Reaction kinetics determination and uncertainty analysis for the synthesis of the cancer drug lomustine

Fast and reliable model development frameworks are required to support current trends in modernization of pharmaceutical processing, promoting the use of digital platforms to assist process design and operation. In this work, we use a parameter estimation framework built into the PharmaPy library to determine rate parameters and uncertainty regions of different mechanistic and semi-empirical kinetic expressions for the synthesis of the drug lomustine. The parameter estimation procedure was complemented by identifiability analysis, resulting in simplified reaction mechanisms. Comparison of parameters and their uncertainty in process design was demonstrated through design space analysis, showing important differences in model prediction and the extent of their corresponding design spaces. The results of this work can serve to analyze lomustine manufacturing processes that include separation and isolation steps, where parametric sensitivity is expected to propagate along the manufacturing line and impact process feasible operation, and attainment of critical quality attributes of the product.

Techno-economic analysis of dynamic, end-to-end optimal pharmaceutical campaign manufacturing using PharmaPy

Increased interest in the pharmaceutical industry to transition from batch to continuouos manufacturing motivates the use of digital frameworks that allow systematic comparison of candidate process configurations. This paper evaluates the technical and economic feasibility of different end-to-end optimal process configurations, viz. batch, hybrid and continuous, for small-scale manufacturing of an active pharmaceutical ingredient. Production campaigns were analyzed for those configurations containing continuous equipment, where significant start-up effects are expected given the relatively short campaign times considered. Hybrid operating mode was found to be the most attractive process configuration at intermediate and large annual production targets, which stems from combining continuous reactors and semi-batch vaporization equipment. Continuous operation was found to be more costly, due to long stabilization times of continuous crystallization, and thermodynamic limitations of flash vaporization. Our work reveals the benefits of systematic digital evaluation of process configurations that operate under feasible conditions and compliant product quality attributes.

Simulation-optimization framework for the digital design of pharmaceutical processes using Pyomo and PharmaPy

The problem of performing model-based process design and optimization in the pharmaceutical industry is an important and challenging one both computationally and in choice of solution implementation. In this work, a framework is presented to directly utilize a process simulator via callbacks during derivative-based optimization. The framework allows users with little experience in translating mechanistic ODEs and PDEs to robust, fully discretized algebraic formulations, required for executing simultaneous equation-oriented optimization, to obtain mathematically guaranteed optima at a competitive solution time when compared with existing derivative-free and derivative-based frameworks. The effectiveness of the framework in accuracy of optimal solution as well as computational efficiency is analyzed on on two case studies: (i) an integrated 2-unit reaction synthesis train used for the synthesis of an anti-cancer active pharmaceutical ingredient, and (ii) a more complex flowsheet representing a common synthesis-purification-isolation train of a pharmaceutical manufacturing processes.

PharmaPy: An object-oriented tool for the development of hybrid pharmaceutical flowsheets

Process design and optimization continue to provide computational challenges as the chemical engineering and process optimization communities seek to address more complex and larger scale applications. Software tools for digital design and flowsheet simulation are readily available for traditional chemical processing applications such as in commodity chemicals and hydrocarbon processing; however, tools for pharmaceutical manufacturing are much less well developed. This paper introduces, PharmaPy, a Python-based modelling platform for pharmaceutical manufacturing systems design and optimization. The versatility of the platform is demonstrated in simulation and optimization of both continuous and batch processes. The structure and features of a Python-based modeling platform, PharmaPy are presented. Illustrative examples are shown to highlight key features of the platform and framework.

Evaluating Manual Sampling Locations for Regulatory and Emergency Response

Drinking water systems commonly use manual or grab sampling to monitor water quality, identify or confirm issues, and verify that corrective or emergency response actions have been effective. In this paper, the effectiveness of regulatory sampling locations for emergency response is explored. An optimization formulation based on the literature was used to identify manual sampling locations to maximize overall nodal coverage of the system. Results showed that sampling locations could be effective in confirming incidents for which they were not designed. When evaluating sampling locations optimized for emergency response against regulatory scenarios, the average performance was reduced by 3%-4%, while using optimized regulatory sampling locations for emergency response reduced performance by 7%-10%. Secondary constraints were also included in the formulation to ensure geographical and water age diversity with minimal impact on the performance. This work highlighted that regulatory sampling locations provide value in responding to an emergency for these networks.

Application of PharmaPy in the digital design of the manufacturing process of an active pharmaceutical ingredient

Flowsheet design and optimization constitute one of the key challenges in the chemical engineering and process optimization communities. Software tools for digital design and flowsheet simulation are readily available for traditional chemical processing problems such as distillation and hydrocarbon processing, however tools for pharmaceutical manufacturing are much less widely developed. This paper introduces, PharmaPy, a Python-based modelling platform for pharmaceutical facility design and optimization. The versatility of the platform is demonstrated in simulating both continuous and batch process flowsheets.

Atrial structural remodeling in patients with atrial chronic fibrillations and in animal models

Arrhythmia's atrium fibrillation (AF) is the most often met in clinical setting and it is associated with an increased in mortality risk. For profound the structural changes in chronic AF, we are studied the morphological changes of atrium biopsies to be effected at 175 patients. With sustained AF malformative and valvular acquired cardiac diseases operated under extracorporeal circulation. Similar studies we are effected to 11 dogs with partial coronary obstructions to a made periodical EKG investigations. The morphological changes mainly concern accommodation (dedifferentiation) of cardiomyocytes (particularly at experimental model) and mal-accommodation (degeneration of cells with fibrosis replacement features) particularly in acquired valvular diseases. These changes were often interfered. Over study, maintain the hypothesis that the structural changes to be an accommodation more than degenerative response to AF.

Myocardial stunning. Morphological studies in acute experimental ischemia and intraoperatory myocardial biopsies

Myocardial stunning represent a consequence of brief ischemia with reversible regional contractile dysfunction dependent persist from minute to days after reperfusion, despite the absence of irreversible damage and restoration of coronary blood flow. The evolution of these new ischemic entity were described by experimental acute ischemia and repeated intraoperatory myocardial biopsies effectuated near 200 patients with heart disease, excluding those with cardiac failure and atrial fibrillation. Using histological histoenzymological and particularly ultrastructural methods, only reversible mitochondrial and sarcoplasmatic reticulum lesions, slight glycogen granules depletions and sporadical dissociation of myofilaments by edema were seen. Major mechanism for the state was suggested: generation of oxygen derived free radicals with consequent oxidative stress and impaired calcium homeostasis. Rare morphological appearance on stunned myocardium was signaled in the references, our collective first made these studies in Romania.

Hibernating myocardium, morphological studies on intraoperatory myocardial biopsies and on chronic ischemia experimental model

Hibernating myocardium represent a prolonged but potentially reversible myocardial contractile dysfunction, an incomplete adaptation caused by chronic myocardial ischemia and persisting at least until blood flow restored. The purpose of this study was to investigate the morphological changes and weather relations exist among function, metabolism and structure in left ventricular hibernating myocardium. Material and methods. Experimental study is making on 12 dogs incomplete coronary obstruction during six weeks for morphologic studies of ischemic zones. On 48 patients with coronary stenosis myocardial biopsies was effectuated during aorto-coronarian bypass graft. On 60 patients with valvular disease associated with segmental coronary atherosclerotic obstructions during surgical interventions on a effectuated repeatedly biopsies from ischemic zones. Dyskinetic ischemic areas was identified by angiography, scintigraphy, low dose dobutamine echography to identify the cells viability. On myocardial biopsies various histological, histoenzymological, immunohistochemical and ultrastructural methods were performed.

RESULTS

The morphological cardiomyocytic changes can summarized: loss of myofilaments, accumulation of glycogen, small mitochondria with reversible lesions, decrease of smooth reticulum, absence of T tubules, depression of titin in puncted pattern, loss of cardiotonin, disorganization of cytoskeleton, dispersed nuclear heterochromatin, embryofetal dedifferentiation, and persistence of viability. Extracellular matrix is enlarged with early matrix protein such fibronectin, tenascin, fibroblasts. In experimental material the morphological changes present similarities with the human biopsies, but intermixed with postinfarction scar tissue. Redifferentiation of hibernanting cells end remodeling of extracellular matrix is possible after quigle revascularization through aorto-coronary bypass grafts.

Studies on pathogenicity of Yersinia enterocolitica in mice with diabetes mellitus

In this study, we investigated the colonizing ability as well as the association of Yersinia enterocolitica serotype 0:9 to epithelial cells of the intestinal tract, Peyer's patches, mesenteric lymph nodes, liver, spleen and lungs in Alloxan-induced diabetes mellitus in mice and controls. The results showed that: (a) in diabetic mice the Y. enterocolitica colonizing values were in range of 10(6.5)-10(8.25) CFU/g of feces; (b) maximum colonizing values were found in distal ileum and Peyer's patches and lower in colon; (c) the infection was progressive with dissemination of bacteria in the liver, spleen and lung; (d) in control (non-diabetic) mice, the colonizing values were 10-100 times lower than those found in the diabetic batch; (e) the main histopathological changes noticed, namely ileitis, mesenteric lymphadenitis and septicemia, were presumably induced by high bacterial load in the liver, spleen and lung leading to a septic course of infection as well as toxic effects of heat-stable enterotoxins of Y. enterocolitica (Yst). The results were confirmed by electron microscopy observations. Summing up, these results demonstrate that diabetic mice were more susceptible to Y. enterocolitica cells than normal mice.

Electronmicroscopic and histoenzymological researches regarding myocardial biology in some malformations

A number of 65 heart malformations, taken from intraoperatory biopsies at different degrees of congestive heart failure were histological, histoenzymological and electronmicroscopical analyzed. It was followed the pathogenesis of the lesions determined by the hemodynamic and hypoxic intracardiac disorders. These hadn't specificity and were disseminated in different evaluative degrees, being predominant in certain myocardial areas. Initially, cardiomyocytes hypertrophical changes appear, and also changes of the edematous matrix. Then, the nuclear lesions, the apoptosis processes and the hypoxic alterations increased to cytolysis. In succession, after the matrix edema was organized, immune lesions and myocardial sclerosis processes appeared. Out of the various lesions, we mention: the sarcoplasmatic fuchsinophilia and alcianophilia, the glycogenic depletion, the decrease of SDH, LDH reactions, the increase of the cytolitic enzymes, especially of the kathepsine B. Out of the ultrastructural changes, we mention: the mitochondrial, sarcotubular lesions and, the lysosomial activations, the interstitial organelles, including the natriuretic granules, synthesized in the ventricular myocytes, details regarding the matrix changes with tendency to fibrosclerosis.

Immunocytomorphological study on the pathogenesis of ankylosing spondylarthritis

The present investigation is based on the cytomorphological, histopathological (HE, VG, PAS-Alcian, Safranin 0, Gömöri), histoenzymological (acid phosphatase, chondroitinsulphatase, peroxidase) and immunological (rheumatoid factor (RF), circulating immune complexes (CIC), anticolagen II antibodies and C reactive protein (CRP) study on ankylosing spondylarthritis (2.5 cases). The synovial fluid (SF) synoviocytogram showed cytosis (6.067/mm3), with polynucleosis (65.19%) and ragocytosis (17.73%) as compared with the hydrarthrosie SF characterized by lymphocytosis (47%). Enzymological findings revealed phosphatasic and myeloperoxidasic activity in the ragocytary polymorphonuclear (PMNs) and mononuclear cells. Histopathologically, the severe forms of AS correlated with villous chronic synovitis, associated to processes of obliterating vascularitis, fibrosclerosis, necrosis and calcification of disintegrated synovial structures. The articular cartilage was severly damaged, while osseous necrobiosis was noted at the osteocartilaginous junction. Histoenzymologically, the chondrocytes and synovial macrophages showed lysosomal and oxidative enzymatic activity. Immunological assessments (72 sera and 25 synovial fluid samples) showed pathological values of circulating immune complexes, anticollagen antibodies and C reactive protein. Correlation of immunocytomorphological findings demonstrates the involvement of immunologic and enzymatic factors in the pathogenesis of AS.

Electronmicroscopic observations regarding the presence of natriuretic granules in the ventricle of patients with cardiopathies

As part of studies regarding the human myocardium biology in hereditary and acquired cardiopathies, we showed the presence of natriuretic granules (NG) not only in atriums but also in ventricles, in ten of our cases with intraoperative myocardium biopsies. Ultrastructurally, the natriuretic granules occur in lesions produced by hemodynamic and consecutively hypoxic disturbances, being present at the ventricular level, too, both near the Golgi apparatus that secrets them, and diffusely, in cardiomyocytes, beneath the altered organelles and phagolysosomes. Their aspect in similar in cardiac malformations (DSIA. Fallot tetralogy) and in mitral valvulopathies, their abundance being in connection with congestive heart failure (CHF). Although predominant in CHF class I and II, they occur also in the severe decompensations class III and IV, being perhaps felt at the cardiac level as they are released in the blood. This phenomenon is expressed by electronmicroscopic presence of natriuretic granules in the subsarcolema and the increased plasma level of natriuretic peptide, according to biochemical findings reported in the literature. They produce a vasodilating, diuretic, natriuretic effect, contributing to blood pressure regulation and testifying in the neuroendocrine role of human myocardium.

Retroperitoneal extraadrenal paraganglioma report of two cases

Two cases with retroperitoneal tumours affecting young women who cannot undergo surgery were investigated by biopsy and needle sampling. One of these cases presented a mainly alveolar histologic pattern and was easily diagnosed by immunohistochemical means, as well as a chromaffin paraganglioma. We discussed different diagnoses and approaches in the literature.

Morphophysiopathologic studies on the biology of myocardium in acquired valvulopathies

Myocardial lesions due to various valvulopathies were sampled during open heart surgery under extracorporeal circulation, and histologically, histoenzymologically and ultrastructurally investigated. Various cardiomyocitary and interstitial nonspecific progressive lesions, due especially to hemodynamic and hypoxic alterations, were identified. During the pathogenic stages, we remarked the onset and chronic evolution of perivascular and interstitial oedema, enhanced by a reduced lymph draining. The progressive processes of hyalinization, sclerosis and interstitial fibrosis were subsequent to the interstitial matrix modification. These processes accentuate the myocardial hypoxic lesion due to the nutritional and gaseous exchange alterations. The infrastructure, mitochondrial enzyme equipment, sarcoplasma and tubular network lesions, as well as the intramyocitary oedema that destroys the sarcomeric structure, ended with the activation of lysosome and lysosomal enzymes, giving rise to consequent cytolytic foci. Therefore, the process was extending. In this context, we remarked at the electronmicroscopic examination ventricular natriuremic granules, that are rarely mentioned in literature.

Morphopathological and clinical diagnosis aspects of a bilateral dysembryoplasic renal tumor associated with Bourneville's tuberous sclerosis

A 34-year old woman was admitted for bilateral flank pain, maleolary and palpebral oedema with an insidious evolution lasting for 5 years. Urogram showed a left ureteral duplicity and a right lacunary pelvic image. MRI and echography indicated the complete modification as a renal structure as well as the presence of some bilateral tumoral formations with a nonhomogenous structure, blood diffusion and adenopathy of the renal hilum. Nephrectomy revealed white-gray tumoral nodular tumours. The histopathological test evidenced proliferations of leiomyofibromatous, angiomatous, lipomatous, cartilaginous types with a benign aspect suggesting the diagnosis of a renal dysembryoplasic tumor (hamartoma).

Anatomoclinical and bacteriological study on chronic marginal periodontal disease. Therapy with staphylococcic vaccine

Histological, histochemical and electronmicroscopic investigations were carried out on gum biopsies taken from cases with chronic marginal periodontal disease before and after the treatment with staphylococcic vaccine, thus, morphopathologically proving the findings of Gafar et al. (1985) and of Georgescu et al. (1973; 1974; 1975; 1979; 1995). Before treatment, gum lesions were severe, consisting in an abundance of polymorphic inflammatory infiltrates in the chorion along with oedema and disorganised connective fibres, atrophies and ulceration of the mucosa, purulent deposits at the surface with bacteria and fungi. After the treatment with the staphylococcic vaccine, an epithelial regeneration was seen together with the absence of the chronic inflammation. The intensely fibroparius granulated tissue was also noted, in all cases observing abundant connective fibres, accounting for good results after treatment, notably the firmness of the tooth fitting.

Immunocytomorphopathological studies on the pathogenesis of rheumatoid arthritis

Thirty cases of rheumatoid arthritis were submitted to cytomorphological, histopathological (HE, VG, PAS Alcian, Gömöri, Safranine O), histoenzymological (Acid Phosphatase, chondroitin-sulphatase, Peroxidase) and immunological (rheumatoid factor (RF)) studies; circulating immune complexes, anti-collagen antibodies II, Reactive C protein (CRP), Complementary C3 fraction were also assessed. The synoviocytogram of the rheumatoid synovial fluid (SF) indicated a cytosis with polynucleosis and ragocytosis compared to the hydroarthrosic SF defined by lymphocytosis (47.8%). Enzymologically, especially for high titres of rheumatoid factor, a phosphatase and peroxidase activity was observed in polymorphonuclear cells of a ragocytary type and in phagocytic mononuclear cells. The severe forms of rheumatoid arthritis (RA) were correlated histopathologically with chronic villous synovitis associated with some processes of obliterant vascularitis, fibrosis and sclerosis. At the level of synovio-cartilage junction, fissures and a homogenization of the cartilaginous fundamental substance in the vicinity of disintegrated synovial structures were noticed. Histoenzymologically, a lysosomal and oxidative activity was found in chondrocytes and in synovial macrophages. Immunological assessments (73 serum and 60 synovial fluid samples) showed pathological values of circulating immune complexes, anti-collagen antibodies and C reactive protein. The complementary synovial depletion of the C3 fraction underlines the immune character of the rheumatoid synovitis. The immunocytomorphologic data correlation demonstrates the involvement of immunologic and enzymatic factors in the evolution of Rheumatoid Arthritis.

Electronmicroscopic and histoenzymologic study regarding morphophysiopathologic visceral modifications during open heart operations under extracorporeal circulation

Morphophysiopathologic modifications occurred in myocardium, liver and lung during open heart operations under extracorporeal circulation had been studied using histologic, histoenzymologic, ultrastructural and biochemical investigations. Preexisting myocardic and hepatic lesions subsequent to chronic stasis and hypoxia are accentuated due to the "controlled shock" state induced by extracorporeal circulation. Mitochondrial marker enzymes like SDH, LDH and ATP-ase in the membrane are decreasing their levels and hydrolytic enzymes like acid phosphatase, nonspecific esterase (ANAE) and peroxidase are increasing their activity. These disseminated lesions can become irreversible under the conditions of a severe cardial insufficiency and of a prolonged operation. In the lung, the increase in the hydrolytic enzyme activity suggests the processes of phagocytosis and metabolization of red cells by macrophages.

Gastrointestinal stromal tumors--a recently defined entity. Literature data and personal case report

Stromal tumors of the gastrointestinal tract are controverted tumoral entities which were recently delimited. They were initially identified by immunohistochemical investigation and processing of the gastrointestinal muscular tumors and of the malignant and benign nervous tumors. Those investigations were subsequently amplified by electronmicroscopic studies and observations during the patient's prognostic follow-up. Within these circumstances, monoclonal tumors responsive to smooth muscular antigens (actin, SMA), to polyclonal antigens reacting to S-100, PGP 9.5, NSE and GEAP were identified. Thus, tumors with a nervous origin known as a gastrointestinal nerve tumors or plexosarcomas were differentiated, taking into account the difficulty of their distinguishing from gastrointestinal tumors (GIST) which also shows multinucleated great cells. There were also difficulties in defining bidirectionally differentiated tumors or those nonresponsive to any antigen, all these elements proving their origin from nondifferentiated mesenchymal cells. These data are presented in a personal case report of a 28-year old woman with an acute anteroenteral invagination due to a gastrointestinal stromal tumor, favorably removed by surgery and with a postoperative outcome.

Histoenzymological and ultrastructural studies of the macrophage-type pulmonary cell modifications under different chronic stasis conditions

The optical histoenzymological and electronomicroscopical investigations were carried out en 90 pulmonary biopsies taken from patients under different chronic stasis conditions. To investigate macrophage-type cells we studied the reactions of acid phosphatase and non-specific esterase like enzyme markers, indicating the metabolic state activation degree of this cellular compartment. The ultrastructural examinations revealed the existence of two types of activated pulmonary macrophages. The former is the alveolar macrophage with a prevailing phagolysosome apparatus that pleads for phagocytic function and the latter is the interstitial macrophage with subcellular aspect corresponding to the synthesis and secretion function. The presence of these activated alveolar and interstitial macrophages, as well as their extremely increased number, plead for their direct participation in the appearance and aggravation of the morphophysiopathological disorders in the chronic stasis lungs.

Histopathological and ultrastructural modifications of the arthrosis articular cartilage

Thirty samples of articular cartilage taken during the operation from patients with incipient arthrosis, arthrosis with radiological modifications and arthrosis under study for Rheumatoid Arthritis (RA) were investigated using histopathological (HE, VG, PAS-Alcian, Gömöri, Safranine O) and electronmicroscopic techniques. The control material was made of posttraumatic cartilage (Moore prosthesis). Histopathologically, the incipient arthrosis cartilage had superficial exfoliations associated with reduced saframinophilic tinctorial perichondrocytic activity. The arthrosic cartilage with typical radiological modifications was individualized at the synovia-cartilage junction by villous aspects of the synovia associated with perichondrocytic gaps, reduction of safraninophilia and modifications of reticuline-collagenic network. The arthrosic cartilage under study for RA revealed destructive fibrous modifications of the synovia and severe affection of the articular cartilage at synovia-cartilage junction. Electronmicroscopically, the ultrastructural affection was minimum in the incipient arthrosis cartilage developing to chondrocytic degeneration in arthrosis with radiological correspondent. Both histopathological and ultrastructural data emphasize the fact that arthrosis is associated with synovitis following a primitive degenerative process similar to rheumathoid synovitis in arthrosis under study for RA.

Interference of some enzymatic modulators in the hepatic aggression induced by xenobiotics

The aim of the paper was to compare the erythrocyte serum and hepatic chomogenate antioxidative factors in order to assess their involvement in the detoxification events. The catalase and superoxiddismutase levels, important factors of the cellular defence, were sensitivity modulated in an acute experiment on Wistar rats. Carbofuran was administered in a non-lethal dose (7 mg/b.w.) single or in the presence of certain antioxidative agents (Vitamin E, Caffeine, Aspirin) EDTA and Cysteine for their role in protecting membranes against oxidative damage. The erythrocyte parameters (SOD, Catalase) were well related to seric factors, especially ceruloplasmin level, with varied magnitudes. GGT a marker of hepatotoxicity and G1-DH, a mitochondrial marker, were in a good correlation with erythrocyte factors. The changes seem to modulate a transmembranary disturbance process, as in hepatocyte pictures.

Pathogenesis aspects of arthrosis in histopathological and electronmicroscopical studies of articular cartilage, correlated to some immunological parameters

Twenty-five biopsies of arthrosic cartilage with radiological correspondence, arthro, sic cartilage under study for Rheumatoid Arthritis (RA) and posttrauma cartilage as control-were examined using histopathological (HE, VG, PAS-Alcian, Gömöri, Safranine O) and electronmicroscopical techniques. The arthrosic cartilage with radiological correspondence shows superficial and deep fissures, perichondrocytic gaps and modified reticulino-collagenic network at the histopathological examination. At the level of synovia-cartilage junction, we found some villous aspects of the synovia desquamating in the proximity of the affected cartilage. The investigated arthroses for RA presented some destructive fibrous modifications of the synovia similar to rheumatoid synovitis and associated with some dystrophic chondrocytic alterations. The ultrastructural affection was severe leading to cellular degeneration. The immunologically-studied arthroses for RA had seric pathologic values regarding: circulating immune complexes (CIC) (mean = 67.08 +/- 1.45 U), Ig.M(mean = 358 +/- 3.02 UI/ml) and anti collagen antibodies (mean = 409.9 +/- 0.42 U). The synovial depletion of complementary fraction C3(mean = 42.3-1 mg%) as against the normal seric level (mean = 63.07 +/- 0.49 mg%) suggests an immune synovitis. Correlation of immunomorphopathological data emphasize that arthrosis coexists with a secondary synovitis following a primitive degenerative process and allows arthroses under study for RA to be separated from other degenerative rheumatism diseases.

Histopathological and histoenzimological investigations of the rheumatoid articular cartilage

Twenty seven biopsies of articular cartilage taken intraoperatively from patients with Rheumatoid arthritis (RA) and from control patients with traumas were examined using histopathological techniques (HE, VG, PAS-Alcian, Gömöri, Safranine 0) and histoenzymological techniques (Acid phosphatase-lysomal marker, Chondroitinsulphatase, Peroxidase). Histopathologically, the rheumatoid articular cartilage appears with superficial and deep cartilaginous fissures, frequent perichondrocytic gaps associated with modification of the tinctorial activity. At the pannus synovia-cartilage junction we found invasive and destructive synovial inflammatory infiltrates penetrating and eroding the cartilage. Histoenzymologically, the rheumatoid chondrocytes have a high lysosomal potential (phosphatasic, chondroitinsulphatasic) and highly oxidative potential (peroxidasic) specific for lesion modifications.

Extensive cutaneous lymphoma

The case of a 35-years-old patient with a progressive and densely developed subcutaneous tumour comprising the whole right cervical and subcutaneous region is presented. The tumour was painless of pale brown and light red colour, with no adherence on the epidermis and subjacent muscles. The patient has no pathological symptoms. After the histopathological examination we found the dermal infiltration with small, round or oval hyperchromatic cells and the histoenzymological investigation revealed intense positive markers CLA and MB2 pleading for their leukocytic nature while L26 reaction attested the B-cell nature of these lymphocytes and the diagnosis of polymorphous centroblastic malignant lymphoma (K type Working Classification).

An uncommon gastric tumour: leiomyoma associated with osteochondroma

The case of a 65-year-old man having a large gastric tumor for about 6 years, revealed echographically, is reported. A well delimited consistent white-grey tumor of 8 x 6 x 2.5 cm occurring in the anterior wall of the stomach that extended to the peritoneal cavity was surgically found. Histologically it showed leiomyomatous zones with fascicular spindle cells and sometimes with perinuclear vacuolizations, which were actin-reaction positive but S-100 protein negative. These zones alternated with large compact benign osteochondromatous zone. The uncertain origin of this uncommon tumor was discussed. We have not found any references to such gastric tumors.

Retroperitoneal malignant fibrous histiocytoma without histological atypias

A case of a 36-year-old woman suspected of hepatic hydatid cyst with dyseptic symptoms, hepatomegalia, profound pains in the right hypochondrium is presented. During the operation a 15/12/17 cm well-incapsulated tumour is extirpated. The tumour stretched from the upper right renal pole behind the right hepatic lobe as far as the diaphragm and while sectioning it was grey and orange. Histopathologically we found a fibrous histiocytoma with zones of storiform fascicular pattern alternating with areas of histocytic cells with vacuolar-foamy cytoplasm, rich in lipids and without atypias or mitoses. We report the frequency, histological aspects of the fibrous histiocytomas as well as some particularities of their retroperitoneal location.

Aspects of immunopathogenesis of rheumatoid arthritis correlated with some immunological parameters in histopathological and electronmicroscopical investigations of the articular cartilage

The histopathological (H. E., V. G., PAS-Alcian, Safranine 0, Gömöri) and electron-microscopical investigations were carried out on twenty samples of articular cartilage taken during operations from patients with Rheumatoid Arthritis (R. A.) and from others with traumatism, as controls. Histopathologically, the rheumatoid synovial membrane is characterized by synovitis with abundant perivascular lymphoplasmocytic infiltrates. At the pannus synovia-cartilage junction we found the invasive and destructive inflammatory infiltrates penetrating and eroding the cartilage. The histopathological characteristics of the rheumatoid articular cartilage lie in alteration of tinctorial activity, affection of reticuline collagen network and the presence of superficial and deep cartilaginous fissures. The histopathological alterations were confirmed ultrastructurally. Immunologically we found pathological serum values regarding the immune circulating complexes (I. C. C.) (mean = 104 +/- 1.04 U), anticollagen II antibodies (mean = 538 +/- 5 U), reactive Protein C (mean = 16.75 +/- 1.95 mg%) and orosomucoid (mean = 151.1 +/- 4.91 mg%), in seropositive R. A. The corroboration of histopathological, electronmicroscopical and immunological data show the inflammatory and autoimmune feature of this rheumatic disease.

Aspects of ankylosing spondylarthritis immunopathogenesis correlated with some immunoseric- and synovial parameters in the investigation of histopathological and electronmicroscopic alterations of the articular cartilage correlated with some immunoseric and synovial parameters

Eighteen biopsies of articular cartilage taken intraoperatory from patients with Ankylosing Spondylarthritis (AS) and from others with traumatisms (controls) were investigated using histopathological (HE, VG, PAS-Alcian, Gömöri, Safranin 0), electronmicroscopic and histoenzymamologic techniques. Histopathologically, the synovitis in AS is characterized by abundant synovia lymphoplasmocytic infiltrates associated with aspects of vascular hyperplasia and fibrosis. At the pannus synovia-cartilage junction we found the invasive synovia lymphoplasmocytic infiltrates. The proteoglycan (PG) depletion is confirmed histopathologically by diminishing the Safranin 0 staining, then ultrastructurally by the existence of collagen revealing areas, whereas biochemically, by the presence of glycosaminoglycans (GAG) in serum and synovial fluid (SF). The morphological data were related to some immunological parameters involved in pathogenesis. In this way, we found pathological values of the immune circulating complexes (ICC) (serum, mean = 73.5 U; SF mean = 81.80 U) and of anti Collagen II antibodies (serum mean = 410 U; SF mean = 436 U). The reactive protein C acting in the phase (CRP) showed high pathological values both in serum (mean = 5.01 mg%) and in SF (mean = 3.6 mg%) of the patients with AS, emphasizing the inflammatory characteristics of the rheumatic disease. The presence of ICC, anticollagen II antibodies and GAS as well in synovia suggests that the inflammatory articulation in AS is a local potential antigen of collagen and proteoglycan nature.

Voluminous solitary non-Hodgkin extraganglionary lymphoma of thigh

The case of a 36-year-old woman is presented. She had a voluminous tumour inside the 1/3 average part of the right thigh at 12 cm from the inguinal region. Apart from some local pains, she had a normal haematological formula, normal spleen, liver and lymph nodes. As the tumour of 5.5 x 5 x 4.5 cm was well incapsulated between the sartorius muscle and the great adductor tendon it was easily extirpated and presented a whitish-light yellow section. The histological cellular aspect was pleiomorphic with round, ovalar cells; some were big and clear cells of centroblast-type with several mitoses and giant multinucleated cells and collagenic bundles in between. The nodular Hodgkin sclerosis is not confirmed immunohistochemically because of the negative reaction for antigen Kil (CD30) so that the diagnosis was lymphoma with lymphoma with big B cells by CD20 reaction. We also found positive T cells at CD43 that might be reactive lymphocytes. The tumour ranks a rare malignant lymphoma and for the first time, an extraganglionar lymphoma in thigh was found. We have not met such a location in the literature.

Mammary carcinosarcoma with osteochondrosarcomatous differentiations

The case of a 77-year-old woman with a 6/5/4.5 cm, mobile, hard, white-yellowish tumour associated with axillary adenopathy, with a progressive evolution in the upper external frame of the right breast is presented. The histopathological examination, carried out after the radical mammectomy, revealed zones with plates of slightly differentiated carcinomatous cells forming keratose pearls next to dense mixofibrochondrosarcomatous proliferations. The scarcity of these tumors as well as the mammary sarcomas and histogenesis questions are discussed.

Infantile spinal amylotrophy Werding-Hoffman disease and congenital contractures

The authors present a rare case of a male infant aged 5 1/2 months with muscular contractures, hypotonia and areflexia. Two male siblings died with the same clinical picture. The microscopic findings of several spinal cord specimens are typical for Werding-Hoffman amylotrophia spinalis. The microscopical aspects are suggestive for neurogenic atrophy of muscular fibres with interstitial myositic process. It is proposed to include the present case in X-linked form of infantile spinal muscular atrophy.

Histopathological and ultrastructural modifications of the articular cartilage in ankylosing spondylarthritis

The present study aims to analyse the articular cartilage in Ankylosing, Spondylarthritis (AS) versus the normal cartilage (18 cases altogether) by histopathological (HE, VG, Pas-Alcian, Gömöri, Safranine O), electronmicroscopic and histoenzymological techniques starting from the finding that the articular exudate in this affection is characterized cytomorphologically by cytosis (6,100/mm3), with polynucleosis (61%) and ragocytosis (25%). Histopathologically, the articular cartilage in AS evinced an alteration of safraninophilic areas and pale zones located in the neighbourhood of synovial lymphoplasmocytic infiltrates, pointing to the depletion of proteoglycans. The cartilage-synovia interference areas are relevant for the invasive nature of the inflammatory infiltrates which erode the cartilage. The histopathological modifications were confirmed ultrastructurally by the existence of some extended areas of revealed collagen, indicative of proteoglycans depletion. Functionally, chondrocytes have a high oxidative potential expressed by the presence of the peroxisomes and the positive reaction of peroxidase (PO), located near the nuclear membrane and the rough endoplasmic reticulum. The corroboration of histopathological, ultrastructural and histoenzymological data shows the alteration of the articular cartilage in AS, expressed morphologically at the level of the chondrocytes and of their synthesis products, collagen and proteoglycans.

Leiomyoosteochondroma of the stomach. A case report

The case of a 65-year-old man with a large 6-year gastric tumour revealed echographically is reported. A well delimited consistent white-grey tumour occurring in the anterior wall of the stomach and projecting from the gastric serosa in the subhepatic region was surgically found. Histologically, it showed leiomyomatous zones with fascicular spindle cells and sometimes with perinuclear vacuolizations that are actin-reaction positive but protein S-100-negative. These zones alternated with large compact benign osteochondromatous ones. The uncertain origin of this uncommon tumour was discussed. We have not found any references to such gastric tumours.

Carcinosarcoma of the kidney (nephroblastoma in an adult). Case report

There was reported a case of a 57-year-old man with right renal colics and haematuria for the past 12 years, supposed to be caused by renal cysts and pyelonephritis. The latest echographs and functional explorations show an expanded right kidney with frequent cysts. The extirpated kidney is about 12/15 cm in size and has an encephaloid tumour in the pyelocalycial areas penetrating in the surrounding parenchyma. The histological picture is that of a carcinosarcoma, showing a possible origin in the restant multipotent cells of the nephrogenic blastoma.

Histoenzymological and ultrastructural research of myocardial mitochondria in cardiac insufficiencies

We performed histoenzymological and electron-microscopic investigations of 40 myocardial biopsies taken during open heart surgery under extracorporeal circulation (ECC) from patients with valvular cardiopathies and septal interatrial defects with various degrees of congestive cardiac insufficiency (CCI). The changes occurring in the topochemistry and intensity of the enzymatic reactions used as markers for mitochondria, namely SDH and LDH, demonstrated the existence of a correlation between the decrease of reactions of the CCI degree. The ultrastructural aspects of the mitochondrial changes attested the precocity and severity of damage in these organelles even from initial moments of hypoxia.

Kawasaki disease in an infant with cystic fibrosis

The authors report a case of a 3-month-old infant with a very rare association: cystic fibrosis and Kawasaki disease. The clinical picture is atypical but cardiovascular signs consist of cardiomegaly, sick sinus syndrome and Q waves in D II, D III and AVF. The diagnosis is confirmed by the pathological changes found at the postmortem examination. The patient is the first case of Kawasaki disease reported in Romania.

Morphophysiopathological correlations in pulmonary hypertension of cardiac origin

100 patients with congenital malformation and acquired cardiac diseases were studied on preoperatory pulmonary biopsies to estimate the pulmonary hypertension by correlating the data obtained by modern multidisciplinary investigation: histological, histoenzymological, ultrastructural, physiological and clinical techniques. The morphological pictures show a range of vascular lesions similar to those found in Heath and Edwards' classification and they are especially thickenings of the intima, hypertrophies of the media, narrowings of vascular lumen and later some plexiform lesions and hemosiderosis. Progressive fibrosis processes as well as immune pulmonary reactions were made evident. The electron microscopical examinations provided new data regarding the thickening of the capillary and alveolary basal lamina, the activity of pneumocytes and macrophages that were also certified from the histoenzymological point of view by increase of peroxidases and acid phosphatases activity. The investigation carried out proved the importance of the cardiac preoperatory catheterism in order to establish the grade of the pulmonary hypertension while the concordance index is more increased than in the cases that were investigated only by non-bleeding techniques.

Jejunoileal alveolar rhabdomyosarcoma. A case report

Intestinal localization of rhabdomyosarcoma is exceptional, this case is the first to be published in the world literature. A 35-year-old patient with abdominal pain, fever, was found to have an infiltrative white-grey tumour, involving 20 cm the jejunoileal wall and also the surrounding mesenterium up to the origin of upper mesenterical vessels and lymph nodes. Histologic examination showed an alveolar type of rhabdomyosarcoma intricated with solid undifferentiated tumoral cells. The presence of multinucleated giant cells and the positivity of protein S 100 reaction was important for differential diagnosis, given the alveolar soft part sarcoma, malignant mesothelioma, malignant melanoma or papillary carcinoma.

Up-to-date aspects of meningoencephalitis. Anatomo-clinical researches

The anatomo-clinical study of the deaths caused by meningoencephalitis at the Infectious Diseases Clinics in Bucharest in 1986 and 1987 showed the increase of morbidity, 194 lethal cases being registered. The most affected age group was up to 1 year, followed by older persons, then by children between 1 and 10 years, the male sex prevailing. The most incriminated pathogenic agents were meningococcus, pneumococcus, as well as negative Gram germs, Escherichia coli, whereas the favouring factors were especially malnutrition, premature birth, dystrophies, focal infections. The lesional pictures are described, underlying the frequency of vascular lesions, ventriculitis cerebral abscesses, as well as the role of demyelinizations and of the glial reactions in pathogenesis.

Histochemical and ultrastructural alterations of lysosomes and acid phosphatase reaction in human chronic hypoxic myocardium

Histochemical and ultrastructural alterations of lysosomes and acid phosphatase reaction were assayed in myocardial human specimens from patients with some acquired and congenital cardiac affections and cardiac failure class II-IV (after NYHA classification). The optic and electron microscopic study of the acid phosphatase (the main lysosomal marker) activity reveals that the intensity and the distribution of the reaction were correlated with the degree of heart failure, being maximum at the IVth degree. The electron microscopic analysis of the lysosomal vacuolar apparatus emphasizes various changes also correlated with the intensity of hypoxia.

Simultaneous investigation of the rat serum and liver response in an acute toxic substances exposure

Some biochemical parameters were simultaneously investigated in serum and hepatic homogenate in acute experiment with three pesticides in rat. The one-dose exposure response was relatively well correlated with the chemical toxicity and showed the statistically significant values, preferentially placed 48 hours after dosing. The liver morphological alteration might be associated with the serum and tissue comportment of the bioenzymological factors. The various genotoxicity induced by the three pesticides, appreciated by the frequency of micronucleus induction in the bone marrow cells, completes the data about the one-dose exposure effects of the chemical in rat.

Osteosarcoma of soft tissues. A case report

The case of a 78-year old man with a non adherent subcutaneous tumour in the right iliac fossa was presented. In about one year and a half it stretched on the third superior part of the fore right thigh and appeared under the shape of a hard plate free from the osseous tissue. Microscopically, besides some fibrosarcomatous proliferations or very slightly differentiated ones with osteoid structures, the predominance of the osteosarcomatous images was found. The problems of pathogenesis and diagnosis of extraskeletal osteosarcomas were discussed.