Morphometric analysis of hepatocellular nodular lesions in HCV cirrhosis

Background and aims. We generated a computerized morphometric model to evaluate and quantify the morphological features in large regenerative nodules (LRN), high-grade dysplastic nodules (HGDN) and hepatocellular carcinoma (HCC). Methods. Sixteen LRN, 10 HGDN and 16 HCC in HCV-cirrhotic livers, were stained with H&E, smooth muscle actin, CD34, CD31 and reticulin to evaluate volume and surface fractions. Results. On H&E stains, the features most discriminatory between LRN, HGDN and HCC were volume fraction and number of hepatocytes nuclei in unit volume, and hepatocyte nuclear/cytoplasmic ratio. On immunohistochemistry, volume fractions of capillarised sinusoids, capillary units and isolated arteries were significantly different among all groups and highest in HCC; surface fraction of reticulin was markedly decreased in HCC. Conclusions. Our morphometric model is an objective method of quantification of the morphological changes of the nodular lesions and it could be applied in studies involving histological evaluation of the spectrum of nodular lesions arising in the cirrhotic liver

Air bubbles in the rectus abdominis muscle

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Liver transplantation in man : morphometric analysis of the parenchymal alterations following cold ischaemia and warm ischaemia/reperfusion

Ischaemia and reperfusion phases represent critical events during liver transplantation. The purpose of this study was to describe morphological alterations of both vascular and parenchymal compartments after ischaemia and reperfusion and to evaluate the possible relationship between morphometric parameters and biochemical/clinical data. Three needle biopsies were drawn from 20 patients who underwent orthotopic liver transplantation. The first biopsy was taken before flushing with preservation solution, and the second and the third to evaluate respectively the effects of cold ischaemia and of warm ischaemia/reperfusion. Biopsies were examined by an image analyser and morphometric parameters related to the liver parenchyma were evaluated. At the second biopsy we observed a decrease of the endothelium volume fraction while the same parameter referred to the sinusoidal lumen achieved a peak value. The hepatocytes showed a lower surface parenchymal/vascular sides ratio. This parameter was reversed at the end of the reperfusion phase; furthermore the third biopsy revealed endothelial swelling and a decreased volume fraction of the sinusoidal lumen. The results quantify the damage to the sinusoidal bed which, as already known, is one of the main targets of cold ischaemia; warm ischaemia and reperfusion accentuate endothelial damage. The end of transplantation is characterised by damage chiefly to parenchymal cells. Hepatocytes show a rearrangement of their surface sides, probably related to the alterations of the sinusoidal bed. In addition, the fluctuations of morphometric parameters during ischaemia/reperfusion correlate positively with biochemical data and clinical course of the patients

Teaching anatomy in a modern medical course: an integrated approach at Vialba Medical School in Milan

Introduction The course of Anatomy in Vialba Medical School \u2013 University of Milan, integrates systemic, topographic and development anatomy, dissection laboratory, peer-teaching, flipped classroom, clinical correlation to radiology and surgery. Methods An anonymous questionnaire based on a five-point Likert scale was submitted to 162 students who had passed the exam of Anatomy. Students evaluated the importance given during study to morphology, relations and variations of organs, the usefulness of different tools in preparing the exam of anatomy. Finally, the impact of the new design course of Anatomy on students\u2019 progress was assessed. Results The results showed that most of the students found very useful dissections, multimedia sources and 3D virtual models. 3D virtual models, dissections and physical models were indicated as the most important tools that should be available for learning Anatomy; instead, medical imaging received a low score. Students focused the study on morphology and relations between organs much more than anatomical variations. Lastly, students who followed the new design course of anatomy showed a significant better performance when compared to students of the previous academic years, in particular on the anatomy of neck, thoracic and abdominopelvic cavity, and neuroanatomy. Conclusions Our study underlines the positive impact of the integration of traditional methods and innovative solutions in learning anatomy, but also the critical approach to radiologic imaging and anatomical variability

Advantage of endoscopic-ultrasound-fine-needle aspiration associated to Sendai clinical guidelines in detecting the malignant risk in patients with undetermined pancreatic cysts: Long-term follow-up

Aims: Contradictory information exists on whether different clinical guidelines are effective in detecting the malignant risk in patients with pancreatic cysts. We have retrospectively evaluated the accuracy and the long-term outcome in patients with pancreatic cysts with a diameter 65 2 cm when indication for surgery was established by clinical evaluation of their malignant risk according to Sendai Clinical Guidelines associated to endoscopic-ultrasoundfine-needle aspiration. Methods: Patients with pancreatic cysts with a diameter 652 cm were evaluated for their potential malignant risk by endoscopic-ultrasound-fine-needle aspiration associated to the clinical evaluation by Sendai Clinical Guidelines. Long-term outcome and comparison in patients survival as well as the accuracy in detecting malignancies were evaluated with the combined clinical and endoscopic evaluation. Results: Two hundred eighteen patients with pancreatic cysts were observed during a 9-year period of the study and 74 of them (33.9%) presenting with a pancreatic cyst 65 2 cm were eligible for the study. Fourteen malignant neoplasms (18.9%) were detected. The accuracy in detecting malignancy of combined clinical and endoscopic evaluation was very high (0.99). The five-year survival rates for patients who underwent surgery with benign and malignant pancreatic cysts and for patients in observational follow-up were similar (70% and 85%). The cohort of patients with malignant pancreatic cysts with ductal adenocarcinoma showed a five-year survival rate of 41%. Conclusion: Endoscopic ultrasound fineneedle aspiration associated to Sendai clinical guidelines showed a high accuracy in detecting malignant risk in patients with pancreatic cysts with a diameter 65 2 cm. allowing appropriate selection for surgical treatment with satisfactory long-term survival

Morphology on the cloud Virtual Campus, an integrated didactic platform for biomedical studies

The current Core Curricula of Degree courses in Biomedical areas has enormously compressed the hours dedicated to the student for self-learning in morphological subjects. The result is a reduced student attitude to integrate the information received by attending lectures and practical sessions, with the indispensable consultation of texts dealing with morphological and \u2018functional\u2019 subjects, a key experience to autonomously logically identify the rational of the morphology/function relationship in the human body, at the macroscopic and microscopic level. These changes are occurring at a time when new medical imaging technologies become more and more informative in both morphological and functional areas. As a consequence, we are modifying our way of organize lessons compared to the generations of colleagues who have preceded us. More and more frontal lessons are organized with a logical morpho-functional approach. For example, the reference to the anatomy of the living, displayed through invasive or not invasive imaging, is added to the necessary and traditional anatomy of the cadaver. The reference to the pathology helps to define how the alteration of morphological integrity is reflected on function, both at the macro and microscopic level, and so on. However, there are no organized easy-to-use guided tours for the student to allow, in the shortest possible time, to \u2018rationally see\u2019 what he has studied, in the various imaging contexts available at the macro- and microscopic level. At the same time, there are no \u2018data bank\u2019 of resources for the preparation of the lessons. That is why we have imagined \u2018virtual campus\u2019 an integrated digital learning platform for self-learning. The platform has been thought and realized thanks to a group of teachers of \u2018morphologic\u2019 and \u2018functional\u2019 biomedical subjects and computer engineers belonging to a publishing house. The presentation will explain the rationale behind the platform, its structure and the educational opportunities offered

Neuroanatomia nel contesto clinico

Neuroanatomia nel contesto clinico, 9\uaa Edizione americana, fornisce tutto ci\uf2 di cui si necessita per conoscere a fondo l\u2019anatomia del sistema nervoso centrale in ambito clinico. Spiegazioni chiare, numerose immagini (RM, TC, ARM, VRM), fotografie a colori e illustrazioni, centinaia di domande di ripasso e risorse on line supplementari costituiscono una solida base anatomica per integrare i concetti di neurobiologia e clinici. Nell\u2019applicare la neuroanatomia al contesto clinico, l\u2019Atlante offre un valido aiuto nello studio di questa materia. Tale approccio autorevole \u2013 combinato con utili strumenti quali sezioni a colori, ampi riferimenti incrociati ai nervi cranici e trattazione di neurobiologia dei sistemi \u2013 assicura l\u2019efficacia per la didattica e l\u2019apprendimento

Morfologia microscopica ed ultrastrutturale

Morfologia Microscopica e ultrastrutturale si sviluppa secondo un percorso affermatosi nella facolt\ue0 Medica milanese, dove gli insegnamenti di istologia e anatomia Microscopica risultano integrati nei contenuti e nei tempi. il testo comprende una prima parte di citologia, introdotta dai capitoli sui metodi di studio e sulla organizzazione della sostanza vivente, a cui fanno seguito gli argomenti propriamente morfologici, sviluppati in forma di sintesi essenziale. Nella seconda parte, dedicata all\u2019istologia, viene affrontato lo studio dei tessuti con particolare attenzione all\u2019approccio microscopico e ultrastrutturale. La terza parte, dove viene affrontata l\u2019anatomia Microscopica, rappresenta l\u2019applicazione delle parti precedenti per l\u2019apprendimento di una metodologia a fini diagnostici in ambito morfologico. allo scopo di facilitare la comprensione dei vari argomenti trattati, la parte teorica risulta arricchita da una iconografia particolarmente accurata, sia con immagini di microscopia ottica ed elettronica sia con disegni e schemi dettagliati