Iatrogenic subcutaneous emphysema – A case report

Subcutaneous tissue emphysema in general terms is defined as an abnormal presence of air under pressure, along or between fascial planes. A sudden blast of air, during an ongoing endodontic treatment or an endodontic surgery can sometimes cause movement of this air through the loose connective tissue layers to distant areas. In case of occurrence of emphysema, the condition should be carefully examined as the entire diagnosis is based merely on clinical examination. The clinician should be aware of the common causes, characteristic diagnostic features, possible complications and the management of the condition. This entrapped air in some cases is self healing and in some cases can lead to serious complications and death. The case report described is a successful management of unintentional and unfortunate tissue emphysema. The case report also emphasis on the importance of timely and accurate diagnosis of the condition.

Automated segmentation by deep learning of loose connective tissue fibers to define safe dissection planes in robot-assisted gastrectomy

The prediction of anatomical structures within the surgical field by artificial intelligence (AI) is expected to support surgeons’ experience and cognitive skills. We aimed to develop a deep-learning model to automatically segment loose connective tissue fibers (LCTFs) that define a safe dissection plane. The annotation was performed on video frames capturing a robot-assisted gastrectomy performed by trained surgeons. A deep-learning model based on U-net was developed to output segmentation results. Twenty randomly sampled frames were provided to evaluate model performance by comparing Recall and F1/Dice scores with a ground truth and with a two-item questionnaire on sensitivity and misrecognition that was completed by 20 surgeons. The model produced high Recall scores (mean 0.606, maximum 0.861). Mean F1/Dice scores reached 0.549 (range 0.335–0.691), showing acceptable spatial overlap of the objects. Surgeon evaluators gave a mean sensitivity score of 3.52 (with 88.0% assigning the highest score of 4; range 2.45–3.95). The mean misrecognition score was a low 0.14 (range 0–0.7), indicating very few acknowledged over-detection failures. Thus, AI can be trained to predict fine, difficult-to-discern anatomical structures at a level convincing to expert surgeons. This technology may help reduce adverse events by determining safe dissection planes.

Approach to Systemic Mastocytosis: A case series.

Mast cells are found in bone marrow, blood, mucosal, and connective tissues. They migrate into the loose connective tissue of all organs. They play a major role in many physiologic processes however as discussed in this article they can become an aggressive force which can damage the natural biological balance

Deep Neck Space Abscess – A Case Report

Deep neck spaces are regions of loose connective tissue present between three layers of deep cervical fascia, namely, superficial, middle, and deep layers. The investing layer is the superficial layer, the pre-tracheal layer is the intermediate layer, and the prevertebral layer is the deep layer. Deep neck space infection (DNI) is defined as an infection in the potential spaces and actual fascial planes of the neck. Spread of infection occurs along communicating fascial boundaries. These deep neck spaces may be further classified into 3 anatomic groups, relative to the hyoid bone: Those located above the level of the hyoid, those that involve the entire length of the neck, those located below the level of hyoid. The patterns of infection may include abscess formation, cellulitis, and necrotizing fasciitis. Antibiotics and surgical drainage form the mainstay of treatment. There are some spaces in the neck present between these layers of deep cervical fascia. These deep neck spaces are filled with loose connective tissue. Deep neck space infection involves the spaces and fascial planes of the neck. Spread of infection occurs along communicating fascial boundaries after overcoming the natural resistance of the fascial planes. With relation to the hyoid bone, these deep neck spaces are further classified as follows: 1. Spaces above the level of the hyoid bone (peritonsillar, submandibular, parapharyngeal, masticator, buccal, and parotid spaces). 2. Spaces that involve the entire length of the neck (retropharyngeal, prevertebral, and carotid spaces). 3. Spaces located below the level of hyoid bone (anterior visceral or pre - tracheal space). Infection may present either as abscess, cellulitis, or necrotizing fasciitis. The mainstay of the management are antibiotics and surgical drainage.

​The Histopathology of Alimentary Canal of Stinging Catfish Heteropneustes fossilis (Bloch, 1794), Susceptible for Trematodes Incursion

Background: Heteropneustes fossilis (Bloch, 1794) is one of the popular freshwater fish known for its food quality and nutritional value. This study was undertaken with an aim to find out histopathological changes in the intestine of freshwater fish Heteropneustes fossilis, host of trematode parasite Masenia vittatusia Agarwal, 1963. Methods: The intestine of uninfected fish used to determine normal anatomy, while infected intestine to determine pathological changes. The normal histological procedure was followed, which included fixing, rinsing, dehydrating and embedding of tissue. Tissue was cut in 4-6 µm thick sections using a rotary microtome. Haematoxylin and eosin stains were used. Result: The highest damage was observed in the mucosal layer with ruptured and fused microvilli, hyperplasia of villi, damaged columnar epithelium layer and spread of loose connective tissue into the lumen. Other degenerative modifications included hypertrophy of blood vessels in mucosa and muscularis part, some of them ruptured might be the cause of haemorrhage inside the layers. Other changes include variation in the routine shape of all three layers. The mucosal layer showed aggregation of lymphocytes and mast cells as well.

Standard of care for lipedema in the United States

Background Lipedema is a loose connective tissue disease predominantly in women identified by increased nodular and fibrotic adipose tissue on the buttocks, hips and limbs that develops at times of hormone, weight and shape change including puberty, pregnancy, and menopause. Lipedema tissue may be very painful and can severely impair mobility. Non-lipedema obesity, lymphedema, venous disease, and hypermobile joints are comorbidities. Lipedema tissue is difficult to reduce by diet, exercise, or bariatric surgery. Methods This paper is a consensus guideline on lipedema written by a US committee following the Delphi Method. Consensus statements are rated for strength using the GRADE system. Results Eighty-five consensus statements outline lipedema pathophysiology, and medical, surgical, vascular, and other therapeutic recommendations. Future research topics are suggested. Conclusion These guidelines improve the understanding of the loose connective tissue disease, lipedema, to advance our understanding towards early diagnosis, treatments, and ultimately a cure for affected individuals.

Sources of Arterial Vascularization of the Polar Owl’s Kidneys

The sources of vascularization of the kidneys of five polar owl carcasses were studied by filling the vessels with self-hardening plastic Belokril through the femoral artery. High-grade oil paints were added to the monomer to give the vessels the desired color. After the injection, the carcasses were placed in a high concentration caustic soda solution for three days. The resulting corrosion impression was washed under warm water and dried. It was identified that in the lumbar trunk, the main vessel was the descending aorta, from which extra- and intraorganic arteries departed for vascularizing the kidneys. Extraorganic arteries included external and internal iliac, sciatic and middle sacral arteries. Intraorganic arteries included cranial, middle, and caudal renal arteries. Inside the parenchyma of each lobe of the kidney, intraorganic arteries branched in the main type of caudomedial, dorsomedial and lateromedial directions and were subdivided into segmental, interlobular and perilobular arteries and intralobular capillaries. An asymmetry in the branching of the renal arteries was observed. During histological examination, we noted that the renal arteries were lined with endothelium on the inner side and the intima contained endotheliocytes with oval nuclei. Under the endothelial layer were loose collagen fibers running along the middle shell. There was no loose connective tissue between the inner and middle shells, so the subendothelial layer was very weak and there was no internal elastic membrane. The muscle membrane was well developed, with collagen and elastic fibers located between the muscle fibers. The outer shell was represented by loose connective tissue with the presence of arterial and venous vessels. The collagen fibers had a slightly convoluted course. Keywords: birds, polar owl, arteries, kidneys, parenchyma, capillaries, endotheliocytes, intima

Ultrastructure of Granulosa Cells of Bovine Ovarian Antral Follicles in Relation to Atresia

The aim of this study was to describe the most common forms of ovarian follicle atresia in large antral follicles of cows and quantify the occurrence of different cell structures in each form. Atresia of antral follicles in ovaries was determined on the basis of ultrastructural images acquired by electron microscopy of ultrathin sections contrasted with uranyl acetate and lead citrate to visualize cell organelles. All forms of atresia in large follicles are accompanied by regressive changes of the granulosa cells. The initial form of atresia is characterized by enlarged intercellular spaces after the disruption of the gap junctions and desmosomes. Small collapsed cells with pyknotic nuclei, substantially reduced the cytoplasm and a higher incidence of lysosomes are located on the surface of the granulosa layer. The stratum granulosum wall collapses and the basal membrane is swollen with a rupture of the lamina basalis. Obliterative atresia is characterized by a multiplied loose connective tissue consisting of collagen fibers, fibroblasts, histiocytes, blood capillaries and sporadically granulocytes. The cystic form of atresia is characterized by small collapsed, pyknotic granulosa cells settled in one or two layers. In luteinization-associated atresia, granulosa cells are hypertrophied, their cytoplasm contains smooth endoplasmic reticulum and mitochondria with tubules. In conclusion, the initial atresia of large antral ovarian follicles is associated with processes of cell death, followed by multiplication of the loose connective tissue cells, its dystrophy and hyalinization of the collagen fibers. Ultrastructural examination could be used as a complementary method to improve histopathological diagnostics of cow reproductive organs in veterinary practice.

THE MORPHOGENESIS OF NONPARASITIC LIVER CYSTS

As a result of the introduction of imaging research methods into clinical practice, the frequency of detection of cavities in the liver has significantly increased, among which nonparasitic cysts have not been sufficiently studied. The paper provides an overview of the most commonly used classifications of this pathology. Clinical and radiological manifestations of cysts were investigated based on the analysis of the results of computed tomography, magnetic resonance imaging and ultrasound sonography of 175 patients (109 with solitary cysts and 66 with polycystic liver). The tissues of the resected areas of 81 cysts and adjacent liver tissue were studied by histological and immune-histochemical methods. Various variants of liver cysts were identified: polycystic cysts, solitary cysts and the rarest variant - ciliated anterior-intestinal hepatic cysts. The morphological and histogenetic features of solitary and ciliated anterior-intestinal hepatic cysts, as well as changes in the liver tissue adjacent to the cavities, are described. Polycystic is characterized by the presence of cavities of various sizes, with thin connective tissue partitions and a lining of cubic or flattened epithelium. The lining of solitary cysts is represented by cubic, cylindrical, sometimes multi-row epithelium. Immature biliary structures in the form of von Meijenburg complexes, islets of hepatocytes, conglomerates of dysplastic vessels are revealed in their wall among the cells of connective tissue. Ciliated anterior-intestinal hepatic cysts contain components of the primary intestine wall - a lining of a cylindrical ciliated epithelium, a layer of loose connective tissue, a muscle layer, a connective tissue capsule. Morphological studies made it possible to establish violations of embryogenesis in various types of cysts. Ciliated anterior intestinal hepatic cysts develop from the anterior section of the primary intestine, while solitary cysts are derived from its middle section. Migration of the developing buds of bronchioles from the cranial part of the primary midgut into the hepatic diverticulum determines the presence of all components of the wall of the hollow organ - cylindrical ciliated epithelium, loose connective tissue, bundles of smooth muscle fibers. Simple solitary cysts are the result of abnormal remodeling of the embryonic ductal lamina, thus being a developmental abnormality of the middle section of the primary midgut. Morphological examination of the liver tissue adjacent to the walls of the cysts reveals hypoplasia of lobules, persistence of elements of the embryonic ductal plate in the form of cords and complexes of the biliary epithelium, foci of ductopenia, von Meijenburg complexes, and various variants of vascular dysplasia.

The Histology of the Trachea in Dogs

The trachea was collected from apparently normal six adult dogs of spitz breed aged between 2-4 years of age from the post-mortem of the Veterinary Pathology department. The aim of the study was to observe the histological details of the trachea in the spitz breed of dogs. The tracheal wall consisted of the mucosa, submucosa, hyaline cartilage, and adventitia. Tracheal mucosa was lined by a pseudostratified ciliated columnar epithelium with mucous secreting goblet cell and basal cells. Lamina propria was made up of loose connective tissue and contained some alveolar mucous glands. Muscularis mucosa was a thin layer with smooth muscle fibers arranged in a dispersed manner. The submucosa contained loose connective tissue with numerous mucous secreting tubule – acinar submucosal gland and was found related to the perichondrium of cartilaginous rings. The dense fibroelastic tissue was found between the cartilaginous rings. The cartilaginous rings were flattened in cross-section. Thin tunica adventitia of loose connective tissue and covered the cartilaginous rings. Trachealis muscle was found.