Due to the current lack of standard definitions for rapidly progressive osteoarthritis of the hip (RPOH) in the literature, this observational study aimed to describe new diagnostic criteria and a grading system for the disease.From a consecutive series of patients undergoing total hip replacement, 2 groups were selected: 1 with RPOH and 1 with primary hip osteoarthritis (POH), and their clinical, paraclinical, and demographic data were compared. The newly proposed clinico-radiological diagnostic criteria are based on characteristics of pain, joint mobility, and radiological assessment. The radiological grading system's inter- and intraobserver reliability was assessed through serial evaluations by 2 blinded reviewers.From the total 863 cases, 82 cases (9.5%) of RPOH were identified and compared with 107 cases of POH. Mean age and disease bilaterality were similar, with a predominance of female patients in the RPOH group (P = 0.03). There were significant differences between the 2 groups in disease onset and aggravation, and intraoperative blood loss. The grading system showed significant inter- and intraobserver agreement (weighted kappa 0.93, and 0.89).Our study presents distinctive, easily recognizable clinico-radiological characteristics of RPOH and confirmed the inter- and intraobserver reliability of the newly proposed grading system.

Hepatocellurar carcinoma (HCC) is the most frequent primary hepatic tumor, the vast majority of patients have less than a 12 month survival rate. The aim of this study was to evaluate the efficacy of TACE in patients with HCC, based on a case series and literature review. The study included 12 consecutive patients with HCC who underwent surgical treatment (resection, liver transplantation � resection) at the Department of Transplantation and Surgery, Semmelweis University, Budapest, during 2009-2015. All the patients received at least one TACE session. Patients with BCLC B-stage who benefit from TACE and another alternative therapy (eg, RFA) may be associated with or exhibit tumor stagnation, or tumor necrosis in most cases. In C BCLC stages, desperate cases - the two patients to whom TACE was the last therapeutic attitude, despite the predicted prognosis, TACE assured the prolongation of life and increased life quality. In the majority of patients in this study, stage A BCLC, chemoembolization was a therapeutic attitude that allowed subsequent liver transplantation (when it was not feasible initially due to tumor size) or liver resection in apparently inoperable cases. The arterial chemotherapy is the unanimously accepted indication in patients with stage B, BCLC. The data presented encourages us to opt for TACE with the intention of destaging BCLC and giving an operability character to the hepatic tumors (resection � hepatic transplantation). In stage C BCLC, TACE can be a last attempt to improve the quality of life and to control tumor progression.

A 64-year-old man was hospitalized showing symptoms suggesting gastric cancer. The gastroscopy showed a 70 × 30-mm tumor. The intraoperatory findings indicated an inoperable gastric tumor located in the antrum and gastric body, which invaded the spleen and pancreas. The abdominal incision was closed without performing gastrectomy. Considering his general condition, after 1 month, he was transferred to our hospital. We decided to perform a total gastrectomy of necessity, spleno-pancreatectomy, and dissection of regional lymph nodes. The surgical incision was performed along to the previous one. At palpation, a well-defined nodule with hard consistency was observed in the surgical scar, which microscopically was composed by osteoblasts-lining mature lamellar bone intermingled with osteoid and cartilage in the intermediary layer and fibroblasts in the central area, without atypia. The final diagnosis was localized metaplastic bone formation. This is a rare condition which can be related to trauma or surgery and should be differentiated by foreign-body granuloma and osteosarcoma.

Rationale:Burkitt lymphoma (BL) is an endemic tumor in Africa but rare sporadic cases are diagnosed in Europe.Patient concerns:A 60-year-old woman was hospitalized with fulminant hematemesis and a history of recurring melena.Diagnoses:The upper gastrointestinal endoscopy revealed a tumor of the antrum.Interventions:Emergency gastrectomy was performed.Outcomes:Gross findings revealed an ulcerated tumor with elevated margins and several perigastric and extragastric lymph nodes. Histological examination showed proliferation of atypical lymphocytes with a Ki67 index of 100%; they were marked by CD20, CD79a, bcl-6, and CD10 and were negative for CD3, CD5, CD23, TdT, bcl-2, and Cyclin D1. The tumor cells crossed the serosa and presented invasion of the lymph nodes. The patient died 10 days after surgery due to bronchopneumonia and acute renal failure.Lessons:In our department, only one gastric BL was diagnosed in a 61 consecutive lymphomas of the gastrointestinal tract (1.64%). Less than 200 reports about gastric-BL have been published to date. This case highlights the difficulty of diagnosis of rare variants of aggressive gastric lymphomas in medium-income countries without screening programmes.

There is little information about the exact trigger mechanisms of vascular endothelial growth factor (VEGF) expression in hematolymphoid malignancies. The aim of this study was to investigate the expression of VEGF in malignant non-Hodgkin lymphoma (NHL), in terms of its immunohistochemical distribution and clinicopathological significance. We evaluated the distribution in tumor cells, macrophages and in non-tumoral cells. VEGF immunoreactivity was estimated according to this score: 0 (0% positive cells); 1 (<10%); 2 (10-30%); 3 (>30%). Histopathological evaluation revealed 18 cases of diffuse type lymphoma and 3 cases of follicular type lymphoma. VEGF was positive in 95.23% of cases and in one case, VEGF was negative in all cell types. We noticed a significant correlation in VEGF expression between tumor cells and macrophages (p=0,001), tumor cells and non-tumoral cells (p=0,002). In non-Hodgkin lymphoma, the main mechanism of angiogenesis seems to be dependent on the VEGF pathway and its expression particularly by stromal cells

The aim of this study was to evaluate the correlation between serum and tissue level of the Neutrophil gelatinase-associated lipocalin (NGAL), a peptide that seems to be predict the postoperative evolution of patients with high abdominal pressure. From 30 consecutive patients hospitalized in the Intensive Care Unit, we have randomly selected five cases that undergo abdominal surgical interventions, received postoperative mechanical ventilation and abdominal pressure was monitorized for at least 48 hours. In all of these cases, the plasmatic level of NGAL was measured using the Elisa method and immunohistochemical (IHC) stains with the anti-NGAL biomarker were performed in the surgically removed tissues. All of the five patients were overweight, showed high serum level of NGAL (over 950 ng/ml) and died with postoperative or septic shock. The NGAL serum level was not correlated with the abdominal pressure. No IHC positivity was observed in the examined tissues, except NGAL positivity for intravascular neutrophils. In conclusion, the postoperative high serum NGAL level may indicate unfavorable evolution. NGAL seems to be syntesized by the circulating neutrophils and its preoperative tissue expression does not reflect the serum value.

No abstract

No abstract