SummaryMultiple synchronous primary tumours can cause diagnostic difficulties regarding primary origin versus metastatic spread. Greater awareness of concurrent carcinogenesis is necessary as more frequent occurrence of multiple primary cancers can be expected in future due to the growing tumour burden in the aging world population along with improved treatment efficacy. Here we report a 58-year-old male patient, who was diagnosed with two rare synchronous tumours: hepatocellular carcinoma and renal clear cell carcinoma. Both tumours were radically removed by simultaneous liver and kidney resection. AIM OF THE DEMONSTRATIONThe aim of our report is to show a case of two synchronous malignant tumours in the liver and kidney in order to increase the awareness about multiple primary cancers and the related diagnostic approach. CASE REPORTA 58-year-old male was admitted to a university hospital for surgical treatment of malignant tumour within kidney and liver. Metastatic spread was suspected. By upper laparotomy approach, the liver segments S5 and S6 were resected. Cholecystectomy and right kidney resection was performed simultaneously. The removed liver segment, gall bladder and kidney segment were sent for histological examination. Grossly, the liver segment measured 11.5x12.5x7.0 cm. A grey, relatively well-demarcated, homogeneous lesion was detected within the removed liver tissue 1.0 cm apart from resection line. Multiple tissue sections were submitted for microscopic evaluation and measurements. Microscopically, an invasive hepatocellular carcinoma was found (Figure 1). The tumour displayed trabecular structure and moderate cellular atypia. Although clear cell areas were present, the cytoplasmic fat vacuoles and rich presence of Mallory hyaline were suggestive of hepatocellular origin. The clear cell areas also contained Mallory hyaline. Areas of typical morphology were present as well. Gall bladder was also removed during the course of operation. It measured 9.0x3.7cm; and the thickness of wall was 0.4 cm. Only tiny cholesterol polyps were identified in the mucosa. There were no signs of malignancy within the gall bladder. Kidney segment grossly measured 6.0x5.4x5.5 cm. At grossing, the resection surface was inked by Alcian blue. In the cross section, a tumour mass 3.4x3.7x4.8 cm was observed. The tumour was soft, yellow with extensive haemorrhage and greyish areas. Multiple sections were submitted for microscopic evaluation yielding invasive renal carcinoma, clear cell type. The malignant tumour cells had irregular morphology, clear cytoplasm, dark and round central nuclei and small nucleoli visible at high magnification corresponding to grade II by Fuhrman (Figure 1).Within tumour mass, secondary changes were presentlarge areas of necrosis and haemorrhages. Tumour was surrounded with fibrous pseudocapsule which was focally penetrated by tumour cells spreading to renal parenchyma. There was no evidence of invasion into perirenal or hilar fat, or large blood vessels. By immunohistochemistry, hepatocellular car...

Background The study aims at solving the problem with the limitations of the homecare CPAP equipment such as sleep apnea devices in the treatment of COVID-19 pneumonia. By adding an advanced, rapid-to-produce oxygenation module to existing CPAP devices we allow distributing healthcare at all levels, reducing the load on intensive care units, promoting treatment in the early stages at homecare. A significant part of the COVID-19 pneumonia patients requires not only an oxygen supply but also additional air pressure. Existing home care devices are able to create precise positive airway pressure, but cannot precisely measure supplied oxygen concentration. Either uses uncertified and potentially unsafe mechanisms. Results The developed system allows using certified and widely available CPAP (constant positive airway pressure) devices to perform the critical function of delivering pressure and oxygen to airways. CPAP device is connected to the designed add-on module that can provide predefined oxygen concentration in a precise and stable manner. Clinical test results include data from 12 COVID-19 positive patients. The device has been compared against certified NIV (non-invasive) equipment under 6–20 hPa pressure and 30–70% FiO2. Tests have proved that the developed system can achieve the same SaO2 (p = 0.93) and PaO2 (p = 0.80) levels as NIV with clinically insignificant differences. Test results show that the designed system can substitute NIV equipment for a significant part of COVID-19 patients while leaving existing NIV devices for unstable and critical patients. The system has been designed to be mass-produced while having medically certified critical components. Conclusion The clinical testing of the new device for oxygen supplementation of patients treated using simple CPAP devices looks promising and could be used for the treatment of COVID-19 pneumonia.

Background: The study aims at solving the problem with the limitations of the homecare CPAP equipment such as sleep apnea devices in the treatment of COVID-19 pneumonia. By adding an advanced, rapid-to-produce oxygenation module to CPAP device we allow distributing healthcare at all levels, reducing the load on intensive care units, promoting treatment in the early stages at homecare. A significant part of the COVID-19 pneumonia patients requires not only an oxygen supply but also additional air pressure. Existing home care devices are able to create precise positive airway pressure but cannot precisely measure supplied oxygen concentration. Either uses uncertified and potentially unsafe mechanisms.Results: The developed system allows using certified and widely available CPAP (constant positive airway pressure) devices to perform the critical function of delivering pressure and oxygen to airways. CPAP device is connected to the designed add-on module that can provide predefined oxygen concentration in a precise and stable manner. Clinical test results include data from 12 COVID-19 positive patients. The device has been compared against certified NIV (non-invasive) equipment under 6-20 hPa pressure and 30-70% FiO2. Tests have proved that the developed system can achieve the same SaO2 (p=0.93) and PaO2 (p=0.80) levels as NIV with clinically insignificant differences. Test results show that the designed system can substitute NIV equipment for a significant part of COVID-19 patients while leaving existing NIV devices for unstable and critical patients. The system has been designed to be mass-produced while having medically certified critical components.Conclusion: The clinical testing of the new device for oxygen supplementation of patients treated using simple CPAP devices looks promising and could be used for the treatment of COVID-19 pneumonia.