A case of bladder purpura

In March 1921, a sick peasant woman was admitted to the Hospital Surgical Clinic with complaints of hematuria, which appeared 3-4 days after a slight malaise. The rest of the patient felt healthy. Objectively, the patient did not represent any deviation from the norm. In particular, her t is normal, there are no symptoms of scurvy. For hematuria, cystoscopic examination. Cystoscopy revealed: the orifices of the ureters are normal, on the normal mucous membrane there are scattered red spots the size of a pinhead and larger, very similar to flea bites; these specks are scattered in various parts of the bladder, mainly at the bottom of it; there are no infiltrates around the spots and other changes.

CHARACTERISTICS OF THE IMMUNE MICROENVIRONMENT OF THE NORMAL MUCOUS MEMBRANE OF THE PERITUMORAL AREA IS AN ADDITIONAL INDEPENDENT PROGNOSTIC FACTOR IN GASTRIC CANCER

The aim of the study was to study and evaluate the predictive value of the immune microenvironment of gastric cancer and morphologically normal mucous membrane of the peritumoral area using an automatic morphometric analysis system on the example of CD 8+ cells.Material and Methods. Surgical samples from 130 patients with a verified diagnosis of gastric cancer were used. After immunohistochemical staining with antibodies to CD 8, a morphological assessment was performed according to the original method. We assessed the average area of CD 8+ cells in three fields of view (lens magn. ×20) using the automatic system of morphometric analysis LAS X (Leica) in the central part of the tumor and areas of morphologically normal mucous membrane of the peritumoral region directly adjacent to the tumor tissue. The results were compared with the main clinical and morphological characteristics of the tumor as well as with the overall five-year survival of patients.Results and Discussion. A high density of CD 8+ infiltration of normal mucous membrane of the peritumoral area was observed in groups T4a and T4b by the depth of invasion (n=96, p=0.0089) and was associated with the presence of emboli in the lymphatic vessels (n=96, p=0.0102) and with the more advanced stage of gastric cancer (n=96, p=0.0107). The studied cases were divided into two groups: less than 3300 square micrometers (better patient survival; n=79, p=0.01) and more than 3300 square micrometers according to the average area of CD 8+ cells in normal mucous membrane of the peritumoral area. According to multivariate survival analysis using the Cox regression model, it was found that the average area of CD 8+ cells in normal mucous membrane of the peritumoral area was a significant negative prognostic factor (RR=1.537; CI : 0.761–3.105; p<0.01) comparable in degree covariance with the stage of the tumor A similar indicator assessed in central part of the tumor was not significantly associated with patient survival (RR=0.803; CI : 0.574–1.122; p>0.05).Conclusion. The possibility of using an automatic analysis system to evaluate the immune microenvironment in gastric cancer was demonstrated for the first time. It was found that a high level of CD 8+ lymphocyte infiltration of morphologically normal mucous membrane of the peritumoral area was an independent negative prognostic factor. Therefore, we recommend the mandatory preoperative biopsy sampling from the mucous membrane of the peritumoral region for morphometric assessment of CD 8+ lymphocyte infiltration.

Contour analysis of endoscopic images in the diagnosis of early gastric cancer

The purpose of the study: The main purpose of the study is creation of a system for digital processing of endoscopic images in white light and narrow band imaging for the early diagnosis of early forms of stomach cancer.Materials and methods: The object of the study is endoscopic images (6320 cases) with PENTAX EG-2790K and OLYMPUS H180 devices. The subjects of the research are mathematical models of gastric epithelial neoplasias, classifi cation of these tissues, methods of digital image processing and contour analysis, methods of mathematical modeling.Results: The work is divided into two stages to obtain quantitative estimates of the studied characteristics: 1. To make a diagnostic map — the image is segmented, then the boundaries between the pathologically altered tissues and the normal mucous membrane are drawn. 2. The calculation of the characteristics of the contour associated with diagnostic signs is made. As a measure of the symmetry of the figure, the symmetry coefficient k was used, defined as the ratio of the number of samples of the normalized autocorrelation function that exceeded the specified threshold in level to the total number of samples. The study revealed that the contours of malignant neoplasms have a symmetry coefficient k < 0,05, and the contours of benign neoplasms k > 0,2. This suggests the possibility of automated differentiation of neoplasms based on the analysis of their shape.The conclusion: An objective assessment of endoscopic signs of early gastric cancer is necessary to standardize and systematize the diagnostic approach. The unified digital processing of endoscopic images will allow the endoscopist to increase the frequency of detecting early forms of gastric cancer, which will affect to reduce mortality.

Fluorescence Bronchoscopy

A new method of fluorescence bronchoscopy is presented which uses a standard light source and a special filter combination to permit the carrying out of fluorescence bronchoscopy with a surface marking method by means of inhaling a fluorescein solution. Normal mucous membrane, or mucous membrane with no histological change other than inflammation, which is cleansed by ciliary activity, does not usually fluoresce for a period longer than about two hours after the inhalation. There were, it is true, 13 false positive fluorescences out of 52 fluorescing areas in the mucous membrane. Correctly recorded were 39 cases of positive, ie, visible tumors, metaplasias, accumulation of mucous glands in the epithelium, and mucous membrane which had undergone a neoplastic change in the sense of a lymphangitis carcinomatosa or a mucous membrane carcinosis; these all caused fluorescence. The false negative results amounted to only two nonfluorescing tumors and one metaplasia. These diagnoses arise from the first 100 patients examined by this method. The fact must be especially emphasized that out of the 58 carcinoma cases, there were 7 where neoplastic changes in the mucous membrane were diagnosed by the fluorescence technique, although they had not been recognized macroscopically either by the naked eye or by the Hopkins optical technique.

Ultraviolet-Fluorescence Bronchoscopy in Early Detection of Bronchogenic Carcinoma

The still unsatisfactory prognosis of bronchogenic carcinoma prompted the search for possibilities of better early and detailed diagnosis. This led us to the idea of UV-fluorescence bronchoscopy. The patient inhales 5 ml of an aqueous 5% solution of fluorescein, together with a β2 stimulator, 10–15 minutes before the bronchoscopy, by means of a pressure inhaler. While the normal mucous membrane cleanses itself by virtue of ciliary action (secretions containing fluorescein are expectorated or drawn off during the bronchoscopy), carcinoma, carcinomatous lymphangiosis, superficial tumor infiltrations and nonciliated metaplasias are stained. These places fluoresce in UV light, even when they cannot be observed with the naked eye or with an optical system. In this way, they are made visible for directed biopsy. Malignant changes not discernible by means of the methods hitherto employed can thus be diagnosed and sites determined with greater accuracy for proposed resection.