ASSOCIATION OF GHRELIN RECEPTOR AND INFLAMMATION IN PERI-ATRIAL ADIPOSE TISSUE FROM OBESE PATIENTS WITH POSTOPERATIVE ATRIAL FIBRILLATION.

CONTEXT: Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. The increasing evidence supports links between inflammation and AF. There is evidence showing that obesity is a major cause of adipose tissue (AT) inflammation. Ghrelin (GHRL), through its growth hormone secretagogue receptor (GHS-R) present on adipose tissue macrophages (ATMs), could modulate AT inflammation. OBJECTIVE: Our study aimed to evaluate the role of adipose tissue macrophages (ATMs) and their GHS-R in adipose tissue samples of right atrial appendages (RAA) biopsies. SUBJECTS AND METHOD: We obtained RAA biopsies from 10 obese patients, undergoing cardiac surgery for coronary artery bypass graft (CABG) and developing postoperative atrial fibrillation (POAF). The epicardial tissue samples were examined using immunohistochemistry to visualize and quantify CD68 and GSH-R expression of the ATMs. RESULTS: Histologically, the mean adipocyte diameter (MAD) of epicardial adipose tissue (EAT) was larger in EAT samples with inflammation as compared to EAT without inflammation (84.2 µm vs. 79.6 µm). The expression of CD68 was lower in EAT without inflammation as compared to EAT with inflammation in adipose tissue samples. Similarly, the expression of GSH-R was lower in EAT samples without inflammation as compared to EAT samples with inflammation in adipose tissue. CONCLUSIONS: Increased epicardial fat area, macrophage infiltration, and GHS-R expression in epicardial ATMs appeared to be associated with postoperative atrial fibrillation in obese patients.

99mTc MIBI THYMIC SCINTIGRAPHY IN DIAGNOSIS AND THERAPEUTIC DECISION MAKING: WHAT IS BEHIND THE IMAGE?

CONTEXT: Despite CT being generally used in thymic pathology, in the case of regions with the same tissue density, only functional radioisotopic imaging can hint towards malignity. OBJECTIVES: To assess the usefulness of 99mTc MIBI scintigraphy for diagnosis and treatment planning in thymoma, in relation with the radiotracer uptake mechanism. PATIENTS AND METHODS: 99mTc MIBI thymic scans for 19 patients diagnosed with thymic disorders were assessed using tumor uptake ratio (UR). Specimens of thymectomies were examined and cytological assessments were correlated with the UR. RESULTS: The UR of all surgical patients was higher than 1.2, with a 1.5 cutoff between lymphoid hyperplasia and thymoma. The UR values were correlated with the histopathologic diagnosis (Pearson correlation 0.91, significant at p<0.01). The highest UR was 3.24, found in the case of an AB thymoma where the rate lymphocytes/epithelial cells (L/E) was 1.6. In B1 thymoma UR was 1.14 and L/E was 2.46. CONCLUSION: Phenotype differences between thymoma types correlate with 99mTc MIBI cellular uptake: lower rate L/E corresponds to higher UR, higher malignity potential and invasiveness. A thymic 99mTc MIBI UR higher than 1.5, corresponding to a CT tumoral image, is suggestive for a thymoma, requiring surgical treatment first.

A mediastinal germ cell tumor of yolk sac type--case report.

OBJECTIVE: We report an extremely rare case of germ-cell tumor localized at the level of the anterior mediastinum. CLINICAL PRESENTATION: A 36-year-old man who presented with left subclavial vein thrombosis was admitted to our hospital for specific cure. Computed tomographic scan of the chest showed a large anterior mediastinal mass. Surgical intervention revealed an infiltrative mediastinal tumor involving the left subclavial vein, which was biopsied for morphological examination. Histologically, the tumoral mass proved to be a carcinoma, with papillary and tubular growth patterns. Immunohistochemical stains for alpha-fetoprotein were positive in the tumor cells while stains for carcinoembryonic antigen and placental like alkaline phosphatase were negative. The serum level of alpha-fetoprotein of this patient was elevated, as well. This supported the diagnosis of Yolk sac tumor, a rare primary tumor within the mediastinum. Postsurgery, the patient received a combination chemotherapy consisting of cisplatin, vepesid and bleomycin every 3 weeks for a total of 4 cycles. During the treatment, the alpha-fetoprotein level, was decreasing. CONCLUSION: Primary mediastinal Yolk sac neoplasm is a rare tumor. The diagnosis should be made not only by morphological studies but also the patient's age and the elevation of serum alpha-fetoprotein. In spite of modern chemotherapy, the prognosis of mediastinal yolk sac tumor remains poor. The single most important prognostic indicator is whether the tumor mass can be completely excised before or after chemotherapy.

[The histopathological study of the bronchopulmonary carcinoma]. / Studiu histopatologic în carcinomul bronhopulmonar.

PURPOSE: The aim of the study is to reveal the predominant histological types of the bronchopulmonary carcinomas diagnosed at the Pneumology Hospital in the period of 1st January 1996-December 31 1998. MATERIAL AND METHODS: The study enclosed 196 cases of CBP, representing 174 men and 22 women with ages between 31 and 78 of years. The studied specimens were pieces of bronchoscopical and surgical biopsies, material obtained from the pneumological clinic. RESULTS AND DISCUSSIONS: The histological analysis revealed the increasing number of the bronchopulmonary carcinoma, mainly to men with mean age of sixty and the predominance of the epidermoid carcinoma (137) and a reduced number of cases of adenocarcinomas (31) and undifferentiated carcinomas (28). The knowing of the histological type of the CBP is very important in the calculation of the prognosis. CONCLUSIONS: Our study demonstrate the predominance of CBP at men (174), with ages between 55 and 65 years (127 cases) and similar incidences for all histological types of CBP comparative with other territories.

Ultrastructural aspects of the alveolar wall in SIDS.

The aim of this study is to make a comparative analyse between light and ultrastructural lesions of the alveolar wall in SIDS. The study was made on lung specimens collected from autopsy of infants with sudden unexplained death. There were studied histopathologically 10 cases of sudden death. Only in 3 cases were made electron microscopically studies. At light microscope, there were put in evidence interstitial and intra-alveolar oedema and the presence of many parietal and intra-alveolar macrophages. There is a good correlation between light and ultrastructural aspects.

New trends in "mystery SIDS" research.

The aim of this study is to suggest some new trends of research in SIDS, leaving from the pathologist's observations of the presence of unusual lesions in SIDS. The histopathological study was made on 27 cases of SD, representing 1996 SIDS cases registered to hospital. There were put in evidence the oesophageal inflammation, the hyperplasia of submucosal laryngeal glands, different grades of bronchiolar mucous hypersecretion and reducing of elastic lung tissue and the hypertrophy of muscular lung small arteries. This lesions are frequently encountered to SIDS cases.

Histological study of Hodgkin disease (HD), an immunohistochemical identification of the cells surrounding Sternberg-Reed cells.

In this study, we analyze histological types of 77 cases H.D. and examine immunohistochemically the reactive cells surrounding Reed-Sternberg cells (40 cases). On the current techniques sections of lymph nodes were def ned H.D. types after the new criteria (Bennett & col., 1985, Buttler, 1992). Immunologic marker studies were performed on paraffin sections of H.D. tissue utilizing the avidin--biotin peroxidase complex technique with limited panel of monoclonal antibodies OKT3, OKB1, OKM1. On histopathologic grounds we established the diagnosis of lymphocytic predominance type in 6 cases--8%, nodular sclerosis type in 36 cases--47%, from which first degree--24 cases and second degree--12 cases, mixed cellularity type in 28 cases--36% and lymphocytic depletion type in 7 cases--9%. Immunohistochemically, in our 40 H.D. cases, the number of T. lymphocytes in all H.D. types, was highly variable, ranging from a minority to a vast majority of cells directly surrounding the Reed-Sternberg cells. These lymphocytes were positive for OKT3, which were more in tissue involved by nodular sclerosis or mixed cellularity types than in the lymphocytic predominance type. Thus, in our few cases of lymphocytic predominance type, the reactive proliferation was consisted of B. cells along side with a few T cells. Also the OKM1 positive mononuclear cells were few. In conclusion, our data support the necessity to extend of several immunohistochemical investigations used for distinguishing H.D. disease from benign hyperplasia and from non-lymphoid malignancies, and for concerning the functional lymphocytic composition and the role of monocyte-macrophage system in the immunological alteration in H.D.

[Two decades of epidemiologic surveillance of the evolution of viral hepatitis in Iasi County (1971-1990)]. / Doua decenii de supraveghere epidemiologica a evolutiei hepatitei virale în judetul Iasi (1971-1990).

The results of epidemiological observations on the evolution of viral hepatitis in the Iasi district in the interval 1971-1990 are presented. A mean morbidity of 251.2 cases/100,000 inhabitants, this being in most years under the national mean, was found. In 75.9% of all cases the infections caused by hepatitis viruses affected the age-groups 1-14 years, indicating a high incidence of hepatitis A... Hepatitis B had a more increased incidence in the children aged 0-1 year, then it decreased but was present in all age groups. Although recorded all year round, increases in the incidence of viral hepatitis A were noticed during fall and winter seasons, prevailing in the children and teenagers collectivities.