[Myocardial fibroelastosis]. / Considérations sur la fibroélastose myocardique

One case of chronic non-obstructive cardiomyopathy diagnosed clinically died suddenly. Post-mortem examination established the diagnosis of endomyocardial fibroelastosis. It was insisted upon the extreme rarity of this form, on the criteria of clinical diagnosis, the diagnosis of cardiomyopathy being one of exclusion, and on the peculiar anatomical characteristics.

[34 epibulbar malignant tumours (author's transl)]. / Réflexions sur 34 tumeurs malignes épibulbaires.

Based on a study of 34 cases, the authors make therapeutical and diagnostical references concerning the epibulbar malignant tumours. These were met with a frequency of 10% of the total amount of the malignant tumours of the visual apparatus. The most frequent setting were at the level of the bulbar conjunctiva and of the sclero-corneal limb, especially in front of the opening of the palpebral slit and in the temporal area. The histological examination of the tumours pointed out the following morphological types; epitheliomas (61%), especially spino-cellular, malignant melanomas (32%) and sarcomas (6%). The therapeutical attitude was the surgical one -- the accurate extirpation -- in the limited tumours, followed by radiotherapy when neoplasic lesions were found at the limit of section. In the invaded tumours, the exenteration of the orbit was performed followed by radiotherapy. On the terms of such a therapeutical conduct, the distant prognosis proved to be dependent on two factors: a. The early diagnosis, that is the stage of the therapeutical action. It is insisted upon the importance of the signs of malignization of some benign tumors: papillomas or naevi. b. The nature and origin of the tumour: the secondary tumours are more severe from the beginning.

[Adult onset Still's disease with normal level of serum ferritin]. / Boala Still a adultului cu manifestari aterosclerotice sistemice severe.

We present a case of an adult onset Still's disease: a 51 year old men presented with one month history of high spiking fever, asymmetric migratory polyarthritis and a previous history of pharyngitis. The diagnostic was based upon clinical criteria and laboratory findings, and necessitated the exclusion of infectious, neoplastic, and other "autoimmune" disease. The systemic involvement in our case induced us to comment therapy with corticosteroid. Patients with systemic disease have a favorable prognosis, with only rare serious complications from the disease (pericarditis, tamponade, diffuse intravascular coagulation, amyloidosis, hepatic disease, and respiratory failure) or the treatment (infections, gastrointestinal bleeding etc.).

[The role of the endothelium in angiogenesis]. / Rolul endoteliului în angiogeneza.

Angiogenesis, the vessel formation process, happens both in normal and pathological conditions, beginning with embryonic period and continuing throughout the post-natal period during the whole life. The stimulating factors of angiogenesis are enumerated: VEGF (vascular endothelial growth factor), PLGF (placental growth factor), IF (Intherpheron gamma), Il1, Il8 (interleukin 1,8), FGF (fibroblast growth factor), acid and basic, TGF (transforming growth factor), PDGF (platelet derived growth factor), GH (growth hormone). A series of factors act as regulators/modulators: hypoxia, PGE1, (prostaglandin E1), gangliosides, heparin, cell-cell and cell-substrate interactions. The main inhibitors are less numerous: trombospondin1, PF4 (platelet factor 4), TNF (tumor necrosis factor), IF (interferon alpha). The implied mechanism are discussed: the ways, paths and action phases of different stimulating factors, modulating or inhibiting factors. The angiogenesis process is shown for the embryonic period, in the wound healing process and in the development and progression of malignant tumors. The main method employed in the study of the microvasculature are enumerated. Some perspective in the cancer treatment are drafted.

[Intercellular communication]. / Comunicarile intercelulare.

There are 3 modalities for intercellular communications: the chemical substances secreted by some cells are transported at distance where they act as signals on other cells; the surface molecules of a group of cells interact with the neighbouring cells; some special junctions or nexus provide direct relations between cells. In the first modality the chemical signals operate in 3 ways: a) many cells secrete one ore more chemical signals which act as local mediators (paracrine model); these mediators act immediately or are destroyed after they influence the neighbouring cells; b) some specialised cells--endocrine cells--secrete hormones, which are liberated in small amounts into the blood and exert their effects on some target cells, able to recognise and to respond to the hormonal signal; c) the neurones secrete chemical mediators--neurotransmitters, which act at the level of some special junctions--the chemical synapses. Most biologic phenomena are under the overlapping control of both systems--thus they are regarded as neuroendocrine system. The nervous cells transmit the informations much more rapidly than the endocrine cells. The chemical signals are various, as regarding the structure and function: they are large polypeptides, small polypeptides, glycoproteins, amino-acids, steroid molecules derived from cholesterol and fatty acids. The ability of the cells to respond to an extracellular signal molecule depends on the existence of some specific proteins, included in the plasma membrane, called receptors. The chemical signals influence the target cells both by altering the properties or the synthesis rate of their own proteins or by initiating the synthesis of new proteins. The chemical signals induce rapid and transient or slow- and long-lasting responses. All the neurotransmitters and the majority of hormones are water-soluble; the steroid and thyroid hormones are relatively water insoluble; the mechanisms of influencing the target cells are dependent of this feature: the water-soluble molecules do not pass through the target cell membrane, they bind to the surface specific receptor while the insoluble molecules cross the plasma membrane of the target cell and bind to the cytoplasmatic receptors. It results that the water-soluble molecules mediate short-time responses while those insoluble--long-lasting responses. As regarding the local chemical mediators they are secreted by mast cells or they are represented by the large category of prostaglandins. They produce a great diversity of biological effects, they are rapidly destroyed, and this way, they don't penetrate into the blood stream in significant amounts. The majority of the receptors from the surface of activated cells generate some intracellular signals both by altering the activity of some membrane enzyme (adenilate cyclase) with the accumulation of cyclic MPA and by modifying the permeability of some membrane channels(Ca2+ channels). The target cell exposed to a signal for a long period of time loose often the ability to respond to this signal. This process called desensibilization is reversible and is explained by endocytosis of surface receptors together with the ligand and by their lysosomal destruction, by the degradation of the receptor molecular conformation which becomes unable to bind the ligand or by the lack of activation of membrane enzymes or the channels. The gap or nexus junctions are composed by some proteic particles which form a hydrophilic channel to assure the communication between 2 neighbouring cells. These junctions allow some molecules (amino-acids, monosaccharides, cAMP, nucleotides) to pass from a cell to another one, facilitating the chemical and electrical coupling. These structures show a low electrical resistance, but they are dynamic, some junctions have the capacity to change from a low resistance to a high resistance state, isolating the cells from communicating with their neighbours. Oxygen deprivation, the increase of intracellul

Histochemical and histoenzymic researches in coronary sudden death.

Using Lie's technique in order to evidence the fuchsinophilia of the early ischaemic zones and Falck-Hillarp's technique to appreciate the disappearance of the myocardial adrenergic network, the authors followed up the concordance between the precocity of the ischaemia and the frequency of the acidophilia. Studying 54 cases of coronary sudden death by using 100-300 slides in each case, the fuchsinophilic zones were evidenced in 46 per cent of the cases, aspects indicating the morphologic substrate of the sudden death with ectopic ventricular electrical activity centres. The results of fluorescence Falck-Hillarps's technique are the same as those obtained by light microscopy, which is to be preferred in routine practice. Farber-Louvière's microscopic histoenzymic method for succinate-dehydrogenase presents multiple advantages, so that it is preferable to Kollin-Neoral's macroscopic reaction.

Paget's disease of the breast.

Criteria of the morphological diagnosis as well as the histogenesis of the lesions in Paget's disease are presented; the authors claim that the initial lesion occurs in the lactiferous ducts, the skin being secondarily involved. Likewise, the dyskeratotic lesions are considered as secondary to the neoplastic process, either by neoplastic induction or by mobilization and proliferation of cancerous cells from lactiferous ducts. The utility of biopsies in all cases of nipple eczema, and of the histologic investigation of the profound tissues is pointed out. In this way the canalicular starting point in the vicinity of the nipple can be noticed.

[Considerations on pleural puncturo biopsy, based on the results of an analysis of 100 samples]. / Consideratii asupra punctiei-biopsii pleurale, rezultate din analiza a 100 de prelevari.

Results are given on 100 cases in which pleural bioptic puncture (PBP) has been performed for diagnosis purposes. The data given in the study show the large possibilities to apply this method, readily acceptable by patients. The high diagnosis value of PBP method in based on strictly objective criteria. Stress is laid upon the contribution of the method in precising the etiology of pleural fluids, which, up to the application of PBP, were labelled as having an "undetermined" etiology. The right therapeutic measures to be taken on precise diagnosis are also stressed in the study.

A peculiar lymph node anti-carcinoma reaction.

A case of a laryngeal extensive carcinoma determining a severe obstruction is reported, where the development of a monstrous adenopathy is followed by the regression of the initial tumour until complete laryngoscopical disappearance, as well as of obstructive and general symptoms. Cytological and histological examinations of the above-mentioned lymph node demonstrated (besides metastatic cells) a peculiar cellular reaction, similar to rhinoscleroma, which represented an original anti-carcinoma defensive mode. The medical importance of this very rare case is discussed and the probable immune origin of this reactive cellular complex is explained by analogy with "Hodgkinom", where granuloma are the immune response of the body against Sternberg-Reed cell.

Ultrastructural aspects in skin allergic vasculitis.

Twelve cases of skin allergic vasculitis were electronmicroscopically studied. The most striking changes were noticed at the level of capillaries, whose wall components were all affected, especially the endothelial cells. These presented at first adaptive changes, with swelling, microvillosities of plasmalemma protruding into the lumen, and many pinocytotic vesicles showing an intensely active transport. Followed different degrees of degenerative changes of cytoplasms and nuclei, the junctional complexes being interrupted, even discontinuous. The pericytes showed similar changes. The basement membrane was thickened, nonhomogeneous, with a spongy aspect, small discontinuities and some electron-dense depots. The endothelial cell damage and the discontinuity of basement membranes, as well as the alteration of pericytes allowed the migration of blood cells into interstitial spaces, followed by leucocytoclasia. As a consequence, in the perivascular tissue a polymorphous cellular infiltrate developed. The mechanisms and significance of these changes are discussed.

[Morphological diagnostic problems in a case of peritoneal blastomycosis]. / Probleme de diagnostic morfologic într-un caz de blastomicoza peritoneala.

Blastomycosis is a mycotic disease, caused by a fungal infection. It has a wide spectrum of clinical presentations, and, particularly, can mimic neoplastic disease. Correct diagnosis of the illness requires fungal culture and biopsy. In Romania, mycotic histopathology is insufficiently developed, and morphological tests are recommended to very few people who present this type of pathology. The paper discusses a case of peritoneal blastomycosis found at a patient with an abdominal pseudotumoral mass. The microscopic exam revealed the characteristic histologic features and budding yeast, in specific dyes, typical to the Blastomyces dermatidis (PAS, silver-methenamin). Authors of this paper hereby intend to draw pathologists' attention on the existence and diagnosis of mycotic lesions, whose number is continuously increasing nowadays.

[Leiomyosarcoma of the small intestine]. / Leiomiosarcomul intestinului subtire.

The authors present a case of leiomyosarcoma, a particular type of small intestine tumor. A review of the literature is also made.

[Architectonics of fibrillary elements of the stroma in carcinomas of the chin area]. / L'architéctonique des éléments fibrillaires du stroma des carcinomes de la région génienne.

The authors studied 58 cutaneous carcinomas in the elderly in order to observe the stromal connective tissue changes of the carcinomas in the region of the cheek as compared to those in the dorsal area. Qualitative microscopic methods and morphometric ones, which make possible an objective evaluation of the existing changes, were used. An inverse relation between the abundance of stroma in the fibrillar structures and the degree of tumoral invasion and dissemination was noticed. A treatment able to enhance this type of stromal reaction, favourably influencing the evolution of carcinoma is needed.

[Considerations of malignant ocular tumours in children (author's transl)]. / Considérations sur les tumeurs malignes de la sphère oculaire chez les enfants.

The authors undertake a clinico-anatomical study of 27 malignant tumours of the orbit and eye in children seen at the Ophthalmological Clinic in Jassy over the last 12 years. The majority (18 cases) were intra-ocular tumours which were clinically and anatomically retinoblastomas. After presenting the clinical symptoms, drawing attention to the signs of the disease presenting to paediatricians, the treatment is described. This was surgical in all cases followed by radiotherapy according to the case. Analysis of fatal cases and those which survived demonstrate certain degrees of seriousness in clinical, histopathological and therapeutic aspects. It can be appreciated that the long-term prognosis of these cases depends on the early diagnosis and the institution of the correct treatment as well as the anatomopathological form.

Liver ultrastructural changes following portal circulation disturbances.

Liver cell changes produced in rats by the ligature of the portal vein and of the spleen pedicle were studied by electron microscopy. There were differences in the liver response to the various types of circulatory disturbances. The earliest and most marked lesions of hepatic cells were noticed in the case of portal vein ligature, and occurred at the level of rough endoplasmic reticulum, mitochondria and lysosomes. No significant changes in Kupffer cells. When the spleen pedicle was ligated, the hepatic cell changes were less obvious, but the Kupffer cells changes were more prominent, testifying and increased hetero- and autophagy.

[Further comment on the importance of microscopy in clinical microbiology. The argument for the diagnosis of the skin manifestations of histoplasmosis and coccidioidomycosis]. / Inca o data despre importanta microscopiei în microbiologia clinica. Argumentum dupa diagnosticarea unor manifestari cutanate ale histoplasmozei si coccidioidomicozei.

This paper presents two interesting cases: a patient with cutaneous coccidioidomycosis, the first case in Romania, and a female patient with latent histoplasmosis with cutaneous manifestations, periodically reactivated during her pregnancies. The etiological diagnosis problems of these affections in relation with the degrees of competence of the clinical laboratories is discussed. The role of direct microscopic examination in the early and more rapid diagnosis of deep mycoses is underlined.

[Metabolic and cardiovascular changes in experimental diabetes, stress and orchiectomy]. / Modificari metabolice si cardiovasculare in conditii de diabet experimental, stres si orhiectomie.

When Aloran (Al) was administered to normal or orchiectomized animals, the adult ones proved to be more sensitive, most normal animals (77.7%) developing a DAla and the remainder (22.3%) a DAlc, while of the orchiectomized animals 66.6 developed a DAlc and 33.4% presented a decreased glucose tolerance. 33.4% of the young normal developed a DAla and 66.7% a DAlc, while of the young orchiectomized ones 33.4% presented a DAlc and 66.7% a STG. No matter of age, orchiectomy induced an increased resistance to the various action of Al. Glycemia and lipid fractions, especially LT and TG were significantly elevated in the normal animals with DAla and in the young orchiectomized animals with DAlc. Insulinemia was elevated in most young animals, except for the orchiectomized ones with DAlc, in which it decreased. Serum cholesterol was the most markedly elevated in the adult animals belonging to the group ACTH + D2 + Al, form DAlc. Histopathologically, in this last group degenerative lesions and microcalcifications in aorta and interstitial infiltrate and homogenization of myocardial fibres in the myocardium were found.