A Case of Fatal Bleeding from Acute Varicose Leg Ulcer: Clinico-pathological Characteristics

AbstractVaricosity of the superficial leg veins is a common human pathology leading to a number of serious complications. Acute severe bleeding is one of the rarest occurrences; however, it could cause death within minutes. This article describes a case of a small (4 mm) acute varicose ulcer in the right medial calf region of a 55-year-old woman that caused fatal exsanguination. The specific clinico-pathological features and possible pathogenesis of this condition are briefly reviewed. The present case along with several others described in the literature suggests that even the small, ‘cosmetic’ leg varicosities are indeed dangerous and require proper and timely management

Transcending Westphalia: The Two Faces of European Foreign Policy

Scholarship has tended to understand the European Union as either intergovernmental or supranational within the context of the Westphalian state system. This study begins with the assertion that the EU is a unique political entity that requires more flexible conceptions of world politics. I argue that the EU is structurally different in the economic and security domains of foreign policy. It is supranational in economic relations and intergovernmental in security issues. This is demonstrated through examining the EU policies on trade, aid, and intervention. I also highlight the weaknesses – democratic deficit, weak public opinion and lack of common identity – that affect the Union’s international identity. Thus, the combination of structural achievements and liabilities has made the Union a complex political creature with dual identity

Variety of transversus thoracis muscle in relation to the internal thoracic artery: an autopsy study of 120 subjects

<p>Abstract</p> <p>Background</p> <p>The transversus thoracis muscle is a thin muscular layer on the inner surface of the anterior thoracic wall that is always in concern during harvesting of the internal thoracic artery. Because the muscle is poorly described in the surgical literature, the aim of the present study is to examine in details its variations.</p> <p>Methods</p> <p>The data was obtained at standard autopsies of 120 Caucasian subjects (Bulgarians) of both sexes (97 males and 23 females), ranging in age from 18 to 91 years (mean age 52.8 ± 17.8 years). The transversus thoracis morphology was thoroughly examined on the inner surface of the chest plates collected after routine incisions.</p> <p>Results</p> <p>An overall examination revealed that in majority of cases the transversus thoracis slips formed a complete muscular layer (left - 75.8%, right - 83.3%) or some of the slips (left - 22.5%, right - 15%) or all of them (left - 1.7%, right - 1.7%) were quite separated. Rarely (left - 3.3%, right - 5.8%), some fibrous slips of the transversus thoracis were noted. In 55.8% of the cases there was left/right muscle symmetry; 44.2% of the muscles were asymmetrical. Most commonly, the highest muscle attachment was to the second (left - 53.3%, right - 37.5%) or third rib (left - 29.2%, right - 46.7%). The sixth rib was the most common lowest attachment (left - 94.2%, right - 89.2%). Most frequently, the muscle was composed of four (left - 31.7%, right - 44.2%) or fifth slips (left - 53.3%, right - 40.8%).</p> <p>Conclusions</p> <p>This study provides detailed basic information on the variety of the transversus thoracic muscle. It also defines the range of the clearly visible, uncovered by the muscle part of the internal thoracic artery and the completeness of the muscular layer over it. The knowledge of these peculiar muscle-arterial relations would definitely be beneficial to cardiac surgeon in performing fast and safe arterial harvesting.</p

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 patient's 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

PREDICTORS OF SUSTAINED VIROLOGICAL RESPONSE (SVR) TO PEGYLATED INTERFERON ALPHA (PEG-IFN α) AND RIBAVIRIN (RBV) IN PATIENTS WITH CHRONIC HEPATITIS C INFECTED WITH GENOTYPE 1.

Objective: The combined PEG-IFN alpha and RBV therapy achieved SVR in 40 - 50% of patients infected with HCV genotype 1. Identification of virological and host paramemeters predicting SVR will be useful to tailor therapy. Methods: 71 patients with chronic HCV genotype 1 infection were treated with PEG-IFN alpha2a and RBV for 12 months. Predictors of SVR were analyzed by using nonparametric correlation test. Results: SVR was found in 57 / 71 of subjects (80,3%). The significant differences in baseline level of HCV RNA, sex, age, baseline ALT and present of liver cirrhosis between the patients with or without SVR were not found. Correlation was not proved between SVR and all these factors when they were analyzed separately. High correlation was found between serum levels of HCV RNA at the end of 3-th month therapy (Early Virological Response) and SVR (r=0,759; p=0,011).Conclusion: The viral response during the first 3 months of PEG-IFN alpha and RBV therapy is the strongest independent predictor among the all baseline viral and host predictive factors for achieving of SVR

A comparative light-microscopic morphological study of the postnatal changes in the myocardium of the left and right ventricles in rat

According to literature data, age-related remodelling of the myocardium is related to the development of hypertrophy of the cardiomyocytes and interstitial fibrosis. In the present study, we observed accumulation of collagen in the walls of the vessels, interstitium and perivascular zones in Wistar rats from various age groups. Normally, the bundles of cardiomyocytes and the separate cells are surrounded by thin layers of peri- and endomysium. In the aging myocardium, hypertrophy of cardiomyocytes, transformation of fibroblasts into myofibroblasts and accumulation of extracellular matrix proteins in the interstitium are observed. Histological analyses of aging rat hearts show progressive loss of cardiomyocytes due to necrosis and apoptosis. Thus, preserved cardiac muscle cells undergo a process of compensatory hypertrophy. In our study, we investigated postnatal changes in the myocardium of 15 adult male Wistar rats, distributed in the following age groups: 2 weeks, 1, 3, 6 and 12 months old. We used routine haematoxylin and eosin staining and Mallory`s trichrome stain in order to analyse morphological changes in the aging myocardium in the wall of the left and right ventricle, as well as changes undergone by cardiomyocytes. In conclusion, it can be stated that by aging, heart morphology becomes impaired at organ level, as well as at individual cardiomyocyte level. Aging of myocardium is a dynamic process, characterized by hypertrophy of cardiomyocytes, reduced capillary density and increased deposition of collagen. Considering the functional dissimilarities between the left and right ventricle (a more pronounced effect of the afterload on the left ventricle), processes in the left ventricle follow a more dynamic pattern and reactive fibrosis occurs earlier. Changes in the right ventricle occur at a relatively smooth pace

Quantitative characteristics of the myocardium and the cardiomyocytes during different stages of the postnatal development in Wistar rats

Until recently there was a consensus that the growth of the heart during the foetal and postnatal development of the rat is primarily due to hyperplasia of the cardiomyocytes but at a certain moment during the early postnatal development of the heart, cardiomyocyte hyperplasia ceases and during the late postnatal period, heart growth occurs due to hypertrophy of the cardiac muscle cells. For this reason, in healthy rats, no significant changes in the number and size of cardiomyocytes are observed. The mean size of the cardiomyocytes increases in correlation with body growth during the postnatal development and these cells also possess the ability for additional hypertrophy in response to increased workload. While studying cell size, most authors measure the diameter of the cells in transverse histological slides by adopting a cylindrical model of the cell. The diameter is measured either directly in the individual cells or is determined indirectly.In the present study, the quantitative data on the morphology of the free wall of the left and right ventricle in Wistar rats have been obtained during the analysis of the hearts of 15 male rats, divided into five groups: two-week-old; one-month-old; three-month-old; six-month-old; twelve-month-old. For morphometric analysis we used five slides of the heart of each animal by randomly selecting zones in the material where there were no massive tears. The morphometric characteristics are presented and organized through schemes and diagrams, demonstrating the dynamics in the following quantitative indices: thickness of the free wall of the left and right ventricle (μm), transverse section of the cardiomyocytes (μm2) cardiomyocytic density (number of cells/mm2). The changes observed in these indices reflect a tendency for age-related hypertrophy. They are more dynamic and start earlier in the left ventricle and occur in a significantly smoother pattern in the right ventricle