Федеральное государственное бюджетное учреждение «Научно-исследовательский институт пульмонологии» Федерального медико-биологического агентства: 115682, Россия, Москва, Ореховый бульвар, 28 2 Государственное бюджетное учреждение здравоохранения города Москвы «Московский клинический научно-практический центр имени А.С.Логинова» Департамента здравоохранения города Москвы: 111123, Россия, Москва, шоссе Энтузиастов, 86 3 Федеральное государственное бюджетное научное учреждение «Научно-исследовательский институт морфологии человека»: 117418, Россия, Москва, ул. Цюрупы, 3 4 Федеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И.Пирогова» Министерства здравоохранения Российской Федерации: 117997, Россия, Москва, ул. Островитянова, 1 5 Государственное бюджетное учреждение здравоохранения города Москвы «Городская клиническая больница № 1 имени Н.И.Пирогова Департамента здравоохранения города Москвы»: 117049, Россия, Москва, Ленинский просп., 8 6 Федеральное государственное бюджетное образовательное учреждение высшего образования «Московский государственный медико-стоматологический университет имени А.И.Евдокимова» Министерства здравоохранения Российской Федерации: 127473, Россия, Москва, ул. Делегатская, 20, стр. 1 7 Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр хирургии имени А.В.Вишневского» Министерства здравоохранения Российской Федерации: 117997, Россия, Москва, ул. Б. Серпуховская, 27 8 Государственное бюджетное учреждение здравоохранения города Москвы «Городская клиническая больница имени И.В.Давыдовского Департамента здравоохранения города Москвы»: 109240, Россия, Москва, Яузская ул., 11 9 Государственное бюджетное учреждение здравоохранения «Городская больница № 52» Департамента здравоохранения Москвы: 123182, Россия, Москва, ул. Пехотная, 3 10 Государственное бюджетное учреждение здравоохранения города Москвы «Инфекционная клиническая больница №2 Департамента здравоохранения города Москвы»: 105275, Россия, Москва, 8-я улица Соколиной горы, 15 11 Клиническая больница № 1 Акционерного общества Группы компаний «МЕДСИ»: 143442, Россия, Московская область, городской округ Красногорск, пос. Отрадное, вл. 2, стр. 1 Резюме Целью статьи явилось изучение особенностей морфологических изменений в легких у умерших от COVID-19 в Москве за период 20.03.20-06.06.20. Материалы и методы. Проанализирован аутопсийный материал легких умерших от коронавирусной инфекции COVID-19 больных (n = 123: 54 женщины, 69 мужчин; средний возраст-71 (30-94) год; продолжительность заболевания-14 (3-65) суток), подтвержденной методом полимеразной цепной реакции. Проанализированы медицинские карты всех стационарных больных и все протоколы вскрытий. По данным всех наблюдений оценены макро-и микроскопические изменения в легких. Результаты. Патоморфологические изменения в легких соответствовали различным фазам диффузного альвеолярного повреждения (ДАП). Экссудативная фаза ДАП выявлена у 54 (43,...
Aim. Compare radiological patterns of COVID-19 pneumonia with pulmonary histology in deceased patients.Materials and methods. The analysis of recent lifetime CT studies of deceased patients was performed with the identification of all existing and leading CT symptoms, including “ground glass”, “crazy paving”, consolidation, as well as the symptom complex (pattern) of organizing pneumonia. Based on the CT symptoms, we selected the target points for taking the specimens by 3-D reconstructions. At the autopsy the lungs were entirely fixed into the front and then marked on CT sections cut from 1 to 3 pieces that were placed in paraffin and processed according to the standard technique, stained with hematoxylin and eosin and fuchsin-facelina. The specimens were analyzed by identifying all available histology changes and selecting the leading one.Results. 45 targeted pieces of lung tissue were obtained from 14 deceased COVID-19 patients (7 men/ 7 women), with an average age of 77.1 ± 12.9 (49–90 years). In deceased patients with the presence of the "ground glass" symptom, in most cases (57.1%) revealed an increase in intra-alveolar cellularity, hyaline membranes, desquamation of the alveolar epithelium and infiltration of the interalveolar septum by lymphocytes, which corresponds to the exudative phase of diffuse alveolar damage (DAP). Mosaic histological changes with alternation of filled alveoli (intraalveolar edema, clusters of red blood cells, macrophages, lymphocytes) and air alveoli were detected from the areas of “crazy paving” zones. Several cases demonstrated interstitial edema and lymphoid infiltration of interalveolar partitions of different severity without their thickening. Areas of consolidation were histologically represented by extensive intraalveolar hemorrhages and / or typical zones of hemorrhagic infarcts in 45.5% of cases. Perilobular consolidation, subpleural cords, symptoms of “halo” and “reverse halo”, which we considered as part of the symptom complex of organizing pneumonia in 43% of cases, morphologically corresponded to organizing pneumonia (the proliferative phase of DAP), as well as to distelectases.Conclusion. Comparison of CT patters and post-mortem pulmonary histology in COVID-19 deceased patients demonstrated that CT symptoms and patterns correspond to certain morphological changes of different phases of DAP.
The article presents a clinical case of hypersensitivity pneumonitis complicated by a viral infection in a 72-year-old woman. The introductory part provides a concise literature review on the etiology, classification, frequency, and possible complications of hypersensitivity pneumonitis. The patient’s computed tomography (CT) lung scan showed bilateral interstitial lesions. The patient was diagnosed with idiopathic pulmonary fibrosis based on the clinical manifestations and radiological findings. The autopsy revealed morphological signs of hypersensitivity pneumonitis (obliterative bronchiolitis, moderate interstitial fibrosis with honey-combing, nonspecific interstitial pneumonia, giant multinucleated cells) and viral lung damage (exudative stage of acute respiratory distress syndrome with interalveolar edema, hyaline membranes lining the alveoli, pneumocyte desquamation, and ugly giant cells). Keywords: hypersensitivity pneumonitis, exogenous allergic alveolitis, viral infection, lungs
Introduction. Lymphatic malformations (LM) is the developmental anomaly of lymphatic vessels which is formed at the stage of early embryogenesis. Intraabdominal and retroperitoneal LM are very rare and account for 4 % of all observed LM. Purpose. To clarify the effectiveness of minimally invasive surgical interventions in children with abdominal LM. Material and methods. Over a ten-year period, 15 children with retroperitoneal lymphangiomas , aged from 1 to 17, were operated on in our clinics. To clarify diagnosis, a comprehensive examination was performed: ultrasound, spiral computed tomography, magnetic resonance imaging of the abdominal cavity. Laparoscopic access was applied in all 15 cases for surgical intervention. Results. In all cases, lymphatic malformations were diagnosed before surgery which was later confirmed at laparoscopy. Malformations were excised laparoscopically. In 2 patients, lymphangiomatous tissue was partially left at the site of the greatest fusion with renal and iliac vessels due to a high risk of their damage. Conclusion. Endovideosurgical technologies in children with retroperitoneal LM may be used at any child’s age and at any size of retroperitoneal cystic formation since emptying the cystic cavity creates the necessary working space in the abdominal cavity. Such an approach minimizes surgical trauma, shortens surgical time and facilitates the postoperative period.
The COVID-19 pandemic is now a global medical and social problem. Little is known about COVID-19 impact on some vulnerable subgroups, such as immunocompromised patients. Therefore, scientists worldwide show interest in studying the impact of SARS-CoV-2 infection on HIV-positive individuals. We report an autopsy clinical case of a deceased 60-year-old HIV-infected patient with lung damage caused by a combination of the SARS-CoV-2 virus, human herpesvirus 6, cytomegalovirus, and pneumocystis with severe fatal respiratory failure. Keywords: COVID-19, HIV, SARS-CoV-2, herpes virus, cytomegalovirus, pneumocystis, pathological anatomy
В работе обобщены данные литературы о влиянии тестостерона и его синтетических производных на организм спортсменов. Охарактеризованы пути биосинтеза и метаболизма тестостерона, сигнальный путь тестостерона, его основные биологические эффекты. Основное внимание уделено проблемам гипо-и гиперандрогенемии, как двум крайним проявлениям отклонения от физиологического уровня тестосте-рона в крови у мужчин. В связи с этим были определены перспективы дальнейших исследований: влияние гиперандрогенемии на сердечную мыщцу у спортсменов и мужчин, использующих природные и синтети-ческие аналоги тестостерона в качестве средств повышающих физическую выносливость и активность. The paper summarizes the literature data on the effect of testosterone and its synthetic derivatives on athletes. Biosynthetic pathways and metabolism of testosterone, testosterone signaling pathway, its main biological effects have been characterized. The main attention is paid to the problems of hypo-and hyperandrogenaemia as the two extreme manifestations of deviation from the physiological level of testosterone in the blood of men. Therefore prospects for further studies were identified: hyperandrogenism influence on the heart muscle in athletes and in men who use natural or synthetic analogs of testosterone as a means of increasing physical endurance and activity.
Lymphatic malformations are benign neoplasms that form as a result of impaired formation of embryonic lymphatic sacs during embryogenesis. Lymphangiomas and lymphgemangiomas (visceral forms) rarely develop in the intra-abdomen, such localization does not exceed 8–15% of all observed lymphangiomas in children. Among the visceral forms are more common the forms that involve intestines, mesentery, spleen, omentum, liver in the pathological process, less often - the lymphatic vessels and lymph nodes of the mediastinum, and retroperitoneal tissue. The clinical presentation of lymphatic malformations is multivaried and depends on their localization, the patient age, and the development of complications. In case of complications, the clinic manifestation of “acute abdomen” requires emergency surgical intervention, during which the diagnosis and scope of surgical treatment are specified. a 14-year-old boy was admitted to the department of infectious diseases with complaints of fever, weakness, abdominal pain, sore throat and loose stools. Previously, the patient had complaints of abdominal pain for a year; ultrasound examination of the abdominal cavity was performed repeatedly, in which no pathological changes were detected. The patient underwent laparoscopic appendectomy; During the revision of the abdominal cavity, a space-occupying lesion emerging from the mesentery of the ascending colon and twisted around the vascular pedicle by 3 turns was revealed. Education removed. Histological and immunohistochemical examination confirmed the diagnosis of lymphatic-venous malformation. No signs of malignancy of lymphatic malformations are described in the literature. However, though lymphatic malformations are benign in nature, they tend to have an infiltrative growth pattern, often relapse, and sometimes become infected. The available literature doesn’t provide a proper description and analysis of the results of treatment of intra-abdominal lymphatic malformations using endovideo technologies. Transabdominal access provides the best exposure of the complete surgical field, freedom of movement and clarity of anatomical landmarks. The main advantages over open abdominal surgery are minimal trauma to the anterior abdominal wall and rapid rehabilitation of patients.
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