Tag Archives: thrombosis

Vascular injury in macroscopically normal skin of patients with severe COVID-19 infection: clinical-pathologic correlations

Mircea-Catălin Coșarcă, Vasile Adrian Mureșan, Emoke Horvath, Eliza Russu, Janos Szederjesi, Matild Keresztes

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0027

Objectives: Taking into account that the documentation of the histopathological features in severe disease caused by SARS-CoV-2 has been scarce due to the avoidance of performing autopsies, the aim of the study was to detect the microscopic changes associated with severe COVID-19 infection in normal-appearing skin, without prominent dermatologic signs of a generalized microvascular thrombotic disorder, in accordance with the clinical evolution of disease.
Methods: In this morphological and immunohistochemical study we included cutaneous biopsy samples from 12 symptomatic patients with severe and critical type SARS-CoV-2 infection (with the admission date between February and June 2020), treated in the Intensive Therapy Unit Care of Emergency County Hospital Targu-Mures, Romania.
Results: The average age of our patients was 65.18 ± 14.21 years (range 41 to 83), and 66.67% of the patients were male. The histological and immunohistochemical assessment of cutaneous biopsies: in 4 cases the histological examination revealed small fibrin thrombi in deep-seated venules and small veins of subcuticular adipose tissue, and also 4 cutaneous biopsies showed occlusive vascular thrombosis in association with massive perivascular inflammatory infiltrate destroying and compromising the integrity of the vessel wall. The immunohistochemical examination of the composition of perivascular inflammatory infiltrate showed a predominance of CD3 positive lymphocytes, admixed with CD68 positive Mo/MF, some of them activated with FXIII expression. In the perivascular infiltrate, the presence of granulocytes and B lymphocytes was not characteristic.
Conclusion: According to our observations, in severe COVID-19, the cutaneous tissue is involved even in the absence of clinically obvious changes. Due to the relatively easy accessibility of skin samples, these could be applied to determine the severity of the patient’s clinical status, and to predict the necessity for anti-complement or anticoagulant treatments in the early stages of a severe SARS-CoV-2 infection.

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Deep Venous Thrombosis Associated With Inferior Vena Cava Abnormalities And Hypoplastic Kidney In Siblings

Duicu Carmen*, Bucur Gabriela, Simu Iunius, Tripon Florin, Marginean Oana

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0011

Congenital inferior vena cava anomalies have a reduced frequency in general population, many times being an asymptomatic finding. Patients caring such anomalies are at risk to develop deep vein thrombosis. In this paper, we present 2 siblings with deep venous thrombosis and inferior vena cava abnormalities, with a symptomatic onset at similar age. The inferior vena cava abnormality was documented by an angio-CT in each case. The thrombophilic workup was negative. Patients were treated with conservative therapy: low molecular weight heparin anticoagulants converted later to oral anticoagulant with resolution of symptoms and disappearance of the thrombus. Finally, in the absence of any risk factor in a young patient admitted with deep vein thrombosis investigations to exclude inferior vena cava anomalies are mandatory.

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Vascular Complications – Poor Prognostic Factors in Severe Acute Pancreatitis

Popa D1, Grigorescu Bianca2, Hoffner S1, Copotoiu C1

1 1st Clinic of Surgery, University of Medicine and Pharmacy of Tg. Mures, Tg. Mures Emergency County Hospital Mures
2 Clinic of Anesthesiology and Intensive Care, Tg. Mures Emergency County Hospital

Background: Various complications occur after the onset of acute pancreatitis. Aproximately 9–11% of the patients with severe acute pancreatitis may develop vascular complications such as haemorrhage, ischaemic visceral lessions, tromboses on the portal venous system and formation of aneurysms.
Aim: To determine the incidence of these complication and to analyze the therapeutic approach for these patients.
Method: We realized a retrospective study on 279 patients with severe acute pancreatitis (SAP), defined by the Atlanta criteria. In this group we annalized the incidence of vascular complications, the therapeutic methods for their solving and the risk for developing complications and mortality.
Results: The incidence of vascular events was 14.33%.Hemorrhagic complications had a higher incidence and were present in 32 patients (80%). Only 8 patients (20%) presented major ischaemic events. The most commonly involved organ in ischaemic lessions was the colon.
Conclusions: Vascular complications, although rare (leading to an increased morbidity and mortality), may jeopardize the patients’ life. Their diagnosis and treatement becomes possible only by the clinician vigilance on their potential occurence using modern investigative methods.

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