Homage to Dimitar Kadanoff - The Grand Teacher in Bulgarian Anatomy

Academician Dimitar Dimitrov Kadanoff is the first academician of the Bulgarian Academy of Sciences (BAS) in the field of Anatomy and founder of the Antropologic section of the Morphologic institute of BAS. Kadanoff is widely considered the most influential figure in Bulgarian Anatomy and the `Grand Teacher`. He remains one of the most highly respected Bulgarian scientists on an international level, with a total of 91 articles referenced in PubMed to his name, which are still highly cited

Demographic, clinical and morphological profile of malignant cutaneous melanoma in a Northeastern region of Bulgaria

IntroductionMelanoma is a malignant tumor with an unfavorable prognosis and an increasing incidence worldwide, with the most significant and the most common type being cutaneous melanoma. The epidemiological characteristics of cutaneous melanoma in Bulgaria are presented with low morbidity, moderate growth rate, and relatively low mortality, but with a rapid rate of increase in both sexes.AimThe aim of this study was to establish the clinical and morphological features of cutaneous melanoma in the Dobrich district and compare them to the European trends.Materials and MethodsA retrospective non-clinical approach was used in the selection of patients. The study included patients with histologically proven skin melanoma in the period 2016–2019. Data on patient sex, age at diagnosis, tumor location, and clinical stage of the disease were collected according to Clark and Breslow criteria.ResultsThe collected data show that the cutaneous melanoma in Dobrich district has a profile different from the average European one—all age groups are affected, except for 11- to 20-year-olds, and most cases occur in the age group of 61- to 70-year-olds, with an average age of diagnosis 59.82 years. In regard to sex distribution, men are more common, and the most common localization is the lower limbs. Morphological features show an advanced nature of the disease with a diagnosis in the late clinical stages.ConclusionOur data show that the gender distribution of cases corresponds to the European average, but the age and clinical stage of the disease are significantly more advanced, indicating a delayed diagnosis and emphasizing the need to develop a campaign for the prevention and early diagnosis

Wearable video documentation devices in anatomic pathology autopsies

IntroductionIn the past decade, many wearable devices for video documentation have been released on the free market. However, they have seldom been implemented into autopsy practice.AimThis research aimed to compare several different types of video recording devices and compare their feasibility, both in regards to their form factor and video quality, in everyday autopsy practice.Materials and MethodsFive separate wearable devices for video documentation devices were used in the standard autopsy practice of a single pathologist – two box-style sports cameras - Kitvision Escape KVESCAPE4KW (Kondor, Hapton, Lancashire, England) and GoPro Hero 7 Silver (San Mateo, California, USA), a pair of camera glasses – NCS0002 (Spardar Smart Technology Co., Ltd., Shenzhen, China), a pair of smart glasses – Cloud-I II (Topsky Digital Technology Co., Ltd., Shenzhen, China), and Google Glass – XE V2 (Google LLC, Mountain View, California, USA). The five devices were compared both for their pros and cons and for their feasibility in autopsy and educational practice.ResultsOnly the box-style sports cameras and Google Glass provided sufficient video resolution on the initial test to be considered efficient aids. A total of sixty-five full autopsies were documented, using the box-style sports cameras and Google Glass, with ten autopsies being recorded simultaneously with the two devices. Flaws present in both types of recording devices were in their relatively short battery life and the limitation of data that could be stored.ConclusionVideo documentation of autopsies using new generation wearable devices is a feasible option for both individual autopsy cases and educational purposes of both students and young pathologists. The different designs are susceptible to individual preferences, however, box-style sports cameras seem to be best suited for autopsy practices

Automated pick-up of suturing needles for robotic surgical assistance

Robot-assisted laparoscopic prostatectomy (RALP) is a treatment for prostate cancer that involves complete or nerve sparing removal prostate tissue that contains cancer. After removal the bladder neck is successively sutured directly with the urethra. The procedure is called urethrovesical anastomosis and is one of the most dexterity demanding tasks during RALP. Two suturing instruments and a pair of needles are used in combination to perform a running stitch during urethrovesical anastomosis. While robotic instruments provide enhanced dexterity to perform the anastomosis, it is still highly challenging and difficult to learn. In this paper, we presents a vision-guided needle grasping method for automatically grasping the needle that has been inserted into the patient prior to anastomosis. We aim to automatically grasp the suturing needle in a position that avoids hand-offs and immediately enables the start of suturing. The full grasping process can be broken down into: a needle detection algorithm; an approach phase where the surgical tool moves closer to the needle based on visual feedback; and a grasping phase through path planning based on observed surgical practice. Our experimental results show examples of successful autonomous grasping that has the potential to simplify and decrease the operational time in RALP by assisting a small component of urethrovesical anastomosis

Cytokeratin AE1/AE3 mimicry in glioblastoma

INTRODUCTION: The diagnosis and treatment of intracranial tumors requires a multidisciplinary approach. A key moment in this process is the pathological verification of the tumor type. This process, although aided by immunohistochemistry (IHC), can often be difficult and misleading.MATERIALS AND METHODS: Ten histologically confirmed cases of glioblastoma multiforme (GBM) were reviewed for their IHC reaction with the anti-glial fibrillary acidic protein (GFAP) glial marker and the CK AE1/AE3 antibody cocktail, whose main use in neuropathology is to either prove or rule out metastatic cancer of epithelial origin, the primary location of which may not be known or even suspected.RESULTS: All ten pathologically verified cases of GBM were diagnostically positive for GFAP, with eight of them also revealing CK AE1/AE3 expression with variable intensity. Out of the CK AE1/AE3 positive cases, five (50% in total) gave a low to intermediate non-diagnostic positive reaction, while the other three cases (30% in total) gave a strong positive reaction with possible diagnostic value. Cells, across all GBM cases, that tested positive for CK AE1/AE3, regardless of the strength of the reaction, were also positive for GFAP on neighboring IHC serial slides.CONCLUSION: The presented results reveal CK AE1/AE3 expression in a great portion of GBM cases, which may be caused by three-dimensional mimicry between the CK AE1/AE3 and GFAP target molecules. This therefore necessitates the need for a careful interpretation of the results. CK AE1/AE3, however, remains a useful tool in neuropathology, regardless of the possibility of false positivity in GBM cells

Differential diagnosis of decreased bone density in an infant without fractures and genetic tests. An autopsy report

Decreased bone density is classically associated with the osteogenesis imperfecta (OI) group of disorders, rickets, and malabsorption. The morphological evaluation, especially without genetic testing and detailed previous medical documentation, is difficult. Hematoxylin and eosin, and special stains give details on the changes in the bone matrix and the severity of dysmorphological bone formation. Herein we present a case report of a diseased infant with surgically corrected ileal atresia and impaired bone formation, without any other morphological changes in the internal organs. Interpretation of the changes, on the background of the lacking medical documentation and genetic tests, was based on the pathophysiological mechanisms of malabsorption and non-specific changes observed and reported in the OI spectrum of disorders

Esophageal neoplasms - single institution report

Introduction:Esophageal malignancies are a diverse group of neoplastic processes. The different entries that contribute to the group have a very wide margin of incidence across different populations, attributed to the presence of different predisposing factors. The aim of this study was to establish the statistical prevalence of histologically verified esophageal neoplasms in a single medical institution.Materials and Methods:All histologically confirmed cases of malignancies isolated from the esophagus, for a period of three-and-a-half-years registered in the St. Marina University Hospital, Varna, Bulgaria, were retrieved from the pathological archive and their incidence compared in a descriptive statistical manner. The cases were further classified based on the age and gender of the patients.Results:For the set time period, 33 cases of esophageal malignancies were registered. From these cases 66.67% (n=22) were diagnosed as squamous cell carcinoma of the esophagus (SCCE), 30.30% (n=10) as adenocarcinoma of the esophagus (ACE) and 3.03% (n=1) as a non-Hodgkin`s B MALT lymphoma diagnoses in an 84-year-old male patient. The mean age of diagnosis of patients with SCCE (n=22) was 59.45 years of age, with a standard deviation of ±11.05 years, while the mean age of diagnosis of patients with ACE (n=10) was 70.40 years of age, with a standard deviation of ±14.83 years.Conclusion:The results show clear statistical difference in the mean age of diagnosis. The male-to-female ratio of all cases is comparable to that of the global population, while the statistical segregation between entries shows a tendency towards the developed countries

The great imitator - EMA positive glioblastoma multiforme

INTRODUCTION: Glioblastoma multiforme (GBM) has always been a diagnostic challenge for pathologists. As a rare oncological entry with astrocytic differentiation, it can manifest itself in a variety of histomorphological forms, mimic other tumors and it often has varying immunohistochemical (IHC) profiles, further challenging the process of its verification.MATERIALS AND METHODS: Four pathologically verified cases of GBM, registered at the St. Marina University Hospital, Varna, Bulgaria were retrieved from the central pathological archive. The cases were tested and reviewed based on their hematoxylin and eosin (H&E) profiles and IHC reactions with GFAP used as a glial differentiation marker, Vimentin - as a positive IHC control and EMA, an epithelial marker, non-reactive in healthy brain tissue.RESULTS: As expected all GBM cases had the histomorphological hallmarks of the tumor on the H&E stain. They were diagnostically positive for GFAP and had a strong positive IHC reaction with Vimentin. Three out of the four cases also revealed a varying in intensity reaction with EMA, with one case having a weak reaction in individual cells that could not be considered diagnostic and the other two cases having a diffuse positive reaction in most of the tumor cells.CONCLUSION: In the age of immunohistochemistry, GBM continues to expand the set of IHC markers that react with it, although several of them such as Cytokeratin AE1/AE3 and EMA, as demonstrated in this study, should be non-reacting as they react with proteins normally present only in epithelial cells and absent in healthy brain tissue. This can often be misleading and, in certain cases, lead to histopathological misdiagnosis

Endoscopic imaging of the human laryngeal complex in an experimental setting - methodology and clinical significance

AIM: The human laryngeal complex has been an endoscopic sight since the late 19th century, however despite the technological advances little has changed in the standard observational methodology, with optical distortion of the image being a major setback in all endoscopic studies. The aim of this study is to evaluate different endoscopes and image correction algorithms in the endoscopic imaging of the laryngeal complex.METHODS AND MATERIALS: Conventional rigid 00, 300, 700 and 900 endoscopes and a flexible otorhinolaryngoscope with two-dimensional imaging capabilities, a digital camera and a direct laryngoscope were used together with an intubation mannequin to obtain endoscopic images of the laryngeal complex. Images of a custom made lens distortion grid were taken to compare the different optical systems and used as a benchmark for image correction. Both sets of images were superimposed in order to digitally correct for angle and lens distortion and to show the true size and proportions of the human laryngeal complex, so far seen only during an intubation or autopsy.RESULTS: After comparing the fiber optic and rigid endoscope obtained images, the rigid endoscopes proved to have better imaging qualities and therefore a better potential for future in depth study of laryngeal anatomy. The rigid 700 endoscope, compared to other rigid systems, allowed for an atraumatic perpendicular to the glottis view of the laryngeal complex, best suited for the study, despite the higher image distortion.CONCLUSION: Based on the collected data the 700 rigid otorhinolaryngoscope together with a standard software correction is an affordable, atraumatic and reliable method for anatomical and proportionate measuring of the human laryngeal complex in a model study

COMPREHENSIVE APPROACH FOR 3D SIMULATION BY MATHEMATICAL MODELING OF GROUNDWATER CONTAMINATION

ABSTRACT Development of precise models for predicting and managing processes of groundwater contamination as a result of a number of natural and technogenic factors (mining activity, industry, agriculture, sanitary landfills, etc.) requires more detailed knowledge on the structure and morphology of aquifers. Some of the aquifers are located in sediments and sedimentary rocks of significant heterogeneity of the lithological properties, causing a rather high heterogeneity of porous medium. Past practice of mathematical modeling has not considered realistically enough the rate and specifics of this heterogeneity. In recent years, sedimentology of aquifers acquires higher importance in the compilation of 3D prediction models. This comparatively new approach allows the application of a set of direct and indirect "in situ" and laboratory sedimentological, stratigraphic and geophysical methods, which allow the correct differentiation and definition of lithofacial and architectural-element units of different rank and scale. Each of them is characterized by relative inner homogeneity of hydrodynamic and migration properties. Thus, the differentiation of zones and layers simulating the correct hydrogeological conditions is allowed easily and precisely enough by compilation of numerical 3D models. The comprehensive approach was successfully tested at the Plovdiv sanitary landfill