Seroprevalence of Measles in Pairs of Mothers and Newborns in Southern Greece.

Maternal immunoglobulin G (IgG) antibodies that are passively transferred to newborns through the placenta confer protection if they are exposed to measles virus. A measles outbreak occurred in several European countries including Greece, between 2016 and 2018. A prospective study was conducted in the General Hospital of Lakonia, regarding the measles seropositivity status of mother and newborn pairs. IgG antibody titer for measles was measured in serum samples acquired from pairs of mothers and newborns. The samples were analyzed through quantitative enzyme-linked immunosorbent assay, and antimeasles IgG >200 IU/mL was considered to be protective. Demographic data for mothers and neonates and data regarding immunization status of mothers were analyzed. Study population included 206 mothers and their newborns. In total, 12.6% of mothers (n = 26) and 10.7% of newborns (n = 22) did not have protective serology. A statistically significant positive linear association between maternal and neonatal antibodies was found (rho = 0.924) (p = 0.001). Neonates whose mothers were seropositive had higher antibodies [geometric mean concentration (GMC): 804.8 (728.3-889.2)] than neonates whose mothers were seronegative/borderline [GMC: 97.7 (64.2-148.8)] (p = 0.001). In the study area, a significant rate of mothers and newborns was found to have nonprotective measles serology that exceeds the limit required for herd immunity. Vaccination coverage in women of reproductive age should be increased to reduce potential for future measles epidemics.

Diagnostic dilemma in spontaneous innominate artery pathology: a case report.

We report the case of a 71-year-old female who presented with sudden onset of right cervical pain and ipsilateral arm hypoaesthesia. The diagnostic evaluation revealed a pathology of the origin of the innominate artery (IA). The differential diagnosis was among a spontaneous acute dissection and a ruptured pseudoaneurysm. The dilemma of the proper treatment emerged. Surgical or medical treatment? Open or endovascular approach? The patient was offered an open treatment under cardiopulmonary bypass and sort circulatory arrest. As less than ten cases of isolated IA dissection have been previously reported in the literature, we discuss the differential diagnosis difficulties and the treatment options.

Massive pulmonary embolism due to hydatid cysts: A rare postoperative complication of liver echinococcosis.

Pulmonary embolism due to hydatid cysts is a very rare pathology. A 55-year-old male was transferred to our hospital due to respiratory failure, as a result of left pulmonary artery obstruction by cystic lesions. His medical history included multiple operations for abdominal echinococcosis. He was urgently operated for the extraction of the proximal hydatid cysts with the use of cardiopulmonary bypass with an excellent outcome and six months later through a right thoracotomy for the distal right pulmonary artery, the cysts were extracted. Meanwhile, he followed additional medication treatment with albendazole, preoperatively as well as postoperatively. Today, 5 years later, he has no evidence of hydatidosis recurrence.

Mediastinal debulking for a T-cell leukaemia/lymphoma presenting with cardiac tamponade.

Anterior mediastinal masses are relatively uncommon and include a wide variety of lesions. Lymphomas account for 25% of anterior mediastinal masses. Lymphomas and other haematological malignancies are associated with pericardial effusion. There are also cases where a cardiac tamponade occurred. The aim of the case reported herein is to discuss the surgical approach and particularly the mediastinal debulking as an adjunct to systematic treatment for haematological diseases presenting as an anterior mediastinal mass responsible for a cardiac tamponade.

Inappropriate antidiuretic hormone secretion due to squamous cell lung cancer.

The syndrome of inappropriate secretion of antidiuretic hormone is a disorder of impaired water excretion caused by the inability to suppress secretion of antidiuretic hormone. It has been commonly associated with small cell carcinoma. The association of this syndrome with squamous cell lung carcinoma has rarely been reported, with only 4 cases over the past two decades in the English literature. We describe the case of a 75-year-old Caucasian male who developed the syndrome after a right pneumonectomy for down-staged squamous cell lung cancer previously treated with neoadjuvant platinum-based chemotherapy and radiotherapy.

Experimental studies in the bronchial circulation. Which is the ideal animal model?

BACKGROUND: The importance of the role of bronchial arteries is notable in modern days thoracic surgery. The significance of their anastomoses with adjusted structures has not yet been sufficiently rated, especially in cases of haemoptysis, heart-lung transplantations and treatment of aneurysms of the thoracic aorta. The need of a thorough study is more relevant than ever and appropriate laboratory animals are required. METHODS: We review the literature in order to highlight the ideal experimental animal for the implementation of pilot programs relative to the bronchial circulation. A comparative analysis of the anatomy of the bronchial arterial system in humans along with these of pigs, dogs, rats, and birds, as being the most commonly used laboratory animals, is presented in details. RESULTS: The pig has the advantage that the broncho-oesophageal artery usually originates from the aorta as a single vessel, which makes the recognition and dissection of the artery easy to perform. In dogs, there is significant anatomical variation of the origin of the bronchial arteries. In rats, bronchial artery coming from the aorta is a rare event while in birds the pattern of the bronchial artery tree is clearly different from the human analog. CONCLUSIONS: The pig is anatomically and physiologically suited for experimental studies on the bronchial circulation. The suitable bronchial anatomy and physiology along with the undeniable usefulness of the pig in experimental research and the low maintenance cost make the pig the ideal model for experiments in bronchial circulation.

Intrapulmonary solitary fibrous tumor masquerade sigmoid adenocarcinoma metastasis.

Solitary fibrous tumor is a rare spindle cell mesenchymal tumor entity, with either benign or malignant behavior that cannot be accurately predicted by histological findings. An intrapulmonary site of origin is even rarer. We report a case of a 51-year-old woman in whom an abnormal nodule in the lower right lung was detected during staging for sigmoid adenocarcinoma. The nodule was excised and pathological examination revealed an intrapulmonary solitary fibrous tumor.

Subpleural lipoma: Management of a rare intrathoracic tumor.

INTRODUCTION: Subpleural lipomas are rare intrathoracic benign tumors. They are often discovered incidentally on plain chest radiographs and the diagnosis is usually established by computed tomography. PRESENTATION OF CASE: We report a case of subpleural lipoma, with enlargement during a period of two years. Pathology examination of the specimen confirmed the diagnosis of lipoma. DISCUSSION: For non-invasive diagnostic investigation, computed tomography enables the identification and quantification of subpleural lipoma due to their characteristic fat attenuation. Surgical resection with thoracotomy or VATS provides more accurate and firm diagnosis, and complete excision. CONCLUSION: This clinical entity needs attention due to difficult preoperative differentiation. Complete surgical excision of these lesions with the appropriate surgical approach is mandatory, for both diagnosis and treatment.

City breathability as quantified by the exchange velocity and its spatial variation in real inhomogeneous urban geometries: an example from central London urban area.

The breathability capacity and its spatial variation within an inhomogeneous urban area is investigated by examining the air flow and the induced flow exchange processes inside a real neighbourhood area of central London. The variation of the exchange velocity (as an index of city breathability) is interpreted in association with the local urban geometrical parameters and hence geometrical inhomogeneity. Numerical studies addressing flow exchange processes in urban areas have addressed so far rather idealised homogeneous geometries (e.g. Hamlyn and Britter, 2005; Salizzoni et al., 2009; Buccolieri et al., 2010; Hang et al., 2009 and 2010). This work analyses the results obtained from a Computational Fluid Dynamics (CFD) simulation study using a Reynolds-Average-Navier-Stokes (RANS) solver to study the flow and induced exchange processes in the area around the Marylebone Road and Gloucester Place intersection modelled at a 1:200 scale, with the wind direction blowing in the direction of the Marylebone street axis. Flow visualisations from the numerical results confirm that the particular building shapes and street canyon geometries determine the shape and size of vortical structures that are present in the flow field and thereby the exchange processes with the flow above. By considering appropriate control volumes enclosing each building, the exchange velocities, U(E), were deduced and found to range between 0.5% and 13% of the characteristic velocity above the urban canopy U(ref), which was referenced at a height 2.5 times of the building height. The range of the exchange velocity coefficient U(E)/U(ref) is higher than that observed in idealised regular cube arrays, mainly due to the enhanced flow mixing associated with the inhomogeneity of the urban geometry and particularly with tall buildings. This work may provide useful insight to urban designers and planners interested in examining the variation of city breathability as a local dynamic morphological parameter with the local building packing density.

Re-expansion pulmonary edema in a patient with total pneumothorax: a hazardous outcome.

Re-expansion pulmonary edema (REPE) is a rare complication of treatment of spontaneous pneumothorax or large pleural effusions. As a complication of spontaneous pneumothorax treatment, only few cases are documented, and even fewer document the role of non-invasive continuous positive airway pressure mechanical ventilation for treatment of this rare entity. We present a case of 23-year-old man who presented with left-sided pneumothorax, developed unilateral REPE and was treated with non-invasive continuous positive airway pressure.

Impact of HER2 and PTEN simultaneous deregulation in non-small cell lung carcinoma: correlation with biological behavior.

BACKGROUND: HER2/neu overexpression due to gene amplification is an important factor in breast cancer, modifying the sensitivity to anti-HER2 monoclonal antibody therapy. The clinical significance of HER2 expression in non small cell lung carcinoma (NSCLC) is currently under evaluation. The tumor suppressor gene PTEN negatively regulates the HER2/PI3K/Akt signalling pathway. The purpose of this study was to evaluate the role of simultaneous alteration in HER2 and PTEN protein expression in relation to biological behaviour of NSCLCs. MATERIALS AND METHOD: Protein expression was determined by immunohistochemistry in sixty-one (n=61) NSCLC cases along with CISH for HER2 gene analysis and detection of chromosome 17 aneuploidy. Patients were followed-up for a period of 34 to 41 months after surgery. RESULTS: HER2 overexpression (2+/3+ score) was detected in 17 (27.9%) patients while loss of PTEN expression was observed in 24 (39.3%) cases, low expression in 29 (47.6%) and overexpression in 8 (13.1%). Simultaneous HER2 overexpression and PTEN low/loss of expression were correlated with metastasis (71.4% vs 36.2% p=0.03) . Analysis in the subgroup of 22 patients of pTNM stage III with lymph node status N1 or N2 revealed that there was a relationship between the number of positive regional lymph node groups and simultaneous deregulation of the two genes (p=0.04). Multivariate analysis determined that HER2 overexpression was associated with an increasing risk of developing metastases (OR: 4.3; 95%CI: 1.2-15.9; p: 0.03) while PTEN overexpression was associated with lower risk (OR: 0.1; 95%CI: 0.1, 1.0; p: 0.05). CONCLUSIONS: Simultaneous HER2/PTEN deregulation is a significant genetic event that leads to a more aggressive phenotype of NSCLC.

Alveolar adenoma: an extremely rare innocent coin lesion.

Alveolar adenoma is an extremely rare benign tumour of the lung. Less than 30 cases have been reported in the English literature. A 42-year-old asymptomatic female who presented with a solitary peripheral pulmonary nodule on chest roentgenogram underwent thoracoscopic wedge resection and was diagnosed with this rare tumour. The indolent clinical progression and the absence of recurrence and metastasis after complete resection are the most important characteristics of this tumour. The classical solitary pulmonary nodule is a common and vexing problem. Nodules are extremely common in clinical practice and challenging to manage. Solitary pulmonary nodules can represent different specific lung diseases, focal non-specific inflammations, and primary and secondary malignant tumours. Identification of malignant nodules is important because they represent a potentially curable form of lung cancer.

Dissection of the aortic root presenting as a double aortic valve.

We report a case of aortic root dissection in a middle-aged male without history of recent trauma, presenting as a critical aortic regurgitation due to right cusp dislodgement. The intraoperative transesophageal echocardiogram revealed the "double aortic valve" sign suggestive of low dissection, which proved to extend to both coronary arteries.

Simultaneous EGFR and VEGF alterations in non-small cell lung carcinoma based on tissue microarrays.

BACKGROUND: Epidermal growth factor receptor (EGFR) overexpression is observed in significant proportions of non-small cell lung carcinomas (NSCLC). Furthermore, overactivation of vascular endothelial growth factor (VEGF) leads to increased angiogenesis implicated as an important factor in vascularization of those tumors. PATIENTS AND METHODS: Using tissue microarray technology, forty-paraffin (n = 40) embedded, histologically confirmed primary NSCLCs were cored and re-embedded into a recipient block. Immunohistochemistry was performed for the determination of EGFR and VEGF protein levels which were evaluated by the performance of computerized image analysis. EGFR gene amplification was studied by chromogenic in situ hybridization based on the use of EGFR gene and chromosome 7 centromeric probes. RESULTS: EGFR overexpression was observed in 23/40 (57.5%) cases and was correlated to the stage of the tumors (p = 0.001), whereas VEGF was overexpressed in 35/40 (87.5%) cases and was correlated to the stage of the tumors (p = 0.005) and to the smoking history of the patients (p = 0.016). Statistical significance was assessed comparing the protein levels of EGFR and VEGF (p = 0.043, k = 0.846). EGFR gene amplification was identified in 2/40 (5%) cases demonstrating no association to its overall protein levels (p = 0.241), whereas chromosome 7 aneuploidy was detected in 7/40 (17.5%) cases correlating to smoking history of the patients (p = 0.013). CONCLUSIONS: A significant subset of NSCLC is characterized by EGFR and VEGF simultaneous overexpression and maybe this is the eligible target group for the application of combined anti-EGFR/VEGF targeted therapies at the basis of genetic deregulation (especially gene amplification for EGFR).

Undifferentiated embryonal sarcoma of the liver mimicking acute appendicitis. Case report and review of the literature.

BACKGROUND: Undifferentiated embryonal sarcoma (UES) of liver is a rare malignant neoplasm, which affects mostly the pediatric population accounting for 13% of pediatric hepatic malignancies, a few cases has been reported in adults. CASE PRESENTATION: We report a case of undifferentiated embryonal sarcoma of the liver in a 20-year-old Caucasian male. The patient was referred to us for further investigation after a laparotomy in a district hospital for spontaneous abdominal hemorrhage, which was due to a liver mass. After a through evaluation with computed tomography scan and magnetic resonance imaging of the liver and taking into consideration the previous history of the patient, it was decided to surgically explore the patient. Resection of I-IV and VIII hepatic lobe. Patient developed disseminated intravascular coagulation one day after the surgery and died the next day. CONCLUSION: It is a rare, highly malignant hepatic neoplasm, affecting almost exclusively the pediatric population. The prognosis is poor but recent evidence has shown that long-term survival is possible after complete surgical resection with or without postoperative chemotherapy.