Panagiotis Kitsoulis

The role of apoptosis in the pathophysiology of Acute Respiratory Distress Syndrome (ARDS): an up-to-date cell-specific review.

ARDS pathophysiology is characterized by complex mechanisms that involve cells of inflammation, lung tissue cells, cytokines, chemokines, as well as apoptosis activators and inhibitors. There are two important theories that link apoptosis with ARDS and suggest that epithelial cell apoptosis, as well as the accumulation of neutrophils in the lung, may contribute to a cascade of events and, finally, ARDS. The activation of the Fas/FasL pathway is an important mechanism of alveolar epithelial injury in the lungs of patients with ALI. In addition, neutrophilic inflammation in the alveolar spaces is characteristic of ALI in humans and in most animal models of ALI. The enhanced phagocytosis of apoptotic neutrophils could lead to resolution of inflammation and repair during ARDS. In this review, we will focus on elucidating the role of apoptosis in the pathophysiology of ARDS and the contribution of Fas-mediated inflammation in ARDS. Furthermore, we will give evidence that TNF-alpha, IL-1beta and IL-13 attenuate the pro-cell death effects of Fas/CD95 on A549 epithelial cells, at least partially, by the NF-kB and PI3-K pathways, suggesting that induction of the expression of antiapoptotic genes protects the epithelial cells from cell death.

Signs and symptoms of temporomandibular joint disorders related to the degree of mouth opening and hearing loss.

BackgroundThe temporomandibular joint is a unique bi-condylar joint involved in mastication and speech. Temporomandibular joint disorders (TMD) have a range of symptoms, including aural symptoms, and are present in approximately 75% of normal populations. The present study examined the relationship between signs and symptoms of TMD and mouth opening, gender, joint and aural symptoms, and hearing loss.MethodsThe study involved 464 healthy Greek university students (156 men and 308 women) with a mean age of 19.6 years. Age, gender and maximum mouth opening was recorded. Mouth opening was measured using Vernier calipers. An anamnestic questionnaire was used to stratify the subjects into four groups based on TMD severity. Aural symptoms and an audiogram were recorded for each subject too. Data were analyzed using multifactor ANOVA, chi-square, t-test, Mann-Whitney and Kruskal-Wallis tests.ResultsThe overall incidence of TMD signs and symptoms was 73.3%. The incidence and severity was greater in females than males (p-value 0.0001 < 0.05). The number of aural symptoms was associated to the TMD severity (p-value 0.0001 < 0.05) as well as maximum mouth opening (p-value 0.004 < 0.05). Audiometry showed that moderate and severe TMD was associated with hearing loss of median and low tones respectively (p-value 0.0001 < 0.05). TMJ pain (p-value 0.0001 < 0.05), TMJ ankylosis (p-value 0.0001 < 0.05), bruxism (p-value 0.0001 < 0.05) and ear itching (p-value 0.0001 < 0.05) were also found to be statistically different between TMD and non-TMD subjects.ConclusionsTMD signs and symptoms were more common and severe in females than males. TMD severity is correlated with the degree of mouth opening and the number of aural symptoms. The absence or presence of mild TMD are associated with normal audiograms while moderate and severe TMD are related to hearing loss in median and low tones respectively. Bruxism, joint ankylosis, joint pain and ear itching were more common in TMD than non-TMD patients.

B-cell differentiation immunophenotypes in classical Hodgkin lymphomas.

The bcl6/CD10/MUM1/CD138 B-cell differentiation immunophenotypes were analysed in 101 cases of classical Hodgkin lymphomas (cHL) aiming to elucidate their histogenesis. Three major bcl6/CD10/MUM1/CD138 immunophenotypes were distinguished on the basis of the immunohistochemical positivity of Hodgkin and Reed-Sternberg (H/RS) cells: (a) the late germinal center (GC)/early post-GC B-cell-like immunophenotype (bcl6−/CD10−/MUM1+/CD138−); 59/101 cases (59%), (b) the post-GC B-cell-like immunophenotype (bcl6−/CD10−/MUM1+/CD138+); 24/101 cases (24%) and (c) the indeterminate immunophenotype (bcl6+/CD10−/MUM1+/CD138−: 14 cases and bcl6+/CD10−/MUM1+/CD138+: four cases); 18/101 cases (18%). The above findings indicate that H/RS cells in most cHL display bcl6/CD10/MUM1/CD138 immunophenotypes consistent with late GC/early post-GC or post-GC B-cell differentiation. In addition, H/RS cells in a small fraction of cHL display indeterminate bcl6/CD10/MUM1/CD138 immunophenotypic profiles which are characterized by simultaneous expression of GC, late GC/early post-GC and post-GC B-cell differentiation proteins. These immunophenotypic profiles do not correspond to the differentiation immunophenotypes of normal B-cells and their identification in a part of cHL suggests that the differentiation process of H/RS cells is not complete in a fraction of these cells and/or is still ongoing at the time of observation.

Sternalis muscle: an underestimated anterior chest wall anatomical variant

Over the recent years, an increased alertness for thorough knowledge of anatomical variants with clinical significance has been recorded in order to minimize the risks of surgical complications. We report a rare case of bilateral strap-like sternalis muscle of the anterior chest wall in a female cadaver. Its presence may evoke alterations in the electrocardiogram or confuse a routine mammography. The incidental finding of a sternalis muscle in mammography, CT, and MRI studies must be documented in a patients medical records as it can be used as a pedicle flap or flap microvascular anastomosis during reconstructive surgery of the anterior chest wall, head and neck, and breast. Moreover, its presence may be misdiagnosed as a wide range of benign and malignant anterior chest wall lesions and tumors.

Variability in superior hypogastric plexus morphology and its clinical applications: a cadaveric study

BackgroundThe superior hypogastric plexus (SHP) that is formed anterior to the aorta and the sacral promontory and is located anterior to the L5–S1 vertebrae, normally continues as the inferior hypogastric plexus. Several variations have been described from a single trunk to a plexiform arrangement.Materials and methodsThe SHP was dissected in 35 formalized cadavers.ResultsA single thin and rounded nerve was found in 17.14% of subjects. The type of a wide reticular formation was observed in 28.57% of specimens. Interestingly, a band-like nerve trunk consisting of nerve bundles connected with loose connective tissue was evident in 22.85% of cadavers. Eventually, two distinct nerves at a short distance with each other were found in 31.44% of subjects. Furthermore, we found that branches of the major and minor splanchnic nerves contributed to SHP constitution. We provided, additionally, the topographic anatomy of the SHP with regard to the sacral promontory and the abdomen midline.ConclusionA detailed knowledge of the course, the morphology, the various forms and the topography of the SHP is of outmost significance for several clinical specialties.

High origin of a testicular artery: a case report and review of the literature

IntroductionAlthough variations in the origin of the testicular artery are not uncommon, few reports about a high origin from the abdominal aorta exist in the literature. We discuss the case of a high origin of the testicular artery, its embryology, classification systems, and its clinical significance.Case presentationWe report a very rare case of high origin of the left testicular artery in a 68-year-old Caucasian male cadaver. The artery originated from the anterolateral aspect of the abdominal aorta, 2 cm cranially to the ipsilateral renal artery. Approximately 1 cm after its origin, it branched off into the inferior suprarenal artery. During its course, the artery crossed anterior to the left renal artery.ConclusionsA knowledge of the variant origin of the testicular artery is important during renal and testicular surgery. The origin and course must be carefully identified in order to preserve normal blood circulation and prevent testicular atrophy. A reduction in gonadal blood flow may lead to varicocele under circumstances. A knowledge of this variant anatomy may be of interest to radiologists and helpful in avoiding diagnostic errors.

A case of eosinophilic granuloma of the skull in an adult man: a case report

Eosinophilic granuloma is very rare benign bone tumor which presents in more than 90% in children under the age of ten. There is predominance for males. It is usually found at flat and long bones. The skull and vertebral spine is often affected. We report a case of 57 year-old man who gradually developed local pain at his skull and orbit. A soft, movable, palpable and tender mass was found at the left temporal bone. The pain deteriorated after an accidental injury at skull and remained so. The clinical examination revealed no pathological findings. The patient was a doctor who smoked and consumed alcohol daily. He had a history of cardial infraction and psoriatic arthritis. X-rays and CT revealed a round lytic defect at the skull. Its borders were sharp and its size was 1.6 × 1.8 cm. No periostic reaction or bone formation was noted. Scintigraphy depicted a lytic lesion without radionuclide enhancement. Thus we suspected an eosinophilic granuloma. An attempt to excise the tumor failed as it had already eroded the underlying temporal bone. The external meninga was affected but not the internal one. Histological diagnosis with dominance of Langerhans cells set the diagnosis. A second surgery was done and the eosinophilic granuloma was extracted. After eight months the gap was bridged with plastic heterologous transplant. After the curettage the patient received antibiotics and five cycles of radiotherapy. The aesthetic result was excellent. The patients head has a normal hairy appearance. No tenderness, swelling or recurrence is recorded until now.Eosinophilic granuloma is of unknown aetiology but uncontrolled proliferation of Langerhans cells, previous inflammations or tumors and autoimmune disorders are suspected. Due to the co-existence of psoriatic arthritis and eosinophilic granuloma to our patient we assume that an autoimmune mechanism is probable.

Accessory muscles in the lower part of the anterior compartment of the arm that may entrap neurovascular elements

The aim of this study was to evaluate the incidence of abnormal muscular bands of the anterior compartment of the arm that may compress the median, the ulnar, and the medial antebrachial cutaneous nerve as well as the brachial artery and vein, thus causing entrapment at and above the elbow. A total of 56 adult cadavers were studied during routine dissections that occurred in our laboratory. In the 112 upper limbs studied, we found three variant muscles of the flexor compartment of the arm (2.68%) entrapping nerves and vessels. The first muscle was emerging from the tendon of long head of biceps brachii and coracobrachialis muscle insertion. The second muscle inserted partially into the belly of biceps brachii and should be considered as a supernumenary head of biceps brachii. The third muscle, in fact, represents an accessory fascicle of the brachialis muscle that is an embryonic remnant of that muscle. A number of structures cross anterior to the median, ulnar, and medial antebrachial cutaneous nerve as well as the brachial artery and vein. Compression of nerves and vessels may be caused by additional muscular bundles that pass anterior to these structures. These additional muscular bundles arise either from the brachialis, coracobrachialis, or biceps brachii muscle. Such variations have clinical implications and should be considered in patients, with a high median or ulnar or medial antebrachial cutaneous nerve paralysis with symptoms of lower brachial artery or brachial vein compression. Clin. Anat. 21: 246–251, 2008.

The accessory deep peroneal nerve: A review of the literature

The accessory deep peroneal nerve (ADPN) is a common variant branch of the superficial peroneal nerve. It unrarely participates in the innervation of the extensor digitorum brevis muscle and interferes with the differential diagnosis of peroneal nerve lesions. Several electrophysiological and anatomical studies have been conducted in order to document the topography, characteristics and prevalence of ADPN, presenting significantly different results. ADPN existence is of great clinical and surgical importance, thus the aim of this study is to select and present all the relevant data available in the literature.

Morphological parameters of the superior articular facets of the atlas and potential clinical significance

BackgroundAlthough remarkable investigations exist in regard to the morphology of the superior articular facets of the atlas in the literature, only a few data exist concerning the correlation of these facets with the age of the specimens.MethodsThe superior articular facets of the atlas were studied in 86 dried vertebrae. Several non-metric parameters were recorded, like presence of notches, grooves, complete or partial dissociation, rough surfaces as well as their morphology.ResultsNo notch was found in 37.2% of the superior articular facets. The incidence of notch is decreased as the age progresses. No transverse groove was found in 24.4% and the presence is increased with the age. The incidence of complete and partial dissociations was also found to be age-related. The incidence of rough surfaces, which corresponds to the site of maximum weight bear, was found to be increased in the old age. We classified the shape of the facets into the following types: oval-shaped, kidney-shaped, S-like, triangle, circular and two portioned.ConclusionsWe assume that the increase of incidence of the dissociation, the rough surfaces, the grooves and the decrease of notches could be possibly the result of a restriction of the atlanto-occipital motion in the old age.