibres in the aneurysmal wall and the normal arteries of the base of the brain were identified by a standard and special staining. Significantly decreased quantity and disturbed distribution of the reticular fibres were found in the congenital aneurysms which was considered to be a consequence of degenerative processes. The finding of the preserved elastic internal lamina in the wall of the congenital aneurysm and its absence or fragmentation in cases of arteriosclerotic aneurysms suggest the different etiology and pathogenesis of these aneurysms.

[Ultrastructural changes in the dermal blood vessels in patients with psoriasis]

The ultrastructural analysis of psoriatic dermal lesions has shown the alteration of the dermal arterioles into specialized postcapillary venules, the so called high endothelial venules (HEV) which are characterized by the presence of tannic acid staining materials (TASM) located among the endothelial cells. This type of venules seen in the lymphatic nodes and other lymphoid organs is considered to be an important site of lymphocyte recirculation. Similar venules are seen in the lymphatic nodes too. In correlation with the immunologic evidences in the lymphoid tissues and in psoriasis most probably in question are the identical surface antigen-lymphocyte receptors on the HVE which support selective binding of the definite subset of lymphocytes and migration from blood to tissues.

[Malignant fibrous histiocytoma of the bone]

Five cases of malignant bone fibrous histiocytoma diagnosed by bioptic material are presented. The authors state that the diagnosis of these rare bone malignant neoplasms do not present a larger diagnostical problem. However, some differential diagnostic problems are often met compared to other bone neoplasms, especially in osteosarcoma, so in these cases are recommended that together with routine histologic examinations in establishment of diagnosis should be also used enzymohistochemical methods, especially alkaline and acid phosphatase. Also, it is necessary to use immunohistochemical methods with corresponding markers which the authors have used in establishment of diagnosis of their cases. Based on the analysis of the presented cases the authors support the theory of J. Brooks on the histogenesis of these tumours within his theory of differentiation of the mesenchimal tissue which is easily recognized in recidives and metastases of soft tissue sarcomas by phenotypes organized at the lower level of differentiation.

[Similarities in morphologic changes in heart valves in acquired heart defects of noninflammatory etiology and in damaged menisci without a history of trauma]

Histologic, histochemical and ultrastructural analyses were performed of the leaflets of all four heart valves in 50 subjects with acquired heart defects of noninflammatory etiology and 88 surgically removed damaged menisci without trauma anamnesis. On the basis of the detailed analysis some morphologic similarities were found in the heart valves and menisci such as myxomatous degeneration as the main pathologic lesion, lack of blood vessels in the altered tissues which point to noninflammatory nature of the lesion, similarity in nourishment by diffusion, degradation of the collagenous fibres which present the main histologic structure and the increased accumulation of acid mucopolysacharrides at the site of their degradation as well as the increased number of fibroblasts, that is, chondroid cells which are considered to excrete acid mucopolysacharrides. Sometimes these changes are hardly identify clinically, especially in meniscal diseases which could simulate rheumatic disease.

[Tuberculous inflammation of the synovial membrane]

Four patients with tuberculous synovitis of the large joints are reported in whom primary tuberculous process has not been confirmed as a possible foci of spreading of the acidoresistant bacilli. The authors, describing in details the histologic picture of tuberculous synovitis, point out the importance of an early biopsy of the synovial membrane and obligatory microbiological confirmation of the established diagnosis.

[Hürthle cell carcinoma of the thyroid gland]

The authors have analysed 9 cases of Hürthle cell thyroid carcinoma diagnosed on the bioptic material in the period 1975-1991. In 7 patients subtotal and in 2 total thyroidectomy was performed. In one patient only signs of metastases of the tumour in the region of the mediastinum, neck lymphatic nodes and brain developed and the patient died a year after surgery. For differential diagnosis of Hürthle cell thyroid carcinoma and Hürthle cell adenoma the authors recommend as necessary that beside the presence of the basic criteria for malignancy (infiltration of the capsule and adjacent tissue, invasion of the blood vessels, pleomorphism and pathologic mytoses) the electron microscopic examination and immunohistochemical methods should be also used which could be of a great help for establishment of a correct diagnosis on which depends further therapy as well.

[Morphologic changes in the valves in acquired heart defects]

The histologic, histochemical and ultrastructural changes of the leaflet tissue of all four cardiac valves obtained by biopsy and autopsy have been studied in 50 patients with acquired valvular defects. The anamnesis confirmed the presence of rheumatic fever in 16 patients and negated it in 34 patients. In all analysed leaflets of all four cardiac valves organic changes were found which were the cause of their dysfunction. The analysis has shown that rheumatic fever does not play a dominant role in development of acquired valvular disease as it has been thought previously. However, degenerative changes were most commonly found being of unknown etiology up to now. The morphological changes of valvular tissue in the patients suffering from rheumatic fever differ from those who did not suffer from it. Vascularization, fibrosis and hyalinization of the connective tissue with fibroelastic densities predominated in patients suffering from rheumatic fever while myxomatous degeneration of valvular tissue predominated in those who did not suffer from it. Different morphological parameters indicate the different etiopathogenesis of these diseases.

[Intraosseous schwannoma]

Neurogenic tumors, primary bone tumors, are rather exceptional; about 50 cases have been reported so far. The study reports a case of intraosseous schwannoma, a primary bone tumor, in a 20-year-old male patient, localized in the distal end of the right tibia.

[Morphologic damage in internal organs in miners caused by explosions of methane gas in mines]

Four cases of blast injuries in miners caused by methane explosion in the mine are described. In all cases besides burns, changes in tissues and organs, according to their microscopic and macroscopic characteristics, corresponded to blast type injuries described in the literature.

[Morphologic changes in the tissues and organs of sheep in blast injuries caused by detonation of aerosol explosives]

The morphologic changes of the tissues and organs of sheep caused by effects of the overpressure wave due to the detonation of the aerosol explosive in the open air are analysed. The experiments were performed on 21 sheep of which 3 served as the control. All animals were autopsized and organ samples were taken for analysis. The most impressive pathologic changes were found in the upper respiratory ways and lungs in the form of massive haemorrhage, edema and emphysema as well as numerous and severe intraabdominal changes both of the air-containing and parenchymatous organs.

[Morphologic characteristics of persons killed in armored vehicles]

The authors have analysed macroscopic and microscopic changes in tissues and organs of 8 members of the Y.P.A. killed by granate explosion in the armoured vehicles. In all the analysed cases multiple mechanic injuries were found as well as combined mechanothermal injuries. Injuries caused by the blast wave were mainly found in the internal air-containing organs and three cases of solid blast injury were described too.

[Pathophysiologic reactions in sheep to blast waves from detonation of aerosol explosives]

In the controlled field experiments 18 sheep were exposed to the detonation of the aerosol explosive generating the blast wave necessary to produce death in 50% of cases. The time of death and characteristic damages on the predilection sites of some organs are interpreted as blast type injuries. General response of the body to blast wave was similar to the one produced by other etiological factors. A special characteristic of the experiment was the frequency and severity of pathologic changes on the internal organs of the chest and abdomen. According to the authors' opinion the severity and type of pathologic changes could be explained by effects of the complex blast wave generated by detonation of the aerosol explosives.

[Morphologic characteristics of surgically removed menisci]

The authors have analysed histologically and histochemically 88 surgically removed damaged menisci of which 8 were studied by the electron microscope. Of the total number of the analysed cases only 20 had the anamnesis specific for meniscus trauma while in the rest meniscus was damaged spontaneously. The age of the operated patients ranged from 16 to 50 years, the majority being from 20 to 25 years old. The authors have reported that the morphological examinations of the damaged menisci have shown that the main cause of the ruptured menisci was destruction of the collagenous fibres of the menisci and severe mucoid degeneration of their tissues with the increasing number of the elastic fibres at the site of the destructed collagenous fibres. The histochemical examinations have shown that the basic meniscus substance contains chodroitin sulfate mucopolysaccharides which, according to their opinion, were secreted by the choindroid cells.