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Biomedical subjects

V R Challa

Publications and source records attributed to V R Challa.

83 records · Page 5Linked to original sources

Infratentorial neuroepithelial cyst (colloid cyst). Case report.

An asymptomatic neuroepithelial cyst (colloid cyst) located in the leptomeninges between the inferior colliculus and the paravermal region of the superior cerebellum was an incidental postmortem finding. The cyst was lined by ciliated pseudostratified columnar epithelium of the respiratory tract type as lell as cuboidal epithelium of the ependymal type. Its developmental relationship to previously described colloid and paraphyseal cysts in the third ventricle is discussed.

Adolescent↗

Eccrine angiomatous hamartoma: a rare skin lesion with diverse histological features.

A case of painful eccrine angiomatous hamartoma of the wrist in a 10-year-old girl is presented. It was located in the reticular dermis and contained abnormal tubules resembling eccrine secretory coils and thin vascular channels dispersed in the collagenous tissue of the dermis. Some eccrine ducts showed dilatation. The noteworthy features of this case were the absence of hyperhidrosis over the lesion, and the presence of focal neural infiltration by the tubular structures. Electron microscopy showed mostly clear cells and occasional dark cells lining the tubular structures. This case supports the theory of abnormal induction of heterotypic dependency with resultant malformation of adnexal as well as mesenchymal elements.

Child↗

Ultrastructural observations of the myenteric plexus of the pylorus in infantile hypertrophic pyloric stenosis.

Myenteric plexuses and smooth muscle of the pylorus obtained by biopsy at pyloro myotomy in 5 infants with hypertrophic pyloric stenosis were studied by electron microscopy. Animal controls consisted of pyloruses from 2 infant and 2 adult rabbits and 2 adult rats. The principal findings in the plexuses of the patients were moderate numbers of variably sized, swollen degenerating axons that contained dense bodies, lamellated figures, vacuoles, granular or fibrillar material, and swollen mitochondria. The significance of this alteration in the etiology and pathogenesis of this disorder is not clear. Neurons in the plexuses showed no definite abnormalities. Although these findings do not confirm previous light microscopic observation of neuronal changes in the pyloric myenteric plexuses, they do not exclude a neurogenic mechanism for this disorder. The presence of small immature neurons and large mature neurons suggests that neuronal maturation and development in infantile hypertrophic pyloric stenosis are not impaired as previously reported. No ultrastructural changes were found in interstitial cells of the myenteric plexuses. Except for hypertrophy of the circular smooth muscle layers, no specific alterations were found in muscle fibers of the pylorus.

Animals↗

Immunohistochemical assessment of constitutive and inducible heat-shock protein 70 and ubiquitin in human cerebellum and caudate nucleus.

The distributions of constitutive and inducible 70-kDa heatshock proteins (Hsc70 and Hsp70, respectively) and ubiquitin (Ub) were investigated in autopsy specimens from 24 adult human brains. The objectives were to verify that the milder fixation and celloidin embedding applied to those specimens preserved protein immunoreactivity in the tissue sections, even with extended intervals between death and fixation, and to determine the typical pattern of distribution of the proteins in aged human cerebellum and caudate nucleus. To achieve these objectives, the patterns of immunoreactivity in human specimens were compared with those in normal rat brain after three methods of immersion fixation: 1. 1% Formalin; 2. 10% Formalin; 3. Methacarn (a modification of Carnoy's solution). Additionally, some rats were left refrigerated, but unfixed for up to 24 h to mimic the postmortem interval that commonly occurs prior to fixation of human autopsy material. Tissues were embedded in celloidin, sectioned at 100 microns, and the celloidin dissolved to permit immunostaining. Immunoreactivity for all antigens was greatly diminished in the rat brain by fixation in 10% formalin compared to 1% formalin or methacarn. Rat and human brain tissues fixed in the latter two solutions showed similar patterns of low levels of Hsp70 immunostaining in gray matter and other areas where neuronal somata were concentrated, whereas Hsc70 immunostaining was much greater in those same areas. Little Hsc70 or Hsp70 immunoreactivity was detected in the white matter from either source, but immunoblots of human gray and white matter suggested that white matter contained more Hsc70 and Hsp70 than apparent by tissue section immunoreactivity. Ubiquitin immunostaining in rat and human brain showed the same high levels as Hsc70 in gray matter, but unlike Hsc70, was also visible in white matter. These patterns remained the same in rat brains even if fixation was delayed for 24 h. In three human brain specimens, elevated Hsc70 staining, but not Hsp70 or Ub, was found in a ring pattern similar to that described as the ischemic penumbra in experimentally induced brain ischemia. These results indicated that dilute formalin preserved Hsc/Hsp70 and Ub antigenicity well, and that the proteins had similar distributions in human and rat brains, despite the extended postmortem delay in fixation of the former. They also suggested that evidence of premortem, localized cellular metabolic stress may be preserved in the postmortem human brain by an alteration in the typical distribution of Hsc70.

Adult↗

A case for cerebral thromboangiitis obliterans.

The existence of cerebral thromboangiitis obliterans (CTAO) has been controversial. The clinical, laboratory and angiographic features of a young woman with recurrent thrombophlebitis, digital gangrene and a bilateral anterior opercular syndrome (Foix-Chavany-Marie) are reported. The cerebral angiogram demonstrated significant narrowing of fronto-opercular branches of both middle cerebral arteries. Histology of small digital muscular arteries revealed segmental adventitial fibrosis, narrowing or occlusion of lumen and mild lymphocitic infiltrates; occasional veins showed phlebitis. An etiologic relationship between cerebral occlusive disease and peripheral thromboangitis obliterans (TAO) is suggested.

Adult↗

A morphologic study of the vasculature of malignant gliomas using thick celloidin sections and alkaline phosphatase stain.

The combination of 100 microm thick celloidin sections and alkaline phosphatase (AP) enzyme histochemistry of the vascular endothelium offers a greatly enhanced, 3D morphologic perspective and reveals intricate details of the vasculature of brain. A study of tumor specimens obtained at craniotomy from 6 patients with glioblastomas, 1 with anaplastic oligodendroglioma and 1 with juvenile pilocytic astrocytoma was undertaken using this technique. Five of the 6 glioblastomas, the anaplastic oligodendroglioma and the low-grade astrocytoma specimen showed uniform staining of afferent tumor blood vessels. In the glioblastomas, newly formed vessels formed dense, festooned networks at the advancing edges of the tumor. Feeding arteries entered the tumor at the junction between the edge of the tumor and adjacent brain or meninges and proceeded to form striking, coiled vessels and smaller branches. The density of both small arteries and veins was greatly increased within the tumor although there was much variability. Disordered arborization, arteriole to venous and arteriole to arteriole shunts were observed, leading to a situation where arteries connected directly to veins. In necrotic areas, there were often no AP-stained vessels. In many places, arterioles and capillaries were lacking. Numerous AP-negative veins of various sizes drained the tumors. Glomeruloid proliferations were presumptively identified as focal stain smudges or clusters of capillaries arising from nearby vascular channels. Increased alkaline phosphatase staining and/or focal new vessels were seen outside necrotic areas. The pilocytic astrocytoma and the oligodendroglioma showed less dense vascularity and no formation of the focal festoons of vessels shown by the glioblastomas. This technique may be useful for the study of tumor angiogenesis and to evaluate vascularity in experimental and human brain tumors after various therapies.

Adult↗

A combined hematoxylin-eosin, alkaline phosphatase and high-resolution microradiographic study of lacunes.

Lacunar infarcts (lacunes) are small, cystic lesions of the brain in patients with hypertension and/or diabetes. In order to improve our understanding of the relationship between lacunes and their blood vessels, the alkaline phosphatase (AP) technique of microvascular staining and high-resolution microradiography were employed in a three-dimensional study of 31 lacunes from 15 hypertensive subjects. A second aim was to compare the usefulness of the techniques with that of routine hematoxylin-eosin (HE) stain employed by previous investigators. Arteries were traced throughout their course. The lesions identified included intimal hyperplasia, hyalinization and atherosclerosis with variable narrowing and occasional occlusions. The small arterioles in the lacune cavities supplied adjacent intact brain. The AP technique clearly distinguished true lacunar infarcts from dilated perivascular spaces. AP and microradiography were superior to HE in showing the three dimensional details with far fewer sections. Four different types of relationships were observed between nutrient arteries and their lacunes, indicating that patterns of vascular involvement can be elucidated in brains of subjects dying with lacunar syndromes by using special techniques such as AP. Such patterns can be correlated with clinical risk factors such as hypercholesterolemia, hypertension etc., singly and in combination. Our data suggest that the natural history of lacunar infarcts may be changing in two ways--the number of lacunes per patient may be diminishing and white matter involvement may be increasing. Possible explanations for these changes are suggested.

Aged↗

The corpus callosum, a unique white-matter tract: anatomic features that may explain sparing in Binswanger disease and resistance to flow of fluid masses.

The corpus callosum exhibits several unusual features: arteriole-venule pairs, perivascular fibrous alae, and recurrent companion arterioles. These and other anatomic aspects are compared and contrasted with those of the centrum semiovale. Vascular changes occurring with aging or hypertension, commonly seen in the centrum semiovale, rarely develop in the corpus callosum. The vascular supply to the central zone of the genu and body of the corpus callosum, via short penetrating arterioles, is similar to that of the cerebral cortex, whereas the vascular supply to the extreme lateral corpus callosum, centrum semiovale, and basal ganglia is substantially carried by long end-arteries. When observed critically, the anatomic features of the corpus callosum may explain such clinically observed phenomena as its relative resistance to flow of fluid masses, radiation injury, Binswanger disease, lacunar infarction, hypoxia, and hypoperfusion.

Aged↗

Decreased production of suppressive-B-cell factor by synovial membrane B-lymphocytes in rheumatoid arthritis.

Suppressive-B-cell factor (SBF) is an autoregulatory B-cell lymphokine produced by heat-aggregated-IgG stimulated B-lymphocytes which suppresses polyclonal immunoglobulin production. SBF production by rheumatoid arthritis (RA) patients' peripheral blood B-lymphocytes inversely correlates with disease activity and in vitro rheumatoid factor production. To further define the role of SBF in the pathogenesis of RA, the present study measured SBF production by surgically-obtained synovial membrane mononuclear leukocytes. SBF production by RA synovial leukocytes was similar to the levels previously described for RA peripheral blood leukocytes. Both RA and osteoarthritis (OA) synovial leukocytes produced significantly less SBF than leukocytes obtained from otherwise healthy patients with plica. OA patients produced less SBF than RA patients, but the difference was not statistically significant. SBF values for combined RA patients and controls with OA or plica correlated with the degree of histological plasma cell infiltration providing further evidence for SBF production by cells of the B-lymphocyte lineage. Depletion studies also demonstrated that synovial SBF was produced by B-lymphocytes. The molecular weight (34,000) of synovial SBF was similar to the molecular weight of peripheral blood SBF. Decreased SBF production by RA synovial B-lymphocytes is a functional abnormality in RA which may contribute to the perpetuation of synovial rheumatoid factor production and chronic synovial inflammation.

Adult↗

Temporal arteritis in Sjögren's syndrome.

We report the first case of co-existing temporal arteritis and Sjögren's syndrome in the English language literature. Characteristic clinical and laboratory findings of both disorders were present. The combination of these two illnesses could be on the basis of chance alone or there may be a common etiology. Temporal arteritis could therefore be an addition to the spectrum of vasculitis diseases seen in Sjögren's syndrome.

Aged↗

Solitary fibrous tumor of the meninges.

The clinical, radiologic, and pathologic features of a case of solitary fibrous tumor of the meninges at the base of the brain are reported. The tumor caused clinical symptoms in a 42-year-old Caucasian male which were indicative of compression of hypothalamus, basal ganglia, and third ventricle. Radiologically it was a large extra-axial mass isointense to brain parenchyma on precontrast T1-weighted images that filled the suprasellar cistern and deformed the left cerebral peduncle. At surgery, the tumor was firm to hard and attached to dura. Histologically the tumor was composed of spindle-cell proliferation in a collagen-rich background but exhibited regional variations. CD34 immunoreactivity was a prominent histologic finding. Ultrastructural features of meningioma, such as complex interdigitation of cell processes and intercellular specialized junctions were absent. The cells showed the typical appearances of fibroblasts with proximity of banded collagen and precollagen and cytoplasmic rough-surfaced endoplasmic reticulum. DNA ploidy analysis showed diploid DNA content. Awareness of this neoplasm may lead to increasingly frequent recognition and the current WHO classification of brain neoplasms should be modified to include this new entity.

Adult↗