Autopsy Histopathologic Lung Findings in Patients Treated With Extracorporeal Membrane Oxygenation.

CONTEXT.­: Extracorporeal membrane oxygenation (ECMO) is increasingly used in the treatment of respiratory and cardiac failure, but data describing lung histopathology in ECMO recipients are limited. OBJECTIVE.­: To examine pulmonary histopathologic findings in patients who underwent venovenous (VV) ECMO for pulmonary reasons, or venoarterial (VA) ECMO for cardiac indications shortly before death, and to determine if the pulmonary changes provided insights into therapy that may prevent complications and improve outcome. DESIGN.­: We conducted a retrospective study of lung autopsies, from VV and VA ECMO recipients and patients with acute respiratory distress syndrome (ARDS) and non-ECMO treatment, between 2008 and 2020 in Silesia Center for Heart Diseases in Zabrze, Poland. RESULTS.­: Among 83 ECMO patients (42-64 years; male, 57 [68.7%]), the most common histopathologic findings were bronchopneumonia (44 [53.0%]), interstitial edema (40 [48.2%]), diffuse alveolar damage (DAD; 32 [38.6%]), hemorrhagic infarct (28 [33.7%]), and pulmonary hemorrhage (25 [30.1%]). DAD was associated with longer ECMO treatment and longer hospital stay. The use of VV ECMO was a predictor of DAD in patients with ARDS and undergoing ECMO, but it also occurred in 21 of 65 patients (32.3%) in the VA ECMO group, even though VA ECMO was used for heart failure. CONCLUSIONS.­: Although DAD was significantly more common in lung autopsies of VV ECMO patients, one-third of VA ECMO patients had histopathologic changes characteristic of ARDS. The presence of DAD in lung autopsies of patients treated with VA ECMO indicates that in these patients, protective lung ventilation should be considered.

Wide-spread myocardial remodeling after acute myocardial infarction in rat. Features for heart failure progression.

The aim of the present study was to assess the relationship between hemodynamic function and cardiac remodeling post-myocardial infarction (MI) in Sprague-Dawley rats - the most commonly used species in pre-clinical studies. The experimental MI was induced by left coronary artery occlusion and the hemodynamics (working heart set-up) were measured at 2, 4, 6, 11, 21, 28, 35 or 70 days as well as morphological features. The maximal increase of coronary and aortic flow (CF, AF), the aortic systolic pressure (AoS) and contraction (+dP/dt; -dP/dt) values were observed at day 4 in comparison to sham-operated rats. By contrast, the preload pressure and aortic diastolic pressure (PP, AoD) were significantly decreased. These drastic changes were followed by recent cardiomyocyte necrosis, hyperemic capillaries and proliferating young vessels. At day 6, a deep drop down of AoS, +dP/dt, -dP/dt and CF was noted, while AF, AoD and PP approximated to the sham values. The recovery was reached in the case of AoS, -dP/dt and AF at day 28, +dP/dt did not recover till day 70, while CF was markedly increased. Accordingly, the inflammatory infiltration was diminished, connective tissue and collagenized scar with a number of capillaries was observed. The recent cardiomyopathy was observed at day 28 and fixed at day 35 with significant decline of AoS, AoD and CF. Clearly, the all natural post-MI compensatory mechanisms (remodeling) were exhausted between 28 and 35 days, while most of the parameters remained unchanged up to 70 days. These changes showed nonlinear, three-phase development of the post-MI heart function in non-treated rat (I, up to 4; II, 6-28; III, 70 days). The morphological processes correlated hemodynamically, however, they were slightly delayed. This model could be fast and relevant in pre-clinical study.

Angiogenesis and cardioprotection after TNFalpha-inducer-Tolpa Peat Preparation treatment in rat's hearts after experimental myocardial infarction in vivo.

The aim of the presented work was to evaluate whether short subcutaneous (s.c.) administration of TNFalpha-inducer-Tolpa Peat Preparation (TPP or TPP batch 0210) modulates the process of ischemic remodeling and spontaneous angiogenesis after experimental myocardial infarction (MI) in rats in vivo. The results obtained using three complementary and correlative methods: histological studies, Proliferating Cell Nuclear Antigen (PCNA) reaction and Lymphocytes Induced Angiogenesis (LIA) test showed a clear pro-angiogenic and cardioprotective effect of TPP administration after experimental MI. TPP batch 0210 should be considered as an angiogenesis stimulating factor and consecutively as a cardioprotective preventing development of ischemic cardiomyopathy after MI in rats. It might possibly be used as an adjunct to conventional therapy of coronary artery disease, including late phase after myocardial infarction or ischemic cardiomyopathy.

Morphometric characteristics of cell nuclei of the precancerous lesions and laryngeal cancer.

BACKGROUND: The purpose of this study was to characterize normal epithelium, precancerous lesions and laryngeal squamous cell carcinoma (SCC) with the use of nuclear morphometry. The relationship between the morphometric parameters of the cell nuclei and the pathological lesions was analyzed. In addition, a morphometric comparison was performed among normal epithelium, precancerous lesions, and cancer of the larynx. MATERIAL/METHODS: Our research involved 12 patients after total laryngectomy. All the postoperative histological specimens consisted of laryngeal SCC, precancerous lesions (dysplasia), keratosis with mild dysplasia, and normal epithelium. The cell nuclei of the SCC, dysplasia, keratosis, and the basal and superficial layers of the normal epithelium were measured. The nuclear parameters included area, equivalent diameter, length, breadth, perimeter, mean and integrated grey levels, convex area and convex perimeter, roundness, aspect ratio and fullness ratio. For each case, 500 nuclei were studied using a Polyvar Reicher microscope connected to a Quantimet 500 computer system. RESULTS: The relationship between karyometrical parameters and pathological lesions was found to be statistically significant. We observed the largest nuclei in keratosis lesions and the smallest in basal layers of normal epithelium. In some cases there were no significant differences between dysplasia nuclei and the superficial layers of normal epithelium. CONCLUSIONS: Karyometrical parameters correlate with morphometrical lesions in the larynx and may be useful in the prediction of laryngeal neoplasm.

Integrative measurements of calcifications in stented, antibiotic sterilized and cryopreserved sheep biological valves implanted for one year in tricuspid position.

UNLABELLED: The aim of the study was the characterization of calcification in the leaflets of a cryopreserved and alive heart valve depending on the diagnosed pathologic process. Sheep antibiotic sterilised and cryopreserved biological valves were implanted in tricuspid position in young sheeps for one year period. After this time the valves removed and studied morphologically. The control group consisted of 7 intact valves, the comparative group, so called group of valves after the processing antibiotic sterilization and cryopreservation consisted of 7 valves after mentioned procedures. Histological investigations were based on paraffin sections, calcium deposits were stained von Kossa technique. The measured values included integrative parameters as: 1. area fraction, 2. number of calcifications per area, 3. anisotropy. CONCLUSIONS: 1. A process of initial processing, sterilization and cryopreservation of biological valve increases a number of microcalcifications. 2. Cryopreserved biological valves explanted after one-year implantation into an animal in a tricuspid position possess fine calcifications and calcification foci. A number and size of fine calcifications decreases together with an intensification of degeneration and regressive processes of the connective tissue, especially in hyalinization. Hyalinization of the biological valve tissue seems to be favorable for a valve durability and as a pathological process decreasing calcification. 3. Mathematic analysis of morphometric features defining density and structure of calcifications indicate similarities among cryopreservation and initial processing groups, hyalinization, inflammation, whereas in a group of calcification foci, the similarity can be noticed between inflammation and hyalinization group.

Mathematical analysis of calcifications in stented, antibiotic sterilized and cryopreserved sheep biological valves implanted for one year in tricuspid position.

UNLABELLED: The aim of the study was morphometric and mathematic analysis of calcification profiles present in the leaflets of a cryopreserved and alive heart valve depending on the diagnosed pathologic process. Sheep antibiotic sterilised and cryopreserved biological valves were implanted in tricuspid position in young sheeps for one-year period. After this time the valves removed and studied morphologically. The control group consisted of 7 intact valves, the comparative group, so called group of valves after the processing antibiotic sterilization and cryopreservation consisted of 7 valves after mentioned procedures. Histologic investigations were based on paraffin sections of formalin-fixed valve cusps, stained with H&E and Masson trichrome, calcium deposits were stained von Kossa technique. The measured values included: 1. area and equivalent diameter, 2. length, 3. breadth, 4. perimeter, 5. elongation, 6. roundness, 7. fullness coefficient. CONCLUSIONS: 1. A process of initial processing and cryopreservation of biological valve increases a dimension and disturbs a shape of microcalcifications. 2. Cryopreserved biological valves explanted after one-year implantation into an animal in a tricuspid position possess microcalcifications and calcification foci. The size of microcalcifications decreases together with an intensification of degenerative processes of the connective tissue, especially in hyalinization. Hyalinization of the biological valve tissue seems to be favorable for a valve durability and as a pathological process decreasing calcification. 3. Mathematic analysis of morphometric features defining differences in size and shape of each calcification indicate morphologic and morphometric autonomy of calcifications, characteristic for the analyzed group of valve pathologic changes.

Cellular viability and ultrastructure of stented, antibiotic sterilized and cryopreserved sheep biological valves implanted for one year in tricuspid position.

UNLABELLED: The aim of the study was an evaluation of viability and damage of biological cells sterilized with antibiotics and cryopreserved a year after the implantation. Sheep antibiotic sterilised and cryopreserved biological valves were implanted in tricuspid position in young sheeps for one-year period. After this time the valves removed and studied morphologically. The control group consisted of 7 intact valves, the comparative group, so called group of valves after the processing antibiotic sterilization and cryopreservation consisted of 7 valves after mentioned procedures. Histologic investigations were based on paraffin sections of formalin-fixed valve cusps, stained with H&E and Masson trichrome. Valve viability was assessed using intravital staining with fluoresceine diacetate, whereas damaged cells were visualized by intravital staining with neutral red. Additionally, the ultrastructural studies were performed. The viability and ultrastructural results were compared with the pathologic process in the valve. CONCLUSIONS: 1. preliminary preparation with antibiotic sterilisation and cryopresrevation induces valve leaflet oedema and degenerative ultrastructural processes, colliquative cell necrosis and apoptotic morphology of a part of valve cells; 2. cryopreserved and antibiotic sterilised pulmonary valve after one-year implantation behaves lining cells, but ultrastructural changes indicates many degenerative phenomena in smaller degree than after preparation, sterilization and cryopreservation. Histopathologically the degenerative changes were prevalent.