1,001 results on '"pulmonary pathology"'
Search Results
2. Pulmonary tumor thrombotic microangiopathy due to early gastric carcinoma in a patient with no antemortem findings suggestive of primary malignancy
- Author
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Jun‐ichi Noiri, Yu Taniguchi, Yu Izawa, Nobuyuki Saga, Kaori Kusakabe, Yu‐ichiro Koma, and Ken‐ichi Hirata
- Subjects
autopsy ,gastric cancer ,pulmonary hypertension ,pulmonary pathology ,pulmonary tumor thrombotic microangiopathy ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Diseases of the respiratory system ,RC705-779 - Abstract
Abstract Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and critical malignancy‐related disease characterized by acute progressive pulmonary hypertension (PH). In most cases of PTTM, the cancer can be diagnosed in advance. Identification of the primary cancer is valuable for PTTM diagnosis. Here, we present the case of a patient with PTTM due to early gastric carcinoma in whom the diagnosis of malignant cancer was not revealed until macroscopic autopsy findings. This case highlights the importance of recognizing causative occult early gastric cancer leading to PTTM in cases of acute progressive PH. more...
- Published
- 2024
- Full Text
- View/download PDF
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3. Features of diagnostic search and experience in the treatment of chronic urticaria in obese patients with pulmonary pathology
- Author
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N.M. Kaspruk and S.O. Batranovska
- Subjects
pulmonary pathology ,chronic urticaria ,obesity ,quifenadine ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Background. In recent decades, along with the growth of allergic diseases, there has been a progressive increase in the number of people with overweight of varying severity, as evidenced by numerous epidemiological studies. Therefore, both allergies and obesity are among the global problems of modern healthcare due to their high prevalence and medical and social significance. The purpose of the study was analysis of the etiological factors of chronic urticaria (CU) in obese patients with pulmonary pathology, optimization of diagnosis and treatment of CU for further planning of preventive measures. Materials and methods. We examined 250 patients who applied for medical care to the regional clinical hospital in Chernivtsi and had CU associated with pulmonary pathology and obesity. Based on the analysis of the obtained data, a group of 140 patients was formed for further clinical and anamnestic examination: analysis of the anamnesis, determination of the severity of urticaria, assessment of quality of life, control of urticaria symptoms, general clinical laboratory studies, tests for verification of urticaria. Allergy testing was carried out when the patient’s anamnestic data indicated its expediency. The survey was carried out for one month and included a diagnostic period and 3 consultations every 7–10 days. Results. Among the causes of CU in patients with pulmonary disease, drug intolerance and parasitic infection dominate. Polyetiology is observed in 60 % of cases. Differences in CU in obese patients are the long-term persistence of urticaria or other elements of the rash, the lack of effectiveness of therapy with the second- and third-generation antihistamines and glucocorticosteroids. Conclusions. The results obtained indicate a positive effect of the quinuclidine derivative quifenadine for the treatment of CU in patients with pulmonary pathology and obesity. Complete and significant effects were obtained in 91.43 % of patients. The worst results (8.57 %) were demonstrated by patients with the etiological significance of chemical factors (including occupational ones), which is associated with more problematic compliance with the elimination regimen in this category of patients. more...
- Published
- 2023
- Full Text
- View/download PDF
4. Septic pulmonary embolism: Is it an underestimated diagnosis?
- Author
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Swati Kolhe and Pradeep Vaideeswar
- Subjects
non-thrombotic pulmonary embolism ,pulmonary necrotizing arteritis ,pulmonary pathology ,septic pulmonary embolism ,Pathology ,RB1-214 ,Microbiology ,QR1-502 - Abstract
Background: Non-thrombotic pulmonary embolism, an uncommon entity, is defined as the embolization of tissues, microorganisms, air, or foreign material. One subset in this non-thrombotic category is septic pulmonary embolism (SPE) that refers to embolism of microorganisms with or without a thrombotic mantle into the pulmonary vasculature. This condition is often recognized on the basis of imaging with a clinical correlation. Unfortunately, data regarding the pathological features are meager. This has prompted to review such cases at autopsy. Aims: To study the pathological features of SPE at autopsy. Materials and Methods: Ten-year (2012 to 2021) autopsy records of the hospital were retrospectively reviewed. The diagnosis was based on the identification of acute necrotizing pulmonary arteritis with peri-bronchoarterial consolidation. These cases were analyzed with reference to the demographics, clinical characteristics, and pulmonary/extrapulmonary findings at autopsy. Statistical Analysis: Nil. Results: According to the inclusion criterion, 19 cases demonstrated the presence of SPE. There were 11 men and 8 women with a mean age of 32.1 years. The major source of infection included infection arising from skin and musculo-skeletal system (11 patients, 59.7%). The common clinical presentation included fever, dyspnea, chest pain, hemoptysis, and altered sensorium. The cause of death was mainly due to septicemia and/or confluent lung consolidations. A large number of bacterial colonies were seen in all; Candida species were also identified in two cases. Other lung findings included diffuse alveolar damage, fresh arterial thrombosis, infarction, arterial pseudo-aneurysms, abscess formation, and pyogenic pleuritis. Conclusion: Presence of an extrapulmonary infection with persistent fever, bacteremia, and pulmonary complaints should raise suspicion for this entity, particularly in resource-poor settings, to prevent grave pulmonary complications. more...
- Published
- 2023
- Full Text
- View/download PDF
5. SARS-CoV-2 Associated Pulmonary Pathology
- Author
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George S. Stoyanov, Hristo Popov, Lilyana Petkova, Dimo Stoyanov, Martin Ivanov, and Anton B. Tonchev
- Subjects
SARS-CoV-2 ,COVID-19 ,pathology ,autopsy ,diffuse alveolar damage ,pulmonary pathology ,Science - Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel entry in the betacoronaviridae group of coronaviruses. This is the second member of this group, and the third of the family overall to emerge in the last 20 years, which has caused significant health concerns due to the clinical severity and spread of the disease it causes—coronavirus disease identified in 2019 (COVID-19). While initially emerging as a respiratory disease, and while most cases experience symptoms predominantly from this system, SARS-CoV-2 has emerged as a multisystem pathogen. From a pathomorphological point of view, the severity of changes in the respiratory system can be summed up as diffuse alveolar damage—desquamation of the alveolar epithelium with exudative and proliferative changes—pulmonary hyaline membranes, Clara cell hyperplasia, squamous cell metaplasia, and fibrosis. The second most prominent way the disease affects the lung is through endotheliitis—damage to the endothelial cells of the pulmonary vasculature, predominantly affecting the medium and large caliber blood vessels that cause the well-established clinical phenomenon of thrombosis/thromboembolism of the pulmonary vasculature. As the spread of the disease continues with the emergence of new variants and the number of cases continues to grow, including a large percentage of recurrent cases, it is essential to remember that the viral effects are not only acute but, due to the proliferative phenomena, can produce chronic sequelae. Therefore, in the background of dwindling publication interest, it is critical to focus on the histopathological aspects of the pulmonary disease, with the goal of better understanding the effects of the virus on the organism and identifying probable future complications after infection. more...
- Published
- 2022
- Full Text
- View/download PDF
6. Features of diagnostic search and experience in the treatment of chronic urticaria in obese patients with pulmonary pathology.
- Author
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Kaspruk, N. M. and Batranovska, S. O.
- Subjects
URTICARIA ,PATHOLOGY ,MEDICAL care ,PARASITIC diseases ,OBESITY ,OVERWEIGHT persons - Abstract
Background. In recent decades, along with the growth of allergic diseases, there has been a progressive increase in the number of people with overweight of varying severity, as evidenced by numerous epidemiological studies. Therefore, both allergies and obesity are among the global problems of modern healthcare due to their high prevalence and medical and social significance. The purpose of the study was analysis of the etiological factors of chronic urticaria (CU) in obese patients with pulmonary pathology, optimization of diagnosis and treatment of CU for further planning of preventive measures. Materials and methods. We examined 250 patients who applied for medical care to the regional clinical hospital in Chernivtsi and had CU associated with pulmonary pathology and obesity. Based on the analysis of the obtained data, a group of 140 patients was formed for further clinical and anamnestic examination: analysis of the anamnesis, determination of the severity of urticaria, assessment of quality of life, control of urticaria symptoms, general clinical laboratory studies, tests for verification of urticaria. Allergy testing was carried out when the patient’s anamnestic data indicated its expediency. The survey was carried out for one month and included a diagnostic period and 3 consultations every 7–10 days. Results. Among the causes of CU in patients with pulmonary disease, drug intolerance and parasitic infection dominate. Polyetiology is observed in 60 % of cases. Differences in CU in obese patients are the long-term persistence of urticaria or other elements of the rash, the lack of effectiveness of therapy with the second- and third-generation antihistamines and glucocorticosteroids. Conclusions. The results obtained indicate a positive effect of the quinuclidine derivative quifenadine for the treatment of CU in patients with pulmonary pathology and obesity. Complete and significant effects were obtained in 91.43 % of patients. The worst results (8.57 %) were demonstrated by patients with the etiological significance of chemical factors (including occupational ones), which is associated with more problematic compliance with the elimination regimen in this category of patients. [ABSTRACT FROM AUTHOR] more...
- Published
- 2023
- Full Text
- View/download PDF
7. SARS-CoV-2 Associated Pulmonary Pathology.
- Author
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Stoyanov, George S., Popov, Hristo, Petkova, Lilyana, Stoyanov, Dimo, Ivanov, Martin, and Tonchev, Anton B.
- Subjects
- *
SARS-CoV-2 , *VENTILATION , *COVID-19 , *BODY piercing , *PATHOLOGY - Abstract
Definition: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel entry in the betacoronaviridae group of coronaviruses. This is the second member of this group, and the third of the family overall to emerge in the last 20 years, which has caused significant health concerns due to the clinical severity and spread of the disease it causes—coronavirus disease identified in 2019 (COVID-19). While initially emerging as a respiratory disease, and while most cases experience symptoms predominantly from this system, SARS-CoV-2 has emerged as a multisystem pathogen. From a pathomorphological point of view, the severity of changes in the respiratory system can be summed up as diffuse alveolar damage—desquamation of the alveolar epithelium with exudative and proliferative changes—pulmonary hyaline membranes, Clara cell hyperplasia, squamous cell metaplasia, and fibrosis. The second most prominent way the disease affects the lung is through endotheliitis—damage to the endothelial cells of the pulmonary vasculature, predominantly affecting the medium and large caliber blood vessels that cause the well-established clinical phenomenon of thrombosis/thromboembolism of the pulmonary vasculature. As the spread of the disease continues with the emergence of new variants and the number of cases continues to grow, including a large percentage of recurrent cases, it is essential to remember that the viral effects are not only acute but, due to the proliferative phenomena, can produce chronic sequelae. Therefore, in the background of dwindling publication interest, it is critical to focus on the histopathological aspects of the pulmonary disease, with the goal of better understanding the effects of the virus on the organism and identifying probable future complications after infection. [ABSTRACT FROM AUTHOR] more...
- Published
- 2022
- Full Text
- View/download PDF
8. Insights on pulmonary tumor thrombotic microangiopathy: a seven‐patient case series
- Author
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Godbole, Rohit, Saggar, Rajan, Zider, Alexander, Betancourt, Jamie, Wallace, William D, Suh, Robert D, and Kamangar, Nader
- Subjects
Lung ,Hematology ,Cardiovascular ,Rare Diseases ,Cancer ,Heart Disease ,pulmonary pathology ,chest imaging ,pulmonary arterial hypertension ,Cardiorespiratory Medicine and Haematology - Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a disease process wherein tumor cells are thought to embolize to the pulmonary circulation causing pulmonary hypertension (PH) and death from right heart failure. Presented herein are clinical, laboratory, radiographic, and histologic features across seven cases of PTTM. Highlighted in this publication are also involvement of pulmonary venules and clinical features distinguishing PTTM from clinical mimics. We conducted a retrospective chart review of seven cases of PTTM from hospitals in the greater Los Angeles metropolitan area. Patients in this series exhibited: symptoms of cough and progressive dyspnea; PH and/or heart failure on physical exam; laboratory abnormalities of anemia, thrombocytopenia, elevated LDH, and elevated D-dimer; chest computed tomography (CT) showing diffuse septal thickening, mediastinal and hilar lymphadenopathy and nodules; elevated pulmonary artery pressures on transthoracic echocardiogram and/or right heart catheterization; and presence of malignancy. Tumor emboli and fibrocellular intimal proliferation were seen in pulmonary arterioles, while two patients had pulmonary venopathy. PTTM is a devastating disease occurring in patients with metastatic carcinoma. An early diagnosis is challenging. Understanding the clinical presentation of PTTM and distinguishing PTTM from clinical mimics may help achieve an early diagnosis and allow time for initiation of treatment. more...
- Published
- 2017
9. Watch the Mime Carefully! A Refractory Interstitial Lung Disease.
- Author
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Graziano, Paolo, Fuso, Paolo, and Carbonelli, Cristiano
- Subjects
- *
INTERSTITIAL lung diseases , *IMMUNOHISTOCHEMISTRY , *MEDICAL personnel , *DIFFERENTIAL diagnosis - Abstract
Epithelioid hemangioendothelioma (EHE) is a rare neoplasm of a vascular origin which can arise in different locations such as the lungs, liver, soft tissue, and rarely, in the bones. In the lungs, pulmonary hemangioendothelioma (PEH) shows a variable clinical behavior, displaying a range from either an asymptomatic course to a highly aggressive progression with metastases. Based on radiological features, PEH differential diagnosis mainly includes primary or metastatic lymphangitic carcinomatosis, granulomatous infections, and diffuse interstitial lung diseases where ground glass pattern predominates. In this case, a transbronchial biopsy and subsequent histological and immunohistochemical analysis allowed for the attribution of the scenario to a pulmonary epithelioid hemangioendothelioma. Clinicians should always consider bronchoscopy as a useful and effective tool to better investigate indeterminate and questionable clinical pictures, sparing patients the morbidity and mortality associated with more invasive techniques such as surgical or thoracoscopic biopsy. [ABSTRACT FROM AUTHOR] more...
- Published
- 2022
- Full Text
- View/download PDF
10. Post-Mortem Computed Tomography Pulmonary Findings in Harbor Porpoises (Phocoena phocoena).
- Author
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Kuijpers, Nienke W., van Schalkwijk, Linde, IJsseldijk, Lonneke L., Willems, Dorien S., and Veraa, Stefanie
- Subjects
- *
HARBOR porpoise , *WILDLIFE conservation , *CROSS-sectional imaging , *DOLPHINS , *AUTOPSY , *COMPUTED tomography , *WHALES - Abstract
Simple Summary: The use of cross-sectional imaging techniques to examine the cause of death and health status of deceased animals is increasing in both veterinary and wildlife conservation programs, including species of whales and dolphins. Lung disease is common in harbor porpoises (Phocoena phocoena), a small whale species that regularly washes up on the coast in North Sea-bordering countries. This study aimed to describe lung changes visible in computed tomographic (CT) images of recently deceased harbor porpoises before pathological dissection was performed, including comparison of these two examination methods. Despite frequently visible signs of body decomposition, several lung abnormalities (collapsed lung, fluid in the airways, lung mineralization) were more often seen on the CT images. In general, lung changes could be described in more detail compared to gross dissection. CT images of lungs of recently deceased harbor porpoises can therefore be used to guide gross dissection, leading to more specific findings and potentially a more complete understanding of the circumstances leading to the death of the porpoise, assessment of the population, and ultimately, ecosystem health. The application of whole-body post-mortem computed tomography (PMCT) in veterinary and wildlife post-mortem research programs is advancing. A high incidence of pulmonary pathology is reported in the harbor porpoise (Phocoena phocoena). In this study, the value of PMCT focused on pulmonary assessment is evaluated. The objectives of this study were to describe pulmonary changes as well as autolytic features detected by PMCT examination and to compare those findings with conventional necropsy. Retrospective evaluation of whole-body PMCT images of 46 relatively fresh harbor porpoises and corresponding conventional necropsy reports was carried out, with a special focus on the respiratory tract. Common pulmonary PMCT findings included: moderate (24/46) to severe (19/46) increased pulmonary soft tissue attenuation, severe parasite burden (17/46), bronchial wall thickening (30/46), and mild autolysis (26/46). Compared to conventional necropsy, PMCT more frequently identified pneumothorax (5/46 vs. none), tracheal content (26/46 vs. 7/46), and macroscopic pulmonary mineralization (23/46 vs. 11/46), and provided more information of the distribution of pulmonary changes. These results indicate that PMCT adds information on pulmonary assessment and is a promising complementary technique for necropsy, despite the frequent presence of mild autolytic features. [ABSTRACT FROM AUTHOR] more...
- Published
- 2022
- Full Text
- View/download PDF
11. Slow radiological improvement and persistent low-grade inflammation after chemotherapy in tuberculosis patients with type 2 diabetes
- Author
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Akhirunnesa Mily, Protim Sarker, Inin Taznin, Delwar Hossain, Md. Ahsanul Haq, S. M. Mostofa Kamal, Birgitta Agerberth, Susanna Brighenti, and Rubhana Raqib
- Subjects
Anti-inflammatory cytokine ,Diabetes mellitus ,IL-10 ,Pulmonary pathology ,Sputum culture ,TB score ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Diabetes mellitus type 2 (DM) may impede immune responses in tuberculosis (TB) and thus contribute to enhanced disease severity. In this study, we aimed to evaluate DM-mediated alterations in clinical, radiological and immunological outcomes in TB disease. Methods Newly diagnosed pulmonary TB patients with or without DM (TB n = 40; TB-DM n = 40) were recruited in Dhaka, Bangladesh. Clinical symptoms, sputum smear and culture conversion as well as chest radiography were assessed. Peripheral blood and sputum samples were collected at the time of diagnosis (baseline) and after 1, 2 and 6 months of standard anti-TB treatment. Blood samples were also obtained from healthy controls (n = 20). mRNA expression of inflammatory markers in blood and sputum samples were quantified using real-time PCR. Results The majority of TB-DM patients had poor glycemic control (HbA1c > 8%) and displayed elevated pulmonary pathology (P = 0.039) particularly in the middle (P more...
- Published
- 2020
- Full Text
- View/download PDF
12. Acute Pulmonary Toxicity and Microglial Activation following Inhalation of Aerosolized Engineered Nanomaterials in Rodents
- Author
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UPADHYAY, PRIYA
- Subjects
Pathology ,Toxicology ,Histology ,Histology ,Inhalational toxicology ,Pathology ,Pulmonary pathology ,Toxicology - Abstract
AbstractEngineered nanomaterials (ENMs) are used in diverse consumer products including, but not limited to antibacterial agents, paints, food additives, cosmetics, rubber-curing agents, textile UV-absorbers, contrast elements for magnetic resonance imaging, heating agents for cancer thermotherapy, and carriers for drug and gene delivery. Nanomaterials possess a greater surface area to volume ratio yielding a greater reactive surface area and unique physiochemical properties, but potentially possessing greater biological activity and possible toxicity than their bulky counterparts. With more than 1800 ENM-based consumer products on the market, greater demands for nanomaterials may pose increased risk for consumer and occupational exposure, in particular for workers who manufacture, handle, and package ENMs and ENM-based products. Hence, there is a need to better understand and test the hazards of these nanomaterials and their effects on human health and the environment.The aim of this study was to assess the potential implications of silver silicate (Ag-SiO2), zinc oxide (ZnO) and reduced graphene oxide (rGO) to the respiratory tract, especially when inhaled. The focus of this study was on the upper respiratory tract composed of the nasal cavity and possible transport to the brain (via the olfactory bulb) and the lower respiratory tract formed by the bronchial tree and lung parenchyma. These two regions of the respiratory system were selected for study, based on unique patterns of particle deposition for each region and the potential implications for nanoparticles being retained in each of these regions following deposition. To address the aim of our study, an acute, single day nose-only inhalation exposure regimen to aerosols of each nanomaterial was conducted in Sprague Dawley rats. Aerosols were well-characterized before and during the study. Animals were necropsied immediately (day 0) and on days 1, 7, 21 or day 56 post-exposure to ENMs. Bronchoalveolar lavage fluid, lung tissues and the nasal cavity with the contiguous olfactory bulbs were collected for assessment. Experiments were conducted to evaluate the pulmonary toxicity via BALF analysis, histological examination, gene expresssion and immunohistochemical staining. For the nasal cavity and olfactory bulb, histological examination and studies of microglial activation were conducted. more...
- Published
- 2022
13. An infectious clone of enterovirus 71(EV71) that is capable of infecting neonatal immune competent mice without adaptive mutations
- Author
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Huiying Zhang, Zhigang Song, Jingyi Zou, Yanling Feng, Jing Zhang, Lehao Ren, Xiaonan Zhang, Yunwen Hu, Zhenghong Yuan, and Zhigang Yi
- Subjects
Enterovirus 71 ,infectious clone ,mouse model ,adaptive mutation ,myolysis ,pulmonary pathology ,Infectious and parasitic diseases ,RC109-216 ,Microbiology ,QR1-502 - Abstract
ABSTRACTEnterovirus 71 (EV71) is a major pathogen that causes hand, foot and mouth disease (HFMD), which is a life threatening disease in certain children. The pathogenesis of EV71-caused HFMD is poorly defined due to the lack of simple and robust animal models with severe phenotypes that recapitulate symptoms observed in humans. Here, we generated the infectious clone of a clinical isolate from a severe HFMD patient. Virus rescued from the cDNA clone was infectious in cell lines. When administrated intraperitoneally to neonatal ICR, BALB/c and C57 immune competent mice at a dosage of1.4 × 104 pfu per mouse, the virus caused weight loss, paralysis and death in the infected mice after 4–5 days of infection. In the infected mice, detectable viral replication was detected in various tissues such as heart, liver, brain, lung, kidney, small intestine, leg skeletal muscle and medulla oblongata. The histology of the infected mice included massive myolysis, glomerular atrophy, villous blunting in small intestine, widened alveolar septum, diminished alveolar spaces and lymphocytes infiltration into the lung. By using the UV-inactivated virus as a control, we elucidated that the virus first amplified in the leg skeletal muscle tissue and the muscle tissue served as a primary viral replication site. In summary, we generated a stable EV71 infectious clone that is capable of infecting neonatal immune competent mice without adaptive mutations and provide a simple, valuable animal model for the studies of EV71pathogenesis and therapy. more...
- Published
- 2020
- Full Text
- View/download PDF
14. Watch the Mime Carefully! A Refractory Interstitial Lung Disease
- Author
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Paolo Graziano, Paolo Fuso, and Cristiano Carbonelli
- Subjects
chest CT ,interventional pulmonology ,lung cancer diagnosis ,interstitial lung disease ,pulmonary epithelioid hemangioendothelioma ,pulmonary pathology ,Medicine (General) ,R5-920 - Abstract
Epithelioid hemangioendothelioma (EHE) is a rare neoplasm of a vascular origin which can arise in different locations such as the lungs, liver, soft tissue, and rarely, in the bones. In the lungs, pulmonary hemangioendothelioma (PEH) shows a variable clinical behavior, displaying a range from either an asymptomatic course to a highly aggressive progression with metastases. Based on radiological features, PEH differential diagnosis mainly includes primary or metastatic lymphangitic carcinomatosis, granulomatous infections, and diffuse interstitial lung diseases where ground glass pattern predominates. In this case, a transbronchial biopsy and subsequent histological and immunohistochemical analysis allowed for the attribution of the scenario to a pulmonary epithelioid hemangioendothelioma. Clinicians should always consider bronchoscopy as a useful and effective tool to better investigate indeterminate and questionable clinical pictures, sparing patients the morbidity and mortality associated with more invasive techniques such as surgical or thoracoscopic biopsy. more...
- Published
- 2022
- Full Text
- View/download PDF
15. Post-Mortem Computed Tomography Pulmonary Findings in Harbor Porpoises (Phocoena phocoena)
- Author
-
Nienke W. Kuijpers, Linde van Schalkwijk, Lonneke L. IJsseldijk, Dorien S. Willems, and Stefanie Veraa
- Subjects
cetacean ,virtopsy ,necropsy ,pulmonary pathology ,decomposition ,Veterinary medicine ,SF600-1100 ,Zoology ,QL1-991 - Abstract
The application of whole-body post-mortem computed tomography (PMCT) in veterinary and wildlife post-mortem research programs is advancing. A high incidence of pulmonary pathology is reported in the harbor porpoise (Phocoena phocoena). In this study, the value of PMCT focused on pulmonary assessment is evaluated. The objectives of this study were to describe pulmonary changes as well as autolytic features detected by PMCT examination and to compare those findings with conventional necropsy. Retrospective evaluation of whole-body PMCT images of 46 relatively fresh harbor porpoises and corresponding conventional necropsy reports was carried out, with a special focus on the respiratory tract. Common pulmonary PMCT findings included: moderate (24/46) to severe (19/46) increased pulmonary soft tissue attenuation, severe parasite burden (17/46), bronchial wall thickening (30/46), and mild autolysis (26/46). Compared to conventional necropsy, PMCT more frequently identified pneumothorax (5/46 vs. none), tracheal content (26/46 vs. 7/46), and macroscopic pulmonary mineralization (23/46 vs. 11/46), and provided more information of the distribution of pulmonary changes. These results indicate that PMCT adds information on pulmonary assessment and is a promising complementary technique for necropsy, despite the frequent presence of mild autolytic features. more...
- Published
- 2022
- Full Text
- View/download PDF
16. The Influence of Body Fat Dynamics on Pulmonary Immune Responses in Murine Tuberculosis: Unraveling Sex-Specific Insights.
- Author
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Dhanyalayam D, Thangavel H, Sidrat T, Oswal N, Lizardo K, Mauro M, Zhao X, Xue HH, Desai JV, and Nagajyothi JF
- Subjects
- Animals, Female, Male, Mice, Tuberculosis, Pulmonary immunology, Tuberculosis, Pulmonary pathology, Tuberculosis, Pulmonary microbiology, Mice, Transgenic, Sex Factors, Disease Models, Animal, CD8-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes metabolism, Sex Characteristics, Mice, Inbred C57BL, Mycobacterium tuberculosis, Lung immunology, Lung microbiology, Lung pathology, Lung metabolism, Adipose Tissue metabolism, Adipose Tissue immunology
- Abstract
The World Health Organization (WHO) highlights a greater susceptibility of males to tuberculosis (TB), a vulnerability attributed to sex-specific variations in body fat and dietary factors. Our study delves into the unexplored terrain of how alterations in body fat influence Mycobacterium tuberculosis ( Mtb ) burden, lung pathology, immune responses, and gene expression, with a focus on sex-specific dynamics. Utilizing a low-dose Mtb -HN878 clinical strain infection model, we employ transgenic FAT-ATTAC mice with modulable body fat to explore the impact of fat loss (via fat ablation) and fat gain (via a medium-fat diet, MFD). Firstly, our investigation unveils that Mtb infection triggers severe pulmonary pathology in males, marked by shifts in metabolic signaling involving heightened lipid hydrolysis and proinflammatory signaling driven by IL-6 and localized pro-inflammatory CD8
+ cells. This stands in stark contrast to females on a control regular diet (RD). Secondly, our findings indicate that both fat loss and fat gain in males lead to significantly elevated (1.6-fold ( p ≤ 0.01) and 1.7-fold ( p ≤ 0.001), respectively) Mtb burden in the lungs compared to females during Mtb infection (where fat loss and gain did not alter Mtb load in the lungs). This upsurge is associated with impaired lung lipid metabolism and intensified mitochondrial oxidative phosphorylation-regulated activity in lung CD8+ cells during Mtb infection. Additionally, our research brings to light that females exhibit a more robust systemic IFNγ ( p ≤ 0.001) response than males during Mtb infection. This heightened response may either prevent active disease or contribute to latency in females during Mtb infection. In summary, our comprehensive analysis of the interplay between body fat changes and sex bias in Mtb infection reveals that alterations in body fat critically impact pulmonary pathology in males. Specifically, these changes significantly reduce the levels of pulmonary CD8+ T-cells and increase the Mtb burden in the lungs compared to females. The reduction in CD8+ cells in males is linked to an increase in mitochondrial oxidative phosphorylation and a decrease in TNFα, which are essential for CD8+ cell activation. more...- Published
- 2024
- Full Text
- View/download PDF
17. Slow radiological improvement and persistent low-grade inflammation after chemotherapy in tuberculosis patients with type 2 diabetes.
- Author
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Mily, Akhirunnesa, Sarker, Protim, Taznin, Inin, Hossain, Delwar, Haq, Md. Ahsanul, Kamal, S. M. Mostofa, Agerberth, Birgitta, Brighenti, Susanna, and Raqib, Rubhana
- Subjects
- *
TYPE 2 diabetes , *TUBERCULOSIS patients , *TUBERCULOSIS , *SPINAL tuberculosis , *BLOOD sampling , *MULTIDRUG-resistant tuberculosis - Abstract
Background: Diabetes mellitus type 2 (DM) may impede immune responses in tuberculosis (TB) and thus contribute to enhanced disease severity. In this study, we aimed to evaluate DM-mediated alterations in clinical, radiological and immunological outcomes in TB disease.Methods: Newly diagnosed pulmonary TB patients with or without DM (TB n = 40; TB-DM n = 40) were recruited in Dhaka, Bangladesh. Clinical symptoms, sputum smear and culture conversion as well as chest radiography were assessed. Peripheral blood and sputum samples were collected at the time of diagnosis (baseline) and after 1, 2 and 6 months of standard anti-TB treatment. Blood samples were also obtained from healthy controls (n = 20). mRNA expression of inflammatory markers in blood and sputum samples were quantified using real-time PCR.Results: The majority of TB-DM patients had poor glycemic control (HbA1c > 8%) and displayed elevated pulmonary pathology (P = 0.039) particularly in the middle (P < 0.004) and lower lung zones (P < 0.02) throughout the treatment period. However, reduction of clinical symptoms and time to sputum smear and culture conversion did not differ between the groups. Transcripts levels of the pro-inflammatory cytokines IL-1β (P = 0.003 at month-1 and P = 0.045 at month-2) and TNF-α (P = 0.005 at month-1) and the anti-inflammatory cytokine IL-10 (P = 0.005 at month-2) were higher in peripheral blood after anti-TB treatment in TB-DM compared to TB patients. Conversely in sputum, TB-DM patients had reduced CD4 (P < 0.009 at month-1) and IL-10 (P = 0.005 at month-1 and P = 0.006 at month-2) transcripts, whereas CD8 was elevated (P = 0.016 at month-2). At 1- and 2-month post-treatment, sputum IL-10 transcripts were inversely correlated with fasting blood glucose and HbA1c levels in all patients.Conclusion: Insufficient up-regulation of IL-10 in the lung may fuel persistent local inflammation thereby promoting lung pathology in TB-DM patients with poorly controlled DM. [ABSTRACT FROM AUTHOR] more...- Published
- 2020
- Full Text
- View/download PDF
18. Frequency and Significance of Pathologic Pulmonary Findings in Postmortem Examinations—A Single Center Experience before COVID-19
- Author
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Sabina Berezowska, Andreas Schmid, Tereza Losmanová, Mafalda Trippel, Annika Blank, Yara Banz, Stephan M. Jakob, and Rupert Langer
- Subjects
pulmonary pathology ,postmortem diagnostics ,autopsy ,Medicine (General) ,R5-920 - Abstract
Coronavirus disease 2019 (COVID-19) has shown the importance of postmortem investigation of deceased patients. For a correct interpretation of the pulmonary findings in this new era, it is, however, crucial to be familiar with pathologic pulmonary conditions observed in postmortem investigations in general. Adequate postmortem histopathological evaluation of the lungs may be affected by suboptimal gross work up, autolysis or poor fixation. Using a standardized preparation approach which consisted in instillation of 4% buffered formaldehyde through the large bronchi for proper fixation and preparing large frontal tissue sections of 1–2 cm thickness after at least 24 h fixation, we comprehensively analyzed postmortem pulmonary findings from consecutive adult autopsies of a two-year period before the occurrence of COVID-19 (2016–2017). In total, significant pathological findings were observed in 97/189 patients (51%), with 28 patients showing more than one pathologic condition. Acute pneumonia was diagnosed 33/128 times (26%), embolism 24 times (19%), primary pulmonary neoplasms 18 times (14%), organizing pneumonia and other fibrosing conditions 14 times (11%), pulmonary metastases 13 times (10%), diffuse alveolar damage 12 times (9%), severe emphysema 9 times (7%) and other pathologies, e.g., amyloidosis 5/128 times (4%). Pulmonary/cardiopulmonary disease was the cause of death in 60 patients (32%). Clinical and pathological diagnoses regarding lung findings correlated completely in 75 patients (40%). Autopsy led to confirmation of a clinically suspected pulmonary diagnosis in 57 patients (39%) and clarification of an unclear clinical lung finding in 16 patients (8%). Major discrepant findings regarding the lungs (N = 31; 16%) comprised cases with clinical suspicions that could not be confirmed or new findings not diagnosed intra vitam. A significant proportion of acute pneumonias (N = 8; 24% of all cases with this diagnosis; p = 0.011) was not diagnosed clinically. We confirmed the frequent occurrence of pulmonary pathologies in autopsies, including inflammatory and neoplastic lesions as the most frequent pathological findings. Acute pneumonia was an important cause for discrepancy between clinical and postmortem diagnostics more...
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- 2021
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19. Evaluation of oxaliplatin-induced pulmonary toxicity in rats.
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Kalemci, Serdar, Tanrýverdi, Ozgür, Şimşek, Abdullah, Aksun, Saliha, Celik, Ozgür I., Barutca, Sabri, Zeybek, Arife, and Demirci, Buket
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OXALIPLATIN , *ANIMAL models of pulmonary toxicology , *GLUTATHIONE peroxidase , *PULMONARY fibrosis , *DRUG administration - Abstract
Introduction: The mechanism of oxaliplatin (OXA) induced pulmonary toxicity is not fully understood. Aim of the study: The present study was designed to investigate the pulmonary toxicity of OXA that has been reported in previous studies. Study design: animal experiments. Material and methods: A total of 40 female Wistar rats were divided into 5 groups. In group 1, 5% glucose was injected intra-peritoneally; then the rats were sacrificed on day 14. OXA was administered in groups 2, 3, 4, and 5; then the animals were sacrificed on day 7 in group 2, day 14 in group 3, day 28 in group 4 and day 48 in group 5. The groups were further categorized as short-term administration and long-term administration groups. Furthermore, tissue glutathione peroxidase (GPX) activity was measured in all rats. Results: The mean GPX activities were 0.66 U/mg in the sham group, 0.74 U/mg in the short-term groups, and 0.74 U/mg in the long-term groups. We found that long-term OXA administration causes pulmonary toxicity resulting in increased intra-alveolar/interstitial macrophages and interstitial pneumonia. Similarly, we found reduced and permanent tissue GPX activity in rats that received OXA in higher doses and for a long term. Conclusions: Long-term OXA therapy causes toxic changes in the lung tissue. [ABSTRACT FROM AUTHOR] more...
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- 2019
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20. Elastin in pulmonary pathology
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Yukio Nakatani, Alain C. Borczuk, Ximena Baez-Navarro, Teodora Radonic, Noriko Motoi, Yuko Minami, Erik Thunnissen, Masayuki Noguchi, Hans Blaauwgeers, Daisuke Matsubara, Wim Timens, and Yuichi Ishikawa more...
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Pathology ,medicine.medical_specialty ,Histology ,Lung Neoplasms ,Connective tissue ,Adenocarcinoma of Lung ,Pathology and Forensic Medicine ,Diagnosis, Differential ,medicine ,Humans ,Pulmonary pathology ,Lung ,biology ,business.industry ,Histocytochemistry ,General Medicine ,medicine.disease ,Staining ,Elastin ,Pulmonary Alveoli ,Adenocarcinoma, Papillary ,medicine.anatomical_structure ,biology.protein ,Pleura ,Papillary carcinoma ,Collagen ,business - Abstract
Elastin and collagen are the main components of the lung connective tissue network, and together provide the lung with elasticity and tensile strength. In pulmonary pathology, elastin staining is used to variable extents in different countries. These uses include evaluation of the pleura in staging, and the distinction of invasion from collapse of alveoli after surgery (iatrogenic collapse). In the latter, elastin staining is used to highlight distorted but pre-existing alveolar architecture from true invasion. In addition to variable levels of use and experience, the interpretation of elastin staining in some adenocarcinomas leads to interpretative differences between collapsed lepidic patterns and true papillary patterns. This review aims to summarise the existing data on the use of elastin staining in pulmonary pathology, on the basis of literature data and morphological characteristics. The effect of iatrogenic collapse and the interpretation of elastin staining in pulmonary adenocarcinomas is discussed in detail, especially for the distinction between lepidic patterns and papillary carcinoma. more...
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- 2022
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21. Pathology of lung‐specific thrombosis and inflammation in COVID‐19
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Kathleen T. Montone, Rustem I. Litvinov, R. R. Khismatullin, Rozalina A Ivaeva, Chandrasekaran Nagaswami, Anastasia A. Ponomareva, and John W. Weisel
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Pathology ,medicine.medical_specialty ,Inflammation ,Autopsy ,blood coagulation ,COVID‐19 ,Humans ,Medicine ,Pulmonary pathology ,Diffuse alveolar damage ,Lung ,lungs ,SARS-CoV-2 ,business.industry ,COVID-19 ,Original Articles ,Hematology ,Neutrophil extracellular traps ,medicine.disease ,Thrombosis ,THROMBOSIS ,medicine.anatomical_structure ,Circulatory system ,Original Article ,medicine.symptom ,business - Abstract
Background Infection by SARS‐CoV‐2 produces significant pulmonary pathology including endothelial damage with resultant thrombotic events. While pathologic features were described, there are limited data on the relationship of these changes to the inflammatory response and the production of thromboses. Objective To investigate pathology of COVID‐19‐related immunothrombosis. Patients/Methods Tissue samples from lung, kidney, brain and heart that were collected from 45 patients who died of COVID‐19. Histopathological examination was performed after H&E and Picro‐Mallory staining in combination with (immuno)fluorescence to visualize neutrophil extracellular traps. Ultrastructural alterations in lungs were studied with scanning and transmission electron microscopy. Results Inflammatory changes and thrombosis were substantially more pronounced in the lung than in the kidney, heart, and brain. The most common pathologic finding was diffuse alveolar damage. In addition, most lung samples showed thrombi in vessels. The cause of death in single cases was massive pulmonary embolism. Ultrastructural examination revealed neutrophils attached to endothelium, perhaps as a step towards transendothelial migration. In addition, platelets were identified in the midst of fibrin as individual procoagulant balloon‐like cells. Ultrastructural examination demonstrated numerous virion‐like particles. Conclusions Studying (ultra)structural features of the autopsy lung samples from patients with COVID‐19 has provided evidence for a pathogenic link between inflammation and thrombosis. The major features in the lungs of COVID‐19 patients comprised primary inflammatory thrombosis associated with diffuse alveolar damage. The lungs had pronounced circulatory changes with inflammation‐dependent intravascular blood clotting, whereas heart, brain, and kidneys had predominantly degenerative changes that were distinct from the lung pathology. more...
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- 2021
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22. NK cells inhibit anti‐Mycobacterium bovis BCG T cell responses and aggravate pulmonary inflammation in a direct lung infection mouse model.
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Wang, Dongfang, Gu, Xiuling, Liu, Xiaoman, Wei, Songtao, Wang, Bin, and Fang, Min
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KILLER cells , *MYCOBACTERIUM bovis , *BCG vaccines , *T cells , *LUNG infections - Abstract
Abstract: Tuberculosis remains a threat to public health. The major problem for curing this disease is latent infection, of which the underlying mechanisms are still not fully understood. Previous studies indicate that natural killer (NK) cells do not play a role in inhibiting the growth of Mycobacterium tuberculosis in the lung, and recent studies have revealed that NK cells regulate the adaptive immunity during mycobacterial infection. By using a mouse model of direct lung infection with Mycobacterium bovis bacillus Calmette‐Guerin (BCG), we found that the presence of NK cells postponed the priming and activation of T cells after BCG infection. In addition, depletion of NK cells before infection alleviated pulmonary pathology. Further studies showed that NK cells lysed BCG‐infected macrophages in an NKG2D dependent manner. Thus, NK cells did not play a direct role in control BCG, but aggravated the pulmonary inflammation and impaired anti‐BCG T cell immunity, likely through killing BCG‐infected macrophages. Our results may have important implications for the design of immune therapy to treat tuberculosis. [ABSTRACT FROM AUTHOR] more...
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- 2018
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23. Evaluation of anti-inflammatory and immunomodulatory activity of Chyawanprash on particulate matter-induced pulmonary disease in mice
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Padmanabha Rugvedi, Arun Gupta, Kamaraj Mani, and Satyendra Kumar
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Chemokine ,medicine.drug_class ,PM2.5 ,Pharmacology ,Anti-inflammatory ,Proinflammatory cytokine ,chemistry.chemical_compound ,Drug Discovery ,medicine ,Pulmonary pathology ,Miscellaneous systems and treatments ,Lung ,Inhalation ,biology ,business.industry ,RZ409.7-999 ,medicine.disease ,medicine.anatomical_structure ,BALF ,Complementary and alternative medicine ,chemistry ,Original Research Article (Experimental) ,biology.protein ,Cytokines ,Tumor necrosis factor alpha ,Pulmonary disease ,business ,Chyawanprash ,Histamine - Abstract
Background Particulate matter (PM) is the major component of air pollution, which includes emissions from both anthropogenic and natural sources. PM, with aerodynamic diameter of 2.5 ± 10 μm can remain in the air for a long time and be deposited in the lungs through inhalation and hence, is a major threat to human health. Objective(s) The objective of the present study was to examine the protective effect of Chyawanprash (CP) on PM-induced pulmonary disease through estimation of cytokines and immunoglobulins. Materials and methods CP, standard drug, and vehicle (Group G1 to Group G7) were administered orally at the dose volume of 10 ml/kg, for 28 consecutive days (Prophylactic treatment; i.e., Day 1 to Day 28) and next 10 days (i.e., Day 29 to Day 38) of co-treatment with inducing agent PM2.5 intratracheally. Animals of group G6 (Inhalation + control) and G7 (Inhalation + CP) were exposed group-wise to PM2.5 aerosol (2 mg/5 ml, 15 min) via inhalation in histamine chamber on Days 29, 31, 33, 35, and 37. On Day 38, animals were anesthetised and blood and broncho alveolar lavage fluid (BALF) were collected. Animals were sacrificed and lungs were collected for histology. Results Prophylactic benefit of CP against pulmonary pathology was evidenced by the inhibition of inflammatory cytokines (BALF: TNF a, IFN-g, IL-7, IL-6 and lung: TNFa, Histamine and IL-6), chemokines (Lung: MMP-9), inflammatory cell infiltration (cell counts in BALF), and histopatholoy in experimental mice model. Conclusion These findings suggest that CP has potential benefit in protecting from harmful effects caused by air pollutants such as PM2.5. more...
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- 2021
24. Basic principles of rehabilitation in patients with chronic obstructive pulmonary disease
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N. N. Mescheryakova, A. S. Belevskiy, and A. V. Chernyak
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хобл ,легочная патология ,реабилитация ,дыхательные тренажеры ,высокочастотная осцилляция ,copd ,pulmonary pathology ,rehabilitation ,respiratory exercisers ,high-frequency oscillation ,Medicine - Abstract
One of the most common systemic defects in patients with chronic obstructive pulmonary disease is skeletal and respiratory muscle dysfunction. Physical exercise in the therapy of such patients therefore plays an important role. The Institute of Pulmonology of the Russian FMBA has developed a system of special physical exercises to decrease dysfunction of respiratory and skeletal muscles and affect the hyperinflation of the lungs. The physical program includes strength exercises for upper and lower skeletal muscles, breathing exercises, training of the respiratory muscles using simulators and high-frequency chest wall oscillation. more...
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- 2014
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25. The Novel Coronavirus in Pediatric and Geriatric Population- What We Know
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Kumar G. Chhbra, Gargi Nimbulkar, Aniket Hedaoo, Punit Fulzele, Anjali Nandanwar, and Amit Reche
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medicine.medical_specialty ,education.field_of_study ,Pediatrics ,business.industry ,Population ,Outbreak ,Disease ,medicine.disease_cause ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Immunity ,030225 pediatrics ,Diabetes mellitus ,Epidemiology ,medicine ,030212 general & internal medicine ,Pulmonary pathology ,business ,education ,General Dentistry ,Coronavirus - Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)is a virus responsible for the coronavirus infection that is currently causing a severe outbreak of the disease in the world, infecting and killing thousands to lacs of people. The pediatric and geriatric population is no exception to this. Children and older adults have less immunity, which makes them more susceptible to infection than other populations. But still the number of cases of Children where less as compared to adults and those having underlying pulmonary pathology or immunocompromising conditions are more vulnerable to infection. Some studies have shown that this virus causes more death in the older age population as compared to adults or children. Patients having any systemic conditions like diabetes, raised blood pressure, heart diseases, lung diseases and chronic renal diseases were more vulnerable to this infection. In this article, we will outline the epidemiology, symptoms, diagnosis, and treatment modalities of the novel coronavirus-2019(COVID 19) infection in humans, with more focusing on infection in children as well as in older adults. more...
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- 2021
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26. Pneumomediastinum, pneumopericardium, and subcutaneous emphysema—a rare complication in COVID-19 infection
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Archana Baburao, Rinki Das, and Shylaja Shyamsunder
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Subcutaneous emphysema ,medicine.medical_specialty ,medicine.medical_treatment ,Pneumomediastinum ,Pneumopericardium ,Disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Diseases of the respiratory system ,0302 clinical medicine ,Case report ,Medicine ,Pulmonary pathology ,Mechanical ventilation ,RC705-779 ,business.industry ,RC86-88.9 ,COVID-19 ,Medical emergencies. Critical care. Intensive care. First aid ,medicine.disease ,Surgery ,Pneumonia ,030228 respiratory system ,medicine.symptom ,Complication ,business - Abstract
Background Coronavirus disease 2019 (COVID-19) has become a global pandemic and is posing a serious public health problem for almost all countries. Spontaneous pneumomediastinum, a rare condition, is usually seen in patients with underlying pulmonary pathology, infections, or mechanical ventilation. Spontaneous pneumomediastinum is a rare complication in COVID-19 pneumonia. Case presentation We report a case of spontaneous pneumomediastinum, pneumopericardium, and subcutaneous emphysema in a 62-year-old diabetic patient with COVID-19 infection who presented with cough, fever, and breathlessness, which turned to be a fatal complication. Conclusion Pneumomediastinum/subcutaneous emphysema, a not so common complication associated with COVID-19 infection, should be considered as a bad prognostic indicator of worsening disease and hence requires early recognition and careful monitoring of the patient for any possible unfavorable outcome. more...
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- 2021
27. Inflammation during Lung Cancer Progression and Ethyl Pyruvate Treatment Observed by Pulmonary Functional Hyperpolarized 129Xe MRI in Mice
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Yoshihiro Kamada, Hirohiko Imai, Renya Nishimori, Hideaki Fujiwara, Neil J. Stewart, Akihiro Shimokawa, Atsuomi Kimura, and Seiya Utsumi
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Male ,Pathology ,medicine.medical_specialty ,Lung Neoplasms ,Xenon ,Article Subject ,Adenoma ,medicine.medical_treatment ,Intraperitoneal injection ,Urethane ,030218 nuclear medicine & medical imaging ,Pulmonary function testing ,Mice ,03 medical and health sciences ,0302 clinical medicine ,Medical technology ,medicine ,Animals ,Radiology, Nuclear Medicine and imaging ,Pulmonary pathology ,R855-855.5 ,Pyruvates ,Lung cancer ,Saline ,Inflammation ,business.industry ,Cancer ,medicine.disease ,Magnetic Resonance Imaging ,030220 oncology & carcinogenesis ,Carcinogens ,Breathing ,business ,Research Article - Abstract
This study aimed to assess the suitability of hyperpolarized 129Xe (HPXe) MRI for noninvasive longitudinal evaluation of pulmonary function in preclinical lung cancer models. A mouse model of lung cancer (LC) was induced in 5 mice by intraperitoneal injection of urethane, while a negative-control (NC) mice (N = 5) was prepared by injection of saline solution. Longitudinal HPXe MRI was performed over a 5-month period to monitor lung ventilation and gas exchange. The treatment efficacy of ethyl pyruvate (EP), an anti-inflammatory drug, to the mouse LC model was monitored using HPXe MRI by commencing administration of EP pre (early-phase) and 1-month post (late-phase) injection of urethane (N = 5 mice for each group). Gas-exchange function in LC mice was significantly reduced at 1-month after urethane injection compared with NC mice administered with saline ( P < 0.01 ). Thereafter, it remained consistently lower than that of the NC group for the full 5-month measurement period. In contrast, the ventilation function of the LC model mice was not significantly different to that of the NC mice. Histological analysis revealed alveolar epithelial hyperplasia in LC mice alveoli at 1 month after urethane injection, and adenoma was confirmed 3 months after the injection. The early- and late-phase EP interventions were found to improve HPXe MRI metrics (reduced at 1 month postinjection of urethane) and significantly inhibit tumor growth. These results suggest that HPXe MRI gas-exchange metrics can be used to quantitatively assess changes in the precancerous lesion microenvironment and to evaluate therapeutic efficacy in cancer. Thus, HPXe MRI can be utilized to noninvasively monitor pulmonary pathology during LC progression and can visualize functional changes during therapy. more...
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- 2021
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28. X-ray study as an alternative method for visualizing changes in lungs, with infection caused by COVID-19
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E. A. Litvinenko, I. V. Burova, and M. M. Erovenko
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medicine.medical_specialty ,Lung ,Radiological and Ultrasound Technology ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Radiography ,X-ray ,Gold standard (test) ,medicine.disease ,medicine.disease_cause ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,Radiology, Nuclear Medicine and imaging ,Pulmonary pathology ,Radiology ,business ,Pathological ,Coronavirus - Abstract
Introduction. Despite the existence of generally accepted diagnostic protocols, when a new coronavirus infection is suspected, in some cases, it is increasingly difficult to detect changes in the lung tissue in a timely manner due to the heavy workload of the main method of radiation diagnostics – computed tomography. Purpose of the study. To determine the effectiveness of the appointment of an X-ray examination as first-line metgod, as well as to carry out a comparative analysis of the use of radiation diagnostics methods – computed tomography and radiography in relation to the diagnostic sensitivity to changes in lung tissue when a person is infected with the SARS-COV-2 virus.Materials and methods. 150 patients (63.0 ± 8.4 years) with confirmed coronavirus infection were examined. Each of the participants underwent X-ray examination and computed tomography of the chest organs. The percentage of subjects studied for each of the degrees of severity of lung damage was determined to identify the proportion of involvement of lung tissue in the pathological process in the bulk of the examined individuals.Results. Of the 150 patients, changes in the lung tissue during chest X-ray were detected in 97 (65%), respectively, in 53 (35%), pathological changes in the lungs were not visualized. When examining patients by computed tomography, changes in the lungs were detected in 143 patients (95%), X-ray morphological changes were not detected in 7 subjects (5%). When detecting the volume of lung damage, it turned out that the majority of the subjects – 86 people (57%) – had the degree of damage CT-2. The degree of CT-1 and CT-3 was determined in 26 (17%) and 25 (17%) patients, respectively. CT-4 was observed in 6 patients (4%), and in 5% of cases, CT was not able to detect pathological changes in the lung tissue, the degree of CT-0 was established.Conclusion. In the assessment of viral lung damage, radiography takes a significant place, but in 35% of cases, radiographic examination failed to identify the existing pathological changes. CT of the chest organs confirms its value as the “gold standard” in the study of pulmonary pathology in coronavirus infection, but if it is impossible to perform it, radiography is recommended. more...
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- 2021
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29. Post-Mortem Computed Tomography Pulmonary Findings in Harbor Porpoises (Phocoena phocoena)
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Kuijpers, Nienke W, van Schalkwijk, Linde, IJsseldijk, Lonneke L, Willems, Dorien S, Veraa, Stefanie, Kuijpers, Nienke W, van Schalkwijk, Linde, IJsseldijk, Lonneke L, Willems, Dorien S, and Veraa, Stefanie more...
- Abstract
The application of whole-body post-mortem computed tomography (PMCT) in veterinary and wildlife post-mortem research programs is advancing. A high incidence of pulmonary pathology is reported in the harbor porpoise ( Phocoena phocoena). In this study, the value of PMCT focused on pulmonary assessment is evaluated. The objectives of this study were to describe pulmonary changes as well as autolytic features detected by PMCT examination and to compare those findings with conventional necropsy. Retrospective evaluation of whole-body PMCT images of 46 relatively fresh harbor porpoises and corresponding conventional necropsy reports was carried out, with a special focus on the respiratory tract. Common pulmonary PMCT findings included: moderate (24/46) to severe (19/46) increased pulmonary soft tissue attenuation, severe parasite burden (17/46), bronchial wall thickening (30/46), and mild autolysis (26/46). Compared to conventional necropsy, PMCT more frequently identified pneumothorax (5/46 vs. none), tracheal content (26/46 vs. 7/46), and macroscopic pulmonary mineralization (23/46 vs. 11/46), and provided more information of the distribution of pulmonary changes. These results indicate that PMCT adds information on pulmonary assessment and is a promising complementary technique for necropsy, despite the frequent presence of mild autolytic features. more...
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- 2022
30. A 33-year follow-up after valvular surgery for carcinoid heart disease
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Anders Albåge, Lennart Lundin, Frank A. Flachskampf, Patrik Öhagen, and Johannes Bergsten
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medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Urinary system ,Carcinoid Heart Disease ,030209 endocrinology & metabolism ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Pulmonary Valve Replacement ,medicine ,Natriuretic peptide ,Humans ,Radiology, Nuclear Medicine and imaging ,Pulmonary pathology ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,business.industry ,valvular heart disease ,General Medicine ,Perioperative ,Hydroxyindoleacetic Acid ,Middle Aged ,medicine.disease ,Heart Valves ,Surgery ,Treatment Outcome ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Aims Valvular surgery has improved long-term prognosis in severe carcinoid heart disease (CaHD). Experience is limited and uncertainty remains about predictors for survival and strategy regarding single vs. double-valve surgery. The aim was to review survival and echocardiographic findings after valvular surgery for CaHD at our institution. Methods and results Between 1986 and 2019, 60 consecutive patients, median age 64 years, underwent valve surgery for severe CaHD. Operations involved combined tricuspid valve replacement (TVR) and pulmonary valve replacement (PVR) in 42 cases, and TVR-only or TVR with pulmonary valvotomy (no PVR) in 18 patients. All implanted valves were bioprosthetic. Preoperative echocardiography, creatinine, NT-pro-brain natriuretic peptide (NT-pro-BNP), and 24-h urinary 5-hydroxyindoleacetic acid (5-HIAA) were obtained. 30-Day mortality was 12% (n=7), and 8% for the most recent decade 2010–2019. Median survival was 2.2 years and maximum survival 21 years. Patients undergoing combined TVR and PVR had significantly higher survival compared with operations without PVR (median 3.0 vs. 0.9 years, P = 0.02). Preoperative levels of NT-pro-BNP and 5-HIAA in the top quartile predicted poor survival. On preoperative echocardiograms, pulmonary regurgitation was severe in 51% and indeterminate in 17%. Postoperative echocardiography confirmed relatively good durability of bioprostheses, relative to the patients’ limited oncological life expectancy. Conclusion Valvular surgery in CaHD has an acceptable perioperative risk. Survival for combined TVR and PVR was significantly higher compared with operations without PVR. Bioprosthetic valve replacement appears to have adequate durability. Preoperative echocardiography may underestimate pulmonary pathology. Combined TVR and PVR should be considered in most patients. more...
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- 2021
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31. The Use of Dornase Alfa in the Management of COVID-19-Associated Adult Respiratory Distress Syndrome
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Andrew Toma, Michele Taylor, Ribal Darwish, Justin Harlacher, and Christina Darwish
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0301 basic medicine ,medicine.medical_specialty ,Ventilator circuit ,ARDS ,Article Subject ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,medicine ,030212 general & internal medicine ,Pulmonary pathology ,Intensive care medicine ,Mechanical ventilation ,Respiratory distress ,RC86-88.9 ,business.industry ,Medical emergencies. Critical care. Intensive care. First aid ,Dornase alfa ,medicine.disease ,Intensive care unit ,030104 developmental biology ,business ,Research Article ,medicine.drug ,Cohort study - Abstract
Objective Currently, management of acute respiratory distress syndrome (ARDS) in COVID-19 infection with invasive mechanical ventilation results in poor prognosis and high mortality rates Interventions to reduce ventilatory requirements or preclude their needs should be evaluated in order to improve survival rates in critically ill patients Formation of neutrophil extracellular traps (NETs) during the innate immune response could be a contributing factor to the pulmonary pathology This study suggests the use of dornase alfa, a recombinant DNAse I that lyses NETs, to reduce ventilatory requirements and improve oxygenation status, as well as outcomes in critically ill patients with ARDS subsequent to confirmed or highly suspected COVID-19 infection Design A single-institution cohort study Setting Intensive care unit in a tertiary medical center Patients Adult patients with acute respiratory distress syndrome (ARDS) admitted to the ICU with confirmed COVID-19 infection Intervention Treatment with aerosolized dornase alfa Measurements and Main Results Of 39 patients evaluated, most patients had improvement in oxygenation measured by increase in the PaO2/FiO2 ratio, reduction in ventilatory support or other supportive oxygen requirements, and partial resolution of bilateral opacities visible on CXR, as well as improved outcome Conclusions Administration of inhalational dornase alfa via a filtered nebulizer medication system or through an adapter in a ventilator circuit should be considered in all COVID-19-positive patients with ARDS as early in the disease course as possible [ABSTRACT FROM AUTHOR] Copyright of Critical Care Research & Practice is the property of Hindawi Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts ) more...
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- 2021
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32. Challenges in the morphological diagnostics of infectious lung diseases among HIV-infected patients: a case-series study
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L. M. Zahaba, O. D. Nikolaieva, O. O. Melnyk, and I. V. Liskina
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medicine.medical_specialty ,Tuberculosis ,business.industry ,diagnosis ,Autopsy ,hiv ,Pneumocystis pneumonia ,medicine.disease ,Dermatology ,Pneumonia ,secondary infections ,Infectious disease (medical specialty) ,Cryptococcosis ,medicine ,Medicine ,Pulmonary pathology ,Medical diagnosis ,business ,lung diseases - Abstract
HIV-infection is a long-term infectious disease, characterized by deterioration of the immune system and it is often complicated by the development of opportunistic diseases, mainly of infectious origin. HIV-associated infections become generalized in the late stages of the disease and often may combine, that makes challenges in the diagnosis of these diseases. Differential morphological diagnosis of HIV-associated lung infections is quite complex. Most frequently, there is the need to differentiate between tuberculosis, bacterial or septic pneumonia, cytomegalovirus lung lesions, and deep mycoses. The aim. To demonstrate the expediency and necessity to apply special complex morphological methods in HIV-infected patients with secondary lung lesions using the series of clinical cases as an example. Materials and methods. The case series consisted of 7 cases with discordance between the clinical-radiologic, laboratory data and histological conclusions. Of these, there were 5 cases of life-time and 2 autopsy diagnoses. All the clinical and laboratory data of these cases were retrospectively analyzed, and a number of additional special histological examinations were performed. The Ziehl–Neelsen and fluorescent methods, Gomori–Grocot and alcian blue-PAS staining as well as immunohistochemical examinations were used for the detection of mycobacterial antigens with different antibodies to M. tuberculosis. Results. The case series of initial morphological misdiagnosis or indeterminate histological diagnosis was revealed among hospitalized HIV-infected patients. Clinical data did not provide an accurate diagnosis of pulmonary pathology. According to the traditional histological examination, a tuberculous process was diagnosed in 3 cases, a chronic granulomatous process – in 2 cases, but without specifying the etiology. In two cases of autopsy, pneumocystis pneumonia was suspected in combination with other infections. Additional morphological examination with using 2–6 special methods made it possible to determine the correct diagnosis. In 2 cases of provisional diagnosis of tuberculosis, invasive cryptococcosis and “pneumonia in a drug user” were revealed. Cryptococcosis and pneumocystis pneumonia were detected in 2 cases with an unspecified process. In the autopsy cases, the diagnosis of pneumocystis pneumonia was ruled out, while viral-bacterial pneumonia and tuberculosis associated with cytomegalovirus infection were detected. Conclusions. The presented factual material demonstrates the principal importance of using a comprehensive morphological examination in cases of lung inflammatory processes in HIV-infected patients. Clinical patient data, namely HIV-status at the time of diagnostic procedures as well as radiological and microbiological findings serve as a substantial aid in the diagnosis. more...
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- 2021
33. Computed tomography in cystic fibrosis lung disease: a focus on radiation exposure
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Mark F. McEntee, David Mullane, Barry J. Plant, Stella Joyce, Michael Moore, Michael M. Maher, Brian W. Carey, Owen J. O'Connor, and Niamh Moore
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medicine.medical_specialty ,Radiography ,Adolescents ,Asymptomatic ,Cystic fibrosis ,030218 nuclear medicine & medical imaging ,Pulmonary function testing ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Pulmonary pathology ,Children ,Computed tomography ,Neuroradiology ,business.industry ,Respiratory disease ,medicine.disease ,Lung disease ,Pediatrics, Perinatology and Child Health ,Etiology ,Ionising radiation ,Radiology ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Thoracic computed tomography (CT) is the imaging reference method in the diagnosis, assessment and management of lung disease. In the setting of cystic fibrosis (CF), CT demonstrates increased sensitivity compared with pulmonary function tests and chest radiography, and findings correlate with clinical outcomes. Better understanding of the aetiology of CF lung disease indicates that even asymptomatic infants with CF can have irreversible pulmonary pathology. Surveillance and early diagnosis of lung disease in CF are important to preserve lung parenchyma and to optimise long-term outcomes. CF is associated with increased cumulative radiation exposure due to the requirement for repeated imaging from a young age. Radiation dose optimisation, important for the safe use of CT in children with CF, is best achieved in a team environment where paediatric radiologists work closely with paediatric respiratory physicians, physicists and radiography technicians to achieve the best patient outcomes. Despite the radiation doses incurred, CT remains a vital imaging tool in children with CF. Radiologists with special interests in CT dose optimisation and respiratory disease are key to the appropriate use of CT in paediatric imaging. Paediatric radiologists strive to minimise radiation dose to children whilst providing the best possible assessment of lung disease. more...
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- 2021
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34. QUANTIFICATION OF PULMONARY PATHOLOGY IN CYSTIC FIBROSIS–COMPARISON BETWEEN DIGITAL CHEST TOMOSYNTHESIS AND COMPUTED TOMOGRAPHY
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K Vult von Steyern, Åse A. Johnsson, Magnus Båth, Rauni Rossi Norrlund, M. Gilljam, Carin Meltzer, and Jenny Vikgren
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Paper ,Cystic Fibrosis ,Computed tomography ,Cystic fibrosis ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Pulmonary pathology ,Lung ,Rank correlation ,Radiation ,Bronchiectasis ,AcademicSubjects/SCI00180 ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Public Health, Environmental and Occupational Health ,Digital Chest Tomosynthesis ,Reproducibility of Results ,General Medicine ,medicine.disease ,Tomosynthesis ,Radiography ,030228 respiratory system ,Lung disease ,business ,Nuclear medicine ,Tomography, X-Ray Computed - Abstract
Purpose: Digital tomosynthesis (DTS) is currently undergoing validation for potential clinical implications. The aim of this study was to investigate the potential for DTS as a low-dose alternative to computed tomography (CT) in imaging of pulmonary pathology in patients with cystic fibrosis (CF). Methods: DTS and CT were performed as part of the routine triannual follow-up in 31 CF patients. Extent of disease was quantified according to modality-specific scoring systems. Statistical analysis included Spearman’s rank correlation coefficient (r) and Krippendorff’s alpha (α). Major findings: The median effective dose was 0.14 for DTS and 2.68 for CT. Intermodality correlation was very strong for total score and the subscores regarding bronchiectasis and bronchial wall-thickening (r = 0.82–0.91, P more...
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- 2021
35. The pulmonary pathology of COVID-19
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Alexandar Tzankov, Matthias S. Matter, Hans Bösmüller, and Falko Fend
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0301 basic medicine ,Pathology ,medicine.medical_specialty ,medicine.disease_cause ,Pathology and Forensic Medicine ,Epithelial Damage ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Pulmonary pathology ,Diffuse alveolar damage ,Molecular Biology ,Lung ,Hyaline ,Coronavirus ,business.industry ,SARS-CoV-2 ,COVID-19 ,Thrombosis ,Cell Biology ,General Medicine ,Capillaritis ,medicine.disease ,Review and Perspectives ,030104 developmental biology ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Autopsy ,Pulmonary disease ,business ,Viral load - Abstract
The lung is the main affected organ in severe coronavirus disease 2019 (COVID-19) caused by the novel coronavirus SARS-CoV-2, and lung damage is the leading cause of death in the vast majority of patients. Mainly based on results obtained by autopsies, the seminal features of fatal COVID-19 have been described by many groups worldwide. Early changes encompass edema, epithelial damage, and capillaritis/endothelialitis, frequently combined with microthrombosis. Subsequently, patients with manifest respiratory insufficiency exhibit exudative diffuse alveolar damage (DAD) with hyaline membrane formation and pneumocyte type 2 hyperplasia, variably complicated by superinfection, which may progress to organizing/fibrotic stage DAD. These features, however, are not specific for COVID-19 and can be found in other disorders including viral infections. Clinically, the early disease stage of severe COVID-19 is characterized by high viral load, lymphopenia, massive secretion of pro-inflammatory cytokines and hypercoagulability, documented by elevated D-dimers and an increased frequency of thrombotic and thromboembolic events, whereas virus loads and cytokine levels tend to decrease in late disease stages, when tissue repair including angiogenesis prevails. The present review describes the spectrum of lung pathology based on the current literature and the authors’ personal experience derived from clinical autopsies, and tries to summarize our current understanding and open questions of the pathophysiology of severe pulmonary COVID-19. more...
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- 2021
36. CLINICAL SIGNIFICANCE OF NESTIN AND ITS ASSOC IATION WITH SURVIVAL IN NEUROENDOC RINE LUNG TUMOURS.
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BROMINSKA, BARBARA, GABRYEL, PIOTR, JARMOŁOWSKA-JURCZYSZYN, DONATA, JANICKA-JEDYŃSKA, MAŁGORZATA, TROJANOWSKI, MACIEJ, SAWICKA-GUTAJ, NADIA, CZEPCZYŃSKI, RAFAŁ, GUT, PAWEŁ, BROMIŃSKI, GABRIEL, DYSZKIEWICZ, WOJCIECH, WOŹNIAK, ALDONA, and RUCHAŁA, MAREK more...
- Abstract
Nestin is considered to be a cancer stem cell marker. Nestin expression in neuroendocrine tumours might be useful to predict prognosis and facilitate treatment planning. 88 patients with neuroendocrine lung tumours operated in the Department of Thoracic Surgery from 2007 to 2015 were included into the study. Immunohistochemical staining for nestin was performed. Clinicopathological and survival data were retrospectively analyzed. Nestin expression was detected in 15 (17%) specimens. Multivariate analysis showed that lymph node metastases (p = 0.0001; hazard ratio (HR) = 3.93; confidence interval (CI) 95%: 1.96-7.87), nestin expression (p = 0.034; HR = 2.30; CI 95%: 1.06-4.99) and patient's age (p = 0.024; HR = 1.04; CI 95%: 1.00-1.09) were independent negative prognostic factors. Nestin expression was significantly higher in large cell neuroendocrine carcinoma when compared with carcinoids (p = 0.001). Collected data support the thesis that nestin can be regarded as a biomarker in patients with neuroendocrine lung tumours. [ABSTRACT FROM AUTHOR] more...
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- 2017
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37. Septic pulmonary embolism: Is it an underestimated diagnosis?
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Kolhe S and Vaideeswar P
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- Male, Humans, Female, Adult, Retrospective Studies, Lung diagnostic imaging, Sepsis diagnosis, Pulmonary Embolism diagnosis, Pulmonary Embolism etiology, Bacteremia microbiology
- Abstract
Background: Non-thrombotic pulmonary embolism, an uncommon entity, is defined as the embolization of tissues, microorganisms, air, or foreign material. One subset in this non-thrombotic category is septic pulmonary embolism (SPE) that refers to embolism of microorganisms with or without a thrombotic mantle into the pulmonary vasculature. This condition is often recognized on the basis of imaging with a clinical correlation. Unfortunately, data regarding the pathological features are meager. This has prompted to review such cases at autopsy., Aims: To study the pathological features of SPE at autopsy., Materials and Methods: Ten-year (2012 to 2021) autopsy records of the hospital were retrospectively reviewed. The diagnosis was based on the identification of acute necrotizing pulmonary arteritis with peri-bronchoarterial consolidation. These cases were analyzed with reference to the demographics, clinical characteristics, and pulmonary/extrapulmonary findings at autopsy., Statistical Analysis: Nil., Results: According to the inclusion criterion, 19 cases demonstrated the presence of SPE. There were 11 men and 8 women with a mean age of 32.1 years. The major source of infection included infection arising from skin and musculo-skeletal system (11 patients, 59.7%). The common clinical presentation included fever, dyspnea, chest pain, hemoptysis, and altered sensorium. The cause of death was mainly due to septicemia and/or confluent lung consolidations. A large number of bacterial colonies were seen in all; Candida species were also identified in two cases. Other lung findings included diffuse alveolar damage, fresh arterial thrombosis, infarction, arterial pseudo-aneurysms, abscess formation, and pyogenic pleuritis., Conclusion: Presence of an extrapulmonary infection with persistent fever, bacteremia, and pulmonary complaints should raise suspicion for this entity, particularly in resource-poor settings, to prevent grave pulmonary complications. more...
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- 2023
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38. Comparative aetio-epidemiological analysis of lung tuberculosis versus sarcoidosis: classical and new concepts
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Alexey V. Nikolaev, Vladimir J. Utekhin, and Leonid P. Churilov
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Tuberculosis ,business.industry ,Disease ,medicine.disease ,Autoinflammatory Syndrome ,medicine.disease_cause ,Comorbidity ,Autoimmunity ,Immunology ,medicine ,Etiology ,Sarcoidosis ,Pulmonary pathology ,business - Abstract
The review presents data on two similar granulomatous inflammatory diseases: tuberculosis and sarcoidosis of the lungs, which together cover about 5% of all pulmonary pathology, albeit occur with different incidence (20 : 1). Despite the established aetiology of tuberculosis, the disease has not disappeared and nowadays has even acquired a new urgency: It is getting out of control due to growing poverty, the comorbidity with HIV infection, increasing cases of drug resistance of Mycobacteria, insufficient effectiveness and the growing costs of its treatment. Against the background of the expansion of anthropogenic influences and other environmental impacts on the immune system, the incidence of lung sarcoidosis is also increasing, while patients are initially often misdiagnosed with tuberculosis, with resulting unjustified anti-tuberculosis chemotherapy, leading to chronization of the disease with frequent relapses and, accordingly, to an increase in disability and mortality rates. In recent years, clinical manifestations of sarcoidosis due to a variety of trigger aetiological factors with adjuvant-like action (from Mycobacteria to xenobiotics) are considered by a number of authors as a variant of autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA). The article emphasizes the similarity of two granulomatous inflammatory diseases and the concept of two variants of the bodys response to similar or even identical aetiological factors within different human reactivity (possibly on a different mosaic/permissive background). In brief the newest data on experimental models of sarcoidosis are reviewed as well as the role of autophagy disorders and opposite macrophageal polarization in tuberculosis versus sarcoidosis. Authors coined the original hypothesis of the possible therapeutic effectiveness of Rapamycin in sarcoidosis and for the first time posed a question of equivocal character of comorbidity between these granulomatoses and COVID-19 infection. more...
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- 2020
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39. Acetylcholine Regulates Pulmonary Pathology During Viral Infection and Recovery
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Ralph Feuer, Ashley V Schwartz, Edgar B Herrera, Kent G. Osborn, Carlos A Alvarez, Alexander P Horkowitz, Uduak Z. George, Marilyn L. Thoman, Dale A. Chatfield, and Joy A. Phillips
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Lung ,business.industry ,Lymphocyte ,Immunology ,Inflammation ,medicine.disease ,medicine.anatomical_structure ,medicine ,Immunology and Allergy ,Cytotoxic T cell ,Cholinergic ,Pulmonary pathology ,medicine.symptom ,business ,Cholinergic anti-inflammatory pathway ,Acetylcholine ,medicine.drug - Abstract
Introduction This study was designed to explore the role of acetylcholine (ACh) in pulmonary viral infection and recovery. Inflammatory control is critical to recovery from respiratory viral infection. ACh secreted from non-neuronal sources, including lymphocytes, plays an important, albeit underappreciated, role in regulating immune-mediated inflammation. Methods ACh and lymphocyte cholinergic status in the lungs were measured over the course of influenza infection and recovery. The role of ACh was examined by inhibiting ACh synthesis in vivo. Pulmonary inflammation was monitored by Iba1 immunofluorescence, using a novel automated algorithm. Tissue repair was monitored histologically. Results Pulmonary ACh remained constant through the early stage of infection and increased during the peak of the acquired immune response. As the concentration of ACh increased, cholinergic lymphocytes appeared in the BAL and lungs. Cholinergic capacity was found primarily in CD4 T cells, but also in B cells and CD8 T cells. The cholinergic CD4+ T cells bound to influenza-specific tetramers and were retained in the resident memory regions of the lung up to 2 months after infection. Histologically, cholinergic lymphocytes were found in direct physical contact with activated macrophages throughout the lung. Inflammation was monitored by ionized calcium-binding adapter molecule 1 (Iba1) immunofluorescence, using a novel automated algorithm. When ACh production was inhibited, mice exhibited increased tissue inflammation and delayed recovery. Histologic examination revealed abnormal tissue repair when ACh was limited. Conclusion These findings point to a previously unrecognized role for ACh in the transition from active immunity to recovery and pulmonary repair following respiratory viral infection. more...
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- 2020
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40. COVID-19 pathology: experience of 2000 autopsies
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O. V. Zayratyants, Maria V. Samsonova, Oleko D. Mishnev, Nikolai M. Krupnov, Dmitry V. Kalinin, Andrey L. Cherniaev, and Liudmila M. Mikhaleva
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0301 basic medicine ,Pathology ,medicine.medical_specialty ,organs pathology ,vascular pathology ,Autopsy ,Disease ,030204 cardiovascular system & hematology ,Pathology and Forensic Medicine ,03 medical and health sciences ,Other systems of medicine ,0302 clinical medicine ,autopsy ,pulmonary pathology ,medicine ,Pulmonary pathology ,Diffuse alveolar damage ,Pathological ,Cause of death ,business.industry ,Microangiopathy ,medicine.disease ,Thrombosis ,030104 developmental biology ,covid-19 ,Anatomy ,business ,Law ,RZ201-999 - Abstract
Background: Pathological anatomy, patogenesis and the morphogenesis of manifestations and complications of COVID-19 remain insufficiently studied. The fullest information on structural bases of organs and tissues alterations by new coronavirus disease can be obtained as a result of autopsies. Aims: The aim of the study was to study the morphological changes of lungs and other organs of the autopsies of COVID-19 deceased persons. Results of 2000 autopsies of people who died of a severe form of COVID-19 in Moscow, consisting of 1212 men and 788 women, from March 20 to May 22, 2020 (a ratio 1.54:1) aged from 20 to 99 years (on average 68.515.63 years) were presented. This experience was previously generalized in the Atlas COVID-19 pathology. Autopsies were made in the converted interstationary pathoanatomical offices at strict observance of rules of biosafety according to standard and legal documents of WHO, Russian Ministry of Health and Rospotrebnadzor. Results: Morphological changes of lungs with varying severity and extent were detected in all examined cases; however, damage to other organs was also common, which in some cases prevailed over pulmonary changes and was the cause of death. The main morphological changes in lungs were diffuse alveolar damage and microangiopathy, alveolar hemorrhage syndrome, thrombosis, and thromboembolism. Conclusion: The involvement of the lungs, other organs, and vascular system in the pathological process is a result of multiple factors. It is advisable to implement clinical and morphological masks of COVID-19. more...
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- 2020
41. Chest MRI of a pregnant woman with COVID-19 pneumonia
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Alexander V. Bazhin, Olga Yu. Panina, Valentin Sinitsyn, Yuriy A. Vasilev, Amir G. Masri, and Yulia N. Vasileva
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medicine.medical_specialty ,Computer applications to medicine. Medical informatics ,R858-859.7 ,medicine.disease_cause ,Loading dose ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Basal (phylogenetics) ,0302 clinical medicine ,medicine ,magnetic resonance imaging ,pneumonia ,Pulmonary pathology ,Respiratory system ,Coronavirus ,Fetus ,Lung ,business.industry ,medicine.disease ,Pneumonia ,medicine.anatomical_structure ,covid-19 ,030220 oncology & carcinogenesis ,Radiology ,pregnancy ,business - Abstract
This paper presents a clinical case of a 39-year-old pregnant woman with respiratory signs of the novel coronavirus Covid-19 infection. Chest MRI showed bilateral lesions in basal segments. The PCR test was positive. A lung condition was assessed without loss of significant diagnostic information. Besides that, the absence of exposure to ionizing radiation allowed to avoid a high loading dose on the patient and the fetus. This case reveals potential opportunities of MRI in the diagnosis of pulmonary pathology without exposure to ionizing radiation, especially in patient risk groups (children, pregnant women, etc.). more...
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- 2020
42. COVID-19 pulmonary pathology: a multi-institutional autopsy cohort from Italy and New York City
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Fiorella Calabrese, Mary Fowkes, Paolo Navalesi, Andrea Crisanti, Maria Mostyka, James B. Bussel, Bing He, Sarah S. Elsoukkary, Claudia Del Vecchio, Alain C. Borczuk, Francesco Fortarezza, Clare Bryce, Federica Pezzuto, Surya V. Seshan, Mary Beth Beasley, Steven P. Salvatore, and Sanjay S. Patel more...
- Subjects
Adult ,Male ,0301 basic medicine ,Pathology ,medicine.medical_specialty ,Pneumonia, Viral ,Autopsy ,Article ,Pathology and Forensic Medicine ,Cohort Studies ,Betacoronavirus ,03 medical and health sciences ,0302 clinical medicine ,Tracheobronchitis ,medicine ,Humans ,Pulmonary pathology ,Diffuse alveolar damage ,Lung ,Pandemics ,Aged ,Retrospective Studies ,Aged, 80 and over ,Respiratory tract diseases ,SARS-CoV-2 ,Viral culture ,business.industry ,COVID-19 ,Middle Aged ,medicine.disease ,Pneumonia ,030104 developmental biology ,medicine.anatomical_structure ,Italy ,030220 oncology & carcinogenesis ,Respiratory epithelium ,Female ,New York City ,Coronavirus Infections ,business - Abstract
SARS-CoV-2, the etiologic agent of COVID-19, is a global pandemic with substantial mortality dominated by acute respiratory distress syndrome. We systematically evaluated lungs of 68 autopsies from 3 institutions in heavily hit areas (2 USA, 1 Italy). Detailed evaluation of several compartments (airways, alveolar walls, airspaces, and vasculature) was performed to determine the range of histologic features. The cohort consisted of 47 males and 21 females with a median age of 73 years (range 30-96). Co-morbidities were present in most patients with 60% reporting at least three conditions. Tracheobronchitis was frequently present, independent from intubation or superimposed pneumonia. Diffuse alveolar damage (DAD) was seen in 87% of cases. Later phases of DAD were less frequent and correlated with longer duration of disease. Large vessel thrombi were seen in 42% of cases but platelet (CD61 positive) and/or fibrin microthrombi were present at least focally in 84%. Ultrastructurally, small vessels showed basal membrane reduplication and significant endothelial swelling with cytoplasmic vacuolization. In a subset of cases, virus was detected using different tools (immunohistochemistry for SARS-CoV-2 viral spike protein, RNA in situ hybridization, lung viral culture, and electron microscopy). Virus was seen in airway epithelium and type 2 pneumocytes. IHC or in situ detection, as well as viable form (lung culture positive) was associated with the presence of hyaline membranes, usually within 2 weeks but up to 4 weeks after initial diagnosis. COVID-19 pneumonia is a heterogeneous disease (tracheobronchitis, DAD, and vascular injury), but with consistent features in three centers. The pulmonary vasculature, with capillary microthrombi and inflammation, as well as macrothrombi, is commonly involved. Viral infection in areas of ongoing active injury contributes to persistent and temporally heterogeneous lung damage. more...
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- 2020
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43. Neurological, neuropsychiatric and neurodevelopmental complications of COVID-19
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Terence J. O'Brien, Daniela Zantomio, Arthur Christopoulos, Cassandra Wannan, Jess Nithianantharajah, Robb Wesselingh, Anthony J. Hannan, Kh Christopher Choy, Warda Syeda, Mahesh Jayaram, Christos Pantelis, and Dennis Velakoulis more...
- Subjects
medicine.medical_specialty ,Offspring ,Anosmia ,neuroinflammation ,03 medical and health sciences ,Epilepsy ,Viewpoint ,0302 clinical medicine ,Pregnancy ,Seizures ,Intensive care ,medicine ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,Pulmonary pathology ,Intensive care medicine ,Pandemics ,Neuroinflammation ,Inflammation ,SARS-CoV-2 ,business.industry ,Mental Disorders ,COVID-19 ,General Medicine ,medicine.disease ,neuropsychiatric complications ,Psychiatry and Mental health ,Schizophrenia ,Perspective ,Autism ,Female ,vertical transmission ,Nervous System Diseases ,business ,030217 neurology & neurosurgery - Abstract
Although COVID-19 is predominantly a respiratory disease, it is known to affect multiple organ systems. In this article, we highlight the impact of SARS-CoV-2 (the coronavirus causing COVID-19) on the central nervous system as there is an urgent need to understand the longitudinal impacts of COVID-19 on brain function, behaviour and cognition. Furthermore, we address the possibility of intergenerational impacts of COVID-19 on the brain, potentially via both maternal and paternal routes. Evidence from preclinical models of earlier coronaviruses has shown direct viral infiltration across the blood–brain barrier and indirect secondary effects due to other organ pathology and inflammation. In the most severely ill patients with pneumonia requiring intensive care, there appears to be additional severe inflammatory response and associated thrombophilia with widespread organ damage, including the brain. Maternal viral (and other) infections during pregnancy can affect the offspring, with greater incidence of neurodevelopmental disorders, such as autism, schizophrenia and epilepsy. Available reports suggest possible vertical transmission of SARS-CoV-2, although longitudinal cohort studies of such offspring are needed. The impact of paternal infection on the offspring and intergenerational effects should also be considered. Research targeted at mechanistic insights into all aspects of pathogenesis, including neurological, neuropsychiatric and haematological systems alongside pulmonary pathology, will be critical in informing future therapeutic approaches. With these future challenges in mind, we highlight the importance of national and international collaborative efforts to gather the required clinical and preclinical data to effectively address the possible long-term sequelae of this global pandemic, particularly with respect to the brain and mental health. more...
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- 2020
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44. Pulmonary pathology of infection by SARS-CoV-2, what we have learnt through post-mortem studies and pathophysiological considerations
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Angela Takano
- Subjects
0301 basic medicine ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Autopsy ,General Medicine ,medicine.disease ,Virology ,Pathophysiology ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Pandemic ,medicine ,Medicine ,Pulmonary pathology ,business - Abstract
Background: Since the declaration of Coronavirus Disease 2019 (COVID-19) caused the by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a pandemic, millions of people throughout the world have contracted the disease and more than 500,000 have died. While this terrible disease has brought devastation to many countries, it has also generated the fastest growing amount of research output that science has seen during the last decades. Objectives: The objectives of this work were to review the pulmonary pathology from post-mortem studies and case reports of patients who succumbed to COVID-19, perform clinicopathologic correlation and hypothesize about pathogenetic mechanisms, and translate this understanding into better prevention, management and outcomes in the battle against COVID-19. Method: I performed a literature search through PubMed. Results: The main histopathologic findings in COVID-19 pneumonia are diffuse alveolar damage, organizing pneumonia, acute fibrinous and organizing pneumonia, interstitial pneumonia, endotheliitis, thromboembolism that correlates with respiratory failure and manifestations of thrombotic microangiopathy and hypercoagulable state. Immunohistochemical and transmission electron microscopic studies demonstrate viral proteins and viral structures within epithelial and endothelial cells. Reverse transcriptase polymerase chain reaction demonstrates the presence of viral RNA in nasopharynx and lung tissue post-mortem. Conclusions: SARS-CoV-2 is a respiratory virus that infects cells by binding to angiotensin-converting enzyme II (ACE2) receptors, produces cell death and ACE2 downregulation, which, in conjunction with dysregulated immune response, orchestrates a proinflammatory and prothrombic state that results in respiratory and multiple organ failure. more...
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- 2020
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45. Autopsy Findings in 32 Patients with COVID-19: A Single-Institution Experience
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Surya V. Seshan, Amy Chadburn, Jose Jessurun, Maria Mostyka, Lucy X Ma, Diana R Berman, Alain C. Borczuk, Steven P. Salvatore, Sarah S. Elsoukkary, Alicia Dillard, and Rhonda K. Yantiss
- Subjects
medicine.medical_specialty ,Lung ,business.industry ,Autopsy ,Cell Biology ,General Medicine ,medicine.disease ,Comorbidity ,Gastroenterology ,Pathology and Forensic Medicine ,Diabetic nephropathy ,03 medical and health sciences ,Pneumonia ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Pulmonary pathology ,Lymph ,business ,Diffuse alveolar damage ,Molecular Biology ,030215 immunology - Abstract
Background: A novel coronavirus, SARS-CoV-2, was identified in Wuhan, China in late 2019. This virus rapidly spread around the world causing disease ranging from minimal symptoms to severe pneumonia, which was termed coronavirus disease (i.e., COVID). Postmortem examination is a valuable tool for studying the pathobiology of this new infection. Methods: We report the clinicopathologic findings from 32 autopsy studies conducted on patients who died of COVID-19 including routine gross and microscopic examination with applicable special and immunohistochemical staining techniques. Results: SARS-CoV-2 infection was confirmed by nasopharyngeal RT-PCR in 31 cases (97%) and by immunohistochemical staining for SARS-CoV-2 spike-protein in the lung in the remaining 1 case (3%). The ethnically diverse cohort consisted of 22 males and 10 females with a mean age of 68 years (range: 30–100). Patients most commonly presented with cough (17 [55%]), shortness of breath (26 [81%]), and a low-grade fever (17 [55%]). Thirty-one (97%) of the patients had at least 1 comorbidity (mean = 4). Twenty-eight patients (88%) had widespread thromboembolic disease, as well as diffuse alveolar damage (30 [94%]), diabetic nephropathy (17 [57%]) and acute tubular injury. Patterns of liver injury were heterogeneous, featuring 10 (36%) with frequent large basophilic structures in sinusoidal endothelium, and increased immunoblast-like cells in lymph nodes. Conclusion: This series of autopsies from patients with COVID-19 confirms the observation that the majority of severely affected patients have significant pulmonary pathology. However, many patients also have widespread microscopic thromboses, as well as characteristic findings in the liver and lymph nodes. more...
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- 2020
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46. Pathology and Pathogenesis of SARS-CoV-2 Associated with Fatal Coronavirus Disease, United States
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Cynthia S. Goldsmith, Sherif R. Zaki, Jana M. Ritter, Brigid C. Bollweg, Sarah Reagan-Steiner, Julu Bhatnagar, Eduard Matkovic, Josilene N Seixas, Timothy M. Uyeki, Amy M. Denison, Hannah A. Bullock, Luciana Silva-Flannery, Wun-Ju Shieh, Roosecelis B Martines, and Joy Gary more...
- Subjects
Male ,Pathology ,Epidemiology ,viruses ,coronavirus ,lcsh:Medicine ,Disease ,medicine.disease_cause ,Pathogenesis ,0302 clinical medicine ,030212 general & internal medicine ,Respiratory system ,Diffuse alveolar damage ,Lung ,Cellular localization ,Coronavirus ,virus diseases ,Middle Aged ,respiratory system ,diffuse alveolar damage ,Infectious Diseases ,coronavirus disease ,immunohistochemistry ,Synopsis ,histopathology ,Female ,Pathology and Pathogenesis of SARS-CoV-2 Associated with Fatal Coronavirus Disease, United States ,Coronavirus Infections ,severe acute respiratory syndrome coronavirus 2 ,Microbiology (medical) ,medicine.medical_specialty ,Pneumonia, Viral ,030231 tropical medicine ,2019 novel coronavirus disease ,lcsh:Infectious and parasitic diseases ,respiratory infections ,Betacoronavirus ,03 medical and health sciences ,medicine ,Humans ,lcsh:RC109-216 ,Pulmonary pathology ,Pandemics ,Aged ,electron microscopy ,SARS-CoV-2 ,business.industry ,lcsh:R ,COVID-19 ,medicine.disease ,United States ,zoonoses ,respiratory tract diseases ,Microscopy, Electron ,pathology ,Histopathology ,business - Abstract
An ongoing pandemic of coronavirus disease (COVID-19) is caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Characterization of the histopathology and cellular localization of SARS-CoV-2 in the tissues of patients with fatal COVID-19 is critical to further understand its pathogenesis and transmission and for public health prevention measures. We report clinicopathologic, immunohistochemical, and electron microscopic findings in tissues from 8 fatal laboratory-confirmed cases of SARS-CoV-2 infection in the United States. All cases except 1 were in residents of long-term care facilities. In these patients, SARS-CoV-2 infected epithelium of the upper and lower airways with diffuse alveolar damage as the predominant pulmonary pathology. SARS-CoV-2 was detectable by immunohistochemistry and electron microscopy in conducting airways, pneumocytes, alveolar macrophages, and a hilar lymph node but was not identified in other extrapulmonary tissues. Respiratory viral co-infections were identified in 3 cases; 3 cases had evidence of bacterial co-infection. more...
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- 2020
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47. Partial anomalous pulmonary venous return in a patient undergoing left upper lobectomy for adenocarcinoma of the lung: A case report
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Ankit Verma, Xander Jacobson, Vincent Nicchi, Katherine Nordick, and Marcus Balters
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medicine.medical_specialty ,Heart disease ,business.industry ,Partial anomalous pulmonary venous return ,Adenocarcinoma ,medicine.disease ,Pulmonary hypertension ,Pulmonary function testing ,Shunting ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Case report ,medicine ,Adenocarcinoma of the lung ,Lobectomy ,Anomalous pulmonary venous return ,030211 gastroenterology & hepatology ,Surgery ,Radiology ,Pulmonary pathology ,business - Abstract
Highlights • Surgical management of left superior pulmonary venous return directly to the left innominate/brachiocephalic vein in patient with pulmonary adenocarcinoma. • Left upper lobectomy in patient with adenocarcinoma of the lung in the presence of partial anomalous pulmonary venous return. • Case report describing operative management of adenocarcinoma of the lung in a patient afflicted with partial anomalous pulmonary venous return of left superior pulmonary vein into the left brachiocephalic vein., Introduction Partial anomalous pulmonary venous return (PAPVR) is a rare congenital heart disease that complicates surgical management of pulmonary pathology. Case presentation This case describes the successful management of a 73-year-old female with a left upper lobe adenocarcinoma and pre-operative discovery of left superior anomalous pulmonary venous return into the innominate vein. This patient presented to our clinic for evaluation regarding her newly discovered adenocarcinoma of the lung. Here, we also discuss findings in the literature for management of these patients regarding the importance of preoperative evaluation to determine the extent to which a lobectomy will alter pulmonary function with special emphasis on identifying patients at risk of increased shunting leading to cardiopulmonary failure. Conclusion Consideration should focus on the extent of the shunting, the presence of symptoms, and underlying right heart strain or pulmonary hypertension. more...
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- 2020
48. Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies: Guideline From the College of American Pathologists in Collaboration With the American College of Chest Physicians, Association for Molecular Pathology, American Society of Cytopathology, American Thoracic Society, Pulmonary Pathology Society, Papanicolaou Society of Cytopathology, Society of Interventional Radiology, and Society of Thoracic Radiology
- Author
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Nicholas J. Pastis, Sinchita Roy-Chowdhuri, Paul A. VanderLaan, Claire W. Michael, Momen M. Wahidi, Jan A. Nowak, Lester J. Layfield, Christopher Lee, Lonny Yarmus, Amita Sharma, Peter B. Illei, Jesse S. Voss, Lesley Souter, Christopher R. Gilbert, Boris Nikolic, Carol A. Rauch, Jason W. Mitchell, Sanja Dacic, Nicole Thomas, Brooke L. Billman, Mohiedean Ghofrani, and Ross A. Miller more...
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medicine.medical_specialty ,medicine.diagnostic_test ,Molecular pathology ,business.industry ,General surgery ,MEDLINE ,Papanicolaou stain ,Interventional radiology ,General Medicine ,Guideline ,medicine.disease ,Pathology and Forensic Medicine ,03 medical and health sciences ,Medical Laboratory Technology ,0302 clinical medicine ,030228 respiratory system ,Cytopathology ,030220 oncology & carcinogenesis ,Biopsy ,medicine ,Pulmonary pathology ,business - Abstract
Context.— The need for appropriate specimen use for ancillary testing has become more commonplace in the practice of pathology. This, coupled with improvements in technology, often provides less invasive methods of testing, but presents new challenges to appropriate specimen collection and handling of these small specimens, including thoracic small biopsy and cytology samples. Objective.— To develop a clinical practice guideline including recommendations on how to obtain, handle, and process thoracic small biopsy and cytology tissue specimens for diagnostic testing and ancillary studies. Methods.— The College of American Pathologists convened an expert panel to perform a systematic review of the literature and develop recommendations. Core needle biopsy, touch preparation, fine-needle aspiration, and effusion specimens with thoracic diseases including malignancy, granulomatous process/sarcoidosis, and infection (eg, tuberculosis) were deemed within scope. Ancillary studies included immunohistochemistry and immunocytochemistry, fluorescence in situ hybridization, mutational analysis, flow cytometry, cytogenetics, and microbiologic studies routinely performed in the clinical pathology laboratory. The use of rapid on-site evaluation was also covered. Results.— Sixteen guideline statements were developed to assist clinicians and pathologists in collecting and processing thoracic small biopsy and cytology tissue samples. Conclusions.— Based on the systematic review and expert panel consensus, thoracic small specimens can be handled and processed to perform downstream testing (eg, molecular markers, immunohistochemical biomarkers), core needle and fine-needle techniques can provide appropriate cytologic and histologic specimens for ancillary studies, and rapid on-site cytologic evaluation remains helpful in appropriate triage, handling, and processing of specimens. more...
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- 2020
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49. Chronic Lung Disease in Primary Antibody Deficiency
- Author
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Paul J. Maglione
- Subjects
medicine.medical_specialty ,Bronchiectasis ,business.industry ,Common variable immunodeficiency ,Immunology ,Interstitial lung disease ,Translational medicine ,Disease ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,medicine ,Immunology and Allergy ,Pulmonary pathology ,030223 otorhinolaryngology ,Intensive care medicine ,Complication ,business ,Asthma - Abstract
Chronic lung disease is a complication of primary antibody deficiency (PAD) associated with significant morbidity and mortality. Manifestations of lung disease in PAD are numerous. Thoughtful application of diagnostic approaches is imperative to accurately identify the form of disease. Much of the treatment used is adapted from immunocompetent populations. Recent genomic and translational medicine advances have led to specific treatments. As chronic lung disease has continued to affect patients with PAD, we hope that continued advancements in our understanding of pulmonary pathology will ultimately lead to effective methods that alleviate impact on quality of life and survival. more...
- Published
- 2020
- Full Text
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50. The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation
- Author
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Dominik Nann, Hans Bösmüller, Leonie Frauenfeld, Antonio Vogelsberg, Helene Häberle, Michael Bitzer, Selina Traxler, Falko Fend, Karin Klingel, and Wolfgang Raiser
- Subjects
0301 basic medicine ,Pathology ,medicine.medical_specialty ,Thrombotic microangiopathy ,Hypertension, Pulmonary ,Pneumonia, Viral ,Autopsy ,Pathology and Forensic Medicine ,Capillaritis ,03 medical and health sciences ,Microthrombosis ,Betacoronavirus ,0302 clinical medicine ,medicine ,Humans ,Pulmonary pathology ,Diffuse alveolar damage ,Molecular Biology ,Lung ,Pandemics ,Disseminated intravascular coagulation ,business.industry ,SARS-CoV-2 ,COVID-19 ,Thrombosis ,Cell Biology ,General Medicine ,medicine.disease ,030104 developmental biology ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Original Article ,business ,Cytokine storm ,Coronavirus Infections - Abstract
The pandemia of coronavirus disease 2019 (COVID-19) has caused more than 355,000 confirmed deaths worldwide. However, publications on postmortem findings are scarce. We present the pulmonary findings in four cases of fatal COVID-19 with a spectrum of lung pathology reflecting disease course and duration, invasive therapies, and laboratory features. Early disease is characterized by neutrophilic, exudative capillaritis with microthrombosis and high levels of IL-1beta and IL-6. Later stages are associated with diffuse alveolar damage and ongoing intravascular thrombosis in small to medium-sized pulmonary vessels, occasionally with areas of infarction equivalents, accompanied by laboratory features of disseminated intravascular coagulation. In late stages, organizing pneumonia with extensive intra-alveolar proliferation of fibroblasts and marked metaplasia of alveolar epithelium can be observed. Viral RNA is encountered in the lung, with virus particles in endothelial cells and pneumocytes. In many patients, multi-organ failure with severe liver damage sets in finally, possibly as consequence of an early-onset pro-inflammatory cytokine storm and/or thrombotic microangiopathy. Electronic supplementary material The online version of this article (10.1007/s00428-020-02881-x) contains supplementary material, which is available to authorized users. more...
- Published
- 2020
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