Anatomical pathology

Objectives: Liver biopsy remains the gold standard to assess histologic liver fibrosis for patients with
chronic hepatitis C before therapy indication. The aim of this study was to evaluate correlate of APRI score with the degree of histologic liver fibrosis in chronic hepatitis C patients at Phramongkutklao Hospital and Bhumibol Adulyadej Hospital.
Methods: Fifty nine patients who tested positive for hepatitis C antibody (anti HCV) and had been
performed liver biopsy from March 2001 to January 2011 were included in the study. Complete blood count, blood urea nitrogen, creatinine, liver function test, coagulogram and HCV genotype were tested for all patients. APRI score was calculated by using the formula, [(AST/ULN)/platelet counts (10
9 /L)] ×100 for every patients. Liver tissues were reviewed by one pathologist for evaluating histologic liver fibrosis by Metavir classification. Patient characteristics and APRI score were compared between those with fibrosis score F ≤2 and those with score F ≥3.
Results: We divided the patients into two groups with non-significant and significant histologic liver
fibrosis (F0, F1, F2 vs. F3, F4). When using APRI score = 0.7515 as the cutoff point, it showed 90.48% sensitivity, 63.16% specificity, 72.88% accuracy, 57.58% positive predictive value and 92.31% negative predictive value.
Conclusions: APRI score cannot be used for predicting histologic liver fibrosis in chronic hepatitis C
patients at Phramongkutklao Hospital and Bhumibol Adulyadej Hospital because of low accuracy (72.88%). Because of high sensitivity and negative predictive value, we can use APRI score as a screening test for evaluating histologic liver fibrosis. In chronic hepatitis C patient who has low APRI score (<0.7515) and no sign of chronic liver disease, we can predict that the patient is less likely to have significant histologic liver fibrosis and have no need to perform liver biopsy

Typically the retro-mandibular vein contributes to formation of common facial and external jugular veins, via its anterior and posterior divisions re-spectively. However, cervico-facial venous variants are rather common. In two successive cadaver dissections the left side of head and neck were unviewable, but the right cervico-facial veins were visible. In both cadavers the right retro-mandibular vein was undivided. The first specimen had right external jugular vein draining into the right subcla-vian vein but did not have a right common facial vein. The second specimen did not have a right external jugular vein, but had a right common faci-al vein draining into the right internal jugular vein.
The first variant was characterized as Posterior Dominant Retromandibular Vein with no Common Facial Vein. The second variant was characterized as Anterior Dominant Retromandibular Vein with no External Jugular Vein. Each was sub-classified as Typical or Atypical based on its final drainage pattern. Cervico-facial venous variants often vary from case to case and side to side. Since external jugular and common facial veins are used for clini-cal and surgical interventions, accurate and struc-tured preoperative classification of variations may preclude intra-operative surprises and consequent complications.

An imaginary line measurement of the thorax is important for clinical need. There are several imaginary anatomical lines on the thorax that can be measured directly using a tape meter, such as: midclavicular line, midaxilla line, chest width, chest circumference, distance of incisura jugularis sterni to the processusxiphoideus, intermidclavicular line, the upper thoracic dome and the lower thoracic dome. The objective of this article is to provide information on the average anatomical imaginary line value on the thoracic of the adult male. The data was then used for manufacturing of a thoracic anatomical phantom. Some marks of imaginary lines formed by clavicula, costae, and sternum were used as a reference in measurement. The anatomical imaginary line measurements were performed using a tape meter directly on 10 adult male samples, and carried out based on Chest X ray image of the same samples on a Computer Radiography (CR) workstation computer. Both measurements were then analyzed; ultrasonography examination was used to get soft tissue thickness for correction. Average values for midclavicular line variable of measurement using a tape measure was (29.10 ± 1.80) cm and the average value for the midclavicular line variable of measurement using Chest X ray on a CR workstation computer was (21.24 ± 0.73) cm. The average values for the variables intermidclavicular line measurement using a tape measure was (19.60 ± 0.69) cm and the average value for the variable intermidclavicular line of measurement using Chest X ray on a CR workstation computer was (16.53 ± 1.19) cm. The average values for the variables distance between incisura jugularis sterni to processus xiphoideus on the measurement using the tape meter was (20.40± 1.95) cm and the average value of the same variable measurement using Chest X ray image on the CR workstation computer was (18.32± 1.48) cm. From the three variables that can be seen for midclavicular line variables there is a difference 7.86 cm between measurements using a tape meter and X Ray image sample on the CR workstation. The difference for intermidclavicular line is 3.07 cm and the different for variable of distance between incisurajugularissterni to the processus xiphoideus is 2.10 cm. Ultrasonography (USG) examination result of soft tissue thickness was (3.08 ± 0.65) cm. There is a difference in the measurement results using tape meter with the measurement at Chest X ray image at the CR workstation about the imaginary line of the thorax. I. INTRODUCTION Anatomical imaginary line measurements of the thorax are useful for clinical necessities. There are several imaginary anatomical lines on the thorax that can be measured directly using a tape meter, including midclavicular line, distance incisurajugularissterni to processus xiphoideus, distance between midclavicular [1]. As a correction, ultrasound examination was used to obtain soft tissue thickness. The imaginary line of thoracic anatomy is an imaginary line for clinical guidance to know the normal border of the organ anatomy in thoracic cavity, for examples of the boundaries of the heart, liver and lung. Enlargement of organ can be seen from the organ's boundary with the imaginary line of anatomy. Measurement of cirtometry for healthy adult men during respiration was conducted to see correlation between cirtometry with lung volume. Measurements was performed using elastic tape meter in the axilla area, xiphoid and umbilical processes at rest, maximal inspiration and maximal expiration of the sample under supine circumstances [2]. An imaginary line anatomical line such as midclavicularlinea, the intermidclavicular and distance between incisura jugularis sterni to processusxiphoideus can also be measured on the Chest X ray, Posteroanterior position. On Chest X Ray examination, Posterior Anterior (PA) is a standard position for examination on the thorax. The results of the radiographs on the Chest X Ray examination of the PA position will be visible as actual conditions. To obtain enough inspiration, standard position of the PA with the patient standing is required. Recognition of these lines as normal radiological anatomy is important given that abnormal appearances may indicate disease. In addition, it allows development of an appropriate differential diagnosis before obtaining further imaging [3]. A good quality PA chest radiograph is an important indicator of the cardiac size. However, Chest X Ray image is still more accessible and feasible for most of the physicians. Chest X Ray image and echocardiography are also used for determination of the heart size [4]. The objective of this work is to provide average anatomical imaginary lines value on the thoracic of the adult male. The data can be used for manufacturing of a thoracic anatomical phantom.

Intimomedial mucoid degeneration (IMMD) is characterised by aneurysm formation following mucin deposition in the intima and media, with elastic tissue degeneration of the arte- rial wall. We present a case of a young adult who developed a diffusely aneurysmal aorta and its major branches, which was histopathologically confirmed as intimomedial mucoid degeneration, and a review of the literature. This case report attempts to raise the awareness of the reader to this rare cause of aortic aneurysm and to the bleeding diathesis associated with IMMD that may complicate surgery.