The role of fine-needle aspiration biopsy in the diagnosis of malignant tumors.

Cytopathology and histopathology play a key role in the process of diagnosing oncological diseases and premalignant conditions. Fine-needle aspiration (FNA) is one of the techniques used for obtaining biopsy of a wide variety of body tissues, causing patients minimal discomfort. Therefore, it is often considered to be the best strategy for investigating and diagnosing some precancerous or potential malignant lesions. Being successful as a means of confirming the clinical suspicion of metastatic recurrence in the cases of an already known cancer, the interest has further focused on the preliminary diagnosis of various types of benign or malignant tumors. In cases of inoperable tumors, this technique is useful for formulating the final diagnosis. FNA biopsy proved its effectiveness as a highly accurate, cost-effective, and safe technique, with potential high diagnostic yield. Immunohistochemistry, used as an additional tool to classical histopathological examination, remains a very practical and reliable technique that promises good results especially in determining the site of origin within metastatic disease.

Aseptic Necrosis of Femoral Head - Clinical Study.

Femoral head osteonecrosis is a disease characterized by the decrease of blood vascularization in the femoral head, which leads to death of the osteocytes, demineralization and resorption of bone spans, change of trabecular architecture, with the reduction of the bone mechanical resistance and collapse of the articular surface in the femoral head. Left untreated, the disease may have a rapid progression, leading to severe symptoms, with significant articular dysfunction, functional impotence and a serious impact on the patient's quality of life. The prevalence of the disease is ever growing all over the world, affecting mainly people in their 30s, 40s or 50s. In the present study, we analyzed a number of 76 patients with femoral head osteonecrosis with severe symptoms that required a surgical treatment. There was observed that more than ¾ of the investigated patients were males, while 81.58% were younger than 60 years old. Among the identified risk factors, smoking came first, followed by alcohol intake, obesity and chronic administration of corticosteroids. A very high percentage of patients (84.21%) were diagnosed in stages III and IV of the disease.

Histopathological and immunohistochemical aspects of bone tissue in aseptic necrosis of the femoral head.

Femoral head osteonecrosis, also known as avascular necrosis, is a disease with a multifactorial etiology, characterized by a profound change of bone architecture, which leads to the diminishing of bone resistance and femoral head collapse. The main causes that lead to femoral head necrosis are represented by the decrease of local blood perfusion and increase of intraosseous pressure, because of an excessive development of adipose tissue in the areolas of the trabecular bone tissue in the femoral head. The histopathological and immunohistochemical (IHC) study performed by us showed that most of bone trabeculae were damaged by necrotic-involutive processes, their sizes being reduced, both regarding their length and their diameter; generally, the spans were thin, fragmented, distanced among them, which led to the occurrence of some large areolar cavities, full of conjunctive tissue, rich in adipocytes. Some of the residual bone spans even presented microfractures. In the structure of the trabecular bone tissue, numerous cavities showed lack of content, which indicates the death of osteocytes inside, while the endosteum appeared very thin, with few osteoprogenitor, flattened, difficult to highlight cells. The IHC study showed a low reaction of the bone reparatory processes and a reduced multiplication capacity of bone cells involved in the remodeling and remake of the diseased bone tissue. Nevertheless, there were identified numerous young conjunctive cells (fibroblasts, myofibroblasts), positive to proliferating cell nuclear antigen (PCNA), cells that have a high capacity of multiplication, participating in the formation of a fibrous conjunctive tissue (sclerous) instead of the damaged bone trabeculae. The formation of fibrous conjunctive tissue causes the reduction of mechanical resistance of the femoral head and its collapse. The IHC study of the microvascularization in the femoral head damaged by aseptic osteonecrosis showed the presence of a very low vascular system, both in the residual bone trabeculae and in the sclerous conjunctive tissue. Of the inflammatory cells present in the spongy bone tissue of the femoral head affected by osteonecrosis, the most numerous ones were the macrophages. Both macrophages and T- and B-lymphocytes had a heterogenous distribution.

Multiple and giant coronary artery aneurysm - case report and a review of the literature.

We report an unusual case of a 70-year-old female patient admitted in the Department of Cardiology, Emergency County Hospital, Oradea, Romania, for unstable angina and heart failure. Coronary angiography and computed tomography revealed multiple coronary artery aneurysms, some of them giant, associated with significant coronary artery disease. Coronary artery aneurysm is a rare disease, but the frequency of diagnostic increased with the development of coronary angiography. However, very rarely coronary artery aneurysm is very large and can be termed "giant aneurysm", and a small number of reports have been described in literature. The management and the prognosis of the disease is still controversial.

Osseointegration of zirconium dental implants three months after insertion in rabbit femur. Histopathological study.

Implantology is a highly researched field with a constant concern in finding and studying new implant materials. Lately, zirconium has become a very attractive alternative to the detriment of titanium, but the research results were sometimes contradictory. Thus, we considered as opportune to study the osseointegration of zirconium dental implants in rabbit femur, three months after insertion. The biological material was represented by five rabbits and the experimental protocol was approved by the Ethics Committee of the University of Oradea, Romania. The implants (zirconium ceramic dental implants: 5 mm length, 2.6 mm diameter) were inserted in the femur under controlled conditions, after creating a bone defect. The animals received the appropriate postoperative care. Three months later, the implantation area was harvested and processed for histological examination. The assessment of the osseointegration process of the zirconium implants showed that they were very well tolerated by the host organism that did not trigger any rejection processes. Approximately 80% of the compromised bone was replaced with newly formed bone in advanced stages of remodeling and consolidation. The proliferated bone near the implants acquired a structure similar to the rabbit diaphyseal bone, but with higher density and size of the osteons. The stage reached by the osseointegration process three months after the insertion of the implants, ensures a good consolidation of the implants that supports the prosthetic structures, which are to be built on them.

The importance of the histopathological examination in lethal acute intoxication with ethylene glycol. Case report.

Ethylene glycol is a toxic alcohol that is mainly introduced into an organism through the digestive pathway. Its priority toxic metabolites are glycolic acid and oxalic acid. We present the case of a young person, of the male persuasion, without any personal pathological history, found unconscious and presenting signs of violence. The patient is emergency hospitalized presenting coma, convulsive syndrome, severe metabolic acidosis and a positive result for alcoholism. Anamnestic data is extremely poor. The results of the clinical and paraclinical examinations suggest a possible poisoning with toxic alcohols. Despite the drug treatment and the hemodialysis, the evolution is unfavorable, resulting in death one week after admission. Through the forensic examination, the followings were found: cerebral and leptomeningeal edema, focal cerebral microhemorrhages, bronchopneumonia, septic spleen, shock kidney, hepatic fatty dystrophy, excoriated plaques in the head area. The histopathological (HP) examination confirms the macroscopic diagnosis and identifies the presence of calcium oxalate crystals in the kidney tubules. Subsequently, the toxicological examination of the biological samples taken from the corpse at the forensic examination, confirms the presence of the glycolic acid. Postmortem, the investigation conducted by the criminal investigation authorities confirms the oral ingestion of antifreeze. The absence of a positive history, along with alcohol consumption, nonspecific clinical symptomatology and the absence of calcium oxalate in urine are trap elements in the diagnosis of acute ethylene glycol poisoning. The presence of calcium oxalate in tissues, identified through the HP examination, is an extremely important factor when establishing the cause of death.

Clinical, surgical and morphological assessment of the pyeloureteral syndrome.

Obstruction of the pyeloureteral junction (PUJ) is by far the most common cause of hydronephrosis in children, with an incidence of one in 1000-2000 newborns. Also, the obstruction of the PUJ is the most common cause of prenatal hydronephrosis, accounting for 80% of the cases. The aim of this study is to observe and discuss first the efficacy of described surgery procedures and second the microscopic modifications of the PUJ (abnormalities of smooth muscle tissue, inflammation and fibrosis). One hundred and eleven children with a diverse urological pathology with an average age of 11.57 years were operated between 2011 and 2015 in Urology Clinic of Oradea, Romania. Of these, 20 children (11 boys and nine girls) with congenital hydronephrosis by junction syndrome required surgical correction. The surgical techniques used were Anderson-Hynes dismembered pyeloplasty, non-dismembered Scardino procedure and the Hellström procedure. Operator interventions were performed by subcostal lombotomy with or without partial XII rib resection. The average operator time was between 40 and 50 minutes. None of the patients required blood transfusions. Average hospitalization was seven days. All patients were monitored through the Ambulatory Pediatric and Urological Service. Anderson-Hynes operation is the main procedure to solve the obstructive syndromes of the PUJ. It can be performed without stentings of the ureter as originally described by the author, but also by protecting anastomosis with a urinary diversion, such as JJ catheter, ureteronephrostomy or ureteropyelostomy. Even though clinical and imaging studies are sufficient for diagnose of PUJ syndromes, morphology and histology bring essential data regarding the age of the lesions.

Postmenopausal osteoporosis - clinical, biological and histopathological aspects.

Osteoporosis is one of the most common disorders in postmenopausal women, affecting the quality of life and increasing the risk for fractures in minor traumas. Changes in the bone microarchitecture causes static changes in the body and affects motility. In this study, we analyzed two groups of women, one with physiological menopause and one with surgically induced menopause. The diagnosis of osteoporosis was suspected based on the clinical symptoms and confirmed by assessing bone mineral density by the dual-energy X-ray absorptiometry (DEXA). Comparing some clinical and biological aspects there was noted that a much higher percentage of women with surgically induced menopause exhibited increases in body mass index, changes in serum lipids, cholesterol, triglycerides, blood glucose, serum calcium, magnesemia and osteocalcin. In contrast, no significant differences were observed in the histopathological aspects of bone tissue examined from these two groups. In all patients, there was identified a significant reduction in the number of osteocytes and osteoblasts, the expansion of haversian channels, reducing the number of trabecular bone in the cancellous bone with wide areola cavities often full of adipose tissue, non-homogenous demineralization of both the compact bone and the cancellous bone, atrophy and even absence of the endosteal, and the presence of multiple microfractures. Our study showed that early surgically induced menopause more intensely alters the lipid, carbohydrate and mineral metabolism, thus favoring the onset of osteoporosis.

Atypical case of Sjögren's syndrome with psychiatric and peripheral neurological disorder.

Sjögren's syndrome is a rare disorder of the immune system characterized by the chronic lymphocytic infiltration of the organs with exocrine secretion (lachrymal, salivary glands), but also of other tissues of the body, that can be primary or secondary and can appear alone or in association with other systemic diseases: rheumatic arthritis, systemic erythematous lupus, scleroderma or polymyositis÷dermatomyositis. The case that we are presenting is that of a 40-year-old man, who came to the Department of Rheumatology with articular, muscular, ocular, psychological and neurological symptoms. After multiple biological, immunological, histological, neurological, psychiatric, ophthalmological, digestive investigations, it was reached the conclusion that the patient presents a rare autoimmune disease (primary Sjögren's syndrome) involving mainly peripheral neuromuscular and psychological (small frequency) and the patient was given specific immunomodulatory, anti-inflammatory and anti-depressive treatment, to which he responded well. Thus, after 18 months of investigation, severe depressive episodes and difficult collaboration of the patient with the medical team, it was possible to reach the definitive diagnosis and to perform the appropriate treatment.