A mediastinal germ cell tumor of Yolk sac type -case report

Rezumat Tumorã cu celule germinale tip Yolk sac -prezentare de caz Obiectiv: Raportãm un caz extrem de rar de tumorã cu celule germinale localizatã la nivelul mediastinului anterior. Este cazul unui bãrbat de 36 de ani care s-a prezentat cu trombozã de venã subclavie stângã şi a fost admis pentru tratament de specialitate. Tomografia computerizatã toracicã a relevat o masã tumoralã mare în mediastinul anterior. Intervenåia chirurgicalã a evidenåiat o tumorã infiltrativã mediastinalã cu implicarea venei subclavii stângi, care a fost biopsiatã pentru examinare morfologicã. Histologic, masa tumoralã s-a dovedit a fi un carcinom, cu mod de creştere papilar şi tubular. Examenul imunohistochimic a relevat imunoreactivitate pozitivã pentru alfa-fetoproteina în celulele tumorale si negativã pentru antigenul carcinoembrionar şi fosfataza alcalinã placentarã. Nivelul seric al alfa-fetoproteinei la acest pacient a fost, de asemenea, ridicat. Acest lucru a susåinut diagnosticul de tumorã Yolk sac, care este o tumorã primarã rarã în mediastin. Post-chirurgical, pacientul a primit o combinaåie chimioterapicã constând din cisplatinã, vespezid şi bleomicinã, fiecare timp de 3 sãptãmâni, în total 4 cicluri. În timpul tratamentului, nivelul alfa-fetoproteinei, a fost în scãdere. Concluzie: Tumora Yolk sac primarã mediastinalã este o tumorã rarã. Diagnosticul ar trebui sã fie fãcut nu numai pe studii morfologice, dar, de asemenea, luând în considerare vârsta pacientului şi nivelul seric crescut al alfa-fetoproteinei. În ciuda chimioterapiei moderne, prognosticul tumorii Yolk sac mediastinale rãmâne sumbru. Cel mai important indicator prognostic este excizia completã a masei tumorale înainte de chimioterapie. Cuvinte cheie: tumora cu celule germinale, tumora Yolk sac, tumora sinusului endodermic Abstract 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, vespezid 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 A mediastinal germ cell tumor of Yolk sac type -case repor

Takayasu Arteritis: new trends in surgical approach – case presentation

Takayasu arteritis (TA) is defined as a rare chronic granulomatous panarteritis that classically involves segments of large arteries such as the aortic arch. The aim of this report is to present our recent experience in diagnosis and treatment of TA and to provide aspects of surgical strategy for inflammatory aneurysms caused by TA. We present the case of a 36-year-old Caucasian female admitted to our clinic with low effort dyspnea, fatigability, palpitations, sweats, malaise and light-headedness. The medical history revealed a history of treated tuberculosis, anemia, arterial hypertension, chronic inflammatory syndrome, aortic insufficiency, and anterior mitral valve prolapse. Echocardiography revealed grade III-IV aortic regurgitation, grade I-II mitral regurgitation, a dilated ascending aorta and mild systolic dysfunction. CT angiography revealed an aneurysmal dilatation of the ascending aorta. Surgical treatment was mandatory, and intraoperative, the surgeon noted a diffuse thickening of the aortic wall and suspected TA, further confirmed by histopathological examination. The tricuspid aortic valve was excised and a composite graft with a biological valve and an aortic conduit were implanted on patient’s request. Postoperative course was uneventful and the patient was discharged from the hospital on the 10th postoperative day, and directed towards Rheumatology Clinic for medical treatment. A multidisciplinary approach to the diagnosis and management of TA patients is essential to a satisfactory outcome

POLICIES AND STRATEGIES AIMED AT ENSURING THE SECURITY OF BANKING INSTITUTIONS AND THEIR IT SYSTEMS

With the development of the banking system, its security and, implicitly, security polic ies emerged as cr itical factors in the entire banking s ector . In the context of the current technological development, the vulnerability of banking institutions has increased dramatically . For both bank employee s and customer s , cybersecurity, operational security and data privacy have become top priorities. Th erefore , a central concern for banks is the prompt detection of threats and the development of measures aimed at eliminat ing such dangers , which might both considerably increas e the level of security in the banking sector

Distinguish the Stable and Unstable Plaques Based on Arterial Waveform Analysis

The rupturing of unstable plaques, formed by atherosclerosis, is the main factor contributing to the stroke event. According to stroke association in 2017, the stroke is the fourth leading cause of death in the UK. The percentage of plaque composition plays an important role for plaque stability and can be considered as important information to determine whether the patients need surgery or not. The main aim of this work is to determine the relationship that exists between plaque composition and arterial waveform for distinguishing stable and vulnerable plaques. An in-vitro experiment, representing the arterial system, is used to investigate the effect of the composition of the atherosclerosis on the propagation of the arterial waveforms. Different types of the artificial plaque, fabricated manually, were implemented into the artificial carotid artery. The pressure, velocity and arterial vessel wall movement were measured simultaneously proximal to the site of the arterial plaques.Wave intensity analysis (WIA) was used to separate the waves into forward and backward waves to identify how the plaque compositions will affect the reflected arterial waveforms. Our results indicated that stable plaques caused the stronger reflected waves, leading to the higher amplitude of the arterial diameter waveform. In general, this study demonstrated that the arterial waveforms are strongly associated with the compositions of the arterial plaques, implying the arterial waveform could provide the information to characterize the types of the plaques, then leading to a novel approach to stratify the atherosclerosis patients and determine if the interventional vascular surgery is neede

Research and Science Today Supplement No. 3/2015

RESEARCH AND SCIENCE TODAY is a biannual science journal established in 2011. The journal is an informational platform that publishes assessment articles and the results of various scientific research carried out by academics. We provide the authors with the opportunity to create and/or perfect their science writing skills. Thus, each issue of the journal (two per year and at least two supplements) will contain professional articles from any academic field, authored by domestic and international academics. The goal of this journal is to pass on relevant information to undergraduate, graduate, and post-graduate students as well as to fellow academics and researchers; the topics covered are unlimited, considering its multi-disciplinary profile. Regarding the national and international visibility of Research and Science Today, it is indexed in over 30 international databases (IDB) and is present in over 200 online libraries and catalogues; therefore, anybody can easily consult the articles featured in each issue by accessing the databases or simply the website

VULNERABILITY INDEX ASSESSMENT OF THE EROSIVE ATHEROSCLEROTIC PLAQUE ON ENDARTERECTOMY SPECIMENS

Background Atherosclerosis is an arterial inflammatory process which causes associated tissue ischemia of different degrees. It is not yet calculated an index of plaque vulnerability as a histological marker of acute cardiac event risk at these patients. Aim of the study This retrospective study aimed to answer the question of whether the index of plaque vulnerability can appreciate the risk of atherothrombosis of the erosive plaques using histological measurements. Material and methods 30 patients were included in the study. American Heart Association (AHA) classification was used for appreciating the histological degree of ATS lesions on endarterectomy pieces. In all patients, intima-media thickness (IMT), erosion depth, and parietal thrombosis area were assessed. Results The proposed vulnerability index showed that about 50% of patients have a medium risk of plaque vulnerability and of associated acute coronary syndrome (ACS). Conclusions The index of plaque vulnerability may be used as a reference in ATS assessment by using intravascular ultrasound (IVUS) methods

A Plaque Instability Index Calculated by Histological Marker Analysis of the Endarterectomy Carotid Artery

(1) Background: Atherosclerosis is a pandemic condition that causes the development of ischemic syndromes including myocardial infarctions and many strokes, in addition to disabling peripheral artery disease. Progression of atheroma plaques has been associated with an increased risk of mortality. It is a challenge to determine in advance if atherosclerotic plaque will become unstable by calculating an index of instability. We proposed a score of ten parameters for the assessment of high-risk plaques, by quantification of 10 risk factors for acute cardiovascular events, most of them representing histological variables. (2) Methods: Carotid endarterectomy samples were collected from 10 highly symptomatic patients who matched for gender, age, risk factors, and plaque morphology. Samples were stained with hematoxylin-eosin, elastic van Gieson, Perls, and Mallory. Immunohistochemistry was performed using specific antibodies, such as CD31 for endothelial cells, CD68 for macrophages, and CD3 for T cells. (3) Results: For each plaque, the presence and/or number of histological features (fibrous cap thickness, lipid core size, plaque and cap infiltration with macrophages and lymphocytes, neovessels, intraplaque hemorrhage, parietal thrombi, and calcium deposits) were recorded on a simple semi-quantitative one- or two-grade scale. The study identified four stable plaques (SPs), two vulnerable plaques (VPs), and four unstable plaques (USPs). We found significantly more macrophages and neovessels in unstable plaques compared with stable plaques. The score for unstable plaques was higher than that for VP. (4) Conclusions: The study showed that symptomatic carotid disease is associated with an increased index score. The proposed algorithm for carotid plaque assessment may be useful for an imaging application

Flaxseed Prevents Leukocyte and Platelet Adhesion to Endothelial Cells in Experimental Atherosclerosis by Reducing sVCAM-1 and vWF

We studied the possible effect of flaxseed to prevent leukocytes and platelets adhesion to endothelial cells and to reduce soluble adhesion molecules (sVCAM-1) and endothelial integrity markers (vWF) in ovariectomized rats fed a high-fat diet. Forty-two female Wistar rats were either sham-operated or ovariectomized and randomly assigned for 36 weeks to three different diets: (1) low-fat diet (8% energy as fat); (2) high-fat diet (40% energy as fat, lard based, lard group); (3) high-fat diet enriched with ground flaxseed 15 g/100 g of food (40% energy as fat, lard + flaxseed group). The ovariectomized rats fed with lard + flaxseeds had significantly lower serum concentrations of sVCAM and vWF, reduced platelet adhesiveness, and lower extent of platelet and leukocyte adherence to endothelium in the histological evaluation of the aorta as compared to Ovx + lard group. In our study, high dose of ground flaxseed incorporated to lard-based diet prevented the progression of atherosclerotic lesions in estrogen deficiency rats by decreasing platelet and endothelium reactivity. Assessment of platelet adhesion, serum soluble adhesion molecule sVCAM, and endothelium integrity molecule vWF could be useful to detect the risk for atherosclerotic lesions in estrogen deficiency states and to estimate the effect of flaxseed supplementation

Rib Exostoses Presenting as Mediastinal Masses: A Rare Presentation and Minireview of the Literature

Costal osteocartilaginous exostoses, also known as osteochondromas, are the most common neoplasms of the long bones but are rare tumors of the ribs. Osteochondroma is often asymptomatic and incidentally observed. Tumors typically begin to grow before puberty and continue until bone maturation is reached. Our paper presents the case of a 16-year-old young male who was admitted to the hospital with nonspecific symptoms and having a family history of exostosis. Chest X-ray and computed tomography imaging revealed multiple costosternal exostoses, manifested as mediastinal masses, with protrusion into the thoracic cavity, exerting compressive effects on the ascending aorta and pulmonary parenchyma. Surgery is required in childhood if lesions are painful. But if tumor formation occurs in adulthood, such pathological bony outgrowths should always be resected for avoiding further complications. In this patient, surgical intervention removed the tumoral masses and improved the symptoms. Subsequently, histological exam confirmed the diagnosis of osteocartilaginous exostoses and showed the lack of dysplastic changes

Macrophage Accumulation and Angiogenesis in Epicardial Adipose Tissue in Cardiac Patients with or without Chronic Heart Failure

Routinely measuring epicardial fat had become a novel tool for cardiovascular risk stratification. Structural changes in epicardial adipose tissue (EAT), including fat thickness, inflammation, and angiogenesis, have been described in coronary artery disease (CAD) patients. We proposed to measure EAT thickness and characterize inflammatory infiltrate and angiogenesis in epicardial adipose tissue in CAD patients with and without chronic heart failure (CHF), established by cardiac dysfunction on echocardiography (left ventricular ejection fraction, LVEF ≤ 50%) and symptoms of heart failure (New York Heart Association (NYHA) functional class II or III).The study included 15 patients with CAD (demonstrated by coronary angiography),, who underwent right atrial appendages (RAA) excision during coronary artery bypass graft (CABG). The study was performed by histopathological, immunohistochemical (IHC), and morphometrical analysis. EAT thickness was assessed by using morphometry applied on routine histological stains. Inflammatory cell infiltration and angiogenesis were investigated immunohistochemically by using antibodies against CD68 and CD34 markers. Diminished EAT thickness in the CAD patients with CHF was associated with increased macrophage infiltration and reduced angiogenesis of the EAT as compared to CAD patients without CHF. In conclusion, the present study on epicardial fat samples of the RAA suggested that high expression of CD68 appeared to be associated with severe deterioration of heart function in CAD patients who underwent myocardial revascularization consisting of CABG