[The patent nasopalatine duct. A rare anomaly and diagnostic pitfall]

The patent nasopalatine duct is a rare anomaly in the anterior maxilla. During the early fetal period, a bilateral and epithelium-lined duct is formed within the primary palatal process as an oro-nasal communication. However, the duct obliterates and degenerates before birth. A persisting patent or through-and-through nasoplatine duct is therefore considered a developmental anomaly. A patent nasopalatine duct normally presents as one (or two) tiny openings lateral or posterior to the incisive papilla. In such a case, the ducts can be partially or completely probed with gutta-percha points with subsequent radiographic imaging. The patients report strange sensations such as squeaking noise, palatal drainage, nasal regurgitation, or airway communication between nasal and oral cavities; however, patients rarely complain about pain. About 40 cases have been documented in the literature. We describe two patients who have been referred to our department for evaluation of "sinus tracts" in the anterior palate. Since a patent nasopalatine duct can become a diagnostic pitfall, a thorough inspection of the mucosa around the incisive papilla is essential to avoid unnecessary endodontic or surgical interventions in the area of the central maxillary incisors.

Postmortem multislice computed tomography and magnetic resonance imaging of odontoid fractures, atlantoaxial distractions and ascending medullary edema

Non-invasive imaging methods are increasingly entering the field of forensic medicine. Facing the intricacies of classical neck dissection techniques, postmortem imaging might provide new diagnostic possibilities which could also improve forensic reconstruction. The aim of this study was to determine the value of postmortem neck imaging in comparison to forensic autopsy regarding the evaluation of the cause of death and the analysis of biomechanical aspects of neck trauma. For this purpose, 5 deceased persons (1 female and 4 male, mean age 49.8 years, range 20-80 years) who had suffered odontoid fractures or atlantoaxial distractions with or without medullary injuries, were studied using multislice computed tomography (MSCT), magnetic resonance imaging (MRI) and subsequent forensic autopsy. Evaluation of the findings was performed by radiologists, forensic pathologists and neuropathologists. The cause of death could be established radiologically in three of the five cases. MRI data were insufficient due to metal artefacts in one case, and in another, ascending medullary edema as the cause of delayed death was only detected by histological analysis. Regarding forensic reconstruction, the imaging methods were superior to autopsy neck exploration in all cases due to the post-processing possibilities of viewing the imaging data. In living patients who suffer medullary injury, follow-up MRI should be considered to exclude ascending medullary edema.

Intraductal papillary neoplasms of the bile duct: stepwise progression to carcinoma involves common molecular pathways

Intraductal papillary neoplasms of the bile duct are still poorly characterized regarding (1) their molecular alterations during the development to invasive carcinomas, (2) their subtype stratification and (3) their biological behavior. We performed a multicenter study that analyzed these issues in a large European cohort. Intraductal papillary neoplasms of the bile duct from 45 patients were graded and subtyped using mucin markers and CDX2. In addition, tumors were analyzed for common oncogenic pathways, and the findings were correlated with subtype and grade. Data were compared with those from 22 extra- and intrahepatic cholangiocarcinomas. Intraductal papillary neoplasms showed a development from preinvasive low- to high-grade intraepithelial neoplasia to invasive carcinoma. Molecular and immunohistochemical analysis revealed mutated KRAS, overexpression of TP53 and loss of p16 in low-grade intraepithelial neoplasia, whereas loss of SMAD4 was found in late phases of tumor development. Alterations of HER2, EGFR, β-catenin and GNAS were rare events. Among the subtypes, pancreato-biliary (36%) and intestinal (29%) were the most common, followed by gastric (18%) and oncocytic (13%) subtypes. Patients with intraductal papillary neoplasm of the bile duct showed a slightly better overall survival than patients with cholangiocarcinoma (hazard ratio (cholangiocarcinoma versus intraductal papillary neoplasm of the bile duct): 1.40; 95% confidence interval: 0.46-4.30; P=0.552). The development of biliary intraductal papillary neoplasms of the bile duct follows an adenoma-carcinoma sequence that correlates with the stepwise activation of common oncogenic pathways. Further large trials are needed to investigate and verify the finding of a better prognosis of intraductal papillary neoplasms compared with conventional cholangiocarcinoma.

Collecting Societies - Not Yet 'Six Feet Under'

Despite ubiquitous digitisation and the advent of Digital Rights Management Systems, it seems that collecting societies are not quite yet six feet under. Even in a world of rapid technological developments collecting societies will keep providing services to authors, users and the public facilitating the management of rights and performing additionally certain important social and cultural functions. However, agreeing on the future of collecting societies and on the particular design of both individual and collective rights administration is not an easy task and the opinions of the major stakeholders are diverse and often conflicting.

Congenital nasolacrimal duct fistula in Brown Swiss cattle

BACKGROUND An increased incidence of nasolacrimal duct fistula in the offspring of dam J and three of her sons (bulls A, B and C) prompted a study to investigate the prevalence and clinical manifestation of this anomaly. The dam J, bull B, 255 direct offspring of bulls A, B, and C and eight other direct and indirect offspring of cow J were examined. The periocular region of each animal was examined for unilateral or bilateral nasolacrimal duct fistula and the location, appearance and size of the lesions. RESULTS Of 265 cattle examined, 54 had unilateral (n = 24) or bilateral fistula (n = 30). The prevalence of affected offspring differed significantly among the three bulls. The fistulae were located medial to the medial canthus of the eye and were 1 to 10 mm (median, 1 mm) in height and 1 to 12 mm (median, 2 mm) in length. The shape of the opening was circular in 58, oval in 23 and slit-like in three. One other animal had a large opening with an atypical shape and another had an abnormal medial canthus with several fistulous openings. Seventy openings were pigmented and 52 were hairless. The fistulae were clinically significant in 12 animals. CONCLUSIONS The findings suggest a hereditary cause of nasolacrimal duct fistula in Brown Swiss cattle.

The patent nasopalatine duct: a potential cause of unclear pain in the anterior maxilla

OBJECTIVE The aim of this report is to describe symptoms that can suggest the presence of a patent nasopalatine duct and to illustrate three cases. SUMMARY Patent nasopalatine ducts connecting the oral cavity with the nasal cavity are extremely rare. This malformation can be considered a developmental abnormality. Clinically, patent nasopalatine ducts appear as single or double spherical or oval apertures lateral or posterior to the incisive papilla. This type of anatomical malformation can be associated with an unclear pain sensation in the anterior maxillary region, which may be misinterpreted for example as toothache of endodontic origin. However, persisting nasopalatine ducts can also exist as an asymptomatic abnormality with no clinical sign of discomfort. Accordingly, understanding the differential diagnosis of a possible patent nasopalatine duct can prevent a general practitioner from performing unnecessary interventions, such as endodontic treatments, apical surgeries, or tooth extractions.

37,X/38,XY Mosaicism in a Cryptorchid Bengal Cat with Müllerian Duct Remnants

A 23-month-old tomcat was referred to our clinic because of male behavioral problems, cryptorchidism, and an undefined intra-abdominal organ resembling a uterus. Ultrasonography and computed tomography showed 2 fluid-filled tubular structures dorsolaterally to the bladder and connected to the pelvic urethra. The cat was castrated, and the tubular structures were surgically removed. Histology identified them as Müllerian duct remnants. The testes were hypoplastic, the epididymes and deferent ducts were normal. Cytogenetic analyses revealed the presence of a mosaic 37,X/38,XY karyotype which explains the clinical findings.

Collecting the Painted Netherlands: The Art Collection of Ernest of Austria in Brussels

The (art) collection of Archduke Ernest of Austria (1553-1595) is widely unknown when it comes to early-modern Habsburg collections. Ernest, younger brother of Emperor Rudolf II (b. 1552) and educated at the Madrid court, was appointed Governor-General of the Netherlands by King Philip II of Spain, his uncle, in summer 1593. Ernest relocated his court from Vienna to Brussels in early 1594 and was welcomed there with lavish festivities: the traditional Blijde Inkomst, Joyous Entry, of the new sovereign. Unfortunately, the archduke died in February 1595 after residing in Brussels for a mere thirteen months. This investigation aims to shed new light on the archduke and his short-lived collecting ambitions in the Low Countries, taking into account that he had the mercantile and artistic metropolis Antwerp in his immediate reach. I argue, that his collecting ambitions can be traced back to one specific occasion: Ernest’s Joyous Entry into Antwerp in June 1594. There the archduke received a series of six paintings of Pieter Bruegel the Elder (1525/30-1569) known as The Months (painted in 1565), hanging today in separate locations in Vienna, New York and Prague. These works of art triggered Ernest’s collecting ambitions and prompted him to focus mainly on works of art and artefacts manufactured at or traded within the Netherlands during the last eight months of his lifetime. Additionally, it will be shown that the archduke was inspired by the paintings’ motifs and therefore concentrated on acquiring works of art depicting nature and landscape scenes from the 1560s and 1590s. On the basis of the archduke’s recently published account book (Kassabuch) and of the partially published inventory of his belongings, it becomes clear that Ernest of Austria must be seen in line with the better-known Habsburg collectors and that his specific collection of “the painted Netherlands” can be linked directly to his self-fashioning as a rightful sovereign of the Low Countries.

A Forgotten Original or an Original Copy? On MS. Douce 387 in the Bodleian Library: Collecting Early Modern Festival Books

Focusing on one manuscript, today in the Bodleian Library, Oxford, this chapter deals with the question how early modern objects became collectable items. The manuscript is categorized as MS. Douce 387 and its name indicates that it came from the collection of Francis Douce (1757–1834), who was keeper of manuscripts in the British Museum from 1799 until 1811. MS. Douce 387 is described in the catalogue of the Douce’ian collection as the “presentation copy with coloured designs by Marten de Vos and others” of the 1595 printed festival book Descriptio publicae gratulationis … in adventu … Ernesti archiducis Austriae. This festival book, printed in Antwerp’s Plantin-Moretus press, was commissioned by the magistrate of the city of Antwerp to commemorate the Joyous Entry of Archduke Ernest of Austria from June 1594; that an “archducal copy” bound in red velvet was commissioned as well and was owned by the Archduke is know as well. However, first research showed that Oxford copy cannot be this “archducal copy” or Marten de Vos’s artist’s copy even though it is the only know version with a handwritten text and hand-drawn illustrations. It rather should be examined as something totally different altogether. The main question remains why someone then commissioned a hand made version of this festival book, something unknown for other books of this genre? Why would someone between 1600 and 1800 sit down and copy texts and prints from a collectable book? Why was there such an on-going interest in early modern festival books? Could this manuscript be the only later made copy of the “archducal volume” or is it rather a forgery made for the European collectors’ market?