A new approach related to structural aspects of pathological appendix ver-sus normal appendix Текст научной статьи по специальности «Клиническая медицина»

© КОЛЛЕКТИВ АВТОРОВ, 2017 UDC 616.346.2-002:612.363

А. Che§ca 1, T. Sandle2

A NEW APPROACH RELATED TO STRUCTURAL ASPECTS OF PATHOLOGICAL APPENDIX VERSUS NORMAL APPENDIX

1Transilvania University of Bra§ov (Bra§ov, Romania), 2University of Manchester (United Kingdom)

This article makes reference to certain structural issues, that can be found during the appendix surgery and which are examined microscopically. For the study permanent preparations resulting from appendectomies, charged for removal in cases of gangrenosum appendicitis, were examined microscopically. For comparison and analytically, de-scribable microscopic permanent preparations with gangrenosum appendix, were compared with normal appendix. Stains used in this structural study are Hematoxylin-Eosin, van Gieson and Gomori silver impregnation. Preparations were examined using Nikon microscope and magnifying lenses with powers x10, x20 and x40. Key words: optical microscopy, structure, normal appendix, pathologically appendix

Appendix is a vestigial embryonic, which often raises medical problems through changes and this can have repercussions on a patient's quality of life [8]. From this point of view, by tracking the changes that can occur in certain circumstances, may require surgical removal of the appendix [4, 6]. Therefore, once the diagnoses of appendicitis catarrhal, phlegmonous or gangrenosum are complete, deciding surgical removal of the appendix, for curative purpose, must be made. Surgical operative practice are made given the complications that can give them a pathological appendix: such as peritonitis for example, which is one of the most common complications in case of non-intervention in time through the surgical act [1, 9]. Appendectomy is practiced by establishing a clear diagnosis [3, 12]. This is possible due to the observation of the patient's condition, which is based on the totality of the signs and symptoms [11]. In addition there are necessary laboratory investigations, including specific blood tests even for otherwise routine diagnosis of appendicitis. Important for diagnosis are imaging investigations, although these are not the most eloquent of laboratory methods [2, 10, 13]. Once diagnosed, the investigator can make a forecast on the shape of appendicitis; and once clearly established track operators can be excised [5, 7].

MATERIALS AND METHOD For the study, observations of microscopic pathologic appendix as the result of appendectomies practiced in cases diagnosed with appendicitis gangrenosum were performed. Pathological microscopic preparations were compared with microscopic normal appendix preparations, based on the idea of observing the difference between the specific structural issues in two situations: pathological

versus normal. Microscopic examination were made using Nikon microscopes, which were viewed prepared using x10 objective for assemblies observations and objectives x20 or x40 for observing structural details. The stains used for making preparations were Hematoxylin-Eosin, van Gieson and Gomori silver impregnation.

A review of macroscopic pieces, from an appendix with estimated length of approximately 40-50 mm, dilated in the middle portion of variable approximately 10- 20 mm. Postoperative parts were processed by classical histological techniques, resulting in permanent preparations. This enabled analysis and diagnosis of a pathological appendix.

Knowing that the pieces came from a gangrenous appendix (where the characteristic of this form of appendicitis has an appendix wall that is thinned by distention, mucous membrane bleeding and ulcers infiltrates and tunics with acute diffuse inflammatory infiltrates) helps with analysis.

RESULTS AND DISCUSSIONS

Following the structural analysis of the microscopic preparations of the gangrenous appendix, the following sequences of images reveal several features of interest. In addition commentary is provided about the areas observed on microscopic preparations for a normal appendix.

The first image captures specific morphological, startled prepared gangrenous appendix. The preparation is shown below. The structural aspects are caught on a longitudinal section. From left to right image is seen lymphoid infiltrates the follicle bleeding, then submucosa followed by the muscle and the right image in the specific atmosphere is surprised a venous blood vessel (fig. 1). The next figure is a detail of the left side of the previous image, restoring the folli-

cle lymphoid infiltrates bleeding (fig. 2). The next microscopic image shows the following aspects related to muscle tunic and also play a venous blood vessel, sectioned longitudinally (fig. 3). Next microscopic image shows the structural aspects surprised microscopic preparations with gangre-

nous appendix. In context, the following microscopic preparation, performed in longitudinal section, is seen from left to right, the area infiltrated hemorrhagic mucosa and to the right, specific crypts in the lining, the atmosphere surrounding the date of the tunica mucosa own (fig. 4).

Figure 1 - H&E staining x10

Figure 2 - H&E staining x40

Figure 3 - H&E staining x20

Figure 4 - H&E staining x10

Figure 5 - Gomori silver impregnation staining x10

Figure 6 - van Gieson staining x10

Using a special stain, Gomori silver impregnation, on below microscopic image, is seen at top left, a few of the specific appendix crypts then, on the right part of image, mucous tunic own, serous and less muscle (fig. 5).

As with any morphological study of an organ excised surgically remove it and a small adjacent area. On the microscopic image below, we can see the adipose tissue from adjacent appendix anatomic area, easily infiltrated with small areas of bleeding (fig. 6).

CONCLUSIONS

This material, brought into focus, clearly shows structural data relating to a pathological gangrenous appendix, observed under a microscope. From this point of view, specific morphological features can be seen. Pathological structural issues reveal more points, via visualized microscopic preparations, compared with a normal appendix. The microscopic stains used in this material were suitable for structural analysis proposed. Thus the study can provide the basis of undertaking comparative structural analysis in other appendectomies, particularly those practiced for removal of appendix catarrhal or phleg-monous appendicitis but not in cases of complicated appendicitis.

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Received 01.02.2017

А. Ческа1, Т Сэндл2

НОВЫЙ ПОДХОД К ИЗУЧЕНИЮ СТРУКТУРНЫХ АСПЕКТОВ ПАТОЛОГИЧЕСКОГО И НОРМАЛЬНОГО АППЕНДИКСА 1 Факультет медицины университета Трансильвании г. Брашов (г. Брашов, Румыния), 2Университет Манчестера (Великобритания)

В представленной статье приведено описание некоторых структурных проблем, которые могут возникнуть во время аппендэктомии. Микроскопически были изучены препараты, полученные в результате аппендэк-томий, которые были изъяты при удалении гангренозного аппендицита. Для анализа описываемые микроскопические перманентные препараты гангренозного аппендицита рассматривались в сравнении с нормальным аппендиксом. Окраску препаратов, используемых в ходе структурного исследования, осуществляли гематоксилином-эозином, с использованием метода ван Гизон и пропитки серебра Гомори. Препараты изучали с использованием микроскопа Nikon и увеличительных линз с мощностями x10, x20 и x40.

Ключевые слова: оптическая микроскопия, структура, нормальный аппендикс, патологический аппендикс

А. Ческа1, Т Сэндл2

ПАТОЛОГИЯЛЫКЖЭНЕКАЛЫПТЫАППЕНДИКСПН К,¥РЫЛЫМДЫК, АСПЕКТ1ЛЕР1НЗЕРТТЕУДЩЖАНА ¥СТАНЫМЫ Брашов K;anacbiHMaFbi Трансильвания университеты^ медицина факультет (Брашов каласы, Румыния), 2Манчестер университет (¥лыбритания)

¥сынылран макалада аппендэктомия кез1нде орын алуы mymkIm б1ркатар проблемалык мэселелердщ сипаттамасы келт1р1лген. Гангреноздык аппендицитт1 алып тастау кез1нде аппендэктомия нэтижес1нде алынран препараттар микроскопиялык туррыдан зерделенд1. Гангреноздык аппендициттН сипатталран микроскопиялык перманентт1 препараттарын талдау yw^ калыпты аппендикспен салыстырумен карастырылды. Курылымдык зерттеу барысында пайдаланылатын препараттарды бояу ванГизон эд1с1 мен Гомори ^м1с1н1н сырындысы эд1с1н колданумен гематоксилин-эозинмен жYзеге асырылды. Препараттар Nikon микроскопы мен улрайту куаты куаты x10, x20 и x40 линзаларын колданумен карастырылды.

Клт свздер: оптикалык микроскопия, курылым, калыпты аппендикс, патологиялык аппендикс