Lucia Maria Kliemann

Transvaginal ultrasound ovarian diathermy: sheep as an experimental model

BackgroundSome techniques of transvaginal ovarian drilling have been previously described. Nevertheless a monopolar transvaginal ovarian cauterization, that use the expertise and safety of transvaginal puncture for oocyte captation seems to be an easier and feasible approach. The aim of this study was to develop a minimally invasive ovarian cauterization technique under transvaginal ultrasound control, and to evaluate the safety of the transvaginal ovarian monopolar cauterization, female sheep at reproductive age were used as an experimental model.FindingsAn experimental study was performed in a university research center. Seventeen female sheep (15 Corriedale e 2 Suffolk) in reproductive age were submitted to transvaginal ovarian cauterization with a monopolar Valleylab Force 2 electrocautery. Macroscopic and microscopic lesions were assessed. Ovarian size were 1.31 cm2 ± 0,43 (Corriedale) and 3.41 cm2 ± 0,64 (Suffolk). From 30 ovaries from Corriedale sheep punctured, only 3 were cauterized, presenting macroscopic and typical microscopic lesion. In the Suffolk sheep group, only one ovary was cauterized. No lesion could be found in the needle path.ConclusionsThis is the first experimental animal model described for ovarian cauterization needle guided by transvaginal ultrasound. The sheep does not seem to be the ideal animal model to study this technique. Another animal model, whose ovaries are better identified by transvaginal ultrasound should be sought for this technique, theoretically less invasive, before it could be offered safely to women with polycystic ovary syndrome.

Effects of the gastrin-releasing peptide antagonist RC-3095 in a rat model of ulcerative colitis.

BackgroundRC-3095, a synthetic gastrin-releasing peptide (GRP) antagonist, has been identified as a candidate compound for the treatment of tumor necrosis factor (TNF)-dependent chronic inflammatory conditions.AimThe aim of this study was to evaluate the effects of RC-3095 in a rat model of ulcerative colitis.MethodsNinety Wistar rats were included in the study. Colitis was induced by a single intracolonic application of acetic acid. Rats were divided into three groups of treatment: subcutaneous RC-3095, intracolonic mesalazine, and subcutaneous dexamethasone. Additionally, there was a fourth group of animals submitted to induction of colitis without receiving any form of treatment, and a fifth group in which no colitis was induced. Seventy-two hours after instillation of acetic acid, the animals were killed and the following parameters were assessed: morphological score of damage, histological score of colonic inflammation, and immunohistochemical expression of TNF-α and interleukin (IL)-1β.ResultsRC-3095 was the only treatment to significantly reduce macroscopic and microscopic scores of inflammation as compared with the animals from the non-treated colitis group. RC-3095 also significantly reduced the colonic expression of TNF-α, but not the expression of IL-1β.ConclusionsRC-3095 reduced the colitis severity in a well-established experimental model of IBD. The anti-inflammatory activity of this compound was associated with a reduction in the colonic expression of TNF-α. These results suggest that interference with GRP pathway might represent a potential new strategy for the treatment of ulcerative colitis that deserves further investigational studies.

Minimal cold knife conization height for high-grade cervical squamous intraepithelial lesion treatment.

OBJECTIVES To assess the relationship between cold-knife conization specimen height, cervical intraepithelial neoplasia (CIN II/III) size and endocervical margin involvement by CIN II/II. STUDY DESIGN A cross-sectional study was performed. Cold knife cone specimens with a diagnosis of CIN II/III were selected. Epidemiological data and pathology reports were obtained through a chart review. All samples from each cone specimen showing CIN II/III and the squamocolumnar junction were selected. Cone height (mean ± standard deviation), intraepithelial lesion size, and size of endocervical surgical margins were measured. RESULTS Four hundred and forty-seven samples were analyzed from 97 cone specimens. Section size ranged from 3.4 to 29.7 mm, tumor size from 0.3 to 17.5mm, and tumor distance from the endocervical margin, from 0.0 to 22.0mm. Age and parity were similar in the positive vs. negative margin groups (37.6 ± 10.0 years vs. 37.7 ± 11.9 years respectively, p=0.952, and 2.2 ± 1.7 births vs. 2.6 ± 1.9 births respectively, p=0.804), whereas cone height (22.4 ± 6.9 mm vs. 17.1 ± 5.6mm, p=0.013) and tumor size (6.12 ± 3.25 mm vs. 10.6 ± 4.45 mm, p<0.001) were significantly different in negative vs. positive margin groups respectively. CONCLUSIONS Use of cone height to identify the likelihood of negative margins enables better estimation of the risk-benefit ratio of greater risks of bleeding, stenosis, and obstetric complications (cervical incompetence) versus greater risks of residual and recurrent disease.

An experimental model of chronic rhinosinusitis in rabbits without bacterial inoculation

PURPOSE Evaluate and compare two different experimental techniques of maxillary sinus ostium occlusion using N-butyl cyanoacrylate in developing chronic histological findings without the inoculation of pathogenic bacteria among rabbits. METHODS In a randomized study, sixteen New Zealand rabbits were assigned for occlusion of the right maxillary sinus through a transmaxillary approach or through the roof of the nasal cavity. The contralateral sinus served as a control. After 12 weeks, the animals were sacrificed for blinded histopathological analysis of the maxillary sinus mucosa. RESULTS Histopathological changes consistent with CRS were found in eight (100%) of the maxillary sinuses approached transmaxillary and three of those through the roof of the nasal cavity (37.5%), p 0.008 and 0.250, respectively, comparing with the control side. Chronic mucosal changes were significantly better induced using the transmaxillary approach (p 0.026). CONCLUSION It is possible to induce a model of chronic sinusitis among rabbits with transmaxillary sinus occlusion without bacterial inoculation. This model can be replicated for future cellular studies.

Optical coherence tomography image in gelatinous drop-like corneal dystrophy: case report

Gelatinous drop-like corneal dystrophy is a rare disorder with few cases described in the present literature. The following report will show how difficult it is to diagnose this disease in early stages. Modern image exams, such as optical coherence tomography helps to diagnose and can be crucial to establish the best treatment. We will present the histopathological changes and clinical features in this unusual dystrophy.

Analysis of the effects of topical renal hypothermia on lung tissue after kidney ischemia and reperfusion in rats

PURPOSE To evaluate whether topical renal hypothermia (TRH) at different levels of temperature has protective effects on lung tissue after renal I/R, through an analysis of organ histology and inflammatory markers in lung tissue. METHODS Twenty-eight male Wistar rats were randomly allocated across four groups and subjected to renal ischemia at different levels of topical renal temperature: normothermia (no cooling, 37°C), mild hypothermia (26°C), moderate hypothermia (15°C), and deep hypothermia (4°C). To induce I/R, the vessels supplying the left kidney of each animal were clamped for 40 minutes, followed by reperfusion. After four hours, another procedure was performed to harvest the tissues of interest. TNF-α, IL-1β and myeloperoxidase activity were measured in lung tissue. Histological analysis was performed in hematoxylin and eosin-stained lung specimens. RESULTS Induction of renal I/R under deep topical hypothermia resulted in a significant decrease in lung concentrations of TNF-α compared with normothermic I/R (p<0.05). A trend toward significant correlation was found between lung IL-1β concentration and intensity of hypothermia (Spearman r=-0.37; p=0.055). No difference was found in myeloperoxidase activity or histologic injury between groups. CONCLUSION Topical renal hypothermia reduces activation of the inflammatory cascade in the lung parenchyma. However, tissue-protective effects were not observed.

Experimental histopathological study on retinal and renal cellular response to intravitreous antiangiogenic drugs

AIM To evaluate histopathological retinal and renal response after one single dose of intravitreous injection of antiangiogenic drugs ranibizumab and bevacizumab in rats. METHODS Experimental study in 60d of life adults Wistar rats. Ten animals were included. Group 1 included 5 animals that were injected with 1 µL ranibizumab 1.25 mg in the right eye and with 1 µL of balanced salt solution (BSS) in the left eye, as control; Group 2 included 5 animals that were injected with 1 µL of bevacizumab in the right eye and with 1 µL of BSS in the fellow eye. All injections were performed with Hamilton syringes. After 15d of the interventions, all animals were sacrificed in CO2 chamber. Both eyes were enucleated and one kidney was removed, fixed and embedded in paraffin for histopathological analysis by optic microscopy. For statistical purposes the initial expected abnormal histopathological responses were defined as 0%. RESULTS Atypical histopathological retinal response was detected in 2 eyes injected with ranibizumab (40%) as well as in 2 control eyes in group 1. Same was detected in 1 eye injected with bevacizumab (20%) as well as in 1 control eye, in group 2. The noted atypical findings were lymphocytes and eosinophils in the vitreous posterior cavity and mild retinal inflammatory reaction with ganglion cell layer edema but without clinical significance. No atypical histopathological renal response was detected. CONCLUSION Unexpected atypical histopathological retinal response without clinical significance was observed in 3 eyes injected with antiangiogenic drugs (2 in group 1 and 1 in group 2) as well as in 3 control eyes (2 in group 1 and 1 in group 2). No atypical renal response was detected suggesting no extra ocular involvement of the intravitreous injected antiangiogenic drugs.

Which mode and potency of electrocoagulation yields the Smallest Unobstructed Area of the Fallopian Tubes

OBJECTIVE  To determine which mode and potency of electrocoagulation, using a modern electrosurgical generator, yields the smallest unobstructed area of the Fallopian tubes. METHODS  In an experimental study, tubes from 48 hysterectomies or tubal ligation were evaluated. Tubes were randomly allocated to one of the following groups: group A) 25 W x 5 seconds (n = 17); group B) 30 W x 5 seconds (n = 17); group C) 35 W x 5 seconds (n = 18), group D) 40 W x 5 seconds (n = 20); group E) 40 W x 5 seconds with visual inspection (blanch, swells, collapse) (n = 16); group F) 50 W x 5 seconds (n = 8). Bipolar electrocoagulation was performed in groups A to E, and monopolar electrocoagulation was performed in group F. Coagulation mode was used in all groups. Digital photomicrography of the transversal histological sections of the isthmic segment of the Fallopian tube were taken, and the median percentage of unobstructed luminal area (mm2) was measured with ImageJ software (ImageJ, National Institutes of Health, Bethesda, MD, USA). The Kruskal-Wallis test or analysis of variance (ANOVA) was used for statistical analysis. RESULTS  Ninety-six Fallopian tube sections were analyzed. The smallest median occluded area (%; range) of the Fallopian tube was obtained in the group with 40 W with visual inspection (8.3%; 0.9-40%), followed by the groups 25 W (9.1%; 0-35.9%), 40 W (14.2; 0.9-43.2%), 30 W (14.2; 0.9-49.7%), 35 W (15.1; 3-46.4%) and 50 W (38.2; 3.1-51%). No statistically significant difference was found among groups (p = 0.09, Kruskal-Wallis test). CONCLUSION  The smallest unobstructed area was obtained with power setting at 40 W with visual inspection using a modern electrosurgical generator. However, no statistically significant difference in the unobstructed area was observed among the groups using these different modes and potencies.

Antifungal Susceptibility, Morphological and Molecular Characterization of Lasiodiplodia theobromae Isolated from a Patient with Keratitis

Lasiodiplodia theobromae is a rare ocular pathogen. We report a patient with fungal keratitis caused by L. theobromae. The patient was a 75-year-old male, a farmer with diabetes type II, and no previous history of ocular trauma. Histopathology analysis revealed the presence fungi invading Descemet’s membrane of the cornea. The fungus was characterized by septate, highly bulged fungal filaments involving full corneal thickness in the corresponding histopathology specimens. A dematiaceous mold was isolated and initally identified as L. theobromae by microscopic and macroscopic morphology, and further confirmed by PCR-based determination of internal transcribed spacer (ITS) regions of ribosomal DNA. Antifungal susceptibility tests showed sensitivity to amphotericin B (AMB) and voriconazole ( VRC), and resistance to other azoles, including itraconazole (ITC) and fluconazole (FLC). Corneal transplant was performed. Despite in vitro itraconazole resistance, the patient was successfully treated with oral itraconazole, topical voriconazole and natamycin, combined with ocular injections of amphotericin B and voriconazole.

Agreement Between Preoperative Endometrial Sampling and Surgical Specimen Findings in Endometrial Carcinoma

Objectives The aims of the study were to evaluate agreement between preoperative endometrial samples and surgical specimens in endometrial carcinoma and to correlate this agreement with sample and patient characteristics. Methods Patients who received primary surgical treatment for endometrial carcinoma at a tertiary care center and had undergone preoperative endometrial sampling were included. Medical records were reviewed to collect information from pathology reports and data on patient characteristics. Results The study sample comprised 166 patients (mean age, 64.6 years). The histological results of the biopsies were the following: endometrioid cancer (n = 118), nonendometrioid tumor (n = 38), and hyperplasia (n = 10). The agreement rates were 93.2% for endometrioid and 68.9% for nonendometrioid tumors, with a &kgr; coefficient of 0.73 for tumor cell type. Tumor International Federation of Gynecology and Obstetrics (FIGO) grade was distributed as follows: 37.1% G1, 35.7% G2, and 27.1% G3, with agreement rates of 61.5%, 56%, and 78.9%, respectively. The overall &kgr; coefficient for FIGO grading was 0.46. Only 1.9% of the tumors originally classified as G1 were upgraded to G3, whereas 16% of G2 lesions were upgraded. There was no significant difference in agreement rates for tumor cell type and FIGO grade in relation to any of the studied variables, except that biopsy specimens weighing more than 3 g had significantly better agreement in FIGO grading (P = 0.040). Conclusions Preoperative biopsy has suboptimal accuracy for prediction of characteristics in the definitive surgical specimen. Caution must be taken when using preoperative information to determine extent of surgical resection, due to the risk of understaging. Additional information must be combined with the biopsy data to help in the decision-making process.