Morphopathological considerations in pulmonary hydatid cyst complicated by endobronchial rupture

Catedra de chirurgie, ortopedie și anesteziologie pediatrică, USMF „Nicolae Testemiţanu”, Centrul Național Științifico- Practic de Chirurgie Pediatrică ,,Natalia Gheorghiu”, Institutul Mamei şi Copilului, Chișinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Atitudinea faţă de cavitatea reziduală post-echinococectomică este diferită, mai frecvent recurgându-se la obliterarea acesteia prin capitonaj, care are ca scop prevenirea pierderilor de aer în urma fistulelor bronhiale reziduale, fiind un deziderat până în prezent. Scopul: Stabilirea aspectelor morfopatologice în chistul hidatic pulmonar complicat prin ruptură endobronșică după 72 ore de la survenirea complicaţiei la copii. Material şi metode: Studiul prevede examinarea chistului larvar, a ţesutului pulmonar perichistic, selectat în 635 probe tisulare, utilizând reţeaua de histoprocesare, şi coloraţie automatizată „Diapath” aplicând metodele H&E, van Geison, selectiv Orceina şi A&E. Rezultate: Prin examinările histologice retrospective şi prospective, s-au relevat modificări în larvochist şi parenchimul pulmonar perichistic. Acestea fiind caracterizate prin modificări degenerescente, necrolitice, infiltrativ-inflamatorii polimorfocelulare în 95% cazuri, cu o frecvenţă de 57% a fisurelor intra- şi transcuticulare, prezenţa membranei proligere în 15%, şi a elementelor germinative parazitare în 37% cazuri. Ţesutul capsular fiind divers hialinizat cu modificări alterativ - erozive, persistării aspectului vascular sinusoidal cu elemente granulocitare în amestec cu eozinofilic. Perichistic fiind atestată o alveolită de tip macrofagal, exudativ-fibrinoasă şi leucocitară în 65% cazuri. Reţeaua vasculară a relevat fenomene de stază, agregaţie şi trombi micşti, vasculite necrotico-fibrinoide, iar pleura viscerală în 48% cazuri – cu diverse proliferări a mezoteliocitelor în aspect micro-papilomatos. Concluzii: Chistul hidatic pulmonar complicat prin ruptură endobronşică este caracterizat de modificări necrolitice a capsulei cu eozinofilie, sindrom trombo-vascular acut; pneumopatie perichistică, pleurezie reactivă micropapilomatoasă mezotelială ce determină o morbiditate postoperatorie îndelungată.Introduction: The attitude towards residual cavity after echinococectomy is different. It is frequently managed by the obliteration through capitonnage, which aims to prevent air leaks as a result of residual bronchial fistulas, it being a desideratum so far. Aim: To establish morphopathological aspects in pulmonary hydatid cyst complicated by endobronchial rupture after 72 hours of complication occurrence in children. Material and methods: The study included the examination of the larval cyst, pulmonary percystic tissue selected in 635 tissue samples, using the histoprocessing network, and „Diapath” automated staining, applying the following methods: H&E, van Geison, selectively Orcein and A&E. Results: The retrospective and prospective histological examinations revealed changes in larval cyst and pulmonary pericystic parenchyma. They are characterized by degenerative, necrolytic, infiltrating inflammatory polymorphocellular changes in 95% of cases, with a frequency of 57% of the intra- and transcuticular fissures, the presence of proligerous membrane in 15% and parasitic germ elements in 37 %of cases. Capsular tissue is diversely hyalinized with alterative-erosive changes, the prevalence of sinusoidal vascular appearance with granulocyte elements mixed with eosinophils. Pericystically it was attested macrophages, exudative-fibrous and leukocytes alveolitis in 65% cases. The vascular network revealed stasis phenomena, aggregation and mixed thrombus, fibrinoid-necrotizing vasculitis and visceral pleura with different proliferation of mesotheliocytes of micro-papillomatous aspect in 48% of cases. Conclusions: Pulmonary hydatid cyst complicated by endobronchial rupture is characterized by necrolytic changes of eosinophilic capsule with acute thrombo-vascular syndrome, pericystic pneumopathy, reactive micropapillomatous mesothelial pleuritis resulting in a prolonged postoperative morbidity

Quasideuteron states with deformed core

The M1 transitions between low-lying T=1 and T=0 states in deformed odd-odd N=Z nuclei are analyzed in the frames of the rotor-plus-particle model. Using the representation of an explicit coupling of angular momenta we show that strong coupling of the quasideuteron configurations to the axially deformed core results in a distribution of the total 0+ --> 1+ strength among a few low-lying 1+ states. Simple analytical formulae for B(M1) values are derived. The realization of the M1 sum rule for the low-lying 1+,T=0 states is indicated. The calculated B(M1) values are found to be in good agreement with experimental data and reveal specific features of collectivity in odd-odd N=Z nuclei.Comment: 11 pages, 1 figure, LaTe

Caracteristica spectrului celular al populaţiei limfocitare şi a macrofagelor în capsula fibroasă și țesutul pulmonar perichistic în chistul hidatic pulmonar la copii

În cazurile de chist hidatic relația gazdă-parazit este interactivă, evoluția bolii fiind dependentă de echilibrul între mecanismele sistemului imun ale gazdei și de strategiile complexe de evaziune ale agentului parazitar. Scopul studiului a fost testarea imunohistochimică a populației limfocitare în componența infiltratului inflamator la nivelul stratului adventicial (perichist) și țesuturile perichistice în diferite forme clinico-morfologice ale chistului hidatic pulmonar la copii. Investigaţiile morfopatologice au fost direcționate în testarea imunohistochimică a tipurilor de limfocite T implicate în imunitatea celulară locală, cât şi aprecierea limfocitelor B și a macrofagilor implicate în componenta celulară inflamatorie cu utilizarea anticorpilor monoclonali împotriva markerilor de suprafață CD3, CD4, CD8, CD20cy-pozitive și CD68. În calitate de material de studiu au servit probele tisulare prelevate intraoperator din capsula fibroasă și țesuturile adiacente la 20 pacienți cu hidatidoză pulmonară cu vârsta între 10-16 ani, grupați în 3 loturi: 1) chist hidatic pulmonar necomplicat (7 copii); 2) chist hidatic pulmonar cu semne de inflamație ăperichistică (7 copii) și 3) chist hidatic pulmonar complicat prin ruptură (6 copii). Rezultatele studiului au permis de a conchide că: 1. Evoluția chistului hidatic pulmonar la copii este caracterizată de un infiltrat inflamator cronic al parenchimului perichistic cu predominarea limfocitelor T CD3 comparativ cu capsula fibroasă, unde predomină procesele necrolitice. 2. Numărul sporit de CD20 indică activarea semnificativă a sistemulu imun adaptativ în agravarea proceselor inflamatorii în parenchimul perichistic în formele complicate ale maladiei, creșterea numărului de macrofage în aceste cazuri fiind nesemnificativă. 3. Numărul de macrofage CD68 din capsula fibroasă și la nivelul pleurei a fost semnificativ mai mic comparativ cu densitatea acestor celule depistate în infiltratele inflamatorii din parenchimul pulmonar subiacent capsulei fibroase, un număr nesemnificativ mai mare fiind constatat în formele complicate ale maladiei.In cases of hydatid cyst the host-parasite relationship is interactive, the evolution of the disease being dependent on the balance between the mechanisms of the host immune system and complex escape strategies of the parasitic agent. The purpose of the study was to carry out the immunohistochemical test of the lymphocyte population in the inflammatory infiltration at the adventitial layer (pericyst) and pericystic tissues in different clinico-morphological forms of the pulmonary hydatid cyst in children. Morphopathological investigations were focused on the immunohistochemical testing of T lymphocytes involved in local cell immunity, as well as the assessment of B lymphocytes and macrophages involved in the inflammatory cell component with the use of monoclonal antibodies against surface markers CD3, CD4, CD8, CD20cy-positive and CD68. As a study material, the tissue samples taken intraoperatively from the fibrous capsule and adjacent tissues in 20 patients with pulmonary hydatidosis, aged 10-16 year,s were grouped into 3 groups: 1) uncomplicated pulmonary hydatid cyst (7 children); 2) pulmonary hydatid cyst with signs of pericystic inflammation (7 children), and 3) pulmonary hydatid cyst complicated by rupture (6 children). The results of the study allowed us to conclude that: 1. The evolution of the pulmonary hydatid cyst in children is characterized by a chronic inflammatory infiltration of the pericystic parenchyma with the predominance of CD3 T lymphocytes compared to the fibrous capsule where the necrolytic processes predominate. 2. The increased number of CD20 indicates a significant activation of the adaptive immune system in the aggravation of inflammatory processes in the pericystic parenchyma in complicated forms of the disease, the increase of the number of macrophages in these cases being insignificant. 3. The number of CD68 macrophages in the fibrous capsule and within the pleura was significantly lower compared to the density of these cells detected in inflammatory infiltrates of the pulmonary parenchyma underlying the fibrous capsule, an insignificant number being found in complicated forms of the disease

Beta-decay in odd-A and even-even proton-rich Kr isotopes

Beta-decay properties of proton-rich odd-A and even-even Krypton isotopes are studied in the framework of a deformed selfconsistent Hartree-Fock calculation with density-dependent Skyrme forces, including pairing correlations between like nucleons in BCS approximation. Residual spin-isospin interactions are consistently included in the particle-hole and particle-particle channels and treated in Quasiparticle Random Phase Approximation. The similarities and differences in the treatment of even-even and odd-A nuclei are stressed. Comparison to available experimental information is done for Gamow-Teller strength distributions, summed strengths, and half-lives. The dependence of these observables on deformation is particularly emphasized in a search for signatures of the shape of the parent nucleus.Comment: 29 pages, 16 figure

Histopathological features in esophageal atresia with lower esotracheal fistula

State University of Medicine and Pharmacy „Nicolae Testemitanu”, Institute Center of Mother and ChildIntroduction. Despite the success obtained in reconstructive operations of esophageal atresia, a major frequency of complications documented in the postoperative period has been still persisting, including dysphagia, gastroesophageal reflux, esophageal peristaltic disorders etc. Aim to analize the spectrum of morphopathological changes revealed in cases of esophageal atresia with lower esophageal-tracheal fistula and to establish the role in the development and evolution of postoperative complications. Methods: Histopathological study was conducted on 21 patients. It included autopsy materials performed on unoperated specimens from 8 newborns with esophageal atresia and lower esophageal-tracheal fistula, and in 13 cases from operated newborns. Serial sections both of the proximal segment (sealed/blunt) of the esophagus and of the distal segment to the fistula were made. Results: On the level of the atretic segment of the esophagus (sealed/blunt), the esophageal wall was characterized by a well differentiated structure, the proper muscular coat of the submucosa being frequently hypertrophied. The submucosa exhibited a dense fibrillar connective tissue with predominance of collagen fibers, with their emphasis towards the atretic end. Reduction of autonomic and myenteric nervous network was found in different ratio in the muscular coats (circular and longitudinal layer). The muscular coat located focally or regionally was often substituted by plates of collagenized and mesenchymal connective tissue. The distal fistulated segment of the esophagus was characterized by advanced dysplastic changes, absence of muscular coats or its reduction, with presence of chaotic hypotrophic or hypertrophic fibers or bundles, arranged in a mass of connective tissue. Compared with the proximal segment, including the region of the fistulous orifice, in some cases presence of glandular structures of pseudoadenomatous and cystic appearance was observed. There could be observed ganglioneuronal structures with vascular and granular dystrophy on the level of fibro-muscular dysplastic processes in areas which showed presence of nervous myenteric network. Conclusion: The results of this study allowed to confm obvious structural pathological changes that may significantly influence regenerative-reparative processes and postoperative esophageal motility after reconstructive operations

Aspects of intra-operative inactivation and methods of surgical resolution of residual cavities in pulmonary hydatid cyst in children

In Clinic of Vertebrology, Orthopedics and Traumotology of the “N.Georgiu” Scientifically - Practical Center of Children’s Surgery 29 patients with spine deformations after traumatic injuries in the acute stage have been pre- and postoperatively examined with a follow-up of 1 to 5 years. Children were aged between 3 and 17 years. The main goals of surgical interventions were: elimination of the compression factor, deformation and disbalance, correction and spine stabilization. The comparative analysis of the quality of the life of patients (according to a questionnaire „EQ-5D”), before and after surgical intervention, has shown that the quality of the life of patients improved, in comparison with the preoperative period, from 12,7±0,3 points to 7,7±0,1. The distant results of surgical treatment were good– 85,1%, satisfactory – 11,2 % and unsatisfactory – 3,7%. Conclusion: 1. In fresh cases of the complicated spinal - marrow trauma with mild and average degree of a neurologic symptomatology (D degree on Frenkel’s scale) the preference was given to the closed, indirect decompression. At a serious neurologic symptomatology (A, B, C degree) carried out open decompression and revision of dural bag’s contents; 2. Optimum method of correction the complicated spinal - marrow trauma were: forward spine release; dorsal correction and backbone fixation by a metal construction

Prototype tests for the ALICE TRD

A Transition Radiation Detector (TRD) has been designed to improve the electron identification and trigger capability of the ALICE experiment at the Large Hadron Collider (LHC) at CERN. We present results from tests of a prototype of the TRD concerning pion rejection for different methods of analysis over a momentum range from 0.7 to 2 GeV/c. We investigate the performance of different radiator types, composed of foils, fibres and foams.Comment: Presented at the IEEE Nuclear Science Symposium and Medical Imaging Conference, Lyon, October 15-20, 2000 (accepted for publication in IEEE TNS), Latex (IEEEtran.cls), 7 pages, 11 eps figure

Projected shell model study of odd-odd f-p-g shell proton-rich nuclei

A systematic study of 2-quasiparticle bands of the proton-rich odd-odd nuclei in the mass A ~ 70-80 region is performed using the projected shell model approach. The study includes Br-, Rb-, and Y-isotopes with N = Z+2, and Z+4. We describe the energy spectra and electromagnetic transition strengths in terms of the configuration mixing of the angular-momentum projected multi-quasiparticle states. Signature splitting and signature inversion in the rotational bands are discussed and are shown to be well described. A preliminary study of the odd-odd N = Z nucleus, 74Rb using the concept of spontaneous symmetry breaking is also presented.Comment: 14 pages, 7 figures, final version accepted by Phys. Rev.