ObjectivesTo understand the impact of COVID-19 on delivery and outcomes of primary percutaneous coronary intervention (PPCI). Furthermore, to compare clinical presentation and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with active COVID-19 against those without COVID-19.MethodsWe systematically analysed 348 STEMI cases presenting to the PPCI programme in London during the peak of the pandemic (1 March to 30 April 2020) and compared with 440 cases from the same period in 2019. Outcomes of interest included ambulance response times, timeliness of revascularisation, angiographic and procedural characteristics, and in-hospital clinical outcomesResultsThere was a 21% reduction in STEMI admissions and longer ambulance response times (87 (62–118) min in 2020 vs 75 (57–95) min in 2019, p<0.001), but that this was not associated with a delays in achieving revascularisation once in hospital (48 (34–65) min in 2020 vs 48 (35–70) min in 2019, p=0.35) or increased mortality (10.9% (38) in 2020 vs 8.6% (38) in 2019, p=0.28). 46 patients with active COVID-19 were more thrombotic and more likely to have intensive care unit admissions (32.6% (15) vs 9.3% (28), OR 5.74 (95%CI 2.24 to 9.89), p<0.001). They also had increased length of stay (4 (3–9) days vs 3 (2–4) days, p<0.001) and a higher mortality (21.7% (10) vs 9.3% (28), OR 2.72 (95% CI 1.25 to 5.82), p=0.012) compared with patients having PPCI without COVID-19.ConclusionThese findings suggest that PPCI pathways can be maintained during unprecedented healthcare emergencies but confirms the high mortality of STEMI in the context of concomitant COVID-19 infection characterised by a heightened state of thrombogenicity.

BACKGROUND:To the authors' knowledge, the diagnostic value of cell block (CB) as an adjunct to ThinPrep liquid-based cytology (LBC) of bronchial washing specimens in the detection and subclassification of pulmonary neoplasms has not been well evaluated. The objective of the current study was to evaluate the diagnostic utility of CB in this setting. METHODS: A total of 74 bronchial washing specimens and concurrently prepared CBs with a diagnosis of malignant or suspicious/atypical obtained from bronchoscopy procedures performed during 2009 were reviewed along with 28 randomly selected negative cases. LBC and CBs were reviewed independently. Deeper levels and ancillary studies were performed on CBs for specific tumor classification if needed. LBC and CB diagnoses were correlated with final histology and/or bronchial brushings. RESULTS: Use of CBs increased the number of positive diagnoses from 18 (LBC only) to 30 (combined LBC and CB) and 36 (combined LBC and CB with ancillary studies), with increased diagnostic yields of 67% and 100%, respectively. CB without ancillary techniques detected 22 malignancies whereas LBC detected 18 malignancies and CB with ancillary techniques detected 29 malignancies. A specific tumor diagnosis was possible in 22 of 29 (76%) malignancies detected by CB. Bronchial brushings and histology confirmed malignancy in 91% and 92% of cases, respectively. CONCLUSIONS: CB combined with LBC was found to improve the rate of detection of malignancy over LBC alone, especially in cases with suspicious or atypical LBC diagnoses. Increased diagnostic yield is observed when CB is used with or without ancillary studies, but the yield is higher with CB using ancillary studies. CB serves as yet another available source of diagnostic material for immunohistochemical and molecular studies. Cancer (Cancer Cytopathol) 2012;120:134-

We report a premature infant with disseminated fungal infection identified as Bipolaris spicifera. The infant was born at 23 4/7 weeks' gestation, weighing 780 g. At day of life (DOL) 7 erythematous areas on the back were noticed that progressed to black, necrotic skin lesions. A shave biopsy showed invasive fungal organisms that were identified by culture as B. spicifera. The lesions progressed despite aggressive surgical debridement and antifungal therapy. On autopsy, fungal organisms found throughout the internal organs confirmed disseminated disease with B. spicifera. This organism is now more often recognized as a human pathogen; however, this is the first reported case in a neonate.

Chordomas represent rare malignant primary bone tumors most often occurring in the sacral area. These tumors uncommonly involve the skin and often follow a progressive course with multiple recurrences, metastases and eventual death. Reports of cutaneous metastases from chordoma are very rare. The immunohistochemical staining characteristics of these cutaneous metastases with comparison to the primary tumors are similarly rarely addressed in the literature. We report a rare case of incidentally discovered, small, solitary distant cutaneous metastasis of sacral chordoma that developed on the right upper back of a 44-year-old man with a history of multiple completely excised melanomas who had also been previously diagnosed with chordoma involving the sacrum 12 years earlier. We describe its pathologic features with comparison to the primary tumor and briefly review the literature. Immunohistochemically, the cutaneous metastasis and primary tumor both stained positively for pancytokeratin and vimentin, as expected. However, the cutaneous metastasis unexpectedly lacked S100 protein expression, whereas the primary tumor was S100 positive. This phenomenon has only been documented in one other case report. We demonstrate that late, incidentally discovered cutaneous metastasis with unexpected immunohistochemical staining features rarely occur and can present a diagnostic challenge.

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