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[Evolutional aspects of changes in the configuration of the foot].

At late stages of anthropogenesis a high positive "hand--foot" structural correlation was disturbed. In paleoanthropuses from the Sxul group and in the fossil man from Sungiry, an excessive development of the fibular components of the foot ("lateralization") was revealed. Certain evolutional and morphological causes contributing to the appearance of this rare variant are considered. A conclusion is made that development of lateralization in the foot can support the hypothesis on transition towards a leading role of the hand at the natural selection of the "hand--foot" system only at the latest stages of anthropogenesis.

Animals

[Subcutaneous localizations of Castleman's pseudolymphoma. Review of the literature apropos of a case].

The angiofollicular lymphoid hyperplasia, first described in 1954 by Castleman in the mediastinum, is a quite rare pseudolymphoma where there are few subcutaneous localizations. Since 1954, more than 300 observations were published including mediastino-pulmonary forms (about 60 p. 100 of the cases) intra-abdominal forms (15 p. 100 of the cases) and superficial forms which represent 25 p. 100 of the cases and associate superficial ganglionic, intra-muscular and subcutaneous localizations. The authors report the observation of a 44-year-old negro who had a subcutaneous tumefaction of the left elbow which appeared recently without a functional sign nor a biological change. The histological findings allowed the diagnosis of Castleman's pseudolymphoma in a hyalino-vascular form or Flendrig's type II. The evolution was marked a few weeks later by a local recurrence of which a second surgery has secured the recovery. The detailed study of the 76 cases of Castleman's superficial pseudo-tumours published in the literature allows us to recall the features of this disease which affects especially the young adult without prevalence of sex at about 25 years old. The circumstances of discovery are univocal, isolated palpable subcutaneous tumefaction in most of the cases. The localizations are distributed by decreasing incidence as following: latero-cervical, axillary, sus-clavicular, inguinal, vulvar, abdominal wall, shoulder, arm, forearm with a few bifocal forms. The histological aspect associated a predominant lymphoid population and vessels with fibro-hyalinous wall which morphological variations have permitted to individualize three forms: a plasmocytic form or Flendrig's type I which should be a stage of beginning often associated with hematological changes, a hyalino-vascular form or Flendrig's type II more frequent and a mixed form or intermediary type. The immunofluorescence, histo-enzymology and immunohistochemistry studies reveal a changeable polyclonal plasmocytosis and a predominance of T-suppressors in the lymphocytic population. The histological differential diagnosis of the superficial forms of the Castleman's pseudolymphoma is rarely set with certain lymphoma in case of ganglionic localization. On the other hand isolated subcutaneous localizations must be distinguished of the Kimura's disease and of the angiolymphoid hyperplasia with eosinophils where the vessels have a different morphology. The evolution is favorable in most of the cases and surgical exeresis insures the recovery.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent

The physiological closure of ductus arteriosus in the rat. An ultrastructural study.

The evolution of morphological changes in the wall of the ductus arteriosus during its physiological closure in newborn rats was examined by electron microscopy. The contraction of smooth muscle cells in the tunica media seems to be the primary mechanism which leads to the physiological closure of the ductus arteriosus. For this reason our attention was centred mainly on the morphology of the tunica media. No important changes in the ultrastructure of smooth muscle cells can be observed in the early phases of the closure. Most of them exhibit ultrastructural features of cells with enhanced synthetic activity during all phases of the closure. The permanent contraction of smooth muscle cells results in their morphological changes. The most striking is the herniation of smooth muscle cell cytoplasm into the endothelial and later into adjoining muscle cells. These changes together with signs of degeneration of the smooth muscle cells are already clearly discernible 120 min after birth. The elastic component of the tunica media exhibits surprisingly fast changes. As soon as 60 min after birth, the fragmentation of elastic membranes and their structural changes provided evidence about the degradation of elastic material. The matrix vesicles, probably derived from the lysosomal apparatus of the muscle cells, may play an essential role in this process.

Animals

A new marker for early detection and indicator of progression of cancer of the bladder. Preliminary results with Ag-NOR index in 38 cases of superficial bladder cancer.

The multiform biology of superficial bladder tumors, both morphologically and evolutively, and the lack of reliable predictors of progression have led the authors to study the Ag-NOR proteins as a new marker of these tumors. It is well known that particularly the low-grade superficial tumors frequently relapse on the same histologic and proliferative module. Their potential of progression is probably present at the time of the first manifestation of the disease or it can show itself along the relapsing evolution with classic modifications translating the cellular dedifferentiation. The NOR index, set up by the authors, has several advantages: firstly, it corresponds to a functional value of normal and neoplastic cells; secondly, it can be used also with paraffin blocks. Another advantage is the semiautomatic lecture, reproducible also in the urinary cytology, mainly of low-grade tumors, reducing the number of false-negatives. The conclusion of the study of 38 cases of superficial bladder cancer has induced the authors to believe that an increased NOR index is a reliable 'marker' of their progression. Therefore, the authors suggest the use of the NOR activity for the surveillance of the urothelial disease and for a more logical therapeutic strategy.

Adult

[Caput valgum in children. Natural history and treatment of a series of 17 hips that reached skeletal maturation].

The growth disturbance of the superior end of the femur which is related to a superior lateral epiphysiodesis of the femoral neck is known as caput valgum (C.V.). Most often, it appears after the treatment of a congenital dislocation of the hip (C.D.H.) which can also produce many other growth disorders of the hip. Fifteen children (seventeen hips) presenting similar evolution and morphological abnormalities have been reviewed. We performed nine surgical procedures most of the time for painful hips because of excentration of the femoral head. When the bone maturity was acquired all hips except two (sequelae of infections) were asymptomatic with femoral heads well covered. When discovered or suspected, this disease needs of careful follow-up. When operative treatment is necessary, we think that it has to be a pelvic surgery. We performed 4 times a triple pelvic osteotomy; 3 times a Chiari osteotomy; and twice a hip shelf arthroplasty. Those operative treatments have always been done with good results in our review.

Adolescent

[MRI of malformative syringomyelia. Descriptive and developmental aspect].

132 cases of malformative syringomyelia have been studied at the C.I.E.R.M. (Interdepartmental Magnetic Resonance Center) of Bicêtre Hospital. The authors describe their technique for the exploration on the cord in case of suspected intramedullary cavitation, and emphasize the morphological and evolutive aspects of these abnormalities, whether they have been operated or not.

Adolescent

[Neuroendocrine tumors of the mammary gland. Current evaluation apropos of a case].

The authors report a case of infiltrating non-mucinous neuroendocrine breast tumor of both nesidioid and carcinoid type, exclusively composed of argyrophil cells and showing estrogen receptors. By comparing it to those published in literature, they conclude that there are two types of breast tumors with argyrophil cells: one very rare, exclusively composed of neuroendocrine cells, which may present all of the morphological, functional, evolutive aspects and particularly the carcinoid pattern of diffuse endocrine system tumors; the other is more common, composite, reminiscent according to the abundance of their neuroendocrine components, either of the features of diffuse endocrine system tumors, or of those of conventional adenocarcinomas. Their findings help to explain that the combined hormonoreceptive and hormonosecreting nature of these tumors is the particular property of their neuroendocrine cells comparable to that of the pituitary gland. In the composite tumors, these cells are associated in symbiosis with the epithelial glandular cells which are of ectodermal origin. Such an association, also observed in other parts of the body, is not fortuitous but functional and thus could contra-indicate antiestrogen hormonetherapy.

Aged

Genetic events in breast cancer and their clinical correlates.

The great heterogeneity of clinical breast cancer probably reflects heterogeneity of the mechanisms that are involved in its genesis and in disease progression. Genetic events that may be critical for tumor etiology, may determine tumor characteristics, and may contribute to tumor evolution should differ among individuals and among individual tumors and may distinguish subgroups with varying prognoses. We approach this problem from two viewpoints: one is based on population studies and the other on genetic events at the cellular level. 1. Population-based questions: What susceptibility factors are associated with individuals and groups who develop tumors? Inheritance patterns, familial aggregates, and associations with other tumors and other genetic diseases have been described for breast cancer. Bilateral and multifocal tumors may be examples of inherited predisposition, and their clinical and biological characteristics should be informative. Are there associations with tumor identifiers, such as histologic type and other tumor markers, for any of the "increased susceptibility" states? 2. Tumor-derived information: What types and frequencies of genetic alterations are found; do they relate to stage of tumor evolution, to morphologic classification, or to clinical evidence of comparative malignancy? Genetic evaluation depends upon cytogenetic and cytometric methods at the cellular level, and on detection of mutation, gene deletion, or amplification at the molecular level. We examine whether observed genetic alterations suggest mechanistic bases for morphologic distinctions among breast cancers and whether they assist in defining clinical phenotypes or steps in tumor progression. The general conclusions are that breast cancer comprises a complex set of neoplasms, that there is as yet little evidence to favor a final common pathway for its origin, and that a wide range of biological perturbations underlie its clinical course in the individual patient. An understanding of the basic mechanisms, their variety, and which of them apply in individual cases, is necessary as a rational basis for classification and for the development of strategies to interfere with tumor development in high-risk individuals.

Breast Neoplasms

[Modern approach to the classification and diagnosis of pneumonia].

New classification of pneumonia is pragmatic since a significant criterion is a condition in which an infection may develop: inflammations of the lungs in the home environment, immunodeficient patients, hospital infections, as a result of iatrogen complication, epidemics, etc. The principle of etiologic differentiation is reasonable when the therapy is indicated with certainty. Due to the difficulties in isolation and identification of sputum as well as the disappearance of the agent on onset of treatment because of specific therapy, the pathogenetic evolution and morphologic definition of the process is of great importance in the diagnostics and classification of pneumonia. In most patients the pneumonia has a clear course and the diagnosis is mostly established either by epidemiologic and clinical finding, laboratory testing and radiographically or by the response on empiric therapy. In some cases the invasive methods of diagnostics should be applied (BAL, transtracheal biopsy) in order to avoid false positive findings from the upper respiratory tract.

Humans

[The association of neuro-endocrine carcinoma of the skin and Bowen's disease. Review of the literature apropos of 4 cases].

Four cases of neuroendocrine carcinoma following Bowen's disease are presented. An immunohistochemical study was performed. The four patients, 3 men and a woman, ranging from seventy to eighty-seven years of age, developed a nodular tumor on a preexisting cutaneous lesion. In one of those cases the diagnosis of Bowen's disease was confirmed histologically before the apparition of the nodular tumor. The tumors were localized on the scalp, thorax, dorsum of the hand, and the scrotum. The four tumors were immunohistologically typical of neuro-endocrine carcinoma: there was a positivity for neurofilaments, cytokeratins and neurone-specific enolase. The clinico-pathological characteristics of those 4 neuro-endocrine carcinomas associated with a Bowen's disease, when compared with the 15 similar described in the literature, are identical to the isolated neuroendocrine carcinoma, from a clinical, morphological and evolutional point of view. The majority are seen in patients older than 60 years old and one third of the cases described survived at least 5 years. The coexistence of Bowen's disease and neuroendocrine carcinoma, the association of neuroendocrine and epidermoid cells in other cutaneous tumors, reactivate the controversy concerning the histogenesis of the so-called Merkel cell carcinoma. In fact, the histogenesis of the tumor is still not fully understood.

Aged

[Morphofunctional changes in potential liver allografts in experimental conditions].

As a part of morphofunctional investigations of validations cadaveric grafts for transplantation evolution of the histomorphological changes was followed by the experiments on guinea pigs. Liver samples were immediately after sacrificing the animals and 1, 2, and 4h later and kept at body temperature, which corresponded to the conditions of "warm ischemia". Second group of samples was immerged in Saline are +4 degrees C (hibernation-preservation) and was taken for analysis in same intervals as previous ones. Evolution of morphological and enzymatic changes was evident in short interval after sacrificing the animals. First changes were observed in cytoplasm and then in nuclei and interestitum. Changes of hepatic cells from hibernation preservation group were significant damaged comparing with the corresponding samples obtained from cadaver. ("warm ischemia"). These preliminary results indicated that length of liver graft preservation is very limited. Furthermore, this results demand for the future investigations in different conditions of preservation.

Animals

[Erythema nodosum and Crohn's disease].

Erythema nodosum was found on 11 out of 106 patients with Crohn's disease (10.4%), being the most common skin complication after the perianal ones. Women were affected more often than men (2.7:1) and most of the patients were above 15 and below 40 years of age. Patients with ileocolic lesions were more often affected than those with lesions confined to the small bowel. No cases of erythema nodosum were found in association with granulomatous colitis, as opposed to other authors experience. The eruption was usually related to the periods of active inflammatory bowel disease but not to the administration of salazopyrine. The morphology and evolution of the lesions was typical of erythema nodosum and joint involvement was almost constant. The differential diagnosis with other nodular eruptions that can occur in association with Crohn's disease are discussed and hypothetical common etiopathogenic factors to both Crohn's disease and erythema nodosum are briefly considered. The relevant literature is reviewed and commented upon.

Adolescent

[Parietal multilocular arachnoid cysts in adults. 2 cases].

Two cases of multiloculated arachnoid cysts of the parietal area are discovered at the ages of 57 and 69. The terrain, the situation and the morphology, the evolution, distinguish these lesions from the more classic cysts of the sylvian fissure. Their pathophysiology is discussed anatomically, these cysts are not far from the post traumatic ones, developing in childhood.

Aged

[Roussy-Levy hereditary areflexic dysstasia. Its historical relation to Friedreich's disease, Charcot-Marie-Tooth atrophy and Dejerine-Sottas hypertrophic neuritis; the present status of the original family; the nosologic role of this entity].

This survey of Roussy-Lévy disease begins with an historical account of the three neurological conditions from which this entity has been separated: Friedreich disease, described in 1861-1863, which proved with time to be a genuine anatomoclinical disorder: Charcot-Marie-Tooth atrophy, described in 1886, particular because of its morphology and evolution but due to various processes: Dejerine-Sottas hypertrophic neuritis, described in 1893, which was the first variant to be individualized within the heterogenous group of primary and familial hypertrophic neuritis. The initial description of Roussy-Lévy disease--in 1926, 1932, and 1934--and the controversies raised by this concept are recalled as well as the present state of the original family: five out of seven members have been examined since 1956 and it has been demonstrated that they are suffering from a form of hypertrophic neuritis. However it is this author's opinion that the concept of an autonomous Roussy-Lévy disease within hypertrophic neuritis is justified by the following criteria: dominant transmission, very precocious onset, extreme slowness of the evolution, remarkable benignity of the prognosis.

Ataxia

The "early" ulcerative lesion of Crohn's disease: correlative light- and scanning electron-microscopic studies.

Submucosal edema and lymphectasia have traditionally been considered the earliest recognizable alterations in Crohn's disease. However, a characteristic pattern of ulceration grossly resembling the oral lesions of aphthous stomatitis is believed by others to be the earliest macroscopic lesion. We have studied 50 consecutively accessioned surgical specimens with Crohn's disease in an effort to define more thoroughly the frequency, distribution, and morphology of these "aphthoid" ulcers. The scanning electron microscope (SEM) was used in the study because an understanding of the morphology and evolution of these lesions requires an appreciation of their three-dimensional configuration. Typical "aphthoid" ulcers were identified in 35 of the 50 specimens studied. Grossly the typical ulcerative lesion varies from barely visible up to 3 mm in diameter. They have a characteristic light-microscopic appearance consisting of focal ulceration usually overlying an aggregate of lymphoid tissue. The SEM was helpful in identifying the smallest of these lesions and was especially useful in defining a variety of villous abnormalities in the small bowel mucosa adjacent to the ulcers.

Adolescent

Origin of Gila seminuda (Teleostei: Cyprinidae) through introgressive hybridization: implications for evolution and conservation.

Morphological and genetic characters from cyprinid fishes of the genus Gila were examined to assess a hypothesized hybrid origin of Gila seminuda from the Virgin River, Arizona-Nevada-Utah. The presumed parents, Gila robusta robusta and Gila elegans, are clearly differentiated from one another based on morphology, allozymes, and mtDNA haplotypes. G. seminuda is morphologically intermediate and polymorphic at allozyme loci diagnostic for the parental species. Restriction endonuclease analysis of mtDNA showed G. seminuda nearly identical to G. elegans. These results support an origin of the bisexual taxon G. seminuda through introgressive hybridization. The Gila population in the Moapa River, Nevada, also appears to be of hybrid origin and is considered a distinctive population of G. seminuda. Inter-specific hybridization is potentially an important mode of evolution among western North American fishes, and valid species of hybrid origin may exist in other groups as well. Consideration of this mode of evolution argues for the need to conserve entire species complexes.

Animals