Clinical and morphological case of developing liver cirrhosis associated with viral hepatitis in a young patient

The significance of chronic hepatitis is determined not only by the disease per se, but also by the increased risk of the formation of long-term adverse effects such as liver cirrhosis. Viral cirrhosis of the liver (as the outcome of chronic hepatitis B, C, B + D) comprise from 10% to 24.5% of all liver cirrhosis cases. Cirrhosis of the liver is considered as an irreversible stage of chronic hepatitis, more often observed in men above 40 years, but recently more and more its cases are found in young, working ones leading to disability. Due to the high liver regenerative potential, a prognosis for liver lesions of different etiologies may be rather favorable. As a result, early diagnostics, dynamic monitoring and the use of promising methods for treating liver pathology to stimulate its regeneration that compensates for lost liver functions are necessary. In the clinical and morphological case, pathomorphological changes in organs with liver cirrhosis, which developed as a result of viral hepatitis are described. The aim of the study was to describe pathomorphological changes in organs during liver cirrhosis, which developed due to viral hepatitis, which led to multiple organ failure in a young patient. Materials and methods. The analysis of the obtained accompanying medical documentation (outpatient card, medical history) was performed. The standard methodology of autopsy was used. To process histological sections of autopsy material, hematoxylin-eosin staining was used. Results. Histological examination in the liver shows development of portal tract fibrosis with lymphohistio cytic infiltration, formation of monolobular regenerated nodes, signs of edema, areas of demyelination, dystrophic changes in neurocytes, signs of acute renal failure, a combined profound change in the kidneys detected in the lungs and brain, which resulted in multiple organ failure and subsequent lethal outcome in a young patient. The early formation of portal hypertension with liver cirrhosis, esophageal and gastric varicose veins dilatation lead to fatal bleeding in half of patients. Therefore, timely diagnosed cirrhosis and hepatitis as their predecessors is one of the most relevant issues in medicine

Organ-specific pathomorphological changes during COVID-19

COVID-19 is an acute respiratory infection caused by SARS-CoV-2 coronavirus causing pneumonia, lesions in the cardiovascular system and other organs, high mortality risk, especially in geriatric patients. Due to the great relevance, this study was aimed at describing the case of severe COVID-19 with development of multiple organ failure. Materials and methods. Available accompanying medical documentation (outpatient charts, medical history) was analyzed. Clinical and morphological analysis was carried out by providing description of macro- and micropreparations; histological methods (hematoxylin and eosin staining, Lee reaction) were used. Results. Female patient K.G., 69 years old, was hospitalized to the therapeutic department diagnosed with coronary heart disease. Acute coronary syndrome with ST segment elevation was made on 04/20/2020. A competing diagnosis: severe community-acquired bilateral multi-segmental pneumonia. The patient’s condition was aggravated wile applying therapy followed by biological death occurred. An autopsy revealed bilateral subtotal hemorrhagic pneumonia. Macroscopic lung examination demonstrated “lungs filled with red fluid”. In the brain — perivascular and pericellular edema, hyalinosis, blood stasis and sludge, marked dystrophic and necrotic neuronal changes. Cardiomyocyte fragmentation, areas of perivascular sclerosis with inflammatory infiltrates as well as erythrocytic sludge are found in the heart and blood vessels, respectively. A weak positive reaction according to Lee method was observed. Such clinical and morphological case demonstrates along with lung damage involvement of the heart resulting in acute coronary syndrome (morphologically manifested by ischemic myocardial dystrophy) and the brain. Thus, premorbid background in elderly patients results in developing acute pulmonary heart failure, pulmonary and cerebral edema

Редкий случай холангиоцеллюлярного рака печени с гематогенными метастазами и изменения в органах при генерализации процесса

Introduction. Cholangiocellular cancer is a malignant tumor from the epithelium of the bile ducts. Intravital diagnosis is often difficult to make due to the absence of any definitive signs of cancer and problems with detecting the first signs. Following the relevance of the problem, a case of cholangiocellular liver cancer with generalized metastases is presented.Materials and methods. The analysis of the received supporting medical documentation and the description of macroand micropreparations using histological (hematoxylin and eosin staining) and immunohistochemical methods were carried out.Results and discussion. Patient L.M., 60 years old, died at home, was referred by a general practitioner to the pathology department for autopsy examination. During the forensic autopsy, the macroscopic examination revealed dense liver substance, a «tree-like» mass of gray-yellow-brown color on the sections around the portal vein and intrahepatic bile ducts, with involvement of the right and left liver lobes and multiple gray nodules located throughout the liver parenchyma. The intrahepatic bile ducts malfunction due to expanding tumor tissue. Histological examination revealed a moderately differentiated tumor growth of cholangiocellular carcinoma, consisting of polymorphic cells separated by layers of fibrous tissue with areas of necrosis, foci of cholestasis. Immunohistochemical analysis of the tumor tissue of the lungs, liver: cytokeratins CAM 5.2 (+). All groups of lymph nodes of hepatoduodenal ligament, along vesicular and common bile ducts, hepatic artery and portal vein, surrounding left gastric and common hepatic artery, as well as lymph nodes of posterior pancreaticoduodenal group and distant lymph nodes are celiac; upper mesenteric and paraaortic zones appear unremarkable. Cerebral edema, pulmonary edema and necronephrosis were reported.Conclusion. The presented case is of particular interest to practitioners owing to the absence of the characteristic lymph node metastases and presence of hematogenous metastases and development of multiple organ failure.Введение. Холангиоцеллюлярный рак представляет собой злокачественную опухоль из эпителия желчных протоков. Прижизненная диагностика зачастую затруднена вследствие отсутствия каких-либо определяющих признаков рака, и отследить первые признаки бывает достаточно сложно. В связи с актуальностью проблемы приводится случай холангиоцеллюлярного рака печени с генерализованными метастазами.Материал и методы. Проведен анализ полученной сопроводительной медицинской документации, описание макро- и микропрепаратов с использованием гистологического (окраска гематоксилином и эозином) и иммуногистохимического методов исследования.Результаты и обсуждение. Больной Л.М, 60 лет, умерший в домашних условиях, по направлению врача общей практики доставлен на секционное исследование в патолого-анатомическое отделение. При аутопсии с помощью макроскопической диагностики выявляется плотное вещество печени, на разрезах вокруг воротной вены и внутрипеченочных желчных протоков наблюдается «древовидное» разрастание серо-желто-коричневого цвета, с поражением правой, левой долей печени и множеством серых узлов, расположенных по всей паренхиме органа. Ход внутрипеченочных желчных протоков нарушен из-за разрастающейся опухолевой ткани. При гистологическом исследовании отмечается опухолевый рост холангиоцеллюлярной карциномы умеренной степени дифференцировки, состоящей из полиморфных клеток, разделенных прослойками фиброзной ткани с участками некрозов, очагами холестазов. Иммуногистохимический анализ в опухолевой ткани легких, печени: цитокератины клона САМ 5,2 (+). Все группы лимфатических узлов гепатодуоденальной связки, вдоль пузырного и общего желчного протоков, печеночной артерии и воротной вены, окружающие левую желудочную и общую печеночную артерии, задней панкреатодуоденальной группы, а также отдаленные лимфатические узлы – чревные, верхние мезентериальные и парааортальной зоны без особенностей. Отмечался отек головного мозга, легких, некронефроз.Заключение. Представленный случай имеет особый интерес для практикующих врачей вследствие того, что отсутствовали характерные метастазы в лимфатические узлы, а отмечалось преимущественно гематогенное метастазирование и развитие полиорганной недостаточности

Hemodynamic criteria of the circulatory system in ethnic groups of students with different types of autonomic regulation of the heart rate

Under physiological conditions, the first years of university studies of the students of Arabic and African subgroups with MPAR and PPAR HR were characterized by toughness, low effectiveness of the system of blood circulation, increased peripheral vascular resistance, vascular TSC; Indian and Latino-American subgroups with MPAR HR revealed the weakness and low efficiency of the circulatory system, the optimal GPBC and cardiovascular TSC were revealed in Indian and Latino-American subgroups with MPAR HR, and subgroups with PPAR HR showed high endurance of the circulatory syste

Изменения органов после инфицирования SARS-CoV-2 у пациентки с системной склеродермией по данным аутопсии

The article presents a description of a clinical case with a fatal outcome due to SARS-CoV-2 coronavirus-induced bilateral viral pneumonia with areas of pneumofibrosis, complicated by acute respiratory failure. The presence of systemic sclerosis in this patient aggravated the course of the disease and became one of the causes of death. Autopsy revealed signs of bilateral pneumonia with lesions in both lungs and areas of pneumofibrosis.Histological examination revealed alveoli with rupture of interalveolar septa, areas of atelectasis, serous-purulent exudate with desquamated alveolocytes, places with organization of exudate, zones of pneumofibrosis. Scleroderma cardiosclerosis, linear necrosis of cardiomyocytes were present in the heart. There were signs of multiple organ failure – pulmonary edema, cerebral edema.В статье представлено описание клинического случая с летальным исходом вследствие вызванной коронавирусом SARS-CoV-2 двусторонней вирусной пневмонии с участками пневмофиброза, осложненной острой респираторной недостаточностью. Наличие у пациентки системной склеродермии усугубило течение болезни и стало одной из причин смерти. По данным аутопсии выявлялись признаки двусторонней пневмонии с поражением обоих легких и участками пневмофиброза.При гистологическом исследовании встречались альвеолы с разрывом межальвеолярных перегородок, участками ателектазов, наблюдался серозно-гнойный экссудат с десквамированными альвеолоцитами, местами с организацией экссудата, зонами пневмофиброза. В сердце определялись склеродермический кардиосклероз, линейные некрозы кардиомиоцитов. Отмечались признаки полиорганной недостаточности – отек легких, отек головного мозга

Characteristics of new cases of infiltrative pulmonary tuberculosis in patients having HIV infection with multidrug resistance of the pathogen according to multi-layer spiral computed tomography

Background. Identification of the characteristics of the pulmonary tuberculosis process using multi-layer spiral computed tomography (MSCT) in patients with tuberculosis and HIV infection is important in the diagnosis of tuberculosis, determining the dissemination of the process and its dynamics during treatment. The aim. To determine the initial characteristics and dynamics of infiltrative tuberculosis according to MSCT in patients with and without HIV infection, with and without multidrug resistance (MDR) of Mycobacterium tuberculosis who were treated in a hospital. Materials and methods. 126 patients aged 19–59 years with tuberculosis, combined with HIV infection and without HIV infection were examined. For statistical processing, we used MS Excel (Microsoft Corp., USA) software package. Results. Patients with tuberculosis and HIV infection in comparison with patients with tuberculosis and without HIV had more expressed intoxication syndrome and respiratory impairement in the clinical picture (p < 0.00001). Patients with coinfection were more likely to suffer from alcohol (p  <  0.05) and drug addiction (p < 0.001). According to MSCT, the pathological process in HIV-positive patients with pulmonary tuberculosis was more disseminated (p < 0.05), included severe intrathoracic lymphadenopathy (p < 0.0001), more common pleural lesions (p < 0.005), less common destructive changes (cavities) (p < 0.001) and outcomes in form of fibro-cavernous tuberculosis (p < 0.01). Process regression was slower in patients with tuberculosis and HIV (p < 0.005). According to MSCT, extensive lung damage, intrathoracic lymphadenopathy were  more often found in patients with MDR in coinfection (p  <  0.05). Cavities and fibro-cavernous tuberculosis outcomes were more common in patients with tuberculosis without HIV infection and with MDR (p < 0.05). Conclusion. MSCT provides detailed information about the pathological process in the lungs and its dynamics under the treatment of tuberculosis and HIV infection

Femtosecond dynamics of the collinear-to-spiral antiferromagnetic phase transition in CuO

We report on the ultrafast dynamics of magnetic order in a single crystal of CuO at a temperature of 207 K in response to strong optical excitation using femtosecond resonant x-ray diffraction. In the experiment, a femtosecond laser pulse induces a sudden, nonequilibrium increase in magnetic disorder. After a short delay ranging from 400 fs to 2 ps, we observe changes in the relative intensity of the magnetic ordering diffraction peaks that indicate a shift from a collinear commensurate phase to a spiral incommensurate phase. These results indicate that the ultimate speed for this antiferromagnetic re-orientation transition in CuO is limited by the long-wavelength magnetic excitation connecting the two phases.Comment: Accepted by Physical Review Letters (Dec. 2, 2011

Acute myocardial infarction and coronavirus infection (COVID-19)

The aim of the study is to describe a case of COVID-19 and myocardial infarction in an elderly patient. Material and methods. The analysis of medical documentation (outpatient card of the patient, medical history, postmortem report) was carried out. Studied macro- and micropreparations (staining with hematoxylin and eosin). Results. A 67-year-old patient, from 23.04.2020 to 26.04.2020, was hospitalized with a diagnosis of suspected coronavirus infection (COVID-19). On the background of the treatment, the patient's biological death occurred (26.04.2020). The sectional study revealed signs of bilateral total hemorrhagic pneumonia. The signs of acute transmural myocardial infarction of the anterior wall of the left ventricle were determined. Posthumously, SARS-CoV-2 RNA was detected in the lung tissue by nucleic acid amplification. In the described clinical case, a patient with concomitant cardiovascular diseases, such as arterial hypertension, coronary heart disease, developed complications against the background of COVID-19: hemorrhagic pneumonia and myocardial infarction with a fatal outcome