Stasis Ulcers – The Unifying Concept

Chronic stasis dermatitis, usually confined to the lower legs, is a complication of longstanding interstitial edema and inflammation, due either to venous hypertension or disorders having in common excessive lymph overload. Heart failure, renal failure, liver cirrhosis, secondary and primary diseases of lymph vessels may complicate with stasis dermatitis. The same mechanisms causing stasis dermatitis can also generate skin ulcers superimposed on stasis dermatitis. In the appropriate context such skin ulcers are called "venous ulcers" or, in different situations, “stasis ulcers”. The distinction between venous and other stasis ulcers is usually possible at the bedside. Also, some general measures of therapy are similar for venous and other stasis ulcers: such are elastic compression, topical skin care and ulcer care. In having in common the pathophysiological mechanisms, in bearing clinical resemblance, and responding to similar therapies, a unifying concept may be opportune to comprise the spectrum of stasis dermatitis, venous and other stasis ulcers. The present work is an appeal to this aim.

Associated Pathology in Case of Death from Circulatory Circulatory Diseases According to the Analysis of Multiple Causes

Background.Comorbidity of diseases deteriorates health and often increases the risk of death. Identification of comorbidities with diseases of the circulatory system (DCS) will help find additional measures to increase life expectancy. Aims to identify causes associated with death from DCS and to analyze their interrelation based on the multiple cause analysis. Materials and methods.Data on DCS deaths of the Death registration in the Moscow Unified Medical Information and Analytical System (RFS-EMIAS) in 2019 (46 000 deaths) and from April to May 2020 (11 000 deaths) excluding perinatal mortality were analyzed. The association analysis was carried out across groups of the ICD-10 DCS blocks by calculating the corresponding frequency. Effect of SARS-CoV-2 was analyzed in the infected deceased and those free from infection. Comparison was carried out by the Chi-square test. Results.The following Diseases of the circulatory system are associated with Diabetes mellitus: Hypertension, Coronary heart disease, Cerebrovascular diseases, and Diseases of arteries, arterioles and capillaries. A synergetic effect has been identified in comorbidity with the diseases characterized by high blood pressure and Chronic rheumatic heart diseases, other forms of heart disease(I30I52), Cerebrovascular diseases and Diseases of arteries, arterioles and capillaries; the latter and Coronary heart disease and Cerebrovascular diseases; other forms of heart disease and Mental disorders due to psychoactive substance use; Diseases of veins, lymphatic vessels and lymph nodes and Pulmonary circulation disorders. Effect of the increased risk of death in non-symmetric associations of causes has been detected for comorbidity of Diseases of veins, lymph vessels and lymph nodes and Chronic viral hepatitis; Coronary heart disease and other forms of heart disease; Hypertension and Coronary heart disease; in males comorbidity of Obesity and Hypertension, and Diseases of arteries, arterioles and capillaries and Hypertension. Associations between DCS and their complications have been identified in females: Diseases of veins, lymph vessels and lymph nodes and Phlegmon, and Cerebrovascular diseases and Decubital ulcers. Conclusion.SARS-CoV-2 increases mortality from Chronic coronary heart disease, ICD-10 I67.8 code for Other specified cerebrovascular diseases and Hypertension in females 1.5-fold. The infection rate in females died from DCS is significantly lower compared to the one in males.

Prognostic markers of canine mammary tumours: Retrospective study of 142 cases

Due to relevance of the problem, prediction of biological behaviour of neoplasias in mammary glands of dogs requires using contemporary approaches to the study, first of all, of ways of dissemination of tumour cells. One of them is studying the mechanisms of migration of cancer cells out of the neoplasm tissues with further dissemination and development of metastatic sites in the regional lymphatic nodes and remote tissues. We studied the survival period of bitches with tumours of the mammary glands following regional or unilateral mastectomy. Among malignant mammary tumours in bitches, the most often diagnosed were single tumours (57.5%), which histologically were classified to carcinomas – ductal (26.9%) and mixed type (21.9%). Probability of intratumoral invasion to blood vessels equaled 12.0%, to lymph vessels – 7.8%, lymph nodes – 12.8%. It depends on the histological type of the tumour, the most aggressive potentially being сomedocarcinoma, tubulopapillary carcinoma and ductal carcinoma. Parameters of life expectancy and survival level after mastectomy depend on clinical stage of the disease (increase in the stage from the first to the third was characterized by decrease from 12.8 ± 9.5 to 9.4 ± 7.8 months), presence of angio/lymphatic invasions, presence of angiolymphatic invasion, but had no correlation with the size of the tumours. An important predictor of tumour-related death of dogs suffering neoplasias of the mammary glands is index vet-NPI, which has significant correlation with the clinical stage according to Owen and median survival. In particular, median survival in patients with the index lower than 4 exceeded the corresponding values in dogs with the index above 4 by 1.3 times. A promising direction of further research would be studying biological mechanisms of development of tumour emboli in the blood and lymph vessels, metastatic sites in lymph nodes, and also determining their role in pathogenesis of canine mammary tumours.

Cystic Lymphangioma of the Pancreas: About A Case and Literature Review

Cystic lymphangioma is a rare malformative benign tumour of the lymph vessels, its histogenesis is still hypothetical. This tumour is mainly found in child’s neck and axillary, the pancreatic location remains exceptional and represents less than 1% of whole lymphangiomas, and occurs more frequently in women and especially in the left pancreas. Its clinical presentation is polymorphic; however, the diagnosis can’t be specifically evoked by imaging and requires therefore histological confirmation. Surgery remains the only curative treatment. We report in this work the case of an incidentally discovered cystic lymphangioma of the pancreatic tail in a 58-year-old woman. The histological study of the surgical specimen concluded on a benign cystic lymphangioma. On later surgical outcomes, the patient developed a pseudokyst of the remaining pancreas and today she has not had any recurrences. The aim of this article is to share our experience in the management of this case and to review the clinical and therapeutic aspects of this rare pathology.

Chylous Ascites, Unusual Association with Ductal Pancreatic Adenocarcinoma with Plasmacytoid Morphology: A Case Report and Literature Review

Chylous ascites represents a relatively uncommon condition. In this paper, we present a case of chyloperitoneum associated with pancreatic ductal adenocarcinoma (PDAC) and a review of literature regarding chylous ascites. A 76-year-old male patient was admitted in emergency department with acute abdomen. A pancreatic cancer was suspected. Subtotal spleno-pancreatectomy, for a nodular mass infiltrating the mild and distal portion of the pancreas, was necessary. During surgical intervention in the peritoneal cavity, a moderate quantity of whitish and thick consistency fluid with milk-like appearance was observed to be accumulated. After examination of the fluid, chyloperitoneum was diagnosed. The histologic examination showed a PDAC, with multiple emboli in lymph vessels, with tumor cells with plasmacytoid morphology, diagnosed as lymphangiosis carcinomatosa. The patient died at 3 weeks after surgical intervention. In patients with pancreatic cancer and chylous ascites, suspicion of tumor-related blockage of the lymphatic flow should be suspected. Prognosis of PDAC should be evaluated not only based on the number of lymph node metastases, but also considering the number of lymph vessels with tumor emboli and the architecture of tumor cells. This is the first reported case of a PDAC with plasmacytoid morphology of lymphangiosis carcinomatosa.

The sentinel node invasion level (SNIL) as a prognostic parameter in melanoma

Sentinel lymph node (SN) tumor burden is becoming increasingly important and is likely to be included in future N classifications in melanoma. Our aim was to investigate the prognostic significance of melanoma infiltration of various anatomically defined lymph node substructures. This retrospective cohort study included 1250 consecutive patients with SN biopsy. The pathology protocol required description of metastatic infiltration of each of the following lymph node substructures: intracapsular lymph vessels, subcapsular and transverse sinuses, cortex, paracortex, medulla, and capsule. Within the SN with the highest tumor burden, the SN invasion level (SNIL) was defined as follows: SNIL 1 = melanoma cells confined to intracapsular lymph vessels, subcapsular or transverse sinuses; SNIL 2 = melanoma infiltrating the cortex or paracortex; SNIL 3 = melanoma infiltrating the medulla or capsule. We classified 338 SN-positive patients according to the non-metric SNIL. Using Kaplan–Meier estimates and Cox models, recurrence-free survival (RFS), melanoma-specific survival (MSS) and nodal basin recurrence rates were analyzed. The median follow-up time was 75 months. The SNIL divided the SN-positive population into three groups with significantly different RFS, MSS, and nodal basin recurrence probabilities. The MSS of patients with SNIL 1 was virtually identical to that of SN-negative patients, whereas outgrowth of the metastasis from the parenchyma into the fibrous capsule or the medulla of the lymph node indicated a very poor prognosis. Thus, the SNIL may help to better assess the benefit-risk ratio of adjuvant therapies in patients with different SN metastasis patterns.