Eosinophilic esophagitis (EoE) is an inflammatory disorder characterized by intraepithelial eosinophilic infiltration followed by esophageal dysfunction. Pathophysiological mechanism of EoE is still ...not well understood, with several factors that may contribute, such as host immunity, environmental and genetic factors. Modern diagnostic for EoE should include: esophageal dysfunction, esophageal biopsy with at least 15 eosinophils per high power field and absence of other pathology characterized by increased number of eosinophils. The most common presenting symptoms in adults are dysphagia, heartburn, food impaction and chest pain. Children are usually presented with nausea and vomiting, anorexia, heartburn, regurgitation, chest burn and abdominal pain. Endoscopically, patients with EoE are characterized by longitudinal furrows (vertical lines, darker than surrounding mucosa), esophageal trachealization (numerous transversal rings, as in trachea), exudate (white plaques), edema (decreased mucosal vascularization), strictures and crepe-paper mucosa (mucosal friability and tearing during endoscopy). Histological features of EoE could be separated into major and minor criteria. Major criteria include: intraepithelial infiltration by eosinophils (>15 eosinophils/HPF), eosinophilic microabscesses (≥4 eosinophils in a collection), eosinophils occupying outer layer of the squamous epithelium, epithelial sloughing and eosinophil degranulation. Minor criteria include: basal zone hyperplasia, lengthening of the epithelial papillae, intracellular edema and subepithelial fibrosis. In order to set adequate diagnosis, all other conditions related to increased number of eosinophils should be excluded. The most common and the most important differential is gastroesophageal reflux disease (GERD). Treatment of the EoE encompasses: proton pump inhibitors (PPI), corticosteroids (topical and systemic), elimination diet and esophageal dilation.
Introduction. Adult-onset Still?s disease (AOSD), a systemic inflammatory disorder, often represents a heterogeneous entity and diagnosis requires the exclusion of mimicking disorders, including ...autoinflammatory diseases. We present a patient who meets the diagnostic criteria for AOSD and Muckle?Wells syndrome (MWS). Case outline. A 35-year-old male presented with lymphadenopathy and a chronic nonspecific rash, fever spikes, widespread arthralgia, and joint effusions. Laboratory results showed increased inflammation, leukocytosis, neutrophilia, thrombocytosis, and elevated liver enzymes, accompanied by negative immunoserological tests. Patient was diagnosed with AOSD and prednisone (15 mg/d), methotrexate (10 mg/w) and chloroquine (250 mg/d) are introduced in therapy. Due to refractory course, patient was introduced with anti IL-6 biological agent tocilizumab in 2014 (8 mg/kg monthly). However, after three doses, the drug is stopped due to disease exacerbation. In 2015, there was suspicion that there was another underlying disease from the autoinflammatory spectrum, but DNA analysis of the most common mutations in the NLRP3 gene was negative. In 2017, an ear, nose, and throat specialist confirmed bilateral sensorineural hearing loss, and in 2019, amyloidosis was confirmed after biopsy of the duodenum. Patient fulfilled a new-proposed diagnostic criteria for MWS and confirmation of mutation in NLRP3 gene is not obligatory according to Eurofever registry. Conclusion. The symptoms of AOSD and MWS partly overlap, as well as their diagnostic criteria. In chronic refractory cases of AOSD, evaluation of diagnosis should be performed and autoinflammatory syndromes must be kept in mind.
Background. Actinomycosis (ACM) is a rare infectious granulomatous disease caused by Actinomyces, a Grampositive, filamentous, saprophytic bacteria. There are several types of pediatric ACM, such as ...orocervicofacial (55%) and other less common forms: abdominopelvic and thoracic. We report a case of a 16-year-old who presented with abdominal ACM in the setting of acute appendicitis. After the case report, we provide a short literature review of pediatric appendicular ACM cases published. Case. A 16-year-old boy presented with nausea, vomiting, pain in the upper part of the abdomen and fever (37.5°C) lasting for 24 hours. On physical examination, the patient`s epigastrium and lower right abdominal quadrant were tender. White cell count and C-reactive protein (CRP) were elevated at 16,300/μL and 48.6mg/L respectively. Ultrasonography (US) showed appendicolith and edema of the appendiceal wall, focally with stratification as well as periappendiceal inflammation. The patient underwent a classic appendectomy, and the postoperative course was without complications. Histopathological analysis showed diffuse transmural neutrophilic infiltration of the appendix, focally with areas of necrosis and abscesses. There were numerous brightly eosinophilic colonies made of filamentous bacteria, located predominantly in submucosa. Special stains Grocott-Gomori`s Methenamine Silver and Gram were positive and a diagnosis of ACM was made. Conclusions. Although appendicitis is very common in the general population, appendicitis associated with ACM is very rare, accounting for 0.02% - 0.06%, especially in the pediatric population. Diagnosis can be very challenging because they usually present with non-specific symptoms, and can form masses that mimic malignancies. Although rare, clinicians and pathologists should be aware of this entity. Satisfactory results and complete cure are achieved with adequate antibiotic therapy and surgery. In most cases, if there are no associated diseases, early and accurate diagnosis ensure an excellent prognosis.
Cardiomyopathies (CMP) represent a significant health problem as they have a poor long-term prognosis and often require transplantation. Heavy metals are known to have cardiotoxic effects and some of ...them, such as cadmium (Cd), are found to be elevated in the urine and blood of individuals with heart diseases; nevertheless, direct measurement of metals (e.g. zinc (Zn) which is necessary for normal heart function), in the myocardium of individuals with CMP has not been performed. Here, we aimed to analyze the levels of a group of metals in the myocardium of the left ventricle in individuals with CMP. At the Institute of Pathology, we collected 52 samples of left ventricle post-mortem, out of which 19 subjects had been diagnosed with CMP (mean age: 72 y ± 10), and 33 subjects had not suffered from any heart disease (mean age: 67 y ± 15). We found out that individuals with CMP had a significantly higher concentrations of lead, nickel, manganese and copper than non-CMP subjects (
p
= 0.002,
p
< 0.001,
p
= 0.011, and
p
= 0.002). Interestingly, zinc was significantly lower in CMP subjects than in n-CMP individuals (
p
= 0.017). Our results indicated the involvement of an increased lead, nickel, copper and manganese heart load in individuals with CMP coupled with lower concentrations of zinc.
Graphical Abstract
Mixed epithelial and stromal tumors (MESTs) of the kidney are rare renal neoplasms, primarily affecting middle-aged women. These tumors are characterized by a mix of epithelial and stromal ...components. While generally benign, MESTs require accurate diagnosis and appropriate management due to the potential for malignant transformation. The present study reports the case of a 75-year-old male patient who underwent a partial nephrectomy following the incidental discovery of a kidney tumor. Histopathological examination revealed a partially cystic tumor with solid areas, measuring 26 mm in diameter. The tumor had cysts lined with cuboidal cells and an ovarian-like stroma. The solid component consisted of elongated cells with eosinophilic cytoplasm and oval nuclei, showing angiocentric growth around small blood vessels without nuclear atypia or mitoses. Since the morphology of the solid component could not reveal the differentiation of those cells, immunohistochemical staining was performed and a myopericytoma/myofibroma component was established, mostly based on the positivity of smooth muscle actin, muscle-specific actin, h-caldesmon, estrogen receptor, progesterone receptor, solute carrier family 2 facilitated glucose transporter member 1 and collagen IV, along with a lack of staining for desmin, CD34, CD31 and CD99. Thus, to the best of our knowledge, for the first time in the literature, MEST with myopericytoma/myofibroma stromal component in a male patient was reported.
Introduction: Skeletal anomalies are a heterogeneous group of disorders including changes in bone shape, size, and density that cause abnormalities of the extremities, trunk, and head. They rank ...second in Europe in the frequency of all congenital anomalies. The most common skeletal anomalies include head, face and limb anomalies. Aim: The aim of this study was to determine the frequency of skeletal anomalies and their association with anomalies of internal organs, as well as to show the age of the mother and the gestational week of the fetus with established skeletal anomalies. Material and methods: All fetal and neonatal autopsies in the period from January 1, 2018 to December 31, 2020 at the Institute of Pathology "Djordje Joannovic" of the Faculty of Medicine University of Belgrade were analyzed. In the mentioned period, 580 fetal and neonatal autopsies were performed. Clinical data were obtained from the Gynecology and Obstetrics Clinic "Narodni Front" on the basis of completed requests for clinical autopsy. Descriptive statistics methods were used (data are presented as absolute numbers and percentage frequencies). Results: The most common skeletal anomalies are divided into seven groups: spina bifida (20; 33.34%), limb anomalies (16; 26.67%), head and face bone anomalies (15; 25%), joint anomalies (2; 3.33%), achondroplasia (3; 5%), osteogenesis imperfecta (2; 3.33%) and other anomalies (2; 3.33%). The most common associated anomalies were central nervous system (CNS) abnormalities, followed by heart and kidney abnormalities. The youngest mother was 15 years old, and the oldest was 47 years old. The mean age of the mothers was 30 years. Conclusion: In our study, the most common anomaly was spina bifida, while limb anomalies and craniofacial anomalies are next in frequency. Skeletal anomalies were often associated with anomalies of the heart, kidneys, and CNS. They were mostly diagnosed between the 22nd and 27th gestational week. Our results showed that skeletal anomalies are more common in fetuses or neonates of mothers older than 30 years.
Introduction/Objective Postmortem examination has a significant role in evaluating the quality of health care. The objective of the paper is to analyze the cause of death as determined by postmortem ...examination in patients who had undergone emergency hospitalization and had subsequently died within 24h, as well as the factors that contributed to the fatal outcome and correlation with available clinical data. Methods the analysis included autopsy reports and protocols, as well as clinical data from medical records and autopsy referrals during the three year period (2018-2020) for patients who had undergone a postmortem examination at the Insitute of Pathology, Medical Faculty, University of Belgrade. The correlation between the clinical diagnosis and postmortem findings was evaluated using Goldman criteria. Results the patients analysed were predominantly male (52/90; 58%). Women were statistically significantly older than men (p=0.024). The most common clinical diagnosis was cardiovascular disease (32.2%). The majority of the patients reported experiencing the first symptoms a few hours before seeking medical help (80%). The majority of the patients were being treated for chronic disease (80%) before hospitalization. The immediate cause of death determined by postmortem examination was most commonly heart failure (38/90, 42.2%). The most common clinically unrecognised causes of death include: bronchopneumonia (8/90), myocarditis (3/90), acute ischemic lesion/acute myocardial infarction (3/90) and bowel infarction (3/90). Conclusion the correlation between clinical and postmortem findings is very important because it enables the discovery of diagnostic and treatment errors and promotes new knowledge crucial for medical advancement.
Dielectric resonator antenna for high power RF plasma applications Jevtic, Jovan; Menon, Ashok; Pikelja, Velibor
2014 IEEE 41st International Conference on Plasma Sciences (ICOPS) held with 2014 IEEE International Conference on High-Power Particle Beams (BEAMS)
Conference Proceeding
Summary form only given. Some of the numerous applications of the inductively coupled plasma, at both atmospheric and low pressure, include plasma manufacturing, optical and mass spectroscopy, ...gasification and plasma reforming, semiconductor fabrication, in-space propulsion, gas lasers, ion sources, and fusion. A coil of copper or silver-plated tubing is typically used to couple the radio-frequency power into the plasma. Although this technology has been used extensively for many decades, an RF coil suffers from limitations which negatively affect the quality of the generated plasma and increase the complexity of the plasma source. These limitations include high ohmic losses in the antenna conductor which necessitate fluid cooling, high levels of capacitive coupling which necessitate RF shielding, high inter-turn voltage which limits the maximum power due to electric breakdown, external tuning capacitors which add to the size and cost, material properties of copper which demand a vacuum or thermal barrier between the coil and the plasma, etc.We will present a remarkable alternative to an RF coil which addresses all of the limitations mentioned above. It increases the maximum power limit by an order of magnitude while operating at a very high efficiency and producing high quality uniform plasma, without the need for RF shielding, and is fully compatible with high vacuum, high purity, and high temperature environment. This is possible due to the outstanding electrical, thermal, and mechanical properties of the advanced technical ceramics. We have used such ceramic materials to construct ring shaped dielectric resonators whose dielectric polarization currents replace the conduction currents of a copper coil. Polarization currents offer many advantages over conduction currents in plasma applications. One of the most outstanding properties of a dielectric resonator is that it completely eliminates capacitive coupling as the resonator maintains exactly zero RF potential even under full power. We will describe the construction and optical plasma diagnostics of prototype plasma sources for both atmospheric pressure thermal plasma at 2.45GHz in air and Nitrogen1 and low pressure cold plasma at 430MHz in Argon at power levels up to 1kW. In addition, we will show conceptual solutions for the implementation of dielectric resonator antennas in many of the inductively coupled plasma applications.
Crohn's disease (CD) is a progressive, multifactorial, immune-mediated disease characterized by chronic inflammation of any part of the gastrointestinal (GI) tract. Pediatric patients present with a ...more extensive form of the disease, especially in the upper GI tract with various histopathological inflammatory patterns. Our study aims to analyze the clinical, laboratory, endoscopic, and histopathological findings in children with diagnosed CD and compare results on the initial and follow-up tests. We have included 100 children and adolescents with CD, with performed endoscopic and histopathological (HP) procedures. The results of multiple biopsies executed in these 8 years were matched and compared. We found a statistically significant frequency reduction in stool changes (65.52% to 18.18%), weight loss (35.24% to 4%), and abdominal pain (41.86% to 6.67%) as presenting symptoms. There was an improvement in all laboratory values: fecal calprotectin (1000 to 60,8 μg/g), C-reactive protein (12.2 to 1.9 mg/L), and albumin (36 to 41 g/L). On esophagogastroduodenoscopy and ileo-colonoscopy 36.59% and 64.86% patients had specific findings, respectively. A total of 32 patients had evidence of Crohn's disease in the upper GI tract. Non-caseating granulomas were found on 9% of oesophageal, 18% of gastric, and 12% of duodenal biopsies. In the lower GI tract, we have observed a disease progression in the rectum (72.29 to 82.22%) and descending colon (73.49 to 80%). There was no registered disease progression in the upper GI tract. Our study demonstrated a significant decline in the frequency of symptoms and an improvement in laboratory values on the follow-up examinations. More than a third of our patients had specific endoscopic and HP findings in the upper GI tract, and an additional 23% had HP findings highly suggestive of CD. We demonstrated the importance of regular clinical, laboratory, endoscopic, and histopathological assessments of pediatric CD patients.
Inflammatory bowel disease (IBD), which encompasses two different phenotypes—Crohn’s disease (CD) and ulcerative colitis (UC)—consists of chronic, relapsing disorders of the gastrointestinal tract. ...In 20–30% of cases, the disease begins in the pediatric age. There have been just a few studies that used fractals for IBD investigation, but none of them analyzed intestinal cell chromatin. The main aim of this study was to assess whether it is possible to differentiate between the two phenotypes in pediatric patients, or either of the phenotypes versus control, using the fractal dimension and lacunarity of intestinal cell chromatin. We analyzed nuclei from at least seven different intestinal segments from each group. In the majority of colon segments, both the fractal dimension (FD) and the lacunarity significantly differed between the UC group and CD group, and the UC group and control group. In addition, the ileocecal valve and rectum were the only segments in which CD could be differentiated from the controls based on the FD. The potential of the fractal analysis of intestinal cell nuclei to serve as an observer-independent histological tool for ulcerative colitis diagnosis was identified for the first time in this study. Our results pave the way for the development of computer-aided diagnosis systems that will assist the physicians in their clinical practice.
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