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Ultrasound is a fundamental tool used in all medical specialties, including ophthalmology. Nowadays, ultrasound biomicroscopy (UBM), a method with higher resolution, allows the investigation of in vivo details of the anterior segment of the eye at microscopic resolution. The examination is especially useful in patients with secondary glaucoma that involves a lens component such as phacomorphic glaucoma and occult phacomorphic glaucoma (OPG). The purpose of this paper was to familiarize audience with UBM and the importance of this investigation in OPG, by presenting a series of cases in which performing an UBM was vital because it provided the information needed in order to safely accomplish a curative surgical treatment that preserved our patients' visual acuity.

The 2016 Surviving Sepsis Campaign guidelines define sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. This study had the objective of assessing the efficacy of presepsin in the prognosis of sepsis. This was a single-center prospective study, performed in Craiova Emergency Hospital, that included 114 patients admitted in the Intensive Care Unit (ICU) department between 2018 and 2019 fulfilling the sepsis criteria. Including criteria were: age &ge, 18, sepsis diagnosed by the Sequential Organ Failure Assessment (SOFA) score of pulmonary, abdominal, urinary, surgical or unknown origin, as well as lactate levels &ge, 2 mmol/l and need of vasopressors for mean arterial pressure (MAP) &ge, 65 mmHg, despite adequate volume resuscitations for patients with septic shock. Patients younger than 18, pregnant, immunocompromised, or with terminal illnesses were excluded. Based on disease severity, patients were distributed into two study groups: sepsis&mdash, 76 patients and septic shock&mdash, 38 patients. As expected, SOFA score and most of its components (PaO2/FiO2, platelets, and Glasgow Coma Score (GCS)) were significantly modified for patients with septic shock compared to those in the sepsis group and for survivors versus non-survivors. Overall death rate was 34.2%, with a significantly higher value for patients with septic shock (55.3% vs. 23.7%, p = 0.035). Sepsis marker presepsin was significantly elevated in all patients (2047 ng/mL) and significantly increased for the septic shock patients (2538 ng/mL, p &lt, 0.001) and non-survivors (3138 ng/mL, p &lt, 0.001). A significant correlation was identified between the SOFA score and presepsin (r = 0.883, p &lt, 0.001). The receiver operating characteristics (ROC)-Area Under Curve (AUC) analysis showed significant prognostic values for presepsin regarding both sepsis severity (AUC = 0.726, 95% confidence interval CI = 0.635&ndash, 0.806) and mortality risk (AUC = 0.861, 95%CI = 0.784&ndash, 0.919). In conclusion, under the revised definition of sepsis, presepsin could be a useful marker for prognosis of sepsis severity and mortality risk. Additional data are required to confirm the value of presepsin in sepsis prognosis.

Introduction. The primitive malignant melanoma of nasal mucosa and paranasal sinus is a rare tumor of uncertain etiology, with unpredictable biologic behavior and bad prognosis. Unlike skin melanomas, there are no risk factors and the disease is frequently manifested in older patients, whose clinical otorhinolaryngology complaints are normally non-specific and ranges from nasal obstruction to rhinorrhea and epistaxis. Unfortunately, this disease is diagnosed basically in advanced stages which makes the surgery difficult. Objective. To report a case of primitive malignant melanoma of nasal mucosa, ethmoid and frontal sinuses, that was diagnosed in 2015. It was performed a subtotal resection in another hospital in 24.08.2015, with a large local reccurence. Report. Our patient was a 78-year-old woman with bilateral nasal obstruction, light epistaxis and unilateral rhinorrhea. The ENT, CT and MRI exams showed a tumour with important, invasion of the nasal cavity structures (billateral nasal bones, left frontal process of the maxilla, the superior midpoint of the nasal septum, bilateral middle and superior turbinates, left ethmoid and bilateral frontal sinuses). The patient was submited for surgery: total macroscopic resection in the combined endoscopic approach; transnasal and modified lateral rhinotomy with titaniul plates reconstruction of the external nose architecture. Conclusions. Malignant melanomas of nasal mucosa are, in general, diagnosed in advanced stages. Their histological characteristics in the mucosa makes difficult the surgical treatment, which is one of the most efficient options, because they are resistant to chemo and radiotherapy. The early diagnosis and a good surgical treatment plan are the best option for this tumor nowadays.

INTRODUCTION: Numerous anti-angiogenic agents are currently developed to limit tumor growth and metastasis. While these drugs offer hope for cancer patients, their transient effect on tumor vasculature is difficult to assess in clinical settings. Confocal laser endomicroscopy (CLE) is a novel endoscopic imaging technology that enables histological examination of the gastrointestinal mucosa. The aim of the present study was to evaluate the feasibility of using CLE to image the vascular network in fresh biopsies of human colorectal tissue. For this purpose we have imaged normal and malignant biopsy tissue samples and compared the vascular network parameters obtained with CLE with established histopathology techniques. MATERIALS AND METHODS: Fresh non-fixed biopsy samples of both normal and malignant colorectal mucosa were stained with fluorescently labeled anti-CD31 antibodies and imaged by CLE using a dedicated endomicroscopy system. Corresponding biopsy samples underwent immunohistochemical staining for CD31, assessing the microvessel density (MVD) and vascular areas for comparison with CLE data, which were measured offline using specific software. RESULTS: The vessels were imaged by CLE in both normal and tumor samples. The average diameter of normal vessels was 8.5±0.9 µm whereas in tumor samples it was 13.5±0.7 µm (p = 0.0049). Vascular density was 188.7±24.9 vessels/mm(2) in the normal tissue vs. 242.4±16.1 vessels/mm(2) in the colorectal cancer samples (p = 0.1201). In the immunohistochemistry samples, the MVD was 211.2±42.9/mm(2) and 351.3±39.6/mm(2) for normal and malignant mucosa, respectively. The vascular area was 2.9±0.5% of total tissue area for the normal mucosa and 8.5±2.1% for primary colorectal cancer tissue. CONCLUSION: Selective imaging of blood vessels with CLE is feasible in normal and tumor colorectal tissue by using fluorescently labeled antibodies targeted against an endothelial marker. The method could be translated into the clinical setting for monitoring of anti-angiogenic therapy.

AIM: To evaluate neoangiogenesis in patients with colon cancer by two fluorescently labeled antibodies on fresh biopsy samples imaged with confocal laser endomicroscopy (CLE). METHODS: CLE is an imaging technique for gastrointestinal endoscopy providing in vivo microscopy at subcellular resolution. An important question in validating tumor angiogenesis is what proportion of the tumor vascular network is represented by pre-existing parent tissue vessels and newly formed vessels. CD105 (endoglin) represents a proliferation-associated endothelial cell adhesion molecule. In contrast to pan-endothelial markers, such as CD31, CD105 is preferentially expressed in activated endothelial cells that participate in neovascularization. Thus, we evaluated CD105 and CD31 expression from samples of ten patients with primary rectal adenocarcinoma, using a dedicated endomicroscopy system. A imaging software was used to obtain the Z projection of the confocal serial images from each biopsy sample previously combined into stacks. Vascular density and vessel diameters were measured within two 50 μm x 475 μm rectangular regions of interest centered in the middle of each image in the horizontal and vertical direction. The results were averaged over all the patients and were expressed as the mean ± SE. RESULTS: The use of an anti-CD105 antibody was found to be suitable for the detection of blood vessels in colon cancer. Whereas anti-CD31 antibodies stained blood vessels in both normal and pathologic colon equally, CD105 expression was observed primarily in malignant lesions, with little or no expression in the vessels of the normal mucosa (244.21 ± 130.7 vessels/mm3 in only four patients). The average diameter of anti-CD105 stained vessels was 10.97 ± 0.6 μm in tumor tissue, and the vessel density was 2787.40 ± 134.8 vessels/mm3. When using the anti-CD31 antibody, the average diameter of vessels in the normal colon tissue was 7.67 ± 0.5 μm and the vessel density was 3191.60 ± 387.8 vessels/mm3, while in the tumors we obtained an average diameter of 10.88 ± 0.8 μm and a vessel density of 4707.30 ± 448.85 vessels/mm3. Thus, there were more vessels stained with CD31 than CD105 (P < 0.05). The average vessel diameter was similar for both CD31 and CD105 staining. A qualitative comparison between CLE vs immunohistochemistry lead to similar results. CONCLUSION: Specific imaging and quantification of tumor microvessels are feasible in human rectal cancer using CLE examination and CD105 immunostaining of fresh tissue samples.

Background: Currently, less frequent than once-weekly subcutaneous epoetin administration regimens were shown to be equally effective and safe as once-weekly schedules in stable predialysis and peritoneal dialysis patients. Bioequivalency of once-every-2-weeks and once-weekly subcutaneous administration of the same total dose of epoetin beta for the maintenance phase of anemia treatment in stable iron-replete long-term hemodialysis patients therefore was investigated prospectively. Methods: Two hundred seven stable selected hemodialysis patients without diabetes, acute illness, significant inflammation, malnutrition or hyperparathyroidism administered once-weekly subcutaneous epoetin beta and preserving stable hemoglobin levels between 10 and 12 g/dL (100 and 120 g/L; difference between maximum and minimum of 3 subsequent levels ≤2.5 g/dL [≤25 g/L]) and optimal iron status for at least 8 weeks before inclusion were enrolled and randomly assigned to subcutaneous administration of the same total dose of epoetin beta either once every 2 weeks (group 2w; n=104) or once weekly (group 1w; n=103) for 24 weeks. Results: Per-protocol analyses (group 1w=102 versus group 2w=101) showed similar hemoglobin levels throughout the assessment period (weeks 13 to 24): mean, 11.38 g/dL; 95% confidence interval (CI), 11.23 to 11.54 versus 11.41 g/dL; 95% CI, 11.22 to 11.58. Mean difference was 0.028 g/dL (95% CI, −0.208 to 0.264) in the prespecified range (±0.5 g/dL). Epoetin dose ratio of group 2w to group 1w was 0.94 (95% CI, 0.813 to 1.076), also in the prespecified range of equivalence (0.80 to 1.25). Hemoglobin levels and epoetin doses were stable during the study irrespective of treatment schedule, with no differences between groups at any time. Both schedules were well tolerated. Conclusion: Once-every-2-weeks and once-weekly subcutaneous epoetin beta regimens are equivalent in the maintenance phase of anemia treatment in long-term stable hemodialysis patients without diabetes, with similar safety profiles.