Angiocatheter Decompression on a Covid-19 Patient with severe Pneumonia, Pneumothorax, and Subcutaneous Emphysema.

BACKGROUND: A novel coronavirus, currently known as Severe Acute Respiratory Syndrome Coronavirus 2, causes Coronavirus disease 2019 (Covid-19). Its most significant complication is a kind of pneumonia known as of 2019 New Coronavirus-Infected Pneumonia (NCIP). Covid-19 pneumonia can have unusual complications that affect both lungs in a widespread manner. Acute lung damage and Acute Respiratory Distress Syndrome (ARDS) are typical in severe Covid-19 cases. Several potential risk factors cause the pneumonia associated with this disease, such as age over 65, diabetes, hypertension, chronic obstructive pulmonary disease, immunosuppression, and pregnancy. Furthermore, various laboratory markers like high levels of C-reactive protein (CRP), D-dimers, ferritin, interleukin-6 (IL-6), and LDH, as well as a low lymphocyte and thrombocyte count, have been linked to increased disease severity and a poor prognosis. METHODS: In this study, we present a case of a 45-year-old patient with a rare evolution of the disease, who made a full recovery against all odds. We highlight the atypical presentation of Covid-19 in this patient, who developed some unusual complications, such as pneumonia, pneumothorax, pneumomediastinum, and subcutaneous emphysema. RESULTS: There is a scarcity of information on patient-related variables linked to pneumothorax in severely sick Covid-19 patients. This study adds to the existing research, reinforcing that spontaneous pneumothorax can be caused by the infection itself, in addition to ventilator-induced trauma in mechanically ventilated patients. CONCLUSIONS: We conclude that patients with Covid-19 pneumonia may develop a more robust and systemic illness characterized by acute lung injury, acute respiratory distress syndrome (ARDS), shock, coagulopathy, and nu¬merous organ dysfunctions, all of which are linked with a high risk of death.

Endothelial dysfunction in psoriatic arthritis patients: correlations between insulin resistance and disease activity.

OBJECTIVE: Cardiovascular atherosclerotic comorbidities represent an important cause of morbidity and mortality in patients diagnosed with psoriatic arthritis. In both atherosclerosis and Psoriatic arthritis, inflammation plays a pivotal role. Psoriatic arthritis is considered as an independent risk factor for the development of atherosclerosis with accelerated evolution. Development of atherosclerosis is initiated by the endothelial cell dysfunction along with inflammation and insulin resistance. The main aim of the study was to evaluate the endothelial function in Psoriatic arthritis patients, and to identify if it is related to the insulin resistance and Psoriatic arthritis disease activity. PATIENTS AND METHODS: In this case-control study, a group of 32 age and gender matched healthy controls was formed and compared to the group of 32 Psoriatic arthritis patients. We assessed the following parameters: Disease Activity in Psoriatic Arthritis Score, Homeostatic Model Assessment for Insulin Resistance, serum levels of the tumor necrosis factor alpha (TNFα), and the endothelial dysfunction by means of the flow-mediated dilation at brachial artery. The Student's t-test, the Pearson correlation and the ANOVA test were used to perform the statistical analysis of the data obtained; p-value <0.05 was considered as statistically significant. RESULTS: Compared to the patients in the control group, TNFα and Homeostatic Model Assessment for Insulin Resistance were increased (p-value <0.001), and flow-mediated dilation at brachial artery was decreased (p-value <0.001) in the disease group. In Psoriatic arthritis patients, significant correlations were found between Disease Activity in Psoriatic Arthritis Score and Homeostatic Model Assessment for Insulin Resistance (r=0.8143, p-value <0.001), and between Disease Activity in Psoriatic Arthritis Score and flow-mediated dilation at brachial artery % (r= -0.8376, p-value <0.001). Psoriatic arthritis patients treated with Methotrexate exhibited reduced values of Disease Activity in Psoriatic Arthritis Score and Homeostatic Model Assessment for Insulin Resistance and increased values of flow-mediated dilation at brachial artery, when compared with the untreated patients. CONCLUSIONS: Endothelial dysfunction is present in Psoriatic arthritis patients and has a significant correlation with both, the course of the disease and the insulin resistance.

Correlation between histopathological form and the degree of neuroendocrine differentiations in prostate cancer.

Prostate cancer (PCa) is the most frequent neoplasic condition in males, but only 64-65% of the cases are sensitive to hormone therapy. The aim of this study was to investigate the neuroendocrine component of the prostatic carcinoma, in relation to the histopathological form and the degree of differentiation. Biopsies were obtained through transurethral resection, from 82 patients with prostate cancer. In order to assess the histopathological form and the Gleason score, one section from each case was stained with Hematoxylin-Eosin. Additional sections were stained with chromogranin A. We considered neuroendocrine cell hyperplasia to have a higher value than that observed in benign prostatic hyperplasia (BPH) and normal prostate (over three neuroendocrine cells÷gland). The quantification of neuroendocrine differentiation (NED) has been significant; the reaction was considered to be weak (2-10% neuroendocrine cells), moderate (10-20%) and intense (over 50%). Cells positive for chromogranin A have been identified in all the cases, but a larger number than that registered in normal tissue has been noted in 59 patients (71.95%). In most of the cases, the neuroendocrine cells have been distributed in small groups among the neoplasic cells, and rarely isolated. In two cases of small cell carcinoma most of the tumoral cells have been positive for chromogranin A. In conclusion, the study of neuroendocrine differentiation in patients with prostatic carcinoma revealed hyperplasia of positive chromogranin A cells, in 71.95% of cases. Neuroendocrine prostatic differentiation is correlated with the advanced stage of evolution and possibly with the resistance to hormonal treatment.

The OPG/RANKL system and zinc ions are promoters of bone remodeling by osteoblast proliferation in postmenopausal osteoporosis.

RANKL and its decoy receptor osteoprotegerin (OPG) is a mediator system involved in bone resorption and may be responsible for the homeostatic mechanism of normal bone remodeling. The serum levels of both OPG and soluble RANKL (sRANKL), the level of RANKL in primary cultures of osteoblasts, and the bone level of Zn(2+) were measured in six women with postmenopausal osteoporosis and three women without osteoporosis (control group). As compared to control cases, patients with less than 15 years of estrogenic deprivation (cohort 1, n=3) presented increased levels of OPG (109.82%, p<0.002), sRANKL (229.13%, p<0.001) and RANKL OBL (272.35%, p<0.001), and decreased levels of Zn(2+) (67.81%, p<0.001), whereas patients with more than 15 years of estrogenic deprivation (cohort 2, n=3) showed decreased levels of OPG (70.44%, p<0.003), and Zn(2+) (61.41%, p<0.001), and increased levels of sRANKL (181.69%, p<0.002) and RANKL OBL (201.1%, p<0.002). The significantly increased levels of sRANKL and RANKL OBL in postmenopausal osteoporosis demonstrate osteoclastogenesis activation. According to the length of the estrogenic deprivation period, postmenopausal women with osteoporosis presented either increased (cohort 1) or decreased (cohort 2) OPG levels demonstrating osteoblast activation and osteoblast apoptosis stimulation, respectively. The bone levels of Zn(2+) were significantly decreased showing limited proliferation and differentiation of the osteoblasts.

VEGF expression in dog mastocytoma.

UNLABELLED: The biologic behavior of mastocytomas is highly variable; some tumors have a benign behavior, whereas others exhibit aggressive growth and metastasis. Vascular endothelial growth factor (VEGF) is a major regulator of angiogenesis and a potential autocrine growth factor for neoplastic cells in various malignancies. MATERIAL AND METHOD: In the present study, we have investigated expression of VEGF in cutaneous tumor from a dog and combined immunohistochemical expression of VEGF with mast cell tryptase, CD117 and vimentin. RESULTS: Tumor cells were positive for VEGF, and inflammatory cells were negative. VEGF expression was found in tumor cells as a heterogeneous positive reaction, with cytoplasmic pattern and moderate to strong in intensity. Arrangement of tumor cells was in clusters, in deepest part, close to the proliferation front. The dog died 5 month from the diagnosis, and our observation suggest that VEGF secretion by tumor cells correlates with unfavorable prognosis.

A new trichrome staining method: its practice and application in normal tissues.

A new trichrome staining method is presented. The staining solution contains: chromotrope RH, lissamine green SF, phosphomolibdic acid and acetic acid in aquous solution. The steps of the technique are described, insisting on the staining solution and dehydration. The authors revealed the staining properties of the method in different tissue and organs. The importance of the method for the histological study and its possible applications in pathology is discussed.

Quantification of the chronic portal infiltrate in chronic hepatitis.

We investigated 50 patients admitted with chronic hepatitis in whom we performed core liver biopsy. The fragment were prepared with the usual histological technique, and the sections were stained with hematoxilin-eosin, in order to prove the pathological and immunohistochemical diagnosis. In order to point out the cell population of the inflammatory infiltrate we used the immunohistochemical method with DAKO monoclonal antibodies (anti-LCA and CD3), Gömöri's trichrome stain and with Alcian Blue and safranin method. In the chronic persistent hepatitis (CPH) B lymphocytes are predominant, while in the chronic aggressive hepatitis (CAH), the predominant cells are of T type (lymphocyte inversion). But there are also cases of persistent chronic hepatitis, in whom the inflammatory infiltrate is represented especially by T lymphocytes, these have a great potential of evolution in CAH. The quantification of the elements of the chronic portal inflammatory infiltrate is a importance factor of prognosis in chronic hepatitis.

Immunohistochemical identification of ito-cells with smooth muscle cell anti-actin in normal and pathological liver.

Eighteen patients with chronic hepatitis of viral and alcoholic etiology investigated and core needle biopsy of the liver was performed. Microscopical investigation consisted of pathological diagnosis, grading and staging of chronic hepatitis and identification of ito cells with smooth muscle cell anti-actin. Ito cells were noted mainly around portal spaces as small cells with vacuolated cytoplasm. Their number is higher in normal liver and chronic persistent hepatitis. Few ito cells were observed in active forms and they are absent in almost all cases with cirrhosis. In chronic hepatitis of alcoholic origin, ito cells are large and their cytoplasma contains many vacuoles. A strong correlation between the number of ito cells and the stage of the chronic hepatitis was noted but it was not possible to correlate the same parameter with Knodell score.

Reticular fibers in the stroma of the thymus.

There were investigated thymic biopsies taken from 14 children deceased of intercurrent diseases. After routine paraffin procedures, slides were stained with hematoxylin-eosin, Gordon-Sweet, Wilder and Laidlaw methods. Reticular fibers are described in the stroma and parenchyma of the thymus. Their number and thickness are higher in connective septa, perivascular sheaths, at the cortico-medullary junction and around Hassall's bodies. Their involvement in a basal membrane like structure located between epithelio-reticular cells and thymocytes is discussed.

Fine needle aspiration biopsy of the liver.

There were investigated 51 patients admitted with suspicion of chronic hepatitis and secondary tumours of the liver. In all cases, fine needle aspiration biopsy was performed, and smears were fixed by drying and stained with BPT-Dragan and May Grunwald-Giemsa. In chronic hepatitis, the needle aspiration biopsy has a limited importance in the diagnosis because it cannot notice architectural features. The nucleo-cytoplasmic lesions are better observed. In secondary tumours of the liver, the aspiration biopsy, through simplicity and fidelity, represents the main method in the diagnosis. Cytological results were compared with histological ones. On smears we observed hepatocytes and atypical cells.

Upper urinary tract washing in the diagnosis of transitional cell carcinoma of the renal pelvis and calices. A comparison with voided urine.

There were cytologically studied 42 patients admitted with radiologically suspected tumors of the upper urinary tract. Samples of voided urine and washing of the upper urinary tract were taken, and dried smears were stained with blue polychrome-tanin method. In all cases, the diagnosis was evaluated intraoperatively and cytologic results were compared with pathological ones. In 42 patients, there were found 34 transitional cell carcinomas (TCC) of the calices, renal pelvis and ureter and lithiasis in 8 cases. Cytology from voided urine identified malignant cells in 76.4% of cases and in washing samples in 97.1%. There were 8 false negative results with voided urine and only one with the upper urinary tract washing; the only false positive result was induced by an epidermoid metaplasia of the pelvic urothelium. The diagnostic value, as a primary procedure, and the importance of cytological method in the follow-up of patients operated with TCC of the upper urinary tract are discussed.