text:
Massive vulvar edema in 2 prepartum dairy cows.
Two late gestation Holstein cows about to begin the third lactation developed massive vulvar edema. These were the only affected animals in the herd of 500 milking cows. The vulvar edema spontaneously regressed postpartum for both cows. Massive vulvar swelling is seldom observed in dairy cows in advanced pregnancy and is not described in the literature. PMID:24790232
Cheong, Soon Hon; Gilbert, Robert O
... cells grow on vulvar skin. This is called vulvar intraepithelial neoplasia (VIN), or dysplasia. Not all VIN cases turn into cancer, but it is best to treat it early. Often, vulvar cancer doesn't cause symptoms at first. However, ...
... younger. Vulvar cancer may be related to genital warts, a sexually transmitted disease caused by the human ... vulvar cancer is found and treated early, the cure rate is over 90%. The key to a ...
In a busy dermatologic practice, it may be frustrating to encounter a vulvar disease patient, who must fully disrobe for examination. Further, the wet mounts, cultures, biopsies, and patient education required for treatment of vulvar disorders take up considerable time. However, most patients will respond to appropriate therapy, and can be very gratifying to treat. PMID:17249297
Werlinger, Kelly D; Cockerell, Clay J
Vulvar cancer is an uncommon malignancy of the female genital tract in developing countries, accounting for 3% of gynaecological cancers. Here, cervical cancer is an everyday problem; ovarian cancer is the second commonest gynaecological cancer; endometrial is less common and vulvar cancer is rare. It is advanced at admission, though is a visible cancer. Records of women who had histopathologically proven vulvar cancer over 24 years were analysed for epidemiological status and preventive possibilities. During the analysis period, 9,419 total cancer cases were diagnosed; 4,726 (50.17%) were in women. A total of 39.52% (1,868 of 4,726) were gynaecological; 18 cases were vulvar (0.38% of the 4,726 women with cancer) and 0.96% of the 1,868 gynaecological cancer cases. Decreasing trends were 2.25% between 1984 and 1988, down to 0.33% between 2004 and 2008. Leading presenting complaints were: dyspareunia, 88.88% (16 of 18 patients); pruritus 13; ulcers 14; vulvar swelling 12 and urinary problems 13. Dystrophy was present in 8 of 18 cases. Overall, four had stage I, one stage II, three stage III and four stage IV disease at admission; all at labia majora or minora, some too advanced to know origin. Four women with metastasis in the lungs, liver and bones could only be given palliation. While vulvar cancer is uncommon, advanced disease at admission is a concern. Awareness is essential. Research is needed as to why cervical cancer is common and vulvar uncommon, as HPV plays a major aetiological role, so that cervical cancer can be prevented, with early diagnosis, management of vulvar cancer should also be available. PMID:24456439
Chhabra, S; Bhavani, M; Deshpande, A
Benign tumors and "dark lesions" accounted for 22% of vulvar disease seen in the Vulvar Clinic at the Milwaukee County Medical Complex over an 8-year period. Biopsy confirmation was obtained for 269 lesions. The order of frequency of lesions in this study was as follows: epidermal inclusion cyst, lentigo, Bartholin's duct obstruction, carcinoma in situ, melanocytic nevi, acrochordon, mucous cyst, hemangiomas, postinflammatory hyperpigmentation, seborrheic keratoses, varicosities, hidradenomas, verruca, basal cell carcinoma, and, last, unusual tumors such as neurofibromas, ectopic tissue, syringomas, and abscesses. The variability in clinical appearance of vulvar tumors suggests that biopsy confirmation should be obtained on all lesions for which there is the least doubt regarding the diagnosis. PMID:1318812
Hood, A F; Lumadue, J
Acquired Vulvar Lymphangioma Circumscriptum
Lymphangioma circumscriptum (LC) is a benign dilation of lymph channels localized to the skin and subcutaneous tissues. It is generally localized in mouth mucosa, tongue, proximal regions of arms and legs, groin, axilla, and trunk. Primary vulvar involvement is very rare. Vulvar involvement occurs in various clinical settings. Here, two uncommon cases with giant lymphangioma circumscriptum mimicking genital warts will be presented: a 55-year-old female patient with extensive lymphangiectasic lesions and genital wart-like papular lesions in the vulva secondary to diffuse scrofuloderma scars and a 60-year-old female patient with verruca-like lesions secondary to chronic inflammation.
Ucmak, Derya; Aytekin, Sema; Sula, Bilal; Akkurt, Zeynep Meltem; Turkcu, Gul; Agacayak, Elif
Angiogenesis in Vulvar Intraepithelial Neoplasia
Vulvar intraepithelial neoplasia (VIN) has been reported to be a precursor of invasive vulvar cancer. Switching to the angiogenic phenotype is considered a key step in tumor growth. Microvessel density (MVD) and vascular endothelial growth factor (VEGF), a highly angiogenic peptide, are important parameters of tumor angiogenesis. Forty-three histologic slides with 38 VIN I�III lesions were immunohistochemically stained for factor
Dagmar Bancher-Todesca; Andreas Obermair; Selcuk Bilgi; Petra Kohlberger; Christian Kainz; Gerhard Breitenecker; Sepp Leodolter; Gerald Gitsch
Vulvar vestibulitis syndrome: a review.
Vulvar vestibulitis syndrome (VVS) is a perplexing disease involving pain limited to the vulvar vestibule without objective clinical findings to explain the symptoms. The condition impairs sexual function and creates significant psychological distress. Its cause is unknown, and few randomized studies exist on the efficacy of interventions. This article reviews disease characteristics, possible etiologies, and approaches to management. PMID:15927350
Farage, Miranda A; Galask, Rudolf P
Pulmonary edema is an abnormal buildup of fluid in the air sacs of the lungs, which leads to ... Pulmonary edema is often caused by congestive heart failure . When the heart is not able to pump blood ...
... Race and Ethnicity, United States, 2004�2008 The graph above shows age-adjusted incidence rates for vulvar ... compared to 1.9 non-Hispanic women. This graph was adapted from Centers for Disease Control and ...
Bioimpedance Spectroscopy in Detecting Lower-Extremity Lymphedema in Patients With Stage I, Stage II, Stage III, or Stage IV Vulvar Cancer Undergoing Surgery and Lymphadenectomy
Lymphedema; Perioperative/Postoperative Complications; Stage IA Vulvar Cancer; Stage IB Vulvar Cancer; Stage II Vulvar Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVA Vulvar Cancer; Stage IVB Vulvar Cancer
Assessment of response to treatment in vulvar vestibulitis syndrome by means of the vulvar algesiometer
Objective: A pilot study was undertaken to investigate the utility of the vulvar algesiometer in correlating symptom improvement with treatment response. Study Design: Women with a diagnosis of vulvar vestibulitis syndrome attending a specialist vulvar clinic were assessed with the vulvar algesiometer before and after treatment. Results: The conditions of 25 patients had improved to the point of discharge, and
Lois J. Eva; Wendy M. N. Reid; Allan B. MacLean; George D. Morrison
Introduction Vulvar lipoma is a rare tumor localization and only a few cases have been reported. The clinical characteristics of vulvar lipoma are well known. However, it is important to distinguish lipomas from liposarcomas. We report a case of vulvar lipoma and discuss its clinical features, including diagnostic aspects, with emphasis on histopathological evaluation of all excised lesions. We also report and discuss patient management and treatment outcomes. Case presentation We report the case of a 27-year-old Moroccan woman. Our patient presented with a painless and slow-growing right vulvar mass that had evolved over one year, which had suddenly become uncomfortable when walking. A physical examination revealed a single soft and pasty mass in her left labium majus, which could be mobilized under her skin towards her mons pubis. The largest dimension of the mass measured 6cm. Magnetic resonance imaging showed a homogenous hyperintense mass with a well-defined contour in her left labium majus; a fat-suppressed magnetic resonance image demonstrated a marked signal intensity decrease. The mass was completely removed surgically. A histological examination revealed a circumscribed benign tumor composed of mature adipocytes, confirming the diagnosis of vulvar lipoma. Conclusion Vulvar lipomas must be differentiated from liposarcomas, which demonstrate very similar clinical and imaging profiles. The final diagnosis should be based on histopathological evaluation. A precise diagnosis should allow for appropriate surgical treatment.
Vulvar vestibulitis syndrome (VVS) is one of the most common causes of genital pain and pain with sexual intercourse, affecting up to 15% of women. The syndrome is characterized by severe pain on vestibular touch or attempted vaginal entry, exquisite tenderness to palpation with a cotton swab, and often subtle physical findings confined to vestibular erythema. The etiology of VVS is unknown. However, it is probably best to consider VVS as a chronic local inflammatory condition with a wide variety of etiologic causes. The heterogeneity of potential etiologies for VVS results in the use of multiple treatment regimens in clinical practice. Scientifically rigorous studies are sorely needed to determine the best treatment approach. PMID:17064641
Gardella, Carolyn
Monoclonal origin of vulvar intraepithelial neoplasia and some vulvar hyperplasias.
Squamous neoplasms of the female genital tract, including vulvar intraepithelial neoplasia, presumably are derived from a single cell. This study addressed this hypothesis and determined the clonal status of other squamous epithelial alterations associated with vulvar carcinoma, including hyperplasia and lichen sclerosis. X chromosome inactivation patterns of 22 epithelial lesions and matched normal epithelium were determined using a polymerase chain reaction (PCR)-based assay targeting the X-linked human androgen receptor gene (HUMARA). Clonality was inferred by comparing matched lesional and control tissues as follows: 1) monoclonal, if intensity of either PCR product was skewed relative to normal reference epithelium (control), 2) polyclonal, if both lesional and control were unskewed, and 3) unknown, if both lesion and control tissues were skewed toward the same allele. Two cases were excluded because of noninformative homozygous HUMARA alleles. Of 8 vulvar intraepithelial neoplasias analyzed, 7 were scored monoclonal and 1 polyclonal. Of 12 hyperplasias, 6 were monoclonal, including one with lichen sclerosis, 2 were polyclonal, and in 4, the clonal status could not be determined. The PCR-based clonal assay supports a monoclonal derivation for vulvar intraepithelial neoplasia and, in some cases, vulvar hyperplasia, and lichen sclerosis. The finding of monoclonal hyperplasia and lichen sclerosis suggests that clonal expansion may evolve before the development of morphological atypia in these epithelia. Images Figure 1 Figure 2
Tate, J. E.; Mutter, G. L.; Boynton, K. A.; Crum, C. P.
Psychological and psychosexual aspects of vulvar vestibulitis
AIMS: To objectively assess the psychological and psychosexual morbidity of patients with vulvar vestibulitis. METHODS: 30 patients with variable degrees of vulvar vestibulitis were recruited from a vulval clinic. Each patient underwent a detailed history and clinical examination. Friedrich's criteria were used for the diagnosis of vulvar vestibulitis. Standardised questionnaires to assess psychological and psychosexual function were completed by the
D Nunns; D Mandal
Estrogen receptor expression in vulvar vestibulitis syndrome
OBJECTIVE: A pilot study was performed to investigate the relationship between vulvar vestibulitis syndrome and estrogen receptor expression.STUDY DESIGN: Women with a diagnosis of vulvar vestibulitis syndrome had tissue samples taken for vulvar estrogen receptor-? expression and this was compared with a control group.RESULTS: The study group showed a significant decrease in estrogen receptor expression, and 50% of the samples
Lois J Eva; Allan B MacLean; Wendy M. N Reid; Kerstin J Rolfe; Christopher W Perrett
Review of squamous premalignant vulvar lesions.
Vulvar squamous cell carcinoma (SCC) develops following two different pathways, which have their own premalignant lesions. In the absence of human papilloma virus (HPV), vulvar SCC can develop in a background of lichen sclerosus (LS), differentiated vulvar intraepithelial neoplasia (VIN) or both. The other pathway leading to vulvar SCC is associated with HPV and the HPV-associated premalignancy is usual VIN. In this review we will discuss the history, epidemiology, aetiology, histology, clinical characteristics, treatment options, malignant potential and prevention strategies of the three squamous premalignant vulvar lesions. PMID:18406622
van de Nieuwenhof, H P; van der Avoort, I A M; de Hullu, J A
[Therapy of vulvar carcinoma].
Thirty-five of totally 50 patients with carcinoma vulvae were treated with bleomycin. Most of the patients were older people and had more advanced disease. They were grouped according to the TNM system and the age. Bleomycin alone (2 X 15 mg/m2 weekly; 390 and 420 mg total dose) was given to two patients. One of the patients had a complete remission and the other one a partial remission with reduction in tumor size of more than 50%. Nineteen patients received bleomycin (2 X 10 up to 2 X 15 mg/m2 weekly: 200-300 mg total dose) in combination with radiation therapy using fast electrons (betatron; 3000-5000 R). In this group 21,1% of the patients had complete remission and 31,5% of patients had a partial remission of more than 50% tumor size reduction (objective remission rate 52,6%). Bleomycin was also beneficial when combined with surgery plus irradiation. Palliative irradiation was used in four patients with a very advanced disease. Eleven patients were irradiated postoperatively with fast electrons (4000-6000 R). In this group, 65% of the patients were free from recurrences more than one year after the beginning of the treatment. Our results indicate that combined therapies using bleomycin, surgery and radiation therapy were more effective in the treatment of vulvar carcinoma than single treatments alone. It should be emphasized that bleomycin is effective as a palliative treatment of squamous cell carcinoma of the vulva. PMID:59432
Marici?, Z; Kolari?, K; Krusi?, J
Granular cell tumors are rare, usually benign, soft tissue neoplasms of neural origin. They occur more often in females than males, the peak age incidence is in the fourth through fifth decades. They can occur anywhere in the body with up to 15% situated in the vulva. The commonest presentation is as an asymptomatic mass. Microscopic findings are usually sufficient, but immunohistochemistry can also be helpful in confirming the diagnosis. The vulvar tumors are benign in 98% of cases with 2% reported as malignant. In this case report we describe a woman with a granular cell tumor confirmed by biopsy who underwent excision of the mass but with focal extension to the resection margin on microscopy. Our recommendation of re-excision was declined. Since it is not uncommon with these tumors to find groups of tumor cells extending beyond the macroscopic limits of growth, we conclude that it is advisable to have margins assessed intraoperatively by frozen section such that further excision can be performed for positive margins. Our patient has been followed for 18 mo without recurrence, should the tumor recur, re-excision, with frozen section control, is indicated. Recurrence rates are reported as 2%-8% with clear margins and 20% with positive margins. PMID:24303488
Rivlin, Michel E; Meeks, G Rodney; Ghafar, Mohamed A; Lewin, Jack R
Granular cell tumors are rare, usually benign, soft tissue neoplasms of neural origin. They occur more often in females than males, the peak age incidence is in the fourth through fifth decades. They can occur anywhere in the body with up to 15% situated in the vulva. The commonest presentation is as an asymptomatic mass. Microscopic findings are usually sufficient, but immunohistochemistry can also be helpful in confirming the diagnosis. The vulvar tumors are benign in 98% of cases with 2% reported as malignant. In this case report we describe a woman with a granular cell tumor confirmed by biopsy who underwent excision of the mass but with focal extension to the resection margin on microscopy. Our recommendation of re-excision was declined. Since it is not uncommon with these tumors to find groups of tumor cells extending beyond the macroscopic limits of growth, we conclude that it is advisable to have margins assessed intraoperatively by frozen section such that further excision can be performed for positive margins. Our patient has been followed for 18 mo without recurrence, should the tumor recur, re-excision, with frozen section control, is indicated. Recurrence rates are reported as 2%-8% with clear margins and 20% with positive margins.
Rivlin, Michel E; Meeks, G Rodney; Ghafar, Mohamed A; Lewin, Jack R
Simplified surgical revision of the vulvar vestibule for vulvar vestibulitis
OBJECTIVE: The prototype of surgical treatment for vulvar vestibulitis has been the Woodruff vulvoplasty. A simpler surgery could be less morbid, technically easier, and equally effective. STUDY DESIGN: Twelve patients underwent vestibular revision, nine with local anesthesia. They were followed up for between 6 months and 6 years. Outcome was judged by ease of healing and relief of tenderness. This
Martha F. Goetsch
What Are the Key Statistics about Vulvar Cancer?
... factors for vulvar cancer? What are the key statistics about vulvar cancer? In the United States, vulvar ... Symptoms of Cancer Treatments & Side Effects Cancer Facts & Statistics News About Cancer Expert Voices Blog Programs & Services ...
Serum Concentrations of Tissue Polypeptide Antigen in Patients with Vulvar Intraepithelial Neoplasia and Vulvar Cancer
The aim of the present study was to evaluate the clinical usefulness of the cytokeratin tumor marker tissue polypeptide antigen (TPA) in patients with vulvar cancer. This retrospective study comprises 41 patients with vulvar cancer FIGO stages I�III, 17 patients with vulvar intraepithelial neoplasia (VIN) III, and 40 healthy female controls. Serum concentrations of TPA were measured using a microparticle
Lukas Hefler; Clemens Tempfer; Katrin Frischmuth; Georg Maenner; Nicole Concin; Gerhard Sliutz; Alexander Reinthaller; Sepp Leodolter; Christian Kainz
Lymphedema After Surgery in Patients With Endometrial Cancer, Cervical Cancer, or Vulvar Cancer
Lymphedema; Stage IA Cervical Cancer; Stage IA Endometrial Carcinoma; Stage IA Vulvar Cancer; Stage IB Cervical Cancer; Stage IB Endometrial Carcinoma; Stage IB Vulvar Cancer; Stage II Endometrial Carcinoma; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVB Vulvar Cancer
Vulvar malignancy in neurofibromatosis syndrome.
Type 1 neurofibromatosis (NF1) is a dominantly inherited neurologic disorder that affects primarily the skin, bones, and peripheral nervous system. It may be associated with a variety of clinical manifestations including cafe-au-lait spots, skinfold freckling, Lisch nodules, and visceral neurofibromas. Individuals affected by NF1 harbor an increased risk for both benign and malignant tumors. Malignant transformation is usually observed in the form of neurosarcoma. Rarely, NF1 affects the genital tract, and isolated vulvar localization is extremely rare. Here is reported a rare case of a solitary neurosarcoma of the vulva in a 43-year-old woman affected by NF1 syndrome treated with surgical excision. The purpose of this case is to underline the possibility of association between NF1 and genital tract sarcoma and to suggest an accurate evaluation of rapid growth vulvar mass in this setting. PMID:24167749
Musella, Angela; Palaia, Innocenza; Domenici, Lavinia; Casorelli, Assunta; Martoccia, Angela; Benedetti Panici, Pierluigi
The role of angiogenesis in vulvar cancer, vulvar intraepithelial neoplasia, and vulvar lichen sclerosus as determined by microvessel density analysis
ObjectivesWe compared microvessel density (MVD) in normal, benign, preneoplastic, and neoplastic (squamous cell carcinoma (SCC)) vulvar disease to ascertain if this parameter could identify cases with lichen sclerosus (LS) and high-grade vulvar intraepithelial neoplasia (VIN3) at risk of developing malignancy.
Jamna Saravanamuthu; Wendy M. N Reid; David S. t George; Julie C Crow; Kerstin J Rolfe; Allan B MacLean; Christopher W Perrett
Therapy for Primary Vulvar Carcinoma
The rather rare vulvar cancer is almost always a squamous cell carcinoma that mostly develops from an underlying VIN or HPV infection. In addition, lichen sclerosus et atrophicans, immune deficiency, nicotine abuse or anogenital intraepithelial neoplasias may play a role in the pathogenesis. Surgical therapy aims at an R0 resection in the sense of a complete vulvectomy or a radical local excision with, if necessary, plastic reconstruction. Also, the vulvar field resection with consideration of the compartment model has been discussed. Besides the classic inguinofemoral lymphadenectomy, in selected cases of vulvar cancer sentinel biopsies are performed by experienced surgeons in the larger centres. In contrast, systemic therapy plays only a subordinate role; in isolated cases down-staging by means of neoadjuvant chemotherapy may be useful. However, there is at present no indication for adjuvant chemotherapy. Neoadjuvant radiochemotherapy is also not to be recommended on account of its unfavourable ratio of efficacy to side effects. On the other hand adjuvant radiotherapy is indicated in cases of positive inguinal lymph nodes. According to the current data the indication should be made generously in such cases.
Herr, D.; Juhasz-Boess, I.; Solomayer, E. F.
Human papillomavirus distribution in vulvar intraepithelial neoplasia.
This pilot study investigated the prevalence and distribution of human papillomavirus (HPV) type in vulvar lesions in women with a history of vulvar intraepithelial neoplasia. Fifty-two specimens were collected. Uncommon HPV subtypes were found among the specimens, which may have implications for HPV vaccination coverage. PMID:22300742
Likes, Wendy; Bloom, Leonard
Vulvar Vestibulitis Syndrome: A Clinical Approach
Vulvar vestibulitis syndrome (VVS) is a heterogeneous, multisystemic, and multifactorial disease and is one of the leading causes of dyspareunia in fertile women. As a multisystemic disease, it involves the mucous structure of the vulvar vestibule and the immune, muscular, vascular, and nervous systems, including pain fibers and centers. As a multifactorial disease, its etiology is complex, involving biological, psychosexual,
Vulvar vestibulitis treated by modified vestibulectomy
Objective: A prospective study to evaluate the success of a modified vestibulectomy in treating vulvar vestibulitis. Methods: Fifty seven consecutive women with vulvar vestibulitis and suitable for surgery based on the criteria: superficial dyspareunia, erythematous vestibular region, positive Q-tip test, symptoms reduced with local anesthetic cream. A modified vestibulectomy with or without a modified Fentons procedure was performed. Response was
Sean Kehoe; David Luesley
Differentiated vulvar intraepithelial neoplasia contains Tp53 mutations and is genetically linked to vulvar squamous cell carcinoma
Differentiated vulvar intraepithelial neoplasia is a unique precursor to vulvar squamous cell carcinoma that is typically HPV-negative and frequently associated with nuclear p53 staining. These features imply a mode of pathogenesis involving somatic mutations. However, the genetic relationship of differentiated vulvar intraepithelial neoplasm and vulvar squamous cell carcinoma and the role of Tp53 mutations in this process have not been
Alvaro P Pinto; Alexander Miron; Yosuf Yassin; Nicolas Monte; Terri Y C Woo; Karishma K Mehra; Fabiola Medeiros; Christopher P Crum
Imiquimod May Help to Prevent Vulvar Cancer
Women with a precancerous condition called vulvar intraepithelial neoplasia (VIN) were successfully treated with imiquimod (Aldara�), a cream that caused less discomfort and pain than standard surgical treatments, according to the April 3, 2008, New England Journal of Medicine.
Treatment Options by Stage (Vulvar Cancer)
... Vulvar cancer is a rare disease in which malignant (cancer) cells form in the tissues of the ... positron emission tomography scan) : A procedure to find malignant tumor cells in the body. A small amount ...
Symptoms of Vaginal and Vulvar Cancers
... Announcements Radio Public Service Announcements Print Materials Campaign Research Doctors Who Use Social Media Poster Presentation Buttons and Badges Related Resources Gynecologic Cancer Symptoms Diary [PDF-503KB] Vaginal and Vulvar Cancer fact sheet [ ...
Vulvar Intraepithelial Neoplasia: New concepts and strategy
Vulvar intraepithelial neoplasia (VIN) is a rare condition which can develop into an invasive\\u000acarcinoma. This skin-disease affects mainly young women, and causes many severe and\\u000along-lasting symptoms such as pruritus, vulvodynia and psychosexual dysfunction. Over\\u000a80% of VIN-affected women present with multifocal vulvar disease, and often neoplastic\\u000achanges can be found in the entire lower genital tract. Clinically, it
Seters van M
Optical coherence tomography in vulvar intraepithelial neoplasia
NASA Astrophysics Data System (ADS)
Vulvar squamous cell carcinoma (VSCC) is a gynecological cancer with an incidence of two to three per 100,000 women. VSCC arises from vulvar intraepithelial neoplasia (VIN), which is diagnosed through painful punch biopsy. In this study, optical coherence tomography (OCT) is used to differentiate between normal and VIN tissue. We hypothesize that (a) epidermal layer thickness measured in OCT images is different in normal tissue and VIN, and (b) quantitative analysis of the attenuation coefficient (?oct) extracted from OCT data differentiates VIN from normal vulvar tissue. Twenty lesions from 16 patients are imaged with OCT. Directly after data acquisition, a biopsy is performed. Epidermal thickness is measured and values of ?oct are extracted from 200 OCT scans of normal and VIN tissue. For both methods, statistical analysis is performed using Paired Mann-Whitney-test. Correlation between the two methods is tested using a Spearman-correlation test. Both epidermal layer thickness as well as the ?oct are different between normal vulvar tissue and VIN lesions (p<0.0001). Moreover, no correlation is found between the epidermal layer thickness and ?oct. This study demonstrates that both the epidermal thickness and the attenuation coefficient of vulvar epithelial tissue containing VIN are different from that of normal vulvar tissue.
Wessels, Ronni; de Bruin, Daniel M.; Faber, Dirk J.; van Boven, Hester H.; Vincent, Andrew D.; van Leeuwen, Ton G.; van Beurden, Marc; Ruers, Theo J. M.
Optical coherence tomography in vulvar intraepithelial neoplasia.
Vulvar squamous cell carcinoma (VSCC) is a gynecological cancer with an incidence of two to three per 100,000 women. VSCC arises from vulvar intraepithelial neoplasia (VIN), which is diagnosed through painful punch biopsy. In this study, optical coherence tomography (OCT) is used to differentiate between normal and VIN tissue. We hypothesize that (a) epidermal layer thickness measured in OCT images is different in normal tissue and VIN, and (b) quantitative analysis of the attenuation coefficient (?oct) extracted from OCT data differentiates VIN from normal vulvar tissue. Twenty lesions from 16 patients are imaged with OCT. Directly after data acquisition, a biopsy is performed. Epidermal thickness is measured and values of ?oct are extracted from 200 OCT scans of normal and VIN tissue. For both methods, statistical analysis is performed using Paired Mann-Whitney-test. Correlation between the two methods is tested using a Spearman-correlation test. Both epidermal layer thickness as well as the ?oct are different between normal vulvar tissue and VIN lesions (p < 0.0001). Moreover, no correlation is found between the epidermal layer thickness and ?oct. This study demonstrates that both the epidermal thickness and the attenuation coefficient of vulvar epithelial tissue containing VIN are different from that of normal vulvar tissue. PMID:23214182
Wessels, Ronni; de Bruin, Daniel M; Faber, Dirk J; van Boven, Hester H; Vincent, Andrew D; van Leeuwen, Ton G; van Beurden, Marc; Ruers, Theo J M
What Are the Risk Factors for Vulvar Cancer?
... invasive vulvar cancer average about 20 years younger. Human papilloma virus Human papilloma virus (HPV) is a ... risk of developing vulvar cancer if they smoke. Human immunodeficiency virus Human immunodeficiency virus (HIV) causes the ...
The diagnosis and Treatment of Vulvar Vestibulitis: A Literature Review
Context Vulvar vestibulitis is a characterized by persistent itching, burning, and vulvar pain that appears to be more prevalent in young females today. In light of the accelerated prevalence of this condition, there is a serious need for a better understanding of this condition since evidence suggests, although not life-threatening, vulvar vestibulitis appears to have a significant impact on quality
Kimberly Nischik
Patients with usual vulvar intraepithelial neoplasia-related vulvar cancer have an increased risk of cervical abnormalities
Background:Vulvar squamous cell carcinoma (SCC) originates the following two pathways, related to differentiated (d) vulvar intraepithelial neoplasia (VIN) or to human papillomavirus (HPV)-related usual (u) VIN. Multicentric HPV infections (cervix, vagina and vulva) are common. We hypothesise that patients with a uVIN-related vulvar SCC more often have cervical high-grade squamous intraepithelial lesions (HSILs) compared with women with dVIN-related vulvar SCC.Methods:All
R. P. de Bie; H. P. van de Nieuwenhof; R. L. M. Bekkers; W. J. G. Melchers; A. G. Siebers; J. Bulten; L. F. A. G. Massuger; J. A. de Hullu; RP de Bie
Expression of Ki67 in Vulvar Carcinoma and Vulvar Intraepithelial Neoplasia III: Correlation with Clinical Prognostic Factors
Objectives. In vulvar carcinoma, the expression of Ki-67 has been previously found to correlate with patient outcome. The objective of the study was to determine whether a specific pattern of expression was associated with occult vulvar cancer in patients with vulvar intraepithelial neoplasia (VIN) III and whether patterns of Ki-67 expression correlated with other clinical prognostic factors.Methods. 19 women with
Susan C. Modesitt; Pamela A. Groben; Leslie A. Walton; Wesley C. Fowler; Linda Van Le
A cluster of vulvar cancer and vulvar intraepithelial neoplasia in young Australian Indigenous women
Objective��To describe the epidemiological features of a possible disease cluster of vulvar cancer and pre-cancers in Australian Indigenous\\u000a women living in the Northern Territory (NT) of Australia.\\u000a \\u000a \\u000a \\u000a Methods��We identified NT-resident women with a confirmed histological diagnosis of vulvar cancer or high-grade vulvar intraepithelial\\u000a neoplasia (VIN) between 1 January 1996 and 31 December 2005.\\u000a \\u000a \\u000a \\u000a Results��Seventy-one women were identified; 32 diagnosed with
John R. Condon; Alice R. Rumbold; Jane C. Thorn; Margaret M. O�Brien; Margaret J. Davy; Ibrahim Zardawi
Subunit Principle of Vulvar Reconstruction: Algorithm and Outcomes
Background Vulvar defects result chiefly from oncologic resection of vulvar tumors. Reconstruction of vulvar defects restores form and function for the purpose of coitus, micturition, and defecation. Many surgical options exist for vulvar reconstruction. The purpose of this article is to present our experience with vulvar reconstruction. Methods From 2007 to 2013, 43 women presented to us with vulvar defects for reconstruction. Their mean age at the time of reconstruction was 61.1 years. The most common cause of vulvar defect was from resection of vulvar carcinoma and extramammary Paget's disease of the vulva. Method s of reconstruction ranged from primary closure to skin grafting to the use of pedicled flaps. Results The main complications were that of long term hypertrophic and/or unaesthetic scarring of the donor site in 4 patients. Twenty-two patients (51%) were able to resume sexual intercourse. There were no complications of flap loss, wound dehiscence, and urethral stenosis. Conclusions We present a subunit algorithmic approach to vulvar reconstruction based on defect location within the vulva, dimension of the defect, and patient age and comorbidity. The gracilis and gluteal fold flaps are particularly versatile and aesthetically suited for reconstruction of a variety of vulvar defects. From an aesthetic viewpoint the gluteal fold flap was superior because of the well-concealed donor scar. We advocate the routine use of these 2 flaps for vulvar reconstruction.
Kang, Gavin Chun-Wui; Tay, Eng Hseon; Por, Yong Chen
Superimposed MRSA infection of vulvar eczematous dermatitis
Background Vulvar eczematous dermatitis predisposes patients to superimposed infections, which may result in late diagnosis and architectural destruction. Methicillin resistant staphylococcus aureus (MRSA) infection is on the rise in genitalia and lower extremities. Case 44 year-old female presented with recurrent vulvar lesions and pain. A diagnosis of methicillin resistant staphylococcus aureus in the setting of eczema was achieved with concomitant use of photography and dermatopathologic review. Antibiotics were tailored to the resistant infection and preventative moisturization therapy was utilized. Conclusion Awareness of dermatologic conditions affecting the vulva is principal in routine gynecologic care. Barrier protection of eczematous vulvar skin may prevent superficial infections. The regular use of photographic documentation and dermatopathology may decrease time to diagnosis with infrequent conditions.
Carey, Erin; Zedek, Daniel; Lewis, Jasmine; Zolnoun, Denniz
[Epidemiology of vulvar intra-epithelial neoplasias].
The vulvar intraepithelial neoplasia has been identified as one of the 12 neoplasias whose incidence increases in the developed countries. The vulvar intraepithelial neoplasia (VIN) and invasive vulvar cancer incidence increases by 2.4% per annum; and this principally in young women. The VIN account for 57% of the vulvar neoplasias and are actually more frequent than invasive carcinomas. In the United States, between 1973 and 2000, the incidence of the VIN increased by 411% against 20% for invasive cancers. Similar figures were reported from Norwegian registers. The VIN have a different age distribution than invasive cancers: the incidence of the VIN increases until the age of 40-49 years then decreases while the incidence of invasive cancers increases after 50 years without real peak of incidence. The increase in the incidence of VIN could be followed by an increase in the incidence of invasive cancers but the unknowns on the natural history of the VIN and the impact of the treatments make any extrapolation hazardous. The association between the VIN and the human papillomavirus (HPV) has been well established. It should be noted that, contrary to the cervical neoplasia that are related for nearly 100% to the HPV, only 30-40% of invasive cancers of the vulva are related to HPV, while the other carcinomas are related to the evolution of a vulvar lichen sclerous. The HPV induce various types of anogenital lesion according to their genotype. These lesions can be benign for the HPV6 and 11 and preneoplastic or neoplastic for the HPV16 and 18. The presence of HPV16 and 18 is found in 70 to 80% of the VIN suggesting that HPV vaccines could decrease the incidence VIN and HPV related invasive vulvar cancer. PMID:18054264
Akerman, G; Dussour, C; Haddad, B; Paniel, B-J; Rouzier, R
Cilnidipine induced ankle edema
Cilnidipine is a 4th generation dihydropyridine calcium channel blocker approved recently for the treatment of essential hypertension. It is not known to present with ankle edema like amlodipine. Moreover, it has been proposed as an alternative anti-hypertensive for patients with amlodipine-induced edema. We report a case of cilnidipine induced ankle edema.
Annil, Vishal R.; Mahajan, Annil; Mahajan, Vivek; Khajuria, Vijay; Gillani, Zahid
Background: Cerebral edema is a potentially devastating compli- cation of various acute neurologic disorders. Its successful treatment may save lives and preserve neurologic function. Review Summary: Different pathophysiological mechanisms are responsible for the formation of cytotoxic and vasogenic edema. Yet, these 2 types of edema often coexist and their treatment tends to overlap, with the exception of corticosteroids, which should
Alejandro A. Rabinstein
Cilnidipine induced ankle edema.
Cilnidipine is a 4(th) generation dihydropyridine calcium channel blocker approved recently for the treatment of essential hypertension. It is not known to present with ankle edema like amlodipine. Moreover, it has been proposed as an alternative anti-hypertensive for patients with amlodipine-induced edema. We report a case of cilnidipine induced ankle edema. PMID:24987189
Annil, Vishal R; Mahajan, Annil; Mahajan, Vivek; Khajuria, Vijay; Gillani, Zahid
Premalignant epithelial disorders of the vulva: squamous vulvar intraepithelial neoplasia, vulvar Paget's disease and melanoma in situ.
No standard screening programs exist to detect vulvar carcinoma or its precursor lesions, and therefore gynecologists, dermatologists and other healthcare providers in this field should be aware of the clinical features, behavior and management of the different existing premalignant vulvar lesions, squamous vulvar intraepithelial neoplasia (VIN), vulvar Paget's disease and melanoma in situ. In 2004, a new classification for squamous VIN was introduced by the International Society for the Study of Vulvar Disease, subdividing squamous VIN into the HPV-related usual type, and into differentiated type, which is associated with lichen sclerosus. This review describes the relevant aspects of squamous VIN, vulvar Paget's disease and melanoma in situ, its epidemiological characteristics, diagnosis, management and malignant potential. PMID:20504079
Terlou, Annelinde; Blok, Leen J; Helmerhorst, Theo J M; van Beurden, Marc
Surgical treatment of vulvar vestibulitis: a review.
Vulvar vestibulitis syndrome, a subset of vulvodynia, is a complex pain syndrome. It causes severe dyspareunia and affects mainly young women. The etiology is unknown and no uniformly effective treatment exists. Surgery has been considered as 'the last resort' in the management of patients not responding to conservative treatment modalities. For this review, all studies of surgical treatment of vulvar vestibulitis were evaluated. We describe the evolution of vestibulectomy techniques through the years. Our aim was also to find out whether any surgical technique is better than others providing better patient satisfaction and lower complication rates. We conclude that surgical technique as such plays a relatively small role. Surgery seems to be effective. However, lack of randomized trials and insufficient data on complication rates must be emphasized. PMID:20955094
Tommola, P�ivi; Unkila-Kallio, Leila; Paavonen, Jorma
This chapter provides the reader with practical information to be applied to the various remaining causes of macular edema. Some clinical cases of macular edema linked to ocular diseases like postradiotherapy for ocular melanomas remained of poor functional prognosis due to the primary disease. On the contrary, macular edema occurring after retinal detachment or after diverse systemic or local treatment use is often temporary. Macular edema associated with epiretinal membranes or vitreomacular traction is the main cause of poor functional recovery. In other cases, as in tractional myopic vitreoschisis, the delay to observe a significant improvement of the vision after surgery should be long. Finally, macular edema associated with hemangiomas or macroaneurysms should be treated, if symptomatic, using the same current treatment as in diabetic macular edema or exudative macular degeneration. PMID:20703051
Creuzot-Garcher, Catherine; Wolf, Sebastian
This article provides the reader with practical information to be applied to the various remaining causes of macular edema. Some macular edemas linked to ocular diseases like radiotherapy after ocular melanomas remained of poor functional prognosis due to the primary disease. On the contrary, macular edemas occurring after retinal detachment or after some systemic or local treatment use are often temporary. Macular edema associated with epiretinal membranes or vitreomacular traction is the main cause of poor functional recovery. However, the delay to observe a significant improvement of vision after surgery should be long, as usually observed in tractional myopic vitreoschisis. Finally, some circumstances of macular edemas such as hemangiomas or macroaneurysms should be treated, if symptomatic, with the treatments currently used in diabetic macular edema or exudative macular degeneration. PMID:23264332
Creuzot-Garcher, Catherine; Jonas, Jost; Wolf, Sebastian
Treatment of vulvar intraepithelial neoplasia with topical imiquimod
Background: Alternatives to surgery are needed for the treatment of vulvar intraepithelial neoplasia. We investigated the effectiveness of imiquimod 5% cream, a topical immuneresponse modulator, for the treatment of this condition. Methods: Fifty-two patients with grade 2 or 3 vulvar intraepithelial neoplasia were randomly assigned to receive either imiquimod or placebo, applied twice weekly for 16 weeks. The primary outcome
Manon van Seters; Marc van Beurden; Kate ten F. J. W; Ilse Beckmann; M. J. C. Eijkemans; C. J. M. Meijer; N. K. Aaronson; K. Aaronson; C. Heijmans-Antonissen; Freek J. Zijlstra; T. J. M. Helmerhorst
Vulvar intraepithelial neoplasia and microinvasive carcinoma of the vulva
The pathological, cytological, and clinical features of vulvar intraepithelial neoplasia (VIN) are described. The rate of progression of VIN III to an invasive carcinoma is very low and spontaneous regression can occur. These features prevent the drawing of a direct analogy between vulvar and cervical intraepithelial neoplasia. The concept of microinvasive carcinoma of the vulva is discussed, and it is
C H Buckley; E B Butler; H Fox
Potential Applications of Intraoperative Lymphatic Mapping in Vulvar Cancer
Objective: We describe early results of and potentially important anatomic findings with intraoperative lymphatic mapping in patients with vulvar cancer. Methods: Isosulfan blue was injected into the dermis at the leading edge of the vulvar lesion in 21 patients. One to five minutes later a standard groin incision was made and carried to the superficial fascia. After gentle dissection, the
Increased Intraepithelial Innervation in Women with Vulvar Vestibulitis Syndrome
Women with vulvar vestibulitis syndrome (VVS) suffer from severe pain and discomfort in the area around the introitus at almost any stimulus that causes pressure within the vestibule. In spite of the severe sensory symptoms present in these women, the influence of the peripheral nerves in the vulvar vestibulum has not been clarified before. In this study the nerve supply
Nina Bohm-Starke; Marita Hilliges; Christian Falconer; Eva Rylander
A deficiency in interferon-? production in women with vulvar vestibulitis
OBJECTIVE: Previous studies have suggested that interferon-? may be an effective treatment for some women with vulvar vestibulitis. We evaluated whether women with this syndrome had a deficiency in endogenous and induced interferon-? production. STUDY DESIGN: Blood was collected in heparinized tubes from 62 women with vulvar vestibulitis and 47 control women of similar age and ethnicity. Whole blood cultures
Stefan Gerber; Ann Marie Bongiovanni; William J. Ledger; Steven S. Witkin
Acupuncture for the treatment of vulvar vestibulitis: A pilot study
Background. The study was conducted to obtain a preliminary indication of the effectiveness of acupuncture in the treatment of vulvar vestibulitis but also to obtain information how well the women tolerate the treatment. Methods. Fourteen young women with vulvar vestibulitis according to Friedrich's criteria were enrolled in the study and 13 fulfilled the acupuncture treatment a total of 10 times.
A New Instrument for Pain Assessment in Vulvar Vestibulitis Syndrome
Vulvar vestibulitis syndrome (VVS) is a common form of dyspareunia in premenopausal women. The standard test for diagnosing VVS is the cotton-swab test, during which a cotton-swab is applied to various locations of the vulvar vestibule. However, there is much variation in the implementation of this test relating to the precise vestibular locations palpated, the order of palpation, and the
Interleukin1? gene polymorphism in women with vulvar vestibulitis syndrome
Objective: The pathogenesis of vulvar vestibulitis syndrome remains unknown but may be related to a localized chronic inflammation. The relation between this syndrome and a polymorphism at position +3953 in the interleukin-1? gene was examined. Allele 2 of this gene has been associated with increased pro-inflammatory immunity. Study design: Buccal or vestibular swabs from 59 women with strictly defined vulvar
Stefan Gerber; Ann Marie Bongiovanni; William J. Ledger; Steven S. Witkin
Differential characterization of women with vulvar vestibulitis syndrome
Objective: We differentiated women with vulvar vestibulitis syndrome into subgroups on the basis of the time of symptom onset, a history of recurrent vulvovaginal candidiasis, and the interleukin-1 receptor antagonist gene polymorphism. Study Design: One hundred sixty-two consecutive patients with strictly defined vulvar vestibulitis syndrome were asked to fill out a questionnaire with the assistance of their gynecologist. A buccal
Steven S. Witkin; Stefan Gerber; William J. Ledger
Evaluation of the surgical treatment of vulvar vestibulitis
Objective: To assess the efficacy of perineoplasty in the management of vulvar vestibulitis. Study design: Forty-two women who had undergone operative perineoplasty for the treatment of vulvar vestibulitis completed a questionnaire, a mean of 4.8 years postoperatively. Results: Vulvodynia was constant or daily in 29 (69%) before surgery and in eight (19%) of respondents after surgery. In all, 27 (80%)
William M. McCormack; Michael R. Spence
Pathophysiology of Macular Edema
Macular edema is defined as an accumulation of fluid in the outer plexiform layer and the inner nuclear layer as well as a swelling of M�ller cells of the retina. It consists of a localized expansion of the retinal extracellular space (sometimes associated with the intracellular space) in the macular area. Macular edema is a common cause of a sudden
Stefan Scholl; Janna Kirchhof; Albert J. Augustin
Hackett, Peter H., and Robert C. Roach. High altitude cerebral edema. High Alt. Med. Biol. 5:136-146, 2004.�This review focuses on the epidemiology, clinical description, pathophysiol- ogy, treatment, and prevention of high altitude cerebral edema (HACE). HACE is an uncom- mon and sometimes fatal complication of traveling too high, too fast to high altitudes. HACE is distinguished by disturbances of consciousness
Peter H. Hackett; Robert C. Roach
Cerebral edema complicating eclampsia
Objective: This study was undertaken to describe and correlate clinical findings with computed tomographic and magnetic resonance imaging scan results in 10 women with eclampsia and widespread cerebral edema. Study Design: This was a clinical descriptive study of 10 women with eclampsia and symptomatic cerebral edema who were encountered at Parkland Hospital from 1986 through 1998. During this 13-year period
F. Gary Cunningham; Diane Twickler
High Altitude Pulmonary Edema.
National Technical Information Service (NTIS)
A centrineurogenic etiology for the pulmonary changes of 'High Altitude Pulmonary Edema' (HAPE) has been established. Respiratory hypoxia leads to the pathological pulmonary complex in unprotected beagles. These pulmonary changes are induced by isolated c...
G. Moss
Brain edema leading to an expansion of brain volume has a crucial impact on morbidity and mortality following traumatic brain injury (TBI) as it increases intracranial pressure, impairs cerebral perfusion and oxygenation, and contributes to additional ischemic injuries.Classically, two major types of traumatic brain edema exist: �vasogenic� due to blood�brain barrier (BBB) disruption resulting in extracellular water accumulation and �cytotoxic\\/cellular�
A. W. Unterberg; J. Stover; B. Kress; K. L. Kiening
Edema: diagnosis and management.
Edema is an accumulation of fluid in the interstitial space that occurs as the capillary filtration exceeds the limits of lymphatic drainage, producing noticeable clinical signs and symptoms. The rapid development of generalized pitting edema associated with systemic disease requires timely diagnosis and management. The chronic accumulation of edema in one or both lower extremities often indicates venous insufficiency, especially in the presence of dependent edema and hemosiderin deposition. Skin care is crucial in preventing skin breakdown and venous ulcers. Eczematous (stasis) dermatitis can be managed with emollients and topical steroid creams. Patients who have had deep venous thrombosis should wear compression stockings to prevent postthrombotic syndrome. If clinical suspicion for deep venous thrombosis remains high after negative results are noted on duplex ultrasonography, further investigation may include magnetic resonance venography to rule out pelvic or thigh proximal venous thrombosis or compression. Obstructive sleep apnea may cause bilateral leg edema even in the absence of pulmonary hypertension. Brawny, nonpitting skin with edema characterizes lymphedema, which can present in one or both lower extremities. Possible secondary causes of lymphedema include tumor, trauma, previous pelvic surgery, inguinal lymphadenectomy, and previous radiation therapy. Use of pneumatic compression devices or compression stockings may be helpful in these cases. PMID:23939641
Trayes, Kathryn P; Studdiford, James S; Pickle, Sarah; Tully, Amber S
Vulvar hematoma following a transobturator sling (TVT-O)
The potential complications from pubovaginal slings are felt to be minimized by the transobturator techniques. Reported is a patient who underwent a tension-free vaginal tape obturator (inside-to-out) procedure and who developed a vulvar hematoma.
Stephen R. Richards; Steven P. Balaloski
Medical and surgical approaches to vulvar intraepithelial neoplasia.
Vulvar intraepithelial neoplasia (VIN) is a precursor to invasive vulvar carcinoma. The two major types of VIN, usual and differentiated, differ in epidemiology, pathogenesis, clinical manifestations, pathology, and malignant potential. Usual VIN commonly occurs in younger women. It is associated with human papillomavirus and tends to have multifocal and multicentric involvement. Differentiated VIN is frequently associated with benign vulvar dermatoses such as lichen sclerosus and lichen simplex chronicus. It occurs in older women and typically is unifocal and unicentric. Clinicians must have a high suspicion for VIN, which is diagnosed by biopsy. Surgical excision has been the standard treatment in order to prevent progression to invasive disease. The objectives of treatment have expanded to include preservation of normal vulvar function and anatomy. Therefore, management options are being investigated, including topical therapy, laser excision and vaporization, and photodynamic therapy. All can be effective in both eliminating disease and maintaining relatively normal-appearing and functioning anatomy. PMID:20868402
Lai, Kimberly W; Mercurio, Mary Gail
The vulvar epithelium differs from the skin: implications for cutaneous testing to address topical vulvar exposures.
Vulvar tissue is more permeable than exposed skin due to differences in structure, occlusion, hydration and susceptibility to friction. The safety assessment of products that contact the vulva should account for this potentially heightened permeability. Standard clinical patch tests may not sufficiently mimic vulvar exposures. Because testing on the vulva is not routinely feasible, we are investigating new and modified cutaneous test methods to increase the degree of conservatism of the safety assessment. To this end, we have 1) developed a method to assess chemical and frictional effects by means of repeated application to the popliteal fossa (the behind-the-knee test); 2) modified the quantitative risk assessment for the induction of allergic contact dermatitis; and 3) proposed a modified human repeat insult patch test for assessing materials intended for vulvar contact. Modification of the traditional 4-day, irritation patch test by using wet samples or compromized skin sites failed to enhance test sensitivity. Future studies will evaluate testing in subjects with heightened susceptibility to chemical and sensory irritation, in order to increase test sensitivity to chemical irritants. These approaches can be employed to augment the margin of safety when cutaneous test methods are applied to agents that contact the vulva. PMID:15500670
Farage, Miranda; Maibach, Howard I
Vestibular Nerve Fiber Proliferation in Vulvar Vestibulitis Syndrome
Objective: To evaluate nerve fiber density in vestibular specimens from women operated upon for vulvar vestibulitis.Methods: Forty-seven women with vulvar vestibulitis syndrome underwent modified posterior vestibulectomies. Vestibular specimens were analyzed after being stained for S-100 neural tissue protein. Women were followed up for 2 years.Results: In specimens from 44 of 47 patients, the densities and numbers of nerve fibers per
Lars V Westr�m; Roger Will�n
Surgical therapy of vulvar cancer in pregnancy.
Squamous cell cancer of the vulva diagnosed and surgically treated during pregnancy is a rare event. Only a few cases have been described until the present. We report two additional women with Stage II and III disease. The first patient, who had a 5 x 2-cm ulcerated lesion under the clitoris was treated by radical anterior vulvectomy and bilateral groin dissection when 22 weeks pregnant. She had an uneventful pregnancy, was delivered by cesarean section, and is free of disease 39 months after initial surgery. The second patient, who had multifocal lesions with a maximal depth of 1.9 mm of tumor invasion underwent modified radical vulvectomy with bilateral groin dissection when 17 weeks pregnant. Because of a grossly positive groin lymph node, she underwent radiation therapy after cesarean section. She is alive without invasive cancer 28 months after diagnosis. Early histological diagnosis and early treatment are mandatory in the management of suspicious vulvar lesions during pregnancy. PMID:7896205
Gitsch, G; van Eijkeren, M; Hacker, N F
Vaginismus: An Important Factor in the Evaluation and Management of Vulvar Vestibulitis Syndrome
Dyspareunia is a common complaint in general gynecological practice. Many patients with dyspareunia suffer from vulvar vestibulitis syndrome (WS). This syndrome constitutes severe pain on vestibular contact or attempted vaginal entry, tenderness to pressure within the vulvar vestibule and physical findings of vulvar erythema of various degrees. As a last resort, and only when all conservative treatments have failed, surgery
L. Abramov; I. Wolman; M. P. David
Defective regulation of the proinflammatory immune response in women with vulvar vestibulitis syndrome
Objective: The cause of vulvar vestibulitis syndrome is unknown. To determine a possible role for defective immune regulation in this chronic condition, proinflammatory and anti-inflammatory immune responses to the 70-kd heat shock protein and to lipopolysaccharide were compared in women with and without vulvar vestibulitis syndrome. Study design: Whole blood cultures from 62 women with vulvar vestibulitis syndrome and 48
Stefan Gerber; Ann Marie Bongiovanni; William J. Ledger; Steven S. Witkin
Cromolyn cream for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled study
Objective: Patients with chronic idiopathic vulvar vestibulitis have increased mast cells when biopsied, and cromolyn has been suggested as a treatment. The purpose of this study was to assess the efficacy of 4% cromolyn cream in women with vulvar vestibulitis.Methods: A prospective, double blind, randomised, placebo controlled study was initiated at two centres. Patients with vulvar vestibulitis were assigned to
Paul Nyirjesy; Jack D Sobel; M Velma Weitz; Deborah J Leaman; Maria J Small; Steven P Gelone
Interleukin 1 receptor antagonist gene polymorphism in women with vulvar vestibulitis
Objective: Vulvar vestibulitis is a chronic inflammatory syndrome of unknown cause and pathogenesis. We examined the relation between vulvar vestibulitis and polymorphisms in the gene coding for the interleukin 1 receptor antagonist, a naturally occurring down-regulator of proinflammatory immune responses. Study Design: Cells from the lower genital tract of 68 women with vulvar vestibulitis, 343 women with no history of
Jan Jeremias; William J. Ledger; Steven S. Witkin
NASA Technical Reports Server (NTRS)
Basic concepts in the physiopathology of edema are reviewed. The mechanisms of fluid exchange across the capillary endothelium are explained. Interstitial flow and lymph formation are examined. Clinical disorders of tissue and lymphatic transport, microcirculatory derangements in venous disorders, protein disorders, and lymphatic system disorders are explored. Techniques for investigational imaging of the lymphatic system are explained.
Villavicencio, J. L.; Hargens, A. R.; Pikoulicz, E.
Vulvar Skin Disorders throughout Lifetime: About Some Representative Dermatoses
The objective of this paper is to present general considerations which should be kept in mind by clinicians in charge of women with vulvar diseases. Four representative vulvar dermatoses are described. Lichen simplex chronicus is a pathological condition related to chemical and mechanical irritant agents. Detrimental effects of these irritants, in the presence of other dermatoses, have to be considered when therapeutic responses are unsatisfactory. Lichen sclerosus is the most common vulvar dermatosis in elderly. However, it should be kept in mind that it may be diagnosed at any age. Lichen planus, in spite of sharing a similar range of etiological factors with lichen sclerosus, is a very distinct entity. Finally, Paget's disease, although rare, is also described especially because of the challenge it represents both clinically and therapeutically.
Doyen, Jean; Demoulin, Stephanie; Delbecque, Katty; Goffin, Frederic; Kridelka, Frederic; Delvenne, Philippe
Vulvar skin disorders throughout lifetime: about some representative dermatoses.
The objective of this paper is to present general considerations which should be kept in mind by clinicians in charge of women with vulvar diseases. Four representative vulvar dermatoses are described. Lichen simplex chronicus is a pathological condition related to chemical and mechanical irritant agents. Detrimental effects of these irritants, in the presence of other dermatoses, have to be considered when therapeutic responses are unsatisfactory. Lichen sclerosus is the most common vulvar dermatosis in elderly. However, it should be kept in mind that it may be diagnosed at any age. Lichen planus, in spite of sharing a similar range of etiological factors with lichen sclerosus, is a very distinct entity. Finally, Paget's disease, although rare, is also described especially because of the challenge it represents both clinically and therapeutically. PMID:24511539
Doyen, Jean; Demoulin, St�phanie; Delbecque, Katty; Goffin, Fr�d�ric; Kridelka, Fr�d�ric; Delvenne, Philippe
Specific intraepithelial localization of mast cells in differentiated vulvar intraepithelial neoplasia and its possible contribution to vulvar squamous cell carcinoma development
AIMS: The aetiology of vulvar squamous cell carcinomas (SCC) that are not causally associated with high-risk human papillomavirus remains largely elusive. The aim of this study was to analyse the inflammatory response in its presumed precursor lesions, lichen sclerosus (LS) and differentiated vulvar intraepithelial neoplasia (dVIN), and provide evidence that dVIN is a likely precursor of vulvar SCC. METHODS AND
H. P. van de Nieuwenhof; K. M. Hebeda; J. Bulten; I. Otte-Holler; L. F. A. G. Massuger; J. A. de Hullu; L. C. L. T. van Kempen
Psychological aspects of vulvar vestibulitis syndrome.
This review is based on a MEDLINE/PSYCHINFO search for all papers on psychological aspects of vulvar vestibulitis syndrome (VVS) published 1995-2002. VVS is a condition in which painful patches appear on the vulva which make intercourse painful. Causation, natural history and prevalence of VVS are unknown. Attempts to identify psychological characteristics typical of women with VVS have not yielded consistent results with some studies suggesting high levels of psychopathology and others not. It is suggested that inconsistencies in findings reflect not only decisions by women about whether and how to access health care but also the health care system acting to actively filter those reaching specialist services and selecting those with particular psychological characteristics. There is no compelling evidence that VVS per se is associated with any particular psychological or behavioural characteristics other than the sort of difficulties in sexual functioning which might be expected with chronic vulval pain. However there is evidence for high levels of psychological distress in some samples of women with VVS being seen in secondary care. PMID:16050535
Green, J; Hetherton, J
Tracheal mucosal edema in hydrostatic pulmonary edema.
Airway edema has been described in heart failure, and, in animal experiments, airway narrowing was observed with elevated left atrial pressure (Pla). On the basis of double-indicator-dilution principles using helium and dimethylether, we were able to measure a water compartment of the tracheal mucosa (VH2O) in dogs. Hypervolemia with an attendant increase in Pla caused by infusion of 2 liters of dextran increased VH2O from 368 +/- 71 (SE) to 794 +/- 177 microliters (P < 0.01). Pulmonary arterial wedge and central venous pressures (Pcv) rose concomitantly. Increases in pulmonary arterial wedge and Pcv by a left atrial balloon catheter produced similar increases in VH2O, whereas increases in Pcv alone by a right atrial balloon did not increase VH2O. Increasing VH2O by dextran infusion was associated with an increase in pulmonary resistance from 1.16 +/- 0.19 to 2.15 +/- 0.24 cmH2O.l-1.s (P < 0.01). These observations show that fluid accumulation in the lung during pulmonary congestion also involves extraparenchymal airways and is related to Pla rather than right atrial pressure. This indicates that sufficient collateral drainage exists during right-sided but not left-sided pressure elevations. PMID:7961256
Baier, H; Onorato, D; Barker, J; Wanner, A
Das Projekt E-DeMa ist eines der sechs hier vorgestellten Projekte (Bild 1). In diesem Projekt besch�ftigen wir uns sehr intensiv\\u000a mit der Fragestellung des Marktplatzes und des IKT Gateways. Vorab jedoch m�chte ich Ihnen gerne noch einmal die entsprechenden\\u000a Konsortialpartner vorstellen, die in diesem Projekt mitwirken. RWE als Konsortialf�hrerin auf der einen Seite, auf der linken\\u000a Seite dieses Bildes sehen
Michael Laskowski
Treatment of vulvar intraepithelial neoplasia with the CO 2 laser
From 1982 to 1987, 18 consecutive patients with vulvar intraepithelial neoplasia were treated with CO2 laser vaporization. Prior genital tract malignancy or premalignancy was seen in 72% of the patients. The area around the commisura posterior was involved in 94% of the cases, and the disease showed multifocal localization in 56%.
Nina Palmgren Colov; Ingrid Thranov; Arne Berget
Vulvar Intraepithelial Neoplasia Treated with Cavitational Ultrasonic Surgical Aspiration
Objective. The aim of the study was to investigate the use of the cavitron ultrasonic surgical aspirator (CUSA) for the treatment of vulvar intraepithelial neoplasia (VIN) as it combines the advantage of laser removal of the superficial dermal layers without scars and the advantage of resection with collection of a pathological specimen.Methods. Between 1992 and 1998, 37 patients with VIN
Brigitte E. Miller
New approaches to external genital warts and vulvar intraepithelial neoplasia.
Human papillomavirus is the most common sexually transmitted disease in the United States. For the majority of affected individuals, the virus remains subclinical. However, human papillomavirus infection may result in a broad spectrum of vulvar disease including genital warts, dysplasia, and invasive carcinoma. We review the evaluation and currently available therapies to assist in patient management. PMID:18677144
Kennedy, Colleen M; Boardman, Lori A
Vulvar vestibulitis syndrome: an overview of non-surgical treatment
Vulvar vestibulitis syndrome, which represents one of the major cause of dyspareunia, is a puzzling clinical entity. Although many treatment options have been employed, a rationale therapeutic strategy is still not stated. The present article reviews the most popular medical approaches of such entity (biofeedback, tricyclic antidepressants, interferon psychologic-behavioural therapy, diet modification), as well as those to avoid.Tricyclic antidepressants and
L. Mariani
The treatment of vulvar vestibulitis syndrome: Towards a multimodal approach
Vulvar vestibulitis syndrome (VVS) is currently thought to be the main cause of dyspareunia in pre-menopausal women (Friedrich, 1988; Meana et al., in press a), with reported prevalence rates of up to 15% in general gynecological practice (Goetsch, 1991). This syndrome is characterized by severe pain on vestibular touch or attempted vaginal entry, point tenderness to cotton-tip palpation of the
Sophie Bergeron; Yitzchak M. Binik; Samir Khalif�; Marta Meana; Karen J. Berkley; Kelly Pagidas
Immunophenotypic and viral (human papillomavirus) correlates of vulvar seborrheic keratosis
Human papillomavirus (HPV) infections of the genital mucosa classically present as warts (condylomata) and are traditionally defined by the presence of viral cytopathic effect (koilocytosis). In recent years, HPV has been detected in vulvar epithelial changes lacking koilocytosis, including squamous papillomas and lesions closely resembling seborrheic keratosis (SK). The purpose of this study was to determine the frequency and type
Hongwei Bai; Aida Cviko; Scott Granter; Liping Yuan; Rebecca A Betensky; Christopher P Crum
NASA Astrophysics Data System (ADS)
The optical coherence tomography (OCT), a noninvasive and noncontact diagnostic method, was introduced in 1995 for imaging macular diseases. In diabetic macular edema (DME), OCT scans show hyporeflectivity, due to intraretinal and/or subretinal fluid accumulation, related to inner and/or outer blood-retinal barrier breakdown. OCT tomograms may also reveal the presence of hard exudates, as hyperreflective spots with a shadow, in the outer retinal layers, among others. In conclusion, OCT is a particularly valuable diagnostic tool in DME, helpful both in the diagnosis and follow-up procedure.
Lobo, Concei��o; Pires, Isabel; Cunha-Vaz, Jos�
Differentiated vulvar intraepithelial neoplasia is often found in lesions, previously diagnosed as lichen sclerosus, which have progressed to vulvar squamous cell carcinoma
Lichen sclerosus is considered to be the precursor lesion of vulvar squamous cell carcinoma, of which only 2�5% progress to squamous cell carcinoma. Differentiated vulvar intraepithelial neoplasia (VIN) has been proposed to be the direct precursor lesion, but this is a recently recognized, and a difficult to diagnose, entity, which may easily be mistaken for a benign dermatosis. The aim
Hedwig P van de Nieuwenhof; Johan Bulten; Harrie Hollema; Rianne G Dommerholt; Leon F A G Massuger; Ate G J van der Zee; Joanne A de Hullu; Leon C L T van Kempen
Topical calcineurin inhibitors for the treatment of vulvar dermatoses.
Repeated courses of potent topical corticosteroids and maintenance therapy with moderately potent topical corticosteroids are frequently needed to treat various forms of vulvar dermatoses, which are often characterized by an abnormal proliferation or activation of T lymphocytes. Because such therapeutic regimen is associated with an increased risk of potential side effects, particularly skin atrophy, an anti-inflammatory alternative to topical corticosteroids is desirable. The two non-steroid topical calcineurin inhibitors pimecrolimus and tacrolimus are immunomodulators that block the release of inflammatory cytokines from T lymphocytes in the skin while promoting cutaneous innate host defences. They are currently approved in Europe and in the United States of America as second-line anti-inflammatory agents for the treatment of atopic dermatitis. We provide a comprehensive summary of existing case reports, series of cases, and open-label prospective studies concerning the use of topical pimecrolimus and tacrolimus for the treatment of anogenital lichen sclerosus, genital lichen planus, vulvar lichen simplex chronicus and related pruritic vulvar dermatoses (chronic vulvar pruritus and allergic contact dermatitis of the vulva). The available data suggest that both topical calcineurin inhibitors may be effective and well tolerated in these vulvar dermatoses, although topical pimecrolimus may exhibit a better long-term tolerability profile. Being devoid of steroid-related side effects, they may represent a useful second-line therapeutic option for patients who are intolerant of, or resistant to topical corticosteroids. Controlled clinical trials and comparative studies are warranted to substantiate the promising findings summarized in this review. PMID:19631446
Goldstein, Andrew T; Tha�i, Diamant; Luger, Thomas
Management options for vulvar carcinoma in a low resource setting
Background Vulvar carcinoma is a rare tumor of the female genital tract. In Nigeria, very few studies have looked at the management options for vulvar carcinoma. The objective of this study was therefore, to describe the management options available and the challenges in treating this malignancy in Nigeria. Methods A descriptive study of all vulvar cancer cases managed at the Nnamdi Azikiwe University Teaching Hospital, Nnewi over a 12 year period (1998-2009). The theatre, ward register, histo-pathologic records and case notes of all women who had surgery for vulvar carcinomas were retrieved and socio-demographic characteristics, clinical presentation, type of surgery, histologic type and complications of treatment were retrieved and analyzed. Results There were 867 gynecological malignancies and vulval carcinoma accounted for 11 cases, giving a prevalence of 1.27%. The ages ranged from 54 to 79 years with a mean of 61.2 years. Parity was 2-14, with a mean of 6.7� 2.33. Most of the patients were of low socio-economic class. All the 11 patients had surgery as 1st line treatment. Radical vulvectomy was done for 6 cases since they presented in the advanced stage. The complications of surgery included hemorrhage (18.2%), chronic lymphedema, wound infection and anesthetic complications. There were no hospital mortalities. Late presentation, with stage III (45.4%) was the commonest stage at presentation while the majority of the vulvar carcinomas (72.7%) were of epithelial origin. Squamous cell carcinoma predominated (63.6%). Conclusion Carcinoma of the vulva is a rare gynecological malignancy in Nigeria. Surgery and radiotherapy remains the mainstay of this disease in Nigeria and can be highly successful if patients present early.
Contact Hypersensitivity to Oxazolone Provokes Vulvar Mechanical Hyperalgesia in Mice
The interplay among pain, allergy and dysregulated inflammation promises to yield significant conceptual advances in immunology and chronic pain. Hapten-mediated contact hypersensitivity reactions are used to model skin allergies in rodents but have not been utilized to study associated changes in pain perception in the affected skin. Here we characterized changes in mechanical hyperalgesia in oxazolone-sensitized female mice challenged with single and repeated labiar skin exposure to oxazolone. Female mice were sensitized with topical oxazolone on their flanks and challenged 1-3 times on the labia. We then measured mechanical sensitivity of the vulvar region with an electronic pressure meter and evaluated expression of inflammatory genes, leukocyte influx and levels of innervation in the labiar tissue. Oxazolone-sensitized mice developed vulvar mechanical hyperalgesia after a single labiar oxazolone challenge. Hyperalgesia lasted up to 24 hours along with local influx of neutrophils, upregulation of inflammatory cytokine gene expression, and increased density of cutaneous labiar nerve fibers. Three daily oxazolone challenges produced vulvar mechanical hyperalgesic responses and increases in nerve density that were detectable up to 5 days post-challenge even after overt inflammation resolved. This persistent vulvar hyperalgesia is resonant with vulvodynia, an understudied chronic pain condition that is remarkably prevalent in 18-60 year-old women. An elevated risk for vulvodynia has been associated with a history of environmental allergies. Our pre-clinical model can be readily adapted to regimens of chronic exposures and long-term assessment of vulvar pain with and without concurrent inflammation to improve our understanding of mechanisms underlying subsets of vulvodynia and to develop new therapeutics for this condition.
Martinov, Tijana; Glenn-Finer, Rose; Burley, Sarah; Tonc, Elena; Balsells, Evelyn; Ashbaugh, Alyssa; Swanson, Linnea; Daughters, Randy S.; Chatterjea, Devavani
Colposcopy and High Resolution Anoscopy in Screening For Anal Dysplasia in Patients With Cervical, Vaginal, or Vulvar Dysplasia or Cancer
Cervical Intraepithelial Neoplasia Grade 1; Cervical Intraepithelial Neoplasia Grade 2; Cervical Intraepithelial Neoplasia Grade 3; Recurrent Cervical Cancer; Recurrent Vaginal Cancer; Recurrent Vulvar Cancer; Stage 0 Cervical Cancer; Stage 0 Vaginal Cancer; Stage 0 Vulvar Cancer; Stage I Vaginal Cancer; Stage I Vulvar Cancer; Stage IA Cervical Cancer; Stage IB Cervical Cancer; Stage II Vaginal Cancer; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage III Vaginal Cancer; Stage III Vulvar Cancer; Stage IV Vulvar Cancer; Stage IVA Cervical Cancer; Stage IVA Vaginal Cancer; Stage IVB Cervical Cancer; Stage IVB Vaginal Cancer
[Differential diagnosis of leg edema].
Both generalized and localized edema needs to be submitted to a differential diagnostic investigation. In the case of edema affecting the lower extremities, in particular the Stemmer sign which is the inability to tent the skin at the dorsum of the toes is a useful distinguishing aid. If there is acute unilateral swelling of a leg, other processes with diffuse space-consuming processes need to be distinguished from deep venous thrombosis and secondary lymphedema. Chronic bilateral leg edema is usually due to a venous flowoff obstruction (stasis edema). Less commonly, lipedema or a primary lymphedema may be responsible for the swelling. PMID:15222499
Fries, R
Guidelines for the follow-up of women with vulvar lichen sclerosus in specialist clinics.
It is recommended that women with vulvar lichen sclerosus be followed in specialist clinics where difficulty exists with symptom control or where there is clinical evidence of localized skin thickening. Follow-up is also recommended for women who have previously been treated for squamous cell carcinoma of the vulva (arising in lichen sclerosus or vulvar intraepithelial neoplasia) or where the pathologist expresses concern and is unable to make a definitive diagnosis of differentiated vulvar intraepithelial neoplasia. PMID:17905173
Jones, Ronald W; Scurry, James; Neill, Sallie; MacLean, Allan B
Vulvar vestibulitis syndrome: reliability of diagnosis and evaluation of current diagnostic criteria
Objective:To assess the reliability of the diagnosis of vulvar vestibulitis as defined by Friedrich and to evaluate the usefulness of Friedrich�s criteria in the diagnostic process.Methods:In a university hospital, 146 women with dyspareunia had two sets of gynecologic examinations involving vulvar pain ratings, took part in structured interviews, and completed the McGill-Melzack Pain Questionnaire.Results:Kappa values for the vulvar vestibulitis diagnosis
Sophie Bergeron; Yitzchak M Binik; Samir Khalif�; Kelly Pagidas; Howard I Glazer
Vulvar dermatoses: lichen sclerosus, lichen planus, and vulval dermatitis/lichen simplex chronicus.
In our vulvar specialty clinic at Oxford Radcliffe Hospital (Oxford, UK), dermatoses are frequently seen. A recent survey of new patients showed that lichen sclerosus was the most commonly diagnosed vulvar dermatosis; approximately one third of the women had this disorder. Vulvar dermatitis was observed in 20% to 25% of new patients, but lichen planus was rare. Differences were observed in treatment outcomes for patients with vulvar dermatoses, such as lichen sclerosus and lichen planus, versus those with dermatologic disorders affecting the vulva, such as psoriasis and eczema. PMID:9759675
Ball, S B; Wojnarowska, F
Clinical care of vulvar pruritus, with emphasis on one common cause, lichen simplex chronicus.
Vulvar pruritus is a common and distressing condition for patients, and its presentation is often delayed and complicated by home remedies. The true prevalence cannot be accurately estimated. Vulvar pruritus is a symptom, and an underlying cause must be sought and not assumed. This is best accomplished by obtaining a careful history of vulvar care regimens and treatments, performing a detailed physical examination, and considering a broad differential diagnosis. This article provides a practical and clinical approach to the evaluation of vulvar pruritus and then focuses specifically on one common cause, lichen simplex chronicus. PMID:20883911
Stewart, Kristen M A
Vulvovaginitis and other common vulvar disorders in children.
Vulvovaginitis, labial adhesions, and other vulvar disorders occur commonly in children and can provoke high anxiety in both the parent and child. Performed correctly, the pediatric gynecologic examination can diagnose and treat, educate and reassure both parent and child. This examination requires patience, sensitivity, direct communication with the child as well as with the parent, and an open manner that inspires trust in both parties to manage a potentially anxiety-provoking situation. This chapter will review common vulvar disorders, including vulvovaginitis, lichen sclerosis et atrophicus, bubble bath vaginitis, labial adhesions, urethral prolapse, and other common problems. A discussion of childhood sexual abuse is beyond the scope of this chapter, with appropriate references available elsewhere. Practical pearls will be offered to make this exam easy for the primary care clinician and/or subspecialist. PMID:22846522
Rome, Ellen S
Immunohistochemical expression of SOX2 in vulvar intraepithelial neoplasia and squamous cell carcinoma.
SOX2 is a transcription factor controlling pluripotency in both embryonic stem cells and adult tissue-specific stem cells. SOX2 has been reported as an important factor in squamous cell carcinomas (SCC) of different locations and is involved in tumorigenesis. We evaluated the expression of SOX2 in vulvar non-neoplastic and neoplastic epithelia to test whether it is related to neoplastic progression. SOX2 immunoexpression was evaluated in 101 formalin-fixed, paraffin-embedded archival vulvar epithelia consisting of normal squamous vulvar epithelia (n=25), lichen sclerosus (n=9), high-grade classic vulvar intraepithelial neoplasia (HG-VIN, n=16), differentiated vulvar intraepithelial neoplasia (d-VIN, n=18), and vulvar invasive keratinizing SCC (n=33). Immunoexpression of SOX2 was nuclear and increased stepwise from normal vulvar epithelia/lichen sclerosus to HG-VIN and d-VIN (P<0.0001), from HG-VIN and d-VIN to invasive SCC (P=0.0029), and followed the morphologic distribution of atypical squamous epithelial cells. Scores for normal vulvar epithelia versus lichen sclerosus and HG-VIN versus d-VIN, respectively, did not differ significantly. SOX2 expression increased from tumor Grade 1 to 3 (P=0.0124); there was no relation to recurrence and survival. This is the first study presenting SOX2 as overexpressed in vulvar intraepithelial and invasive squamous lesions. This overexpression apparently reflects an early event in the neoplastic transformation of vulvar squamous epithelia. However, SOX2 seems to play a role in histologic dedifferentiation to Grade 3 invasive SCC too, and may be relevant to vulvar carcinogenesis. PMID:23518916
Brustmann, Hermann; Brunner, Andreas
Detection and identification of human papiliomavirus in vulvar intraepithelial neoplasia
Objective��To evaluate the rate and types of human papillomavirus infection in vulvar intraepithelial neoplasia.\\u000a \\u000a \\u000a \\u000a Methods��We detected and identified HPV in 40 VIN cases with 67 lesions using PCR based reverse line blot hybridization and DNA sequencing.\\u000a Among the 40 patients, 13 were diagnosed as VIN III, 11 as VIN II, and 16 as VIN I. 31 patients had multifocal disease.
Yi Guo; Juan-hua Wu; Wei Li; Qian Wang; Hui Li
[Vulvar lichen sclerosus in a girl with Turner syndrome].
Dermatological complications in Turner syndrome are infrequent but occasionally cause significant morbidity. Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous affection characterized by pruritus in the anogenital area. It is yet not clear its pathophysiology but it's linked with genetic factors and autoimmunity. This is a case report of a girl with Turner syndrome with growth hormone treatment that started with vulvar pruritus and was diagnosed as lichen sclerosus. PMID:24955917
Ocampo, Dolores; Gonz�lez, Ver�nica
EGFR expression in vulvar cancer: clinical implications and tumor heterogeneity.
Epidermal growth factor receptor (EGFR) protein expression was assessed by immunohistochemistry (IHC) in 150 cases of invasive vulvar squamous cell carcinoma. In addition, gene copy number status by fluorescence in situ hybridization was performed in a smaller set of samples. Results were correlated with patient's clinical data and prognostic factors. EGFR overexpression (2+ and 3+) was observed on the membrane in 24.66% and 21.33% of all cases, respectively. Higher EGFR expression was associated with depth of invasion (P = .0409) and disease recurrence (P = .0401). Cytoplasm staining was found in 21.33% of the cases and was associated with absence of nodal metastasis (P = .0061) and better survival (P = .0199). Intratumor heterogeneity of EGFR IHC staining was frequently observed (55.33%) and was associated with the presence of nodal metastasis (P = .0207) and tumor invasion (P = .0161). Worse survival outcomes have been demonstrated in tumors with EGFR heterogeneity (P = .0434). EGFR gene status evaluated by fluorescence in situ hybridization did not correlate with protein expression evaluated by IHC. In conclusion, EGFR cytoplasm staining has no link with poorer outcome; still, this pattern of staining is even more related to better prognosis. EGFR heterogeneity of staining correlated with more aggressive tumors, and presented to be an important marker of poor prognosis in vulvar squamous cell carcinoma. The usage of small biopsies or even tissue microarrays for vulvar cancer evaluation should be carefully reconsidered for the assessment of EGFR as the results may be misleading. Protein overexpression may be independent on gene amplification, showing that other molecular mechanisms than copy number variation may regulate protein expression of EGFR in vulvar cancer. PMID:24746196
de Melo Maia, Beatriz; Fontes, Adriana Mazega; Lavorato-Rocha, Andr� Mour�o; Rodrigues, Iara Sant'ana; de Brot, Louise; Baiocchi, Glauco; Stiepcich, Monica Maria; Soares, Fernando Augusto; Rocha, Rafael Malagoli
Psychophysical evidence of nociceptor sensitization in vulvar vestibulitis syndrome
Vulvar vestibulitis syndrome (VVS) is a long lasting disorder of superficial dyspareunia in young women. Quantitative sensory testing, including mechanical and temperature pain thresholds and warm\\/cold difference limen (WCL), was performed in the vestibular mucosa in 22 women (mean age 25.0 years) with vestibulitis and 20 control subjects (mean age 25.6 years). The tests were carried out on days 7�11
Nina Bohm-Starke; Marita Hilliges; Gunilla Brodda-Jansen; Eva Rylander; Erik Torebj�rk
Trends in Squamous Cell Carcinoma of the Vulva: The Influence of Vulvar Intraepithelial Neoplasia
Objective: To determine trends in the clinicopathology of vulvar squamous cell carcinoma over the past 2 decades, with particular reference to the possible effects of the increasing incidence of vulvar intraepithelial neoplasia (VIN) during this time.Methods: Two cohorts of 56 and 57 women with squamous cell carcinoma of the vulva and separated by at least 2 decades were reviewed retrospectively.
R. W Jones; Judith Baranyai; S Stables
The etiologic role of HPV in vulvar squamous cell carcinoma fine tuned
PURPOSE: High-risk human papilloma virus (HPV) plays a role in the development of a subset of vulvar squamous cell carcinomas. Uncertainty exists about the true impact of HPV in this tumor type because conflicting reports have been published with diverging prevalence rates. This study was done to fine tune the role of high-risk HPV infection in vulvar squamous cell carcinoma
H. P. van de Nieuwenhof; L. C. L. T. van Kempen; J. A. de Hullu; R. L. M. Bekkers; J. Bulten; W. J. G. Melchers; L. F. A. G. Massuger
Vulvar intraepithelial neoplasia III: occult cancer and the impact of margin status on recurrence
Objective: To determine the impact of margin status on disease recurrence and the incidence of occult cancer in women diagnosed with vulvar intraepithelial neoplasia (VIN) III and treated with surgical excision.Methods: Between 1989 and 1995, 73 women were diagnosed preoperatively with VIN III by vulvar biopsy and were treated with surgical resection. Patients were examined postoperatively, and recurrence was diagnosed
Susan C Modesitt; Anne B Waters; Leslie Walton; Wesley C Fowler; Linda Van Le
Vulvar Intraepithelial Neoplasia III: A Viral Disease of Undetermined Progressive Potential
Seventy-three patients with vulvar intraepithelial neoplasia (VIN) grade III were followed for a median of 5 years after primary treatment. Thirty women also had a diagnosis of cervical neoplasia. During the follow-up 26 patients (36%) had one or more vulvar recurrences. Recurrences were seen significantly more often in the patients who also had cervical neoplasia, indicating a common etiology. Microinvasive
Ulla H�rding; Jette Junge; Hemming Poulsen; Finn Lundvall
Intraoperative Lymphatic Mapping and Sentinel Node Identification with Blue Dye in Patients with Vulvar Cancer
Objective. To determine the effectiveness of intraoperative lymphatic with blue dye alone as a means of localizing sentinel nodes in patients with vulvar cancer.Methods. All patients undergoing primary surgical treatment for vulvar cancer were eligible for this prospective study. Isosulfan blue dye was injected intradermally at the edge of the primary tumor closest to the adjacent groin. Bilateral dye injections
Charles Levenback; Robert L. Coleman; Thomas W. Burke; Diane Bodurka-Bevers; Judith K. Wolf; David M. Gershenson
Genital human papillomavirus infections in young women with vulvar and vestibular papillomatosis
Possible involvement of human papillomaviruses (HPV) in the development of vulvar and vestibular papillomatosis was investigated by using PCR to determine whether HPV DNA was present in lesions. Fourteen of 272 (5.1 %) young women studied were found on gross and histological examination to have vulvar or vestibular papillomatosis. HPV DNA sequences were detected in cervicovaginal lavage specimens of 2
C. C. Pao; J. J. Hor; Y. L. Fu
Feasibility of Collecting Vulvar Pain Variability and Its Correlates Using Prospective Collection with Smartphones
Context. Vulvar pain level may fluctuate in women with vulvodynia even in the absence of therapy; however, there is little evidence suggesting which factors may be associated with variability. Objective. Determine the feasibility of using smartphones to collect prospective data on vulvar pain and factors that may influence vulvar pain level. Methods. 24 clinically confirmed women were enrolled from a population-based study and asked to answer five questions using their smartphones each week for one month. Questions assessed vulvar pain level (0�10), presence of pain upon wakening, pain elsewhere in their body, treatment use, and intercourse. Results. Women completed 100% of their scheduled surveys, with acceptability measures highly endorsed. Vulvar pain ratings had a standard deviation within women of 1.6, with greater variation on average among those with higher average pain levels (P < 0.001). On the weeks when a woman reported waking with pain, her vulvar pain level was higher by 1.82 on average (P < 0.001). Overall, average vulvar pain level was not significantly associated with the frequency of reporting other body pains (P = 0.64). Conclusion. Our smartphone tracking system promoted excellent compliance with weekly tracking of factors that are otherwise difficult to recall, some of which were highly associated with vulvar pain level.
Nguyen, Ruby H. N.; Turner, Rachael M.; Sieling, Jared; Williams, David A.; Hodges, James S.; Harlow, Bernard L.
Neural correlates of painful genital touch in women with vulvar vestibulitis syndrome
Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Recent evidence points to the importance of the sensory component in VVS, particularly the heightened processing of tactile and pain sensation in the vulvar vestibule. The goal of the present study was to examine the neural basis of heightened sensitivity to touch (i.e. allodynia) in women with
Caroline F. Pukall; Irina A. Strigo; Yitzchak M. Binik; Rhonda Amsel; Samir Khalif�; M. Catherine Bushnellf
Neurochemical Characterization of the Vestibular Nerves in Women with Vulvar Vestibulitis Syndrome
Women with vulvar vestibulitis syndrome (VVS) have a distinct burning pain provoked by almost any stimuli in the area around the vaginal introitus. In a previous study we observed an increased number of intraepithelial free nerve endings in women with VVS. The aim of the present study was to neurochemically characterize the superficial nerves in the vulvar vestibular mucosa of
Nina Bohm-Starke; Marita Hilliges; Christian Falconer; Eva Rylander
Combination of Subtotal Perineoplasty and Interferon for the Treatment of Vulvar Vestibulitis
Purpose: To evaluate the efficacy of a combination of subtotal perineoplasty and interferon (IFN) infiltration of the remaining anterior vestibule in the treatment of vulvar vestibulitis. BasicProcedures: Nineteen women with vulvar vestibulitis were randomized to undergo either a total perineoplasty or a subtotal perineoplasty without removal of the anterior vestibule. The second group was further treated 6 weeks later with
Jacob Bornstein; Haim Abramovici
Treatment of Experimental Cerebral Edema.
National Technical Information Service (NTIS)
The edema associated with hemorrhagic cerebral lesions produced by focal freezing in subhuman primates (rhesus monkeys) was studied by quantitative chemical methods. This research involved measuring not only the hemispheric water, potassium, sodium, chlor...
G. M. Hass R. A. Clasen
Pulmonary Edema in Myasthenic Crisis
We report a previously asymptomatic 50-year-old lady who came with myasthenic crisis as initial presentation of myasthenia gravis. She developed pulmonary edema following intravenous immunoglobulin administration and had ischemic changes in ECG and left ventricular dysfunction on echocardiography. She improved with diuretics, dobutamine, and fluid restriction alone. This is the first report in English-language medical literature describing the association between myasthenic crisis and likely takotsubo cardiomyopathy-related pulmonary edema following intravenous immunoglobulin administration.
Anand, Uttara Swati; Arulneyam, Jayanthi
Recognition and management of vulvar dermatologic conditions: lichen sclerosus, lichen planus, and lichen simplex chronicus.
Lichen sclerosus, lichen planus, and lichen simplex chronicus are dermatologic conditions that can affect the vulva. Symptoms include vulvar itching, irritation, burning, and pain, which may be chronic or recurrent and can lead to significant physical discomfort and emotional distress that can affect mood and sexual relationships. With symptoms similar to common vaginal infections, women often seek care from gynecological providers and may be treated for vaginal infections without relief. Recognition and treatment of these vulvar conditions is important for symptom relief, sexual function, prevention of progressive vulvar scarring, and to provide surveillance for associated vulvar cancer. This article reviews these conditions including signs and symptoms, the process of evaluation, treatment, and follow-up, with attention to education and guidelines for vulvar care and hygiene. PMID:22594865
Thorstensen, Katrina Alef; Birenbaum, Debra L
The most common chromosome aberration detected by high-resolution comparative genomic hybridization in vulvar intraepithelial neoplasia is not seen in vulvar squamous cell carcinoma
We analyzed genetic changes in condylomas (four cases), vulvar intraepithelial neoplasia I�III (VIN I�III, eleven cases), and primary vulvar squamous cell carcinomas (VSCC, ten cases) by high-resolution comparative genomic hybridization (HR-CGH) and flowcytometry. All samples were also human papilloma virus (HPV)-genotyped. Gain of chromosome 1, the aberration most often seen in VIN III (67%), was not seen in HPV-positive or
T. Bryndorf; M. Kirchhoff; J. Larsen; B. Andreasson; B. Bjerregaard; H. Westh; H. Rose; C. Lundsteen
Edema: a silent but important factor.
Edema is a normal response to injury. Even the smallest injury is associated with some inflammation, and initial edema is part of the normal inflammatory process. However, edema becomes a concern when it persists beyond the inflammatory phase. Once we have progressed into the rebuilding, or fibroplastic phase of healing, edema will delay healing and contribute to complications such as pain and stiffness. Early prevention and management to prevent this progression are therefore critical. This article discusses edema in relation to stages of healing and presents the research behind techniques available to the clinician to manage localized extracellular upper extremity edema in the patient with an intact lymphatic system. PMID:22212492
Villeco, June P
Extragastrointestinal stromal tumor presenting as a recurrent vulvar mass.
Extragastrointestinal stromal tumors (EGIST) primarily arising from the female genital tract are extremely rare. We report a case of EGIST presenting as a recurrent vulvar mass with genetic analyses. A 59-year-old woman was found to have a 4-cm recurrent mass in the right vulva after 6 months of the first resection. Histological findings showed that the uniform spindle cells formed interlacing bundles, with high cellular density and mild to moderate atypia. Mitotic activity averaged 10 mitoses per 50 high-power fields. Immunohistochemical evaluation revealed that the tumor cells exhibited strong and diffuse staining for CD117, CD34 and DOG1. Ki67 labeling was approximately 15%. Molecular analysis showed an in-frame protein deletion (P551_Q556del) at exon 11 of c-KIT. The tumor was diagnosed as an EGIST. The patient was treated with imatinib, and was healthy at 12-month follow-up. EGIST should be considered in the differential diagnosis of vulvar mesenchymal tumors. PMID:24606551
Li, Dujuan; Zhao, Yuewu; Xie, Hongjian; Liu, Qiuyu; Kong, Lingfei
Pathways of vulvar intraepithelial neoplasia and squamous cell carcinoma.
Vulvar squamous cell carcinoma (VSCC) accounts for >90% of the malignant tumours of the vulva. Most VSCCs originate in intraepithelial lesions, named vulvar intraepithelial neoplasia (VIN), that precede the development of VSCC by a variable period of time. Strong evidence has accumulated showing that there are two different aetiopathogenic pathways for the development of VSCC and VIN, one associated with infection by human papillomavirus (HPV), and a second independent of HPV infection. These two different types of VSCC have different epidemiological, pathological and clinical characteristics, and should therefore be considered as two separate entities. Histologically, HPV-associated VSCCs are of the basaloid or warty type, and arise from VIN of the usual type. Inactivation of p53 and the retinoblastoma tumour suppressor gene product by the viral gene products E6 and E7 is involved in the process of malignant transformation. HPV-independent VSCCs are histologically keratinizing, are associated with differentiated VIN and lichen sclerosus, and frequently show mutations of p53. p16(INK4a) and p53 immunostaining can be useful for classifying VSCC into HPV-associated or HPV-independent. Although large, multicentre studies are needed to definitively assess the involvement of HPV in the prognosis of VSCC, most studies have not found clear differences in survival between HPV-associated and HPV-independent tumours. PMID:23190170
Del Pino, Marta; Rodriguez-Carunchio, Leonardo; Ordi, Jaume
Recurrent Negative Pressure Pulmonary Edema
An African-American man, aged 34 years, underwent an elective uncomplicated right wrist laceration repair while under general anesthesia. Following extubation, the patient developed hypoxemia, tachypnea, shortness of breath, pulmonary rales, frothy sputum, decreased oxygen saturation, and evidence of upper airway obstruction. Chest radiograph showed pulmonary edema. The patient was diagnosed with post-extubation pulmonary edema (aka. negative pressure pulmonary edema [NPPE]) and was treated with intravenous furosemide and oxygen therapy; he improved remarkably within a few hours. Once stabilized, the patient described a similar episode 10 years earlier following surgery for multiple gunshot wounds. Negative pressure pulmonary edema following tracheal extubation is an uncommon (0.1%) and life-threatening complication of patients undergoing endotracheal intubation and general anesthesia for surgical procedures. The common pattern in these cases is the occurrence of an episode of airway obstruction upon emergence from general anesthesia, usually caused by laryngospasm. Patients who are predisposed to airway obstruction may have an increased risk of airway complications upon extubation after general anesthesia. Prevention and early relief of upper airway obstruction should decrease incidence. Recurrent NPPE has not been previously described in the literature. Herein, we describe the first case of recurrent NPPE in the same patient following extubation.
Pathak, Vikas; Rendon, Iliana S. Hurtado; Ciubotaru, Ronald L.
Pulmonary edema: pathophysiology and diagnosis.
Healthy human lungs are normally the sites of fluid and solute filtration across the pulmonary capillary endothelium. Unlike other organs, the filtrate in the lungs is confined anatomically within adjacent interstitial spaces, through which it moves by a built-in pressure gradient from its site of formation to its site of removal through pulmonary lymphatic channels. The quantity of fluid filtered and its protein content depend on the transvascular hydrostatic and protein osmotic (colloid) pressure differences, and the leakiness of the endothelial barrier to water and protein. Lymphatic drainage can increase several-fold, which means that pulmonary edema-defined as an increase in extravascular water content of the lungs-cannot occur until the rate of fluid filtration exceeds the rate of lymphatic removal. Two main types of pulmonary edema are recognized: first, cardiogenic (or hydrostatic) pulmonary edema from, as the name implies, an elevated pulmonary capillary pressure from left-sided heart failure; second, noncardiogenic (increased permeability) pulmonary edema from injury to the endothelial and (usually) epithelial barriers. Owing to their fundamental differences, each occurs in distinct clinical conditions, requires separate therapy, and has a different prognosis. PMID:21219673
Murray, J F
Aberrant staining patterns of E-cadherin and ?-catenin: a potential diagnostic value for distinguishing vulvar intraepithelial neoplasia from non-neoplastic vulvar lesions
Histologically, vulvar intraepithelial neoplasm (VIN) is a proliferative disorder of the female vulva. No single clinical characteristic or pathognomonic feature facilitates the diagnosis of VIN, and the agreement between different pathologists on the diagnoses varies significantly. In this study, we evaluate the immunohistochemical expression patterns of E-cadherin and ?-catenin in 22 patients with VIN and 10 patients with non-neoplastic vulvar lesions. our results showed that membranous staining for E-cadherin and ?-catenin was observed in squamous epithelial cells of all control non-neoplastic vulvar samples. Abnormal E-cadherin (17/19, 89.5%) and ?-catenin (15/19, 78.9%) staining occurred more frequently in usual-type VIN than in non-neoplastic vulvar lesions (P=0.000 and P=0.000, respectively). However, in differentiated VIN, only 1 patient showed abnormal E-cadherin and ?-catenin immunohistochemical expressions, which did not differ significantly. The abnormal expression of E-cadherin and ?-catenin proteins might be useful in distinguishing VIN from non-neoplastic vulvar squamous epithelium lesions in problematic cases.
Li, Bo; Zhang, Qingfu; Ouyang, Ling; Jia, Lin; Han, Xue; Zhou, Yang; Tong, Xin; Song, Zixuan; Zhang, Shulang; Qiu, Xueshan
Aberrant staining patterns of E-cadherin and ?-catenin: a potential diagnostic value for distinguishing vulvar intraepithelial neoplasia from non-neoplastic vulvar lesions.
Histologically, vulvar intraepithelial neoplasm (VIN) is a proliferative disorder of the female vulva. No single clinical characteristic or pathognomonic feature facilitates the diagnosis of VIN, and the agreement between different pathologists on the diagnoses varies significantly. In this study, we evaluate the immunohistochemical expression patterns of E-cadherin and ?-catenin in 22 patients with VIN and 10 patients with non-neoplastic vulvar lesions. our results showed that membranous staining for E-cadherin and ?-catenin was observed in squamous epithelial cells of all control non-neoplastic vulvar samples. Abnormal E-cadherin (17/19, 89.5%) and ?-catenin (15/19, 78.9%) staining occurred more frequently in usual-type VIN than in non-neoplastic vulvar lesions (P=0.000 and P=0.000, respectively). However, in differentiated VIN, only 1 patient showed abnormal E-cadherin and ?-catenin immunohistochemical expressions, which did not differ significantly. The abnormal expression of E-cadherin and ?-catenin proteins might be useful in distinguishing VIN from non-neoplastic vulvar squamous epithelium lesions in problematic cases. PMID:23826417
Li, Bo; Zhang, Qingfu; Ouyang, Ling; Jia, Lin; Han, Xue; Zhou, Yang; Tong, Xin; Song, Zixuan; Zhang, Shulang; Qiu, Xueshan
[The rare case of erosive lichen planus with large leasions in vulvar area and vagina].
The main aim of our paper was to point out the rare localization of erosive lichen planus in vulvar region and vagina. Moreover, these untreated lesions may be the starting point of squamous cell carcinoma. PMID:17477090
Rotsztejn, Helena; Kolasa-Zwierzchowska, Dorota; Krawczyk, Tomasz; Szpakowski, Marian; Kulig, Andrzej
Sentinel Node Dissection Safe in the Treatment of Early Vulvar Cancer
Sentinel node dissection is an effective way to detect whether cancer has spread in early-stage vulvar cancer, though significant experience with the technique is essential, according to the Feb. 20, 2008, Journal of Clinical Oncology.
Pathophysiological and pathochemical aspects of cerebral edema
Conclusions and summary Cerebral edema is an increase in brain water content causing expansion of cerebral tissue volume. There are two different entities of cerebral edema occurring alone or together. Formation of vasogenic brain edema requires breakdown of the blood-brain barrier, while cytotoxic edema forms by alterations of the permeability of cell membranes, and\\/or disturbances of active, energy-dependent transport. In
A. Baethmann
The contribution of MIB 1 in the accurate grading of vulvar intraepithelial neoplasia
AIM: To determine the interobserver variation in scoring presence and grade of vulvar intraepithelial neoplasia (VIN) in haematoxylin\\/eosin (H\\/E) slides, MIB 1 slides, and the combined use of H\\/E and MIB 1 slides. METHODS: 10 slides were stained with H\\/E and MIB 1 with each of the following diagnoses: normal vulvar skin, VIN 1, VIN 2, and VIN 3. Six
M. van Beurden; A. J. de Craen; H. C. de Vet; J. L. G. Blaauwgeers; P. Drillenberg; M. P. W. Gallee; N. W. de Kraker; F. B. Lammes; F. J. ten Kate
A Clinical and Pathological Overview of Vulvar Condyloma Acuminatum, Intraepithelial Neoplasia, and Squamous Cell Carcinoma
Condyloma acuminatum, intraepithelial neoplasia, and squamous cell carcinoma are three relatively frequent vulvar lesions. Condyloma acuminatum is induced by low risk genotypes of human papillomavirus (HPV). Vulvar intraepithelial neoplasia (VIN) and squamous cell carcinoma have different etiopathogenic pathways and are related or not with high risk HPV types. The goal of this paper is to review the main pathological and clinical features of these lesions. A special attention has been paid also to epidemiological data, pathological classification, and clinical implications of these diseases.
Leonard, Boris; Kridelka, Frederic; Delbecque, Katty; Goffin, Frederic; Demoulin, Stephanie; Doyen, Jean; Delvenne, Philippe
Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome
Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Little is known about sensory function in the vulvar vestibule, despite Kinsey's assertion that it is important for sexual sensation. We examined punctate tactile and pain thresholds to modified von Frey filaments in the genital region of women with VVS and age- and contraceptive-matched pain-free controls. Women
Caroline F Pukall; Yitzchak M Binik; Samir Khalif�; Rhonda Amsel; Frances V Abbott
A case of usual (basaloid)-type vulvar intraepithelial neoplasia that failed to respond to imiquimod cream: clinical implications
The authors report a case of usual-type (basaloid-type) vulvar intraepithelial neoplasia (VIN) 3 that failed to respond to\\u000a imiquimod cream. A 51-year-old Japanese woman visited her local gynecologist complaining of vulvar itching. Atypical cells\\u000a were noted in cytology smears, but nine vulvar biopsy specimens showed benign proliferation of epithelial tissue. The patient\\u000a was placed under careful observation for 8�months, when
Takaya Shiozaki; Tsutomu Tabata; Kuniaki Toriyabe; Takashi Motohashi; Eiji Kondo; Kouji Tanida; Toshiharu Okugawa; Norimasa Sagawa
Diabetic ketoacidosis and cerebral edema.
Cerebral edema is the leading cause of death in children presenting in diabetic ketoacidosis and occurs in 0.2 to 1% of cases. The osmolar gradient caused by the high blood glucose results in water shift from the intracelluar fluid (ICF) to the extracellular fluid (ECF) space and contraction of cell volume. Correction with insulin and intravenous fluids can result in a rapid reduction in effective osmolarity, reversal of the fluid shift and the development of cerebral edema. The goals for treatment should be a combination of intravenous fluid and insulin that results in a gradual reduction of the effective osmolarity over a 36- to 48-hour period, thereby avoiding rapid expansion of the ICF compartment and brain swelling. PMID:12011666
Bohn, Desmond; Daneman, Denis
Alterations of the p16 INK4a\\/Rb\\/cyclin-D1 pathway in vulvar carcinoma, vulvar intraepithelial neoplasia, and lichen sclerosus
Three different alterations in the p16\\/pRb\\/cyclin-D1 pathway (p16INK4a-promoter hypermethylation and expression of pRb and cyclin-D1) were investigated in a series of 38 cases of vulvar carcinoma (VC), 13 cases of vulvar intraepithelial neoplasia (VIN), and 21 cases of lichen sclerosus (LS). Paraffin blocks from 72 patients were selected for investigation of DNA methylation patterns in the CpG island of p16INK4a
Enrique Lerma; Manel Esteller; James G. Herman; Jaime Prat
Phosphorylated S6 as an immunohistochemical biomarker of vulvar intraepithelial neoplasia.
As life expectancy lengthens, cases of non-viral-associated vulvar squamous cell carcinoma and its precursor lesion, so-called differentiated vulvar intraepithelial neoplasia (VIN), continue to increase in frequency. Differentiated VIN often is difficult to recognize and failure to detect it before invasion results in morbidity and mortality. Thus, identification of a reliable biomarker for this type of lesion would be of great clinical benefit. Our recent studies have identified activation (ser235/236 phosphorylation) of ribosomal protein S6 (p-S6) in basal epithelial cells as an event that precedes and accompanies laminin ?(2) overexpression in most preinvasive oral dysplasias. To test this as a potential biomarker of vulvar dysplasia, we immunostained seven differentiated VINs and nine papillomavirus-related 'classic' VINs, most of which were associated with carcinoma, for p-S6. All carcinomas, all differentiated VINs, and most classic VINs contained regions of p-S6 staining in the basal layer, whereas basal and parabasal cells of normal vulvar epithelium and hyperplastic and inflamed lesions lacking cellular atypia were p-S6 negative. Laminin ?(2) was expressed in a subset of VINs, always occurring within basal p-S6 positive regions, as we had found previously for oral dysplasias. Lichen sclerosus is considered a potential precursor of vulvar carcinoma. Two lichen sclerosus lesions of patients with a concurrent carcinoma and one of six lichen sclerosus lesions without atypia or known concurrent carcinoma were basal p-S6 positive. In summary, there is a distinct difference in p-S6 basal cell layer staining between benign and neoplastic vulvar squamous epithelium, with consistent staining of differentiated VIN and of some lichen sclerosus lesions. These results support further studies to assess the potential of p-S6 as a biomarker to identify vulvar lesions at risk of progressing to invasive cancer. PMID:23765247
Pinto, Alvaro P; Degen, Martin; Barron, Patricia; Crum, Christopher P; Rheinwald, James G
Self-Reported Vulvar Pain Characteristics and Their Association with Clinically Confirmed Vestibulodynia
Abstract Objective We evaluated a series of questions pertaining to vulvar pain symptoms to determine their association with a localized vulvodynia (vestibulodynia) diagnosis in women from the general population. Methods A sample of 12,435 women completed a self-administered screening questionnaire for the presence of specific types and characteristics of vulvar pain lasting 3 months or longer. Sensitivity, specificity, and predictive values were calculated for each cross-classification of vulvar pain type and characteristic, using as the gold standard 121 subjects with a clinically confirmed vestibulodynia diagnosis. Results Relative to women with clinically confirmed vestibulodynia, 83% reported >10 episodes of pain on contact at the time of tampon insertion, intercourse, or pelvic examination, and 83% also reported pain on contact that limited or prevented sexual intercourse. These strong associations with a vestibulodynia diagnosis were not observed with respect to women who reported vulvar pain symptoms of burning or knifelike pain, or vulvar pain characteristics of continuous versus intermittent pain, or provoked versus spontaneous pain. Conclusions Our findings suggest that a small number of symptoms may be suitable for identifying a large proportion of women suffering from vestibulodynia which may be ideal for the development of an effective screening test in the future. However, we also recognize that a large proportion of women experiencing vulvar pain symptoms will not meet the diagnostic criteria for vestibulodynia. Thus, implementing such a screening procedure as part of a routine examination or testing would require a subsequent pelvic examination to confirm a vestibulodynia diagnosis and to rule out other known explanations for vulvar pain.
Vazquez, Gabriela; MacLehose, Richard F.; Erickson, Darin J.; Oakes, J. Michael; Duval, Susan J.
Ranibizumab in diabetic macular edema.
By 2050 the prevalence of diabetes will more than triple globally, dramatically increasing the societal and financial burden of this disease worldwide. As a consequence of this growth, it is anticipated that there will be a concurrent rise in the numbers of patients with diabetic macular edema (DME), already among the most common causes of severe vision loss worldwide. Recent available therapies for DME target the secreted cytokine, vascular endothelial growth factor (VEGF). This review focuses on the treatment of DME using the first humanized monoclonal antibody targeting VEGF that has been Food and Drug Administration-approved for the use in the eye, ranibizumab (Lucentis(�)). PMID:24379922
Krispel, Claudia; Rodrigues, Murilo; Xin, Xiaoban; Sodhi, Akrit
A case of vulvar hematoma with rupture of pseudoaneurysm of pudendal artery
Vulvar hematomas are uncommon outside of the obstetric population and may be the result of trauma to the perineum. Vulvar hematomas most often present with low abdominal pain and urologic and neurologic symptoms. The vulva has rich vascularization that is supplied by the pudendal artery, a branch of the anterior division of the internal iliac artery. We describe a rare case of a 15-cm-sized vulvar hematoma with the suggested rupture of a pseudoaneurysm of the left pudendal artery without trauma injury. A 14-year-old girl presented with sudden pain and swelling in her left labium and was successfully treated with selective arterial embolization and surgical evacuation. We provide a literature review and discuss patient treatment and management strategies.
Hong, Hye Ri; Kim, Sung Ae; Kwon, Jeong Eun; Jeon, Hye Won; Choi, Ji Eun; So, Young Ho
Association of human papillomavirus with vulvar and vaginal intraepithelial disease: opportunities for prevention.
While the majority of studies regarding the health benefits from human papillomavirus (HPV) vaccination have focused on cervical neoplasia and cancer, few have investigated how the epidemiology of vaginal and vulvar disease may be affected. To better understand how occurrence rates for vaginal and vulvar neoplasias and carcinomas may change in the future, we must have an understanding of the overall disease prevalence within a given population, the efficacy of vaccination and the proportion of cases attributable to HPV types administered in the vaccine. In this review, we will examine basic HPV epidemiology and prevalence, the molecular transformation events carried out by HPV oncoproteins, and clinical trials monitoring HPV-induced disease of the female genital tract. While precise projections of exactly how vaginal and vulvar disease prevalence will change with vaccination will require more studies, the preliminary data are promising. PMID:19072516
Pearson, J Matt; Feltman, Richard S; Twiggs, Leo B
Mitochondrial genotype in vulvar carcinoma - cuckoo in the nest
Vulvar squamous cell carcinoma (VSCC) is a rare female genital neoplasm. Although numerous molecular changes have been reported in VSCC, biomarkers of clinical relevance are still lacking. On the other hand, there is emerging evidence on the use of mtDNA as a diagnostic tool in oncology. In order to investigate mtDNA status in VSCC patients, haplogroup distribution analysis and D-loop sequencing were performed. The results were compared with available data for the general Polish population, cancer free-centenarians as well as patients with endometrial and head and neck cancer. The obtained data were also compared with the current status of mitochondrial databases. Significant differences in haplogroup distribution between VSCC cohort, general Polish population and cancer-free centenarians cohort were found. Moreover, a correlation between the VSCC patients haplogroup and HPV status was observed. Finally, a specific pattern of mtDNA polymorphisms was found in VSCC. Our results suggest that the mitochondrial genetic background may influence the risk of VSCC occurrence as well as susceptibility to HPV infection.
Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome.
Vaginal sEMG biofeedback and pelvic floor physical therapists' manual techniques are being increasingly included in the treatment of vulvar vestibulitis syndrome (VVS). Successful treatment outcomes have generated hypotheses concerning the role of pelvic floor pathology in the etiology of VVS. However, no data on pelvic floor functioning in women with VVS compared to controls are available. Twenty-nine women with VVS were matched to 29 women with no pain with intercourse. Two independent, structured pelvic floor examinations were carried out by physical therapists blind to the diagnostic status of the participants. Results indicated that therapists reached almost perfect agreement in their diagnosis of pelvic floor pathology. A series of significant correlations demonstrated the reliability of assessment results across muscle palpation sites. Women with VVS demonstrated significantly more vaginal hypertonicity, lack of vaginal muscle strength, and restriction of the vaginal opening, compared to women with no pain with intercourse. Anal palpation could not confirm generalized hypertonicity of the pelvic floor. We suggest that pelvic floor pathology in women with VVS is reactive in nature and elicited with palpations that result in VVS-type pain. Treatment interventions need to recognize the critical importance of addressing the conditioned, protective muscle guarding response in women with VVS. PMID:16050536
Reissing, E D; Brown, C; Lord, M J; Binik, Y M; Khalif�, S
Laparoscopic treatment of massive ovarian edema.
Massive ovarian edema is an unusual cause of ovarian enlargement in young girls and women. A woman with the disorder was managed laparoscopically by wedge resection of the ovary. We believe that endoscopic surgery is the appropriate approach for ovarian edema, as it establishes the diagnosis by minimally invasive means and at the same time ensures conservative treatment. PMID:10548716
Kallipolitis, G; Sklia, E; Milingos, S; Michalas, S
A clinical and pathological overview of vulvar condyloma acuminatum, intraepithelial neoplasia, and squamous cell carcinoma.
Condyloma acuminatum, intraepithelial neoplasia, and squamous cell carcinoma are three relatively frequent vulvar lesions. Condyloma acuminatum is induced by low risk genotypes of human papillomavirus (HPV). Vulvar intraepithelial neoplasia (VIN) and squamous cell carcinoma have different etiopathogenic pathways and are related or not with high risk HPV types. The goal of this paper is to review the main pathological and clinical features of these lesions. A special attention has been paid also to epidemiological data, pathological classification, and clinical implications of these diseases. PMID:24719870
L�onard, Boris; Kridelka, Frederic; Delbecque, Katty; Goffin, Frederic; Demoulin, St�phanie; Doyen, Jean; Delvenne, Philippe
Vulvar Intraepithelial Neoplasia in Women Infected with Human Immunodeficiency Virus1
The purpose of this study was to determine the response of vulvar intraepithelial neoplasia (VIN) lesions to standard treatment methods in women infected with human immunodeficiency virus (HIV). We reviewed all cases of VIN over a 4-year period at an inner-city hospital. We reviewed the clinical records of these women to abstract demographic information as well as information about tobacco
Abner P. Korn; Priscilla D. Abercrombie; Anne Foster
Vulvar intraepithelial neoplasia�The need for auditable measures of management
ObjectivesSurgical excision is currently the standard treatment for vulvar intraepithelial neoplasia (VIN). To date it has proved difficult to evaluate the management of VIN in reported series due to heterogeneity in datasets. The objective of this study was to justify standardised data presentation to permit comparison between series and facilitate determination of an optimal strategy for management of VIN. We
Ram Athavale; R. Naik; K. A. Godfrey; P. Cross; M. H. Hatem; A. de Barros Lopes
Vulvar intraepithelial neoplasia: Age, morphological phenotype, papillomavirus DNA, and coexisting invasive carcinoma
Recent studies suggest that subsets of vulvar intraepithelial neoplasia (VIN) may be distinguished based on morphological presentation, the presence or absence of human papillomavirus (HPV) nucleic acids, and patient age. We analyzed 65 VIN lesions, including 15 with associated squamous cell carcinoma, to determine the relationship between pathological parameters associated with common types of VIN (multinucleation, koilocytosis, verruco-papillary morphology, diffuse
Hope K Haefner; James E Tate; Catherine M McLachlin; Christopher P Crum
Photodynamic Therapy of Vulvar Intraepithelial Neoplasia III Using Topically Applied 5-Aminolevulinic Acid
Objectives. The aim of this study was twofold: first, to determine the feasibility of photodynamic therapy (PDT) of vulvar intraepithelial neoplasia III (VIN III) using topically applied 5-aminolevulinic acid (ALA) for photosensitization, and second, to compare PDT results with those of laser evaporation and local excision.Methods. Fifteen patients with VIN III had 10 g of 10% ALA gel applied to
Mathias K. Fehr; Ren� Hornung; Viola A. Schwarz; Ren� Simeon; Urs Haller; Pius Wyss
Integration of HPV16 and HPV18 DNA in vulvar intraepithelial neoplasia
Objective.Vulvar intraepithelial neoplasia (VIN) is a premalignant disease of the lower genital tract. The increased occurrence of high-risk human papillomavirus (HPV) infection seems to be associated with the increasing frequency of VIN. Integration of HPV DNA into host chromosome has been hypothesized to be a critical step in the carcinogenesis of cervical neoplasia resulting in altered expression of two viral
Peter Hillemanns; Xiuli Wang
Vulvar epithelial inclusion cyst as a late complication of childhood female traditional genital surgery
Epithelial inclusion cysts may be a late complication of traditional female genital surgery. We present the case of a 19-year-old Eritrean woman who had been circumcised at birth and sought treatment for an enlarging vulvar mass that arose after the onset of puberty. Symptoms included pain, pruritus, and interference with walking. (Am J Obstet Gynecol 2000;183:509-10.)
Gigi L. Kroll; Leslie Miller
[Vulvar cancers. Retrospective study of 23 cases at the Cancer Institute of Dakar].
The vulvar cancer is an uncommon disease which is beginning mostly on vulvar intraepithelial neoplasma and it keeps a very bad prognostic. The purpose of this study is to report the epidemiological, the anatomo-clinic and and to discuss the treatment. We tell about 23 vulvar cancer from 1956 to 1995 which were followed at the cancer Institut of Dakar. The mean age of patients is 47 years and they are on menopause in 78.6%. The most of the tumors are ulcerate (96%). The clinical investigation find according the staging of FIGO: 15 tumors (T2), 8 tumors (T3), 6 tumors (N1), 9 tumors (N2) and 1 tumor (M1b). The surgery is the principal treatment with 6 radical vulvectomy and 17 palliative vulvectomy. The surgery was associated with radiotherapy and chemotherapy. So the vulvar cancer is uncommon in our country and concern the young wives. The vulvectomy with lymphadenectomy is the principal treatment; the prognostic still very bad because the diagnostic is often later. PMID:14666788
Dem, A; Kasse, A A; Diop, M; Diop, A K; Diop, P S; Dembele, B; Toure, P
Case-control study of vulvar vestibulitis risk associated with genital infections.
OBJECTIVE: To evaluate the risk of vulvar vestibulitis syndrome (VVS) associated with genital infections in a case-control study. METHODS: Diagnosed cases with VVS (n = 69) and age-frequency-matched healthy controls (n = 65) were enrolled from gynecology clinics in a university medical hospital during 1999. They were compared for potential risk factors and symptoms of disease. RESULTS: VVS cases had a significantly higher risk of physician-reported bacterial vaginosis (BV) (odds ratio, OR = 9.4), Candida albicans (OR = 5.7), pelvic inflammatory disease (PID) (OR = 11.2), trichomoniasis (OR = 20.6), and vulvar dysplasia (OR = l5.7) but no risk associated with human papillomavirus (HPV), ASCUS, cervical dysplasia, genital warts, chlamydia, genital herpes or gonorrhea. Genital symptoms reported significantly more often with VVS included vulvar burning (91 vs. 12%), dyspareunia (81 vs. 15%), vulvar itching (68 vs. 23%) and dysuria (54 vs. 19%) (p < 0.0001). CONCLUSION: A history of genital infections is associated with an increased risk of VVS. Long-term follow-up case-control studies are needed to elucidate etiologic mechanisms, methods for prevention and effective treatment.
Smith, Elaine M; Ritchie, Justine M; Galask, Rudolph; Pugh, Erica E; Jia, Jian; Ricks-McGillan, Joan
Vulvar vestibulitis subjects undergoing surgical intervention: a descriptive analysis and histopathological correlates
Objective: We describe here a series of selected patients from an established vaginitis research clinic diagnosed with vulvovestibulitis (VV) who underwent surgical intervention for focal disease. Long-term results of surgical correction are reported and characteristic histopathology findings associated with vulvar vestibulitis are emphasized. Study Design: A retrospective chart review was carried out to extract relevant clinical, histologic, and outcome data.
Walter Chaim; Curtis Meriwether; Bernard Gonik; Faisal Qureshi; Jack D. Sobel
Vulvar vestibulitis severity�assessment by sensory and pain testing modalities
Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Previous quantitative sensory test (QST) studies have demonstrated reduced vestibular pain thresholds in these patients. Here we try to find whether QST findings correlate to disease severity. Thirty-five vestibulitis patients, 17 with moderate and 18 with severe disorder, were compared to 22 age matched control women. Tactile
Lior Lowenstein; Yoram Vardi; Michael Deutsch; Michael Friedman; Ilan Gruenwald; Michal Granot; Elliot Sprecher; David Yarnitsky
Polymerase chain reaction search for viral etiology of vulvar vestibulitis syndrome
OBJECTIVE: Our purpose was to assess the prevalence of infections by human papillomavirus, herpes simplex virus, and cytomegalovirus among women with severe vulvar vestibulitis. STUDY DESIGN: Eighty-six women referred for dyspareunia and diagnosed as having severe vestibulitis underwent perineoplasty, including surgical removal of the sensitive vestibule. Controls included 25 age-matched patients without dyspareunia undergoing vaginal operations for various benign causes
Jacob Bornstein; Sara Shapiro; Michal Rahat; Nimrod Goldshmid; Zeev Goldik; Haim Abramovici; Nitza Lahat
Epidemiology of vulvar vestibulitis syndrome: an exploratory case-control study
BACKGROUND: Vulvar vestibulitis syndrome (VVS) is a chronic, persistent syndrome characterised by vestibular pain, tenderness, and erythema. The aetiology of VVS is unknown and few of the hypothesised risk factors have been tested in controlled studies. METHODS: Using a matched case-control study design, medical, sexual, health behaviour, and diet history of 28 women with VVS were compared with 50 friend
A. V. Sarma; B. Foxman; B. Bayirli; H. Haefner; J. D. Sobel
Optic disc edema associated with spinocerebellar degeneration.
A 58-year-old man presented with optic disc edema as a rare association with spinocerebellar degeneration (SCD). The patient also had chronic idiopathic intestinal pseudo-obstruction with hypoalbuminemia. No elevation of intraspinal pressure and no intracranial lesion was observed. The hypoalbuminemia reacted promptly to treatment, whereas the optic disc edema regressed gradually. An association between SCD and optic atrophy has often been described, but to our knowledge this is the first report of SCD in association with optic disc edema. PMID:9672220
Nakazawa, T; Abe, T; Hasegawa, T; Tamai, M
Acute pulmonary edema associated with naphazoline ingestion.
In published reports of naphazoline ingestion, clinical effects are hypertension, bradycardia, pallor, diaphoresis, and respiratory distress. We report three cases of acute pulmonary edema after the intentional ingestion of naphazoline-containing antiseptic first aid liquid. These cases presented with altered mental status, hypertension, bradycardia, and diaphoresis. Chest x-ray on admission revealed acute pulmonary edema. Two cases required mechanical ventilation. All of these clinical effects resolved within 24 hours and the patients were discharged with no sequelae. Since naphazoline stimulates the peripheral alpha-2 adrenergic receptor, we speculate that intense vasoconstriction may have elevated cardiac afterload and left atrial-ventricular blood volume and caused acute pulmonary edema. PMID:17852165
Fukushima, Hidetada; Norimoto, Kazunobu; Seki, Tadahiko; Nishiguchi, Takashi; Nakamura, Tatsuya; Konobu, Toshifumi; Nishio, Kenji; Okuchi, Kazuo
HPV Detection and Genotyping in Vulvar Squamous Cell Carcinoma in Northern Thailand.
Background: The study was aimed to evaluate the prevalence and genotype distribution of HPV infection in vulvar squamous cell carcinoma (SCC) in northern Thailand and the clinicopathological difference with regard to HPV infection status. Materials and Methods: Formalin-fixed paraffin-embedded tissue samples of vulvar SCC diagnosed between January 2006 and December 2012 were collected. HPV infection was detected by nested polymerase chain reaction (PCR) with primers MY09/11 and GP5+/6+. HPV genotyping was performed using the Linear Array Genotyping Test, followed by type-specific PCR targeting the E6/E7 region of HPV16/18/52 if the Linear Array test was negative. The histologic slides of vulvar lesions and the medical records were reviewed. Results: There were 47 cases of vulvar SCC included in the study (mean patient age 57.9�13.2 years). HPV infection was detected in 29 cases (62%), all of which had single HPV infections. HPV16 accounted for 23 (49%). The patients with HPV-positive SCC had a significantly younger mean age than those with HPV-negative tumors (52.7 years vs 66.2 years, p<0.001). There was no significant difference in tumor stage distribution with regard to the status of HPV infection. The presence of vulvar intraepithelial neoplasia (VIN) of usual type (basaloid or warty) was significantly more frequent in HPV-positive cases compared with HPV-negative cases (62% vs 6%, p<0.001), whereas differentiated-type VIN was more common in HPV-negative cases (24% vs 0%, p=0.019). Conclusions: HPV infection was detected in 62% of vulvar SCC in northern Thailand. HPV16 was the predominant genotype similar to the data reported from other regions. HPV-positive SCC occurred in younger patients compared with HPV-negative SCC, and was associated with usual-type VIN. Vaccination against HPV16/18 may potentially prevent almost one half of vulvar SCC in northern Thailand. PMID:24870792
Siriaunkgul, Sumalee; Settakorn, Jongkolnee; Sukpan, Kornkanok; Srisomboon, Jatupol; Utaipat, Utaiwan; Lekawanvijit, Suree; Khunamornpong, Surapan
Rates of Self-Reported Urinary, Gastrointestinal and Pain Comorbidities in Women with Vulvar Lichen Sclerosus
Objective To determine the prevalences of comorbid disorders in women with vulvar lichen sclerosus. Materials and Methods A retrospective review of self-administered questionnaires regarding the health history of 308 women with lichen sclerosus seen at a vulvar clinic between 2006�2011 was performed. Responses to questions about urinary [overactive bladder (OAB), urinary incontinence (UI), stress urinary incontinence (SUI)], gastrointestinal [inflammatory bowel diseases (IBD), constipation, irritable bowel syndrome (IBS)], thyroid dysfunction, and pain [interstitial cystitis (IC), fibromyalgia, temporomandibular joint disorder (TMJ) and vulvar pain] disorders were collected. The percentage of subjects self-reporting each comorbidity was compared to the published prevalence in the general population using a single-value binomial test. Results Subject demographics [data presented as median (minimum, maximum) or percentage]: Age 56.4 years (20.0, 92.5), BMI 27.5 kg/m2 (17.4, 53.1), Parity 2 (0, 10), Caucasian 92.9%, Biopsy proven 65.6%. Prevalences of self-reported comorbidities in our subjects are: OAB 15.3%, UI 38.6%, SUI 27.9%, IBD 1.9%, Constipation 32.5%, IBS 19.5%, Thyroid dysfunction 33.1%, IC 2.6%, Fibromyalgia 9.1%, TMJ 13.0%, Vulvar pain 83.1%. The prevalence of each disorder is significantly different than that in the general population, with all p values ? 0.02. Conclusions Vulvar lichen sclerosus is associated with numerous bladder, bowel, and pain comorbidities. The prevalences of all of these disorders are higher in our subjects than the general population except OAB, which we find at approximately 1/3 that of the general population. Patients with lichen sclerosus should be screened for comorbidities that may affect their health and/or quality of life.
Berger, Mitchell B.; Damico, Nicholas J.; Menees, Stacy B.; Fenner, Dee E.; Haefner, Hope K.
A review of molecular pathological markers in vulvar carcinoma: lack of application in clinical practice.
Vulvar carcinoma is a rare female genital neoplasia. Radical surgery, which has been the standard treatment approach, is often accompanied by considerable morbidity. To reduce the incidence of complications there has been a movement toward individualised therapy and less radical surgery. Associated with this, new tumour markers that could serve as prognostic indicators would be of considerable value to guide treatment decision. In this review, a brief update of molecular pathological markers of vulvar carcinomas is provided, and their impact as prognostic markers is addressed. p16, p21, p14, p27, cyclin A, cyclin D1, p53, vascular endothelial growth factor (VEGF), transforming growth factor alpha, HER-2 and epidermal growth factor receptor (EGFR) have been found to be important in the pathogenesis and/or progression of vulvar carcinomas. Furthermore, human papillomavirus, p16, p21, p14, p53, VEGF, CD44v3, CD44v6, CD44v4, CD44v9, CD44v10, HER-2, EGFR, matrix metalloproteinase-12, caspase 3, Bcl-2 and nm23-H1 have been correlated to clinical outcome of patients with vulvar carcinomas. However, due to the relative small number of studies reported for each molecular pathological marker, and the relative small number of vulvar carcinomas included and the lack of multivariate analysis in the majority of these studies, no conclusion regarding the prognostic value of these markers can be drawn. Therefore, the investigated markers have not yet earned a place in standard clinical diagnostics or treatment, and further studies are needed to clarify the clinical value of these markers. PMID:19251952
Knopp, S; Trop�, C; Nesland, J M; Holm, R
Immunohistochemical expression of p16 and p53 in vulvar intraepithelial neoplasia and squamous cell carcinoma of the vulva
This study was undertaken to examine the expression of p16 and p53 in vulvar intraepithelial neoplasia (VIN) and squamous\\u000a cell carcinoma (SCC) of the vulva. We also analyzed the relationship between p16 and p53 immunoexpression in women younger\\u000a vs. older than 55 years of age. Seventyseven histologic samples of vulvar tissue, treated surgically between June 2000 and\\u000a November 2004 at
Mauricio Cordoni Nogueira; Ernesto de Paula Guedes Neto; Marcos Wengrover Rosa; Eduardo Zettler; Cl�udio Galleano Zettler
Acute vulvar pain in a lady with post circumcision inclusion cyst of the vulva containing stones: a case report
Background Despite global eradication efforts, female genital cutting is still deep routed practice in some parts of Asia and East Africa. The crude and unscientific natures of the practice lead to many complications. Epidermoid inclusion cysts of the vulva are one of the late complications of female genital cutting and typically present as painless cystic swellings. But clinical presentation as �stone� containing, hard vulvar mass is reported only once in the literature and presentation with acute vulvar pain has never been documented. Case presentation A 21 yrs old, Ethiopian, unmarried, lady presented with sever acute vulvar pain, discharge, and a stony hard vulvar swelling 13 years after type-III female genital cutting (infibulation). Surgical excision of the cyst, which contained two �stones� inside it, and defibulation were done. Histopathology confirmed calcified, keratinizing epidermoid inclusion cyst of the vulva. Conclusions Clinicians, in areas where female genital cutting is prevalent, should be aware of such unusual late vulvar complication of the practice which might be misdiagnosed for other solid vulvar swellings and be familiar with the appropriate management.
Preoperative neurogenic pulmonary edema: A dilemma for decision making
Neurogenic pulmonary edema may be a less-recognized consequence of obstructive hydrocephalus. The authors report a patient with acute obstructive hydrocephalus due to cerebellar metastatic lesion, who presented with neurogenic pulmonary edema. The edema resolved on placement of the ventriculoperitonial shunt. This report addresses the importance of recognition of neurogenic pulmonary edema as a possible perioperative complication resulting from an increase in intracranial pressure and the issues involved with anesthetic management of co-existing neurogenic pulmonary edema and intracranial hypertension.
Lakkireddigari, Siva Kumar Reddy; Durga, Padmaja; Nayak, Madhukar; Ramchandran, Gopinath
Case of lung carcinoma revealed by vulvar metastasis associated with systemic scleroderma and literature review
Metastatic carcinoma to the vulva is rare, where the incidence is believed to be between 5% and 8%. However, malignant tumors have been described in 3�11% of systemic scleroderma (SSc) cases. We report the case of one patient, a 66-year-old postmenopausal woman, whose medical history was marked with rheumatic vascular disease (systemic scleroderma) since 1993 without muscular, renal, cardiac lesions or HTA (arterial hypertension) and without tobacco history. The woman presented with a new vulvar mass of the right labia in December 2011 that had progressively enlarged in size. CT scan of the abdominopelvic region demonstrated a lobular mass of the right labia with central necrosis, 7�cm on the wide axis, and the rectum and the vaginal wall were normal. No inguinal or iliac lymphadenopathy was noted. An outpatient excisional biopsy revealed a poorly differentiated malignant tumor suggestive of carcinoma. IHC: CK7+/CK20?, estrogen receptors?, AE 1 AE 3+, vimentine+, S100?, Desmina?, CD34?, KI 67: 20%. The thoracic scan revealed a large mass of 4�cm�נ3�cm in the right lung base with right paratracheal lymphadenopathy 3�cm�נ2�cm. A bronchoscopy revealed discrete stenosis of the mediastinal portion of the right bronchial tree. The bronchial biopsy also revealed poorly differentiated lung carcinoma, non-small cell, which was identical with the vulvar tumor. Conclusion The presence of the single lung lesion with only one lymphadenopathy paratracheal with pathological and immunohistochemical (IHC) profile similar to the vulvar lesion, and a particular IHC profile with CK7+ and CK20? was detected � that is more specific to the primitive pulmonary cancer, and the presence of only one sarcoma marker vementine+, desmine and actine?. Also the presence of KI 67: 20%, predicted the proliferative and great metastatic power of the lung tumor was observed. Additionally, lung cancer was the most frequent type and may develop in scleroderma as reported in most studies. This allows to conclude for primitive lung carcinoma revealed with vulvar metastasis after elimination of the possibility of vulvar sarcoma. The patient was treated by chemotherapy (Taxol/Platin) with partial response from the lung after 3 cycles and palliative radiotherapy in the vulva with a good response. This case described primary lung carcinoma associated with scleroderma, revealed by a vulvar metastasis, which may be related to the aggressiveness of lung cancer when the lung fibrosis follow-up is not performed well to detect early the development of lung tumors in the patient with systemic scleroderma.
Mansouri, Safae; Glaria, Luis A.; Asmae, Naim; Flores, Luis F.
Magnetic resonance imaging of vulvar dermatofibrosarcoma protuberans - report of a case
Background Dermatofibrosarcoma protuberans (DFSP) of the vulva is a rare low-grade soft tissue sarcoma. Magnetic resonance imaging (MRI) findings of vulvar DFSP were essentially unreported in the literature. Case report We report a DFSP of vulva with its clinical, histological and MRI features. As far we know this is the first case of histologically confirmed vulvar DFSP presenting with MR images. The diagnosis of DFSP is usually made by histopathologic and clinical findings. Conclusions MRI is useful both for the diagnosis of DFSP and following up the patients since it has high soft tissue resolution and no risk of radiation exposure. With MRI the relation to the adjacent anatomical structures, extension and depth of the tumour and possible lymph node involvement can also be demonstrated.
Ozmen, Evrim; Guney, Guven; Algin, Oktay
Diabetic macular edema: New promising therapies.
The treatment of diabetic macular edema is rapidly evolving. The era of laser therapy is being quickly replaced by an era of pharmacotherapy. Several pharmacotherapies have been recently developed for the treatment of retinal vascular diseases such as diabetic macular edema. Several intravitreal injections or sustained delivery devices have undergone phase 3 testing while others are currently being evaluated. The results of clinical trials have shown the superiority of some of these agents to laser therapy. However, with the availability of several of these newer agents, it may be difficult to individualize treatment options especially those patients respond differently to various therapies. As such, more effort is still needed in order to determine the best treatment regimen for a given patient. In this article, we briefly summarize the major new therapeutic additions for the treatment of diabetic macular edema and allude to some future promising therapies. PMID:24379924
Shamsi, Hanan N Al; Masaud, Jluwi S; Ghazi, Nicola G
Investigation of prognostic significance of CD109 expression in women with vulvar squamous cell carcinoma
Objective The goal of this study was to investigate the between cluster of differentiation 109 (CD109) expression and tumor diameter, invasion depth, tumor grade, presence of lymph-node metastasis, and overall survival in patients with vulvar squamous cell carcinoma, which is the most common type of vulvar cancer. Method Twenty-six patients who underwent an operation for vulvar cancer between 1999 and 2009 in our clinic were included in this study. Immunohistochemical staining was performed on formalin-fixed and paraffin-embedded tissue. Result Tumor diameter was not found to be significantly associated with CD109 expression, intensity of cytoplasmic staining, or combined score (P = 0.325, P = 0.169, P = 0.352, respectively). Invasion depth and combined score were also not significantly correlated with CD109 expression (P = 0.324 and P = 0.174 respectively). There was a negative correlation between invasion depth and the intensity of cytoplasmic staining (P = 0.042). There was no significant correlation between tumor stage and CD109 expression, the intensity of cytoplasmic staining, and the combined score (P = 0.574, P = 0.389, P = 0.605, respectively). A significant positive correlation was observed between tumor grade and CD109 expression, the intensity of cytoplasmic staining, and the combined score (P = 0.003, P = 0.018, P = 0.008, respectively). No significant difference was found between the percentages of CD109 expression in patients with positive (48%) and negative (11%) lymph nodes (P = 0.058). The percentage of CD109 expression did not significantly differ in relation to overall survival (P = 0.483). Conclusion Comprehensive and more extensive studies are needed to examine the relationship between CD109 expression and vulvar malignant lesions.
Ozbay, Pelin Ozun; Ekinci, Tekin; Yigit, Seyran; Yavuzcan, Ali; Uysal, Selda; Soylu, Ferit; Cakalagaoglu, Fulya
Evaluation of CO 2 Laser Excision or Vaporization for the Treatment of Vulvar Intraepithelial Neoplasia
Objective. Ourobjective was to evaluate the results of laser surgery in patients with vulvar intraepithelial neoplasia (VIN).Methods. From January 1990 to December 1996, 52 patients with histologically proven VIN were treated with CO2 laser vaporization or laser excision. The analysis included anamnestic characteristics, clinical aspects, types of treatment, correlation of the preoperative biopsy with the excised pathologic specimen, and follow-up
M. Sideri; L. Spinaci; N. Spolti; F. Schettino
HPV-related vulvar intraepithelial neoplasia: Outcome of different management modalities
Objective: To evaluate the outcome of various management schemes for HPV-related vulvar intraepithelial neoplasia (VIN, usual type). Methods: Retrospective chart review of patients with histologically diagnosed grade 2\\/3-VIN who had at least one year of follow-up. The variables that were collected included patient characteristics, management modalities, and clinical outcome. Results: Fifty patients with a median age of 45 years old
I. Bruchim; S. Mahmud; E. Tunitsky; K. Grzywacz; A. Ferenczy
Vulvar vestibulitis and risk factors: a population-based case-control study in Oslo.
Vulvar vestibulitis is a major cause of entry dyspareunia in young women. The aim of this study was to evaluate a self-reported history of bacterial vaginosis, candidiasis, use of oral contraception and nulli-pregnancy as risk factors for vestibulitis. A retrospective examination of medical records was performed for 45 patients with vestibulitis from a vulvar clinic in Oslo, median age 24 years, age range 19-49 years. Four controls per case were selected randomly from the same Oslo source population as the cases. Age-matching was not performed, as matching does not control for confounding in the case-control design. Controls anonymously answered a postal questionnaire, response rate 61%. The crude effect for the major potential predictors for vulvar vestibulitis was estimated, and stratification on age for the major potential predictors. The method of Mantel Haenszel was used to quantify confounders, and control for multi-confounders and the gradient effect of different covariates was performed. The major confounder was age. Independent risk factors for vestibulitis were nulli-pregnancy, odds ratio (OR) 8.4 (95% confidence interval (CI) 2.8-25.2) and bacterial vaginosis, OR 3.37 (95% CI 1.06-10.6). Adjusting for age diluted the effect of oral contraception and frequent treatment for candidiasis. This study is the third case-control study identifying bacterial vaginosis as a risk factor for vestibulitis. Thus, it remains to be investigated whether abnormal vulvo-vaginal microbiota belongs to the aetiology of vulvar vestibulitis. PMID:17598040
Edgardh, Karin; Abdelnoor, Michael
Use of neutral plasma coagulation in groin node dissection for vulvar malignancy: a novel technique
Vulvar cancer is an uncommon disease with approximately 1000 cases reported annually in the UK. Lymph node involvement is an important prognostic indicator. Vulvectomy and bilateral groin node dissection are the preferred surgical treatments for early disease and increase survival. However, significant morbidity with lymphocyst formation and wound breakdown has been reported in more than 50% of cases. We report the first case following use of the PlasmaJet� neutral argon coagulation system to reduce postoperative lymphocyst formation.
Madhuri, Thumuluru Kavitha; Tailor, Anil; Butler-Manuel, Simon
[Uvular edema : Rare complication in anesthesia].
A uvular edema can be associated with angioedema, urticaria and anaphylaxis. Furthermore, it can be caused by medications, such as angiotensin-converting enzyme (ACE) inhibitors, non-steroidal anti-inflammatory drugs and angiotensin II receptor antagonists. Other reasons can be cannabis or cocaine use or a traumatic irritation of the uvula. This article presents the case of a patient who underwent kidney transplantation and developed extensive edema of the uvula that occurred postoperatively after general anaesthesia. The case report describes the diagnosis and therapy of this rare disease. PMID:25052718
L�ser, B; Z�llner, C
Optimization of Near-Infrared Fluorescent Sentinel Lymph Node Mapping for Vulvar Cancer
Objectives Near-infrared (NIR) fluorescence imaging has the potential to improve sentinel lymph node (SLN) mapping in vulvar cancer, which was assessed in the current study. Furthermore, dose optimization of indocyanine green adsorbed to human serum albumin (ICG:HSA) was performed. Study Design Nine vulvar cancer patients underwent the standard SLN procedure using 99mtechnetium-nancolloid and patent blue. In addition, intraoperative imaging was performed after peritumoral injection of 1.6 mL of 500, 750 or 1000 �M of ICG:HSA. Results NIR fluorescence SLN mapping was successful in all patients. A total of 14 SLNs (average 1.6, range 1�4) were detected: 14 radioactive (100%), 11 blue (79%), and 14 NIR fluorescent (100%). Conclusions This study demonstrates feasibility and accuracy of SLN mapping using ICG:HSA. Considering safety, cost, and pharmacy preferences, an ICG:HSA concentration of 500 �M appears optimal for SLN mapping in vulvar cancer.
Hutteman, Merlijn; Van Der Vorst, Joost R.; Gaarenstroom, Katja N.; Peters, Alexander A.W.; Mieog, J. Sven D.; Schaafsma, Boudewijn E.; Lowik, Clemens W.G.M.; Frangioni, John V.; Van De Velde, Cornelis J.H.; Vahrmeijer, Alexander L.
Relationship between gonadal steroid hormones and vulvar bleeding in southern tamandua, Tamandua tetradactyla.
This study aimed at demonstrating the profiles of circulating gonadal steroid hormones during the estrous cycle and pregnancy in a southern tamandua (Tamandua tetradactyla). Additionally, this study clarified the relationship between vulvar bleeding and hormonal changes. The concentrations of serum progesterone (P(4)) and estradiol-17? (E(2)) were determined by enzyme immunoassays. Serum P(4) and E(2) concentrations changed cyclically and the estrous cycle length (� SD) based on the E(2) cycles was 44.3 � 4.5 days. Vulvar bleeding started to be seen at the decreasing of P(4). The cycle length for vulvar bleeding was 43.3 � 4.2 days. Interval from the first day of bleeding to the peak of E(2) concentration was 23.1 � 3.1 days. Serum P(4) during pregnancy remained high and E(2) increased 8 weeks after conception and remained high until parturition. The female delivered normally after a 165 day-pregnancy period and reared the offspring well. Approximately 3 weeks after parturition, serum E(2) and P(4) cycles resumed. Visual bleeding may be useful as a real-time indicator for understanding the ovarian cycle of southern tamanduas, and estrus could be expected approximately 3 weeks after the first bleeding. PMID:21462248
Kusuda, Satoshi; Endoh, Tomoko; Tanaka, Hiroyuki; Adachi, Itsuki; Doi, Osamu; Kimura, Junpei
Pidotimod in the management of vulvar papillomatosis: double-blind clinical trial versus placebo.
To investigate whether the immune system improvement induced by pidotimod increases the rate of spontaneous disappearance of vulvar papillomatous lesions, a multicenter, double-blind, placebo-controlled, randomized clinical trial was performed. Forty-nine patients (23 in the pidotimod group and 26 in the placebo group) with first diagnosis of vulvar papillomatosis as shown by clinical and histological findings underwent 90-day treatment with oral 800-mg pidotimod once a day or identical placebo. The main outcome measure was the difference between vulvar papillomatous infected area before and after treatment judged by the following: complete regression (complete disappearance of all papillomatous lesions); partial regression (a decrease of at least 75% of the infected area); no response (a decrease of less than 75% of the infected area or new viral lesions not present at baseline). Forty patients completed the trial according to the study protocol and were entered in the "per protocol" analysis of efficacy. Complete regression was observed in 12 of 18 patients (66.7%) receiving pidotimod compared with 7 of 22 patients (31.8%) receiving placebo. The total infected surface area at the end of treatment was 10.1 +/- 18.5 mm2 (mean +/- SD) in the pidotimod arm and 198.3 +/- 399.2 mm2 in the placebo arm (p < 0.05 between treatment). Notwithstanding the fact that better results were obtained in the pidotimod group, more data are needed to confirm our encouraging results. PMID:10099052
Guerra, B; Perino, A; Polatti, F; Scala, M
Stage IA vulvar squamous cell carcinoma: an analysis of tumor invasive characteristics and risk.
Early invasive vulvar squamous cell carcinoma (SCC) with less than 1.0 mm of invasion (FIGO stage IA) has been shown to have a minimal risk of lymph node metastasis and is associated with an excellent prognosis. The prognostic significance of other histologic parameters other than depth of invasion, however, remains controversial. Seventy-eight consecutive cases of vulvar SCC having a depth of invasion of 5.0 mm or less were reviewed and the clinical outcome compared with the type of surgical excision, the presence of concurrent lymph node metastases, the depth of tumor invasion, the tumor thickness, the tumor horizontal spread, the estimated tumor volume, tumor histologic subtype, tumor histologic grade, tumor pattern of invasion, tumor multifocality, presence of perineural invasion, presence of angiolymphatic invasion and the presence of precursor lesions, including the type of vulvar intraepithelial neoplasia and presence of lichen sclerosus. The only histologic feature for predicting concurrent lymph node metastasis was tumor depth of invasion. The 3 most important features of stage IA tumors in predicting tumor recurrence were the depth of invasion, presence of SCC at the surgical margins, and the histologic grade. PMID:18379417
Yoder, Brian J; Rufforny, Irina; Massoll, Nicole A; Wilkinson, Edward J
Vulvar pain: a phenomenological study of couples in search of effective diagnosis and treatment.
Vulvar vestibulitis syndrome (VVS), a vulvar pain disorder, continues to puzzle medical and mental health professionals due to its unknown etiology and lack of effective treatment. This study used transcendental phenomenology methodology to explore the experiences of couples in which the woman has a diagnosis of VVS. Sixteen in-depth semi-structured interviews were conducted with 13 heterosexual couples and 3 women. Four essences emerged: (1) In search of ... the medical journey required extensive searching for knowledgeable and respectful practitioners to provide treatment. (2) The process of developing a personal understanding of this disorder led many couples to question their role in causing and maintaining VVS. (3) Developing strategies for coping with painful intercourse led to three strategies: becoming non-sexual, using alternatives to vaginal sex, and altering or enduring painful intercourse. (4) Feelings of isolation were experienced as adapting to this chronic pain syndrome was often a lonely process. Clinical suggestions included: treating the couple, not just the woman with VVS; encouraging couples to broaden definitions about the importance and primacy of vaginal intercourse and suggest alternative sexual activities less likely to cause vulvar pain; developing shared meaning as a couple, and assisting couples in locating physicians and resources. Suggestions are relevant for couples with VVS and those with chronic health problems affecting sexual relationships. PMID:18605118
Connor, Jennifer J; Robinson, Bean; Wieling, Elizabeth
Postoperative pulmonary edema in young, athletic adults
Pulmonary edema secondary to postextubation laryn gospasm is a potentially life-threatening problem, de manding early diagnosis and prompt treatment. We believe that this problem has been grossly underesti mated in its incidence, as only seven adults have been reported in the English literature, whereas seven adults have been observed at our institution in only a 24 month period. All were
James R. Holmes; Robert N. Hensinger; Edward W. Wojtys
Pathogenesis of edema formation in burn injuries
One of the obvious acute features of cutaneous thermal injury is the swelling of the involved tissue. This swelling is caused by a fluid shift from circulating plasma. Along with the evolution of intravenous fluid therapy in trauma and surgery, the implementation of such therapy to burn victims has improved survival. Edema generation aggravated by fluid therapy may, however, represent
Tj�stolv Lund; Henning Onarheim; Rolf K. Reed
The Detection of Pulmonary Edema by Means of Electrical Impedance.
National Technical Information Service (NTIS)
The detection, localization, and quantification of pulmonary edema by electrical impedance were investigated using band, circumferential, and longitudinal electrode arrays in a series of four studies utilizing 35 dogs. Pulmonary edema was induced with all...
J. C. Denniston L. E. Baker
Intravitreal Cortisone Injection for Refractory Diffuse Diabetic Macular Edema
Purpose: The purpose of this study was to evaluate the safety and efficacy of intravitreal triamcinolone acetonide injection in patients with diffuse diabetic macular edema. We also compared the effect of intravitreal triamcinolone with macular grid laser photocoagulation in macular edema. Patients and Methods: Thirty patients with diabetic diffuse macular edema unresponsive to grid laser photocoagulation for at least 4
Hamdi Er
Prevention, identification and treatment of vulvar squamous (pre)malignancies: a review focusing on quality of care.
Vulvar squamous cell carcinoma, its precursor lesions (usual and differentiated vulvar intraepithelial neoplasia) and lichen sclerosus are rare diseases that may have a large impact on the lives of affected women and their partners. Proper identification is vital, but the lesions are sometimes difficult to diagnose because of their rarity and variety of symptoms. High quality of care and proper treatment is important in order to minimize the morbidity and mortality caused by these lesions. This review gives an outline of the latest insights regarding the current evidence in this area and unresolved issues. Additionally, it highlights the improvements that should be made in order to optimize prevention and identification of (pre-)malignant vulvar lesions and to increase the quality of care for these patients. PMID:23875663
van den Einden, Loes Cg; van der Avoort, Irene Am; de Hullu, Joanne A
Myocardial Edema Imaging in Acute Coronary Syndromes
Acute coronary syndromes (ACS) continue to be the most common morbid condition of industrialized nations. The advent of and technical improvements in revascularization and medical therapy have led to a steady decline in mortality rates. However, many patients who suffer unstable angina or myocardial infarction require further testing and risk stratification to guide therapeutic selection and prognosis assignment. Myocardial edema imaging with cardiac magnetic resonance (CMR) affords the ability to define the amount of myocardium at risk, refine estimates of prognosis and provide guidance for therapies with excellent sensitivity compared to standard clinical markers. This review will discuss the rationale for edema imaging, how it is performed using CMR and its potential clinical applications.
Walls, Michael C.; Verhaert, David; Raman, Subha V.
[Pharmacological correction of traumatic brain edema].
Experiments on rats were made to study the action of the derivatives of benzodiazepine (diazepam, 0.5 mg/kg and phenazepam, 0.1 mg/kg), and GABA (phenibut, 50 mg/kg, pantogam, 160 mg/kg, nicotinoyl-GABA, 500 mg/kg, piracetam, 1000 mg/kg) on the development of a traumatic brain edema. Diazepam, phenazepam and phenibut were demonstrated to produce a marked antiedematous action. The drugs made water content in the brain return to normal and reduced marked biochemical alterations in the brain. It is suggested that the protective action of the drug under study on the development of brain edema is linked with the action on the mediator structures and brain tissue metabolism. PMID:6142833
Novikov, V E; Iasnetsov, V S
Near-infrared fluorescence sentinel lymph node biopsy in vulvar cancer: a randomised comparison of lymphatic tracers.
This study aims to confirm the feasibility of near-infrared (NIR) fluorescence imaging for sentinel lymph node (SLN) biopsy in vulvar cancer and to compare the tracer indocyanine green (ICG) bound to human serum albumin (HSA) versus ICG alone. Women received 99mTc-nanocolloid and patent blue for SLN detection. Subsequently, women randomly received ICG:HSA or ICG alone. In 24 women, 35 SLNs were intraoperatively detected. All SLNs detected were radioactive and NIR fluorescent and 27 (77%) were blue. No significant difference was found between ICG:HSA and ICG alone. This trial confirms the feasibility of NIR fluorescence imaging for SLN mapping in vulvar cancer. PMID:23418877
Schaafsma, B E; Verbeek, F P R; Peters, A A W; van der Vorst, J R; de Kroon, C D; van Poelgeest, M I E; Trimbos, J B M Z; van de Velde, C J H; Frangioni, J V; Vahrmeijer, A L; Gaarenstroom, K N
Near-infrared fluorescence sentinel lymph node biopsy in vulvar cancer: a randomized comparison of lymphatic tracers
This study aims to confirm feasibility of near-infrared (NIR) fluorescence imaging for sentinel lymph node (SLN) biopsy in vulvar cancer and to compare the tracer indocyanine green (ICG) bound to human serum albumin (HSA) versus ICG alone. Patients received 99mTc-nanocolloid and patent blue for SLN detection. Subsequently, patients randomly received ICG:HSA or ICG alone. In 24 patients, 35 SLNs were intraoperatively detected. All SLNs detected were radioactive and NIR fluorescent and 27 (77%) were blue. No significant difference was found between ICG:HSA and ICG alone. This trial confirms the feasibility of NIR fluorescence imaging for SLN mapping in vulvar cancer.
Schaafsma, Boudewijn E.; Verbeek, Floris P.R.; Peters, Alexander A.W.; van der Vorst, J.R.; de Kroon, Cornelis D.; van Poelgeest, Mariette I. E.; Trimbos, J. Baptist M.Z.; van de Velde, Cornelis J.H.; Frangioni, John V.; Vahrmeijer, Alexander L.; Gaarenstroom, Katja N.
Cystoid Macular Edema in Bietti's Crystalline Retinopathy
A 27-year-old man with progressive bilateral visual decline was diagnosed to have Bietti's crystalline dystrophy (BCD). Fluorescein angiography revealed bilateral petaloid type late hyperfluorescence implicating concurrent cystoid macular edema (CME). Optical coherence tomography exhibited cystoid foveal lacunas OU. During the follow-up of six years, intraretinal crystals reduced in amount but CME persisted angiographically and tomographically. CME is among the rare macular features of BCD including subfoveal sensorial detachment, subretinal neovascular membrane, and macular hole.
Pigmentary epitheliopathy, disc edema, and lead intoxication.
A 52-year-old lead-exposed worker presented with disc edema, nerve fiber layer infarcts, and an acute bilateral pigment epitheliopathy that phenotypically resembled APMPPE. The patient had definite laboratory evidence of increased total body lead burden. The simultaneous involvement of retina, disc, and choriocapillaris suggests that what has been reported as the spectrum of APMPPE may represent a nonspecific vascular response to multiple injurious stimuli, including lead. PMID:3420315
Schubert, H D; Lucier, A C; Bosley, T M
High altitude cerebral and pulmonary edema.
Altitude illness, which comprises of acute mountain sickness (AMS) and its life threatening complications, high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE) is now a well recognized disease process. AMS and HACE are generally thought to be a continuum. Some historical facts about the illness, its new intriguing pathophysiological processes, and clinical picture are discussed here. Although the review deals with both HACE and HAPE, HAPE is covered in greater detail due to the recent important findings related to its pathophysiology and prevention mechanisms. Relevant clinical correlation, the differential diagnosis of altitude sickness for a more sophisticated approach to the disease phenomenon, the possibility of dehydration being a risk factor for altitude sickness, the hypothetical role of angiogenesis in cerebral edema, and the emphasis on some vulnerable groups at high altitude are some of the other newer material discussed in this review. A clear-cut treatment and basic prevention guidelines are included in two panels, and finally the limited literature on the role of genetic factors on susceptibility to altitude sickness is briefly discussed. PMID:17292039
Basnyat, Buddha
Risk factors for short- and long-term complications after groin surgery in vulvar cancer
Background: The cornerstone of treatment in early-stage squamous cell carcinoma (SCC) of the vulva is surgery, predominantly consisting of wide local excision with elective uni- or bi-lateral inguinofemoral lymphadenectomy. This strategy is associated with a good prognosis, but also with impressive treatment-related morbidity. The aim of this study was to determine risk factors for the short-term (wound breakdown, infection and lymphocele) and long-term (lymphoedema and cellulitis/erysipelas) complications after groin surgery as part of the treatment of vulvar SCC. Methods: Between January 1988 and June 2009, 164 consecutive patients underwent an inguinofemoral lymphadenectomy as part of their surgical treatment for vulvar SCC at the Department of Gynaecologic Oncology at the Radboud University Nijmegen Medical Centre. The clinical and histopathological data were retrospectively analysed. Results: Multivariate analysis showed that older age, diabetes, �en bloc' surgery and higher drain production on the last day of drain in situ gave a higher risk of developing short-term complications. Younger age and lymphocele gave higher risk of developing long-term complications. Higher number of lymph nodes dissected seems to protect against developing any long-term complications. Conclusion: Our analysis shows that patient characteristics, extension of surgery and postoperative management influence short- and/or long-term complications after inguinofemoral lymphadenectomy in vulvar SCC patients. Further research of postoperative management is necessary to analyse possibilities to decrease the complication rate of inguinofemoral lymphadenectomy; although the sentinel lymph node procedure appears to be a promising technique, in ?50% of the patients an inguinofemoral lymphadenectomy is still indicated.
Hinten, F; van den Einden, L C G; Hendriks, J C M; van der Zee, A G J; Bulten, J; Massuger, L F A G; van de Nieuwenhof, H P; de Hullu, J A
Vulvar squamous cell carcinoma developing in a young black African HIV woman.
Vulvar cancers are uncommon, represented in 90% of cases by squamous cell carcinoma (SCC). The reduction of the frequency and the severity proceed by recognition of precancerous or beginning lesions. They occur most often in the third age in postmenopausal women. The diagnosis is almost difficult and often late and therefore prognosis is severe. Conditions for diagnosis and treatment are difficult in underdeveloped countries due to the inaccessibility of proper equipment in the healthcare system. The authors report a case of SCC diagnosed late in a young human immunodeficiency virus (HIV) women who have been treated with neoadjuvant chemotherapy and radical surgery of the vulva. PMID:24475594
Nguessan, K L P; Mian, D B; Kasse, K; Boni, S
Itch and burning pain in women with partial vaginismus with or without vulvar vestibulitis.
Fifty-three women with partial vaginismus with or without vulvar vestibulitis and 27 asymptomatic women estimated sensations of burning pain and itch at 20 standardized moments during a standardized penetration situation, including vaginal muscle contractions. Forty-three women with partial vaginismus (81.1%) reported burning pain, 23 (43.4%) itch, and 22 (41.5%) both complaints, compared to 0% of the asymptomatic women. In 17 of 22 cases, burning pain preceded the appearance of itch and in four cases the two complaints coincided. The median time from the moment when burning pain started until itch appeared was 150 seconds. PMID:17365516
Engman, Maria; Wijma, Klaas; Wijma, Barbro
Changes in Men's Salivary Testosterone and Cortisol Levels, and in Sexual Desire after Smelling Female Axillary and Vulvar Scents.
Several studies have shown that a woman's vaginal or axillary odors convey information on her attractivity. Yet, whether such scents induce psychoneuroendocrinological changes in perceivers is still controversial. We studied if smelling axillary and vulvar odors collected in the periovulatory and late luteal phases of young women modify salivary testosterone and cortisol levels, as well as sexual desire in men. Forty-five women and 115 men, all of them college students and unacquainted with each other, participated in the study. Female odors were collected on pads affixed to the axilla and on panty protectors both worn the entire night before experiments. Men provided five saliva samples, a basal one before the smelling procedure, and four more 15, 30, 60, and 75?min after exposure to odors. Immediately after smelling the odor source, men answered a questionnaire rating hedonic qualities of scents, and after providing the last saliva sample they answered questionnaire on sexual desire. We found that periovulatory axillary and vulvar odors increased testosterone and cortisol levels, with vulvar scents producing a more prolonged effect. Luteal axilla odors decreased testosterone and cortisol levels, while luteal vulva odors increased cortisol. Periovulatory axilla and vulva scents accounted for a general increase of interest in sex. These odors were also rated as more pleasant and familiar, while luteal vulvar odors were perceived as intense and unpleasant. PMID:24194730
Cerda-Molina, Ana Lilia; Hern�ndez-L�pez, Leonor; de la O, Claudio E; Chavira-Ram�rez, Roberto; Mondrag�n-Ceballos, Ricardo
Fissured tongue: A sign of tongue edema?
Fissured tongue (FT) is a condition frequently seen in the general population. Clinically, FT is characterized by grooves that vary in depth and are noted along the dorsal and/or dorsolateral aspects of the tongue. Furthermore, FT presents many enlarged, smooth filiform papillae and subepithelial inflammatory infiltration. Despite of many studies, the etiology of FT remains obscure. FT is believed to be a congenital anomaly associated with several disorders and with geographic tongue (GT). We hypothesize that FT is not a congenital anomaly, and FT with swollen filiform papillae may represent edema in the subepithelial tissue of the tongue. According to the literature, the difference in prevalence among different age groups indicates that FT is not a congenital disorder. FT appears to occur more commonly in adults, and it is very rare or not at all in children younger than 10 years old. An association between FT and GT is well established in the literature, supporting the results of previous authors suggesting that FT might be a consequence of GT. The most remarkable finding in the region of swollen papillae of FT samples has been the subepithelial infiltrates of polymorphonuclear leucocytes and lymphocytes causing the subepithelial edema. The clinically visible grooves and large edematic papillae clustered on the region of the fissures might be caused by the inflammation and edema underneath the epithelium. In the future, FT and GT must be researched together as two different entities of the same disease so that GT is a prestage of FT. The diagnosis of FT must be taken to consideration whether the tongue surface have smooth and swollen papillae or normal-appearing filiform papillae. PMID:24698850
J�rvinen, Jaana; Mikkonen, Jopi J W; Kullaa, Arja M
EMAS clinical guide: Vulvar lichen sclerosus in peri and postmenopausal women.
INTRODUCTION: Vulvar lichen sclerosus (LS) is a chronic inflammatory disease which affects genital labial, perineal and perianal areas, producing significant discomfort and psychological distress. However there may be diagnostic delay because of late presentation and lack of recognition of symptoms. AIMS: The purpose of this clinical guide is to provide advice on early recognition and treatment. MATERIAL AND METHODS: Literature review and consensus of expert opinion. RESULTS AND CONCLUSIONS: The etiology of LS in peri and postmenopausal women is unknown, although autoimmune, genetic and infectious factors have been implicated. Definitive diagnosis of non-malignant disorders depends on the histology of biopsied tissue. LS associated with cellular atypia should be classified as intraepithelial neoplasia. Topical corticosteroids are the most effective treatment, although prolonged treatment may be associated with dermal atrophy. Topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, may be a safe and effective alternative treatment without risk of corticosteroid-related vulvar atrophy since they do not affect collagen synthesis. LS recurrences are frequent, and can lead to significant physical discomfort and emotional distress that affect mood and sexual relationships. Anatomical changes may require surgical management. PMID:23291001
P�rez-L�pez, Faustino R; Ceausu, Iuliana; Depypere, Herman; Erel, C Tamer; Lambrinoudaki, Irene; Rees, Margaret; Schenck-Gustafsson, Karin; Tremollieres, Florence; van der Schouw, Yvonne T; Simoncini, Tommaso
Multiple primary tumours in women with vulvar neoplasms: a case-control study.
We sought to determine whether women with in situ or invasive squamous cell vulvar cancer were more likely than other women to have had a previous or concurrent tumour at other anogenital sites. One hundred and fifty-eight women with vulvar cancer were identified who were first diagnosed during 1980-1985, were ages 18-79 years at that time, and were residents of one of three counties in western Washington. Two control groups were selected: (1) from records of hospital pathology departments, a sample of 113 women with certain benign conditions of the vulva; (2) through random digit dialing, a sample of 212 women from the general population of these counties. Information on a history of other cancers, and on sexual, reproductive, medical, and demographic characteristics was collected from cases and controls in at-home interviews. Cases were more likely to report a history of other anogenital cancers than were controls, with relative risks of 3.5-29.8, depending on the type of case group and type of control. These associations were not explained by case-control differences in demographic characteristics or frequency of cervical screening. On the other hand, prior or concurrent non-anogenital cancers were equally common in cases and controls. These results support the hypothesis that the different anogenital cancers have at least one aetiology in common.
Sherman, K. J.; Daling, J. R.; Chu, J.; McKnight, B.; Weiss, N. S.
Subclinical pulmonary edema in endurance athletes.
Strenuous exercise may cause progressive and proportional haemodynamic overload damage to the alveolar membrane, even in athletes. Despite the high incidence of arterial desaturation reported in endurance athletes has been attributed, into other factors, also to the damage of the alveolar-capillary membrane this evidence is equivocal. Some studies demonstrated flood of the interstitial space and consequent increase in pulmonary water content, but most of them were able to show this through indirect signs of interstitial oedema. The present review illustrates the literature's data in favour or against pulmonary interstitial edema due to intense exercise in athletes. PMID:23193844
Bussotti, M; Di Marco, S; Marchese, G; Agostoni, P G
Lymphoscintigraphy in the evaluation of limb edema.
Lymphedema is a chronic condition caused by ineffective lymphatic transport that results in edema and skin damage. Distinguishing lymphedema from other causes can be difficult. Lymphoscintigraphy is a simple and noninvasive functional test for the evaluation of the lymphatic system. (99m)Technetium-labeled sulfur colloid is injected intradermally at the interdigital web spaces of the upper/lower limbs. Once injected, the radiolabeled colloid particles travel through the superficial lymphatic channels. Thus, their lymphatic transport is monitored with dual-head gamma camera. The typical patterns of upper and lower limb lymphedema on lymphoscintigraphy are summarized in this section. PMID:24089069
Sundaram, P Shanmuga; Subramanyam, Padma
[Cardiogenic and non cardiogenic pulmonary edema: pathomechanisms and causes].
The development of pulmonary edema is divided in cardiogenic and non-cardiogenic. Cardiogenic edema pathogenically is caused by elevated hydrostatic pressure in the pulmonary capillaries due to left sided congestive heart failure. Non-cardiogenic pulmonary edema is categorized depending on the underlying pathogenesis in low-alveolar pressure, elevated permeability or neurogenic edema. Some important examples of causes are upper airway obstruction like in laryngeal paralysis or strangulation for low alveolar pressure, leptospirosis and ARDS for elevated permeability, and epilepsy, brain trauma and electrocution for neurogenic edema. The differentiation between cardiogenic versus non-cardiogenic genesis is not always straightforward, but most relevant, because treatment markedly differs between the two. Of further importance is the identification of the specific underlying cause in non-cardiogenic edema, not only for therapeutic but particularly for prognostic reasons. Depending on the cause the prognosis ranges from very poor to good chance of complete recovery. PMID:20582896
Glaus, T; Schellenberg, S; Lang, J
MR characterization of post-irradiation soft tissue edema
Objective. Radiation therapy is often used to treat bone und soft tissue neoplasms, and commonly results in soft tissue edema in the\\u000a radiation field. However, the time course, distribution and degree of this edema have not been well characterized. Our study\\u000a was carried out to better define these features of the edema seen following neutron and photon radiation therapy. Design
M. L. Richardson; Gordon C. Zink-Brody; Randall M. Patten; Wui-Jin Koh; Ernest U. Conrad
Licorice induced hypokalemia, edema, and thrombocytopenia.
Licorice originates from the root of Glycyrrhiza glabra, which has a herbal ingredient, glycyrrhizic acid, and has a mineralocorticoid-like effect. Chronic intake of licorice induces a syndrome similar to that found in primary hyperaldosteronism. Excessive intake of licorice may cause a hypermineralocorticoidism-like syndrome characterized by sodium and water retention, hypertension, hypokalemia, metabolic alkalosis, low-renin activity, and hypoaldosteronism. In this case report, an association of hypokalemia, edema, and thrombocytopenia that is developed due to the excessive intake of licorice is presented. There are case reports in the literature, which suggest that toxicity findings may emerge with hyperaldosteronism-like manifestations such as hypokalemia, edema, and hypertension. However, any knowledge of thrombocytopenia as a resultant was not encountered among these reported toxic effects. Our case is important because it shows that the excessive intake of licorice may cause a toxic effect in the form of thrombocytopenia. This report is the first presented case to show thrombocytopenia due to licorice syrup consumption. PMID:22653692
Celik, M M; Karakus, A; Zeren, C; Demir, M; Bayarogullari, H; Duru, M; Al, M
Pathophysiology and treatment of edema following femoropopliteal bypass surgery.
Substantial lower-limb edema affects the majority of patients who undergo peripheral bypass surgery. Edema has impairing effects on the microvascular and the macrovascular circulation, causes discomfort and might delay the rehabilitation process of the patient. However, the pathophysiology of this edema is not well understood. The Cochrane Library and Medline were used to retrieve literature on edema following peripheral bypass surgery. Factors other than local wound healing alone are suggested in the literature to play a role, given the severity and duration of this edema. Hyperemia, microvascular permeability, reperfusion-associated inflammation and lymphatic disruptions are likely to facilitate the development of edema. Preventive methods could be lymphatic-sparing surgery, intraoperative antioxidative therapy and postoperative elevation. Successful treatment strategies to reduce postoperative edema are based on lymph massage and external compression. In conclusion, the pathophysiology of edema following peripheral surgery is not fully understood, although reperfusion-associated inflammation and lymphatic disruptions are likely to play a crucial role. When future less-invasive techniques prove to be successful, postoperative edema might be minimized. Until then, a careful lymphatic-sparing dissection should be executed when performing a peripheral bypass reconstruction. Postoperatively, the use of compression stockings and leg elevation are currently the golden standards. PMID:22983547
te Slaa, A; Dolmans, D E J G J; Ho, G H; Moll, F L; van der Laan, L
Lower limb pitting edema in systemic lupus erythematosus.
We report two patients with lower limb pitting edema and systemic lupus erythematosus (SLE) who showed immediate response to systemic steroids. In one of the patients, the edema had been present for about 6 months and was the first manifestation of her SLE. In the second patient with a long history of SLE and antiphospholipid syndrome, a thrombosis was suspected, but not confirmed. Only after therapy with steroids did the edema disappear completely. Pitting edema of the lower limb could be a rare manifestation of SLE. PMID:10220838
G�naydin, I; Daikeler, T; Mohren, M; Kanz, L; K�tter, I
Overexpression of carbonic anhydrase IX (CAIX) in vulvar cancer is associated with tumor progression and development of locoregional lymph node metastases
Carbonic anhydrase IX (CAIX) is a strictly membranous expressed metalloenzyme involved in cell adhesion, pH homeostasis, and\\u000a cancer progression. The protein is specifically overexpressed in a wide variety of malignant tumors. This study was designed\\u000a to assess the role of CAIX in primary vulvar cancer. One hundred forty-two well-characterized primary vulvar carcinomas were\\u000a analyzed on a tissue microarray (TMA). Three
Matthias Choschzick; Linn Woelber; Stephan Hess; Christine zu Eulenburg; J�rg Schwarz; Ronald Simon; Sven Mahner; Fritz Jaenicke; Volkmar M�ller
Spontaneous Regression of Grade 3 Vulvar Intraepithelial Neoplasia Associated with Human Papillomavirus16Specific CD4 and CD8 T-Cell Responses
Cell-mediated immunity directed against human papillomavirus 16 (HPV-16) antigens was studied in six patients affected with grade 3 vulvar intraepithelial neoplasia (VIN3, also known as bowenoid papulosis). Five of the patients presented with a chronic and persistent disease that re- lapsed after destructive treatments. They showed no detectable anti-HPV blood T-cell responses and no T-cell intraepidermal vulvar infiltrate containing both
Isabelle Bourgault Villada; Micheline Moyal Barracco; Marianne Ziol; Aude Chaboissier; Nathalie Barget; Sophie Berville; Bernard Paniel; Eric Jullian; Thierry Clerici; Bernard Maillere; Jean Gerard Guillet
Resolution of pulmonary edema. Thirty years of progress.
In the last 30 years, we have learned much about the molecular, cellular, and physiological mechanisms that regulate the resolution of pulmonary edema in both the normal and the injured lung. Although the physiological mechanisms responsible for the formation of pulmonary edema were identified by 1980, the mechanisms that explain the resolution of pulmonary edema were not well understood at that time. However, in the 1980s several investigators provided novel evidence that the primary mechanism for removal of alveolar edema fluid depended on active ion transport across the alveolar epithelium. Sodium enters through apical channels, primarily the epithelial sodium channel, and is pumped into the lung interstitium by basolaterally located Na/K-ATPase, thus creating a local osmotic gradient to reabsorb the water fraction of the edema fluid from the airspaces of the lungs. The resolution of alveolar edema across the normally tight epithelial barrier can be up-regulated by cyclic adenosine monophosphate (cAMP)-dependent mechanisms through adrenergic or dopamine receptor stimulation, and by several cAMP-independent mechanisms, including glucocorticoids, thyroid hormone, dopamine, and growth factors. Whereas resolution of alveolar edema in cardiogenic pulmonary edema can be rapid, the rate of edema resolution in most patients with acute respiratory distress syndrome (ARDS) is markedly impaired, a finding that correlates with higher mortality. Several mechanisms impair the resolution of alveolar edema in ARDS, including cell injury from unfavorable ventilator strategies or pathogens, hypoxia, cytokines, and oxidative stress. In patients with severe ARDS, alveolar epithelial cell death is a major mechanism that prevents the resolution of lung edema. PMID:24881936
Matthay, Michael A
[Treatment of pseudophakic cystoid macular edema].
Pseudophakic cystoid macular edema (PCME) is the most common complication following cataract surgery. In 1-3% of cases it is associated with a decrease in visual acuity. However, PCME has a good prognosis, persisting in only 10% of the patients beyond 2 years. The prophylactic therapy of eyes without additional disease with non-steroidal antiphlogistic drugs or steroids does not influence the final visual acuity. Under certain circumstances, prophylaxis can be a reasonable option. Risk factors that promote the formation of PCME are discussed. The course of acute or chronic PCME can be influenced by drug treatment, but in general the level of evidence for the treatment of this widespread problem is low. We would therefore like to present the Freiburg treatment scheme for PCME for discussion. PMID:17443332
Agostini, H T; Hansen, L L; Feltgen, N
Oxygen-deficient metabolism and corneal edema
Wear of low-oxygen-transmissible soft contact lenses swells the cornea significantly, even during open eye. Although oxygen-deficient corneal edema is well-documented, a self-consistent quantitative prediction based on the underlying metabolic reactions is not available. We present a biochemical description of the human cornea that quantifies hypoxic swelling through the coupled transport of water, salt, and respiratory metabolites. Aerobic and anaerobic consumption of glucose, as well as acidosis and pH buffering, are incorporated in a seven-layer corneal model (anterior chamber, endothelium, stroma, epithelium, postlens tear film, contact lens, and prelens tear film). Corneal swelling is predicted from coupled transport of water, dissolved salts, and especially metabolites, along with membrane-transport resistances at the endothelium and epithelium. At the endothelium, the Na+/K+ - ATPase electrogenic channel actively transports bicarbonate ion from the stroma into the anterior chamber. As captured by the Kedem�Katchalsky membrane-transport formalism, the active bicarbonate-ion flux provides the driving force for corneal fluid pump-out needed to match the leak-in tendency of the stroma. Increased lactate-ion production during hypoxia osmotically lowers the pump-out rate requiring the stroma to swell to higher water content. Concentration profiles are predicted for glucose, water, oxygen, carbon dioxide, and hydronium, lactate, bicarbonate, sodium, and chloride ions, along with electrostatic potential and pressure profiles. Although the active bicarbonate-ion pump at the endothelium drives bicarbonate into the aqueous humor, we find a net flux of bicarbonate ion into the cornea that safeguards against acidosis. For the first time, we predict corneal swelling upon soft-contact-lens wear from fundamental biophysico-chemical principles. We also successfully predict that hypertonic tear alleviates contact-lens-induced edema.
Leung, B.K.; Bonanno, J.A.; Radke, C.J.
Effectiveness of CT for Clinical Stratification of Occupational Lung Edema
We treated two occupational lung diseases in different situations during military training. The purpose of this study is to investigate the availability of CT scanning for the evaluation of inhalation pulmonary edema. Two soldiers suffered severe lung edema after using a spray for the daily maintenance of their firearms. Four soldiers suffered severe dyspnea after undertaking drills in a narrow
Yoshinori MASAKI; Keisaku SUGIYAMA; Hiroyuki TANAKA; Yasuhide UWABE; Masanori TAKAYAMA; Masao SAKAI; Takuya HAYASHI; Masayuki OTSUKA; Shinya SUZUKI
Microhemorrhages in nonfatal high-altitude cerebral edema
Vasogenic edema in the corpus callosum is a characteristic finding in high-altitude cerebral edema (HACE). Furthermore, microhemorrhages have been found at autopsies in brains of HACE victims. The objective of this study was to determine if microhemorrhages also occur in nonlethal HACE. Consequently, magnetic resonance imaging (MRI) was performed in patients who had suffered from HACE and in patients who
Kai Kallenberg; Christoph Dehnert; Arnd D�rfler; Peter D Schellinger; Damian M Bailey; Michael Knauth; Peter D B�rtsch
Pathogenesis of cerebral edema after treatment of diabetic ketoacidosis
Pathogenesis of cerebral edema after treatment of diabetic ketoacidosis. We studied the roles of acidosis, plasma osmolality, and organic osmolytes in the pathogenesis of cerebral edema in an animal model of diabetes mellitus. Normonatremic rats with streptozotocin-induced nonketotic (NKD) and ketotic (DKA) diabetes were sacrificed before or after treatment with hypotonic saline and insulin. Brains were analyzed for water, electrolyte,
Stephen M Silver; Edward C Clark; Barbara M Schroeder; Richard H Sterns
Homocysteine is Linked to Macular Edema in Type 2 Diabetes.
Abstract Aim: To explore the relationship between plasma total homocysteine concentration and diabetic macular edema in patients with type 2 diabetes. Methods: Patients with type 2 diabetes (n?=?176) were enrolled in a cross-sectional hospital-based study. Diabetic macular edema status was documented by fundus photographs. Plasma total homocysteine concentration was measured using fluorescence polarization immunoassay. Normal control plasma homocysteine was established in 115 healthy subjects. Risk factors for diabetic macular edema were obtained from fasting blood samples and interviewer questionnaire. Results: Diabetic patients had increased plasma homocysteine compared with normal control. Plasma homocysteine levels were higher in subjects with diabetic macular edema than without ((11.4?�?2.7) versus (8.5?�?1.9)?(?mol/l), p?=?0.000). The association of homocysteine with diabetic macular edema was independent of major risk factors for diabetic macular edema (duration of diabetes, HbA1c, lipid) and determinants of higher homocysteine concentration (age, gender, serum folate and vitamin B12, renal status, and biguanide use) (OR: 1.63 (1.02-2.14), p?=?0.018). Furthermore, per increase of 5.0??mol/l plasma homocysteine was related to macular edema, after controlling for per unit increase of other factors (OR: 1.64 (1.04-2.16), p?=?0.019). Conclusions: Plasma total homocysteine concentration is independently associated with the occurrence of macular edema in type 2 diabetes. Future prospective studies are warranted to clarify the relationship. PMID:24502555
Li, Jianbo; Zhang, Hongman; Shi, Min; Yan, Lingfei; Xie, Min
[A rare form of acute pulmonary edema: case report].
We report the case of a 21-year-old man who underwent appendectomy under general anesthesia and developed acute pulmonary edema immediately after extubation. We then review the literature, focusing on the pathophysiology and the most important aspects of diagnosis and treatment of post-extubation pulmonary edema. PMID:22118132
Ricardo, Jos�; Anaya, Maria Jos�; Barbosa, M�rio; Andr�, Nelson; Magno, Pedro; Morais, Jos�; Proen�a, Gon�alo; Raba�al, Carlos; Gil, Victor
Long-Term Outcome after Vitrectomy for Diabetic Macular Edema
Background: To determine the benefit of vitrectomy on eyes with diabetic macular edema. Methods: A retrospective institutional case series was used including 66 patients (69 eyes) who had undergone pars plana vitrectomy for diabetic macular edema between 1992 and 2000. Prior to surgery, the patients had been treated with laser coagulation as recommended by the Early Treatment Diabetic Retinopathy Study.
Martina T. Kralinger; Markus Pedri; Franz Kralinger; Josef Troger; Gerhard F. Kieselbach
Oro-vaginal-vulvar lichen planus: report of two new cases.
Atrophic-erosive lichen planus with oral and genital involvement is a rare condition and is often difficult to diagnose. Patients seldom report genital symptoms to the dentist and dentists do not generally investigate about genital lesions. Delays in diagnosis may cause complications and affect the quality of life. We report the clinical and histopathological features of two new cases of oro-vaginal-vulvar lichen planus and review current treatment options for this condition. Genital lichen planus should be suspected in case of atrophic-erosive oral lichen planus. A thorough multidisciplinary medical management and active early treatment are necessary to improve symptoms and prevent genital sequelae. This might also be a relevant prevention strategy for the risk of squamous cell carcinoma, although data to fully support this statement still need investigation. PMID:15653012
Petruzzi, Massimo; De Benedittis, Michele; Carriero, Carmine; Giardina, Carmela; Parisi, Giuseppe; Serpico, Rosario
Context and dating of Aurignacian vulvar representations from Abri Castanet, France.
We report here on the 2007 discovery, in perfect archaeological context, of part of the engraved and ocre-stained undersurface of the collapsed rockshelter ceiling from Abri Castanet, Dordogne, France. The decorated surface of the 1.5-t roof-collapse block was in direct contact with the exposed archaeological surface onto which it fell. Because there was no sedimentation between the engraved surface and the archaeological layer upon which it collapsed, it is clear that the Early Aurignacian occupants of the shelter were the authors of the ceiling imagery. This discovery contributes an important dimension to our understanding of the earliest graphic representation in southwestern France, almost all of which was discovered before modern methods of archaeological excavation and analysis. Comparison of the dates for the Castanet ceiling and those directly obtained from the Chauvet paintings reveal that the "vulvar" representations from southwestern France are as old or older than the very different wall images from Chauvet. PMID:22586111
White, Randall; Mensan, Romain; Bourrillon, Rapha�lle; Cretin, Catherine; Higham, Thomas F G; Clark, Amy E; Sisk, Matthew L; Tartar, Elise; Gard�re, Philippe; Goldberg, Paul; Pelegrin, Jacques; Valladas, H�l�ne; Tisn�rat-Laborde, Nadine; de Sanoit, Jacques; Chambellan, Dominique; Chiotti, Laurent
Psychological factors associated with perception of experimental pain in vulvar vestibulitis syndrome.
This study assessed the association between pain perception and psychological variables in women with vulvar vestibulitis syndrome (VVS) by comparing 28 VVS women with 50 healthy women. We assessed non genital systemic pain perception with quantitative sensory testing by administering experimental pain stimuli to the forearm. The VVS women demonstrated a lower pain threshold and a higher magnitude estimation of pain, combined with a higher trait anxiety, increased somatization, and a lower body image. Among the VVS women, nonvaginal pain catastrophizing was significantly related to reported pain during coitus. A cluster analysis revealed four subtypes of VVS women, as characterized by levels of pain and personality variables. I suggest implications for the assessment and treatment of women suffering from painful coitus. PMID:16020147
Granot, Michal; Lavee, Yoav
Vulvar "proximal-type" epithelioid sarcoma: report of a case and review of the literature
Background The �proximal-type� epithelioid sarcoma is a very rare kind of mesenchimal tumor characterized by the difficulty in histological diagnosis and the very aggressive biological behavior. Case We report of a case of a 63 years old woman with a vulvar �proximal-type� epithelioid sarcoma that underwent a radical surgical staging followed by an adjuvant radiotherapy. She is on follow-up care for 14 months and there is no clinical evidence of disease. Conclusion Even if quite rare the proximal type epithelioid sarcoma should be regarded as a separate entity of particularly aggressive biologic behaviour. Its diagnosis attracts controversies and criticism related to the surgical approach and the choice of an adjuvant therapy. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1508554852942125
Severe cerebral edema in a patient with anasarca and hypernatremia.
We describe a woman whose fatal post-liver transplantation cerebral edema was unexpected and of unusual pathogenesis. Her severe cerebral edema is of considerable pathophysiologic interest: 1) it developed in the setting of marked anasarca and persistent hypernatremia, and 2) although hepatic function was poor, it was not considered sufficiently deranged to induce cerebral edema. Furthermore, there was no histologic evidence of hepatic rejection or antemortem hepatic necrosis. We postulate that an impairment of the blood brain barrier in association with a degree of hepatic dysfunction insufficient by itself to cause cerebral edema permitted the brain interstitial fluid volume to increase pari passu with ECF expansion. Cytotoxic cerebral edema and vascular engorgement may also have contributed to a life-threatening increase in intracranial pressure. PMID:1541060
Wacks, I; Oster, J R; Roth, D; Norenberg, M; Gardner, L B; Perez, G O; Burke, G; Milgrom, M
Treatment of vulvar intraepithelial neoplasia with topical imiquimod: Seven years median follow-up of a randomized clinical trial
ObjectiveRecently we reported on the efficacy of imiquimod for treating vulvar intraepithelial neoplasia (VIN) in a placebo-controlled, double-blinded randomized clinical trial (RCT). Four weeks after treatment, a complete response was observed in 35% of patients and a partial response in 46%. All complete responders remained disease-free at 12months follow-up. In the current investigations, we assessed long-term follow-up at least 5years
Annelinde Terlou; Manon van Seters; Patricia C. Ewing; Neil K. Aaronson; Chad M. Gundy; Claudia Heijmans-Antonissen; Wim G. V. Quint; Leen J. Blok; Marc van Beurden; Theo J. M. Helmerhorst
A cognitive-behavioral group program for women with vulvar vestibulitis syndrome (VVS): factors associated with treatment success.
The results of this prospective open clinical trial (N = 76) indicate that a cognitive-behavioral group program for women with vulvar vestibulitis syndrome (VVS) affects sexuality, pain control, vaginal muscle control, and vestibular pain and that these changes may mediate changes in pain during intercourse. Improvements in sexual functioning and vestibular pain during treatment seem to be particularly important factors in determining short and longer term treatment outcome. These findings are consistent with a cognitive-behavioral conceptualization of VVS. PMID:16809249
ter Kuile, Moniek M; Weijenborg, Philomeen Th M
Xylazine-induced pulmonary edema in rats.
Inhibitors of cytochrome P450, such as SK&F 525-A, prolong the duration of xylazine-ketamine anesthesia and cause pulmonary edema (PE) and death in rats. To determine the cause of PE, Sprague-Dawley rats were given a single dose of xylazine (21 mg/kg, im) alone or in combination with ketamine (45 mg/kg, im) and/or SK&F 525-A (50 mg/kg, ip) and percentage lung to body weight (%LW/BW) ratios (as an indicator of PE) were compared. The results indicated that xylazine caused PE which was independent of ketamine and was enhanced by SK&F 525-A. Subsequently, it was determined that 42 mg/kg xylazine, im, is an optimal edemagenic dose. Xylazine (42 mg/kg, im) increased the %LW/BW ratio as compared to control. Pleural effusion (PLE) of various amounts was observed in 75% of the animals. The pleural fluid to serum protein ratio for xylazine was similar to that obtained for alpha-naphthylthiourea (5 mg/kg, ip). Extensive serous PLE and alveolar edema with hemorrhage were found at necropsy in xylazine-treated rats. Pretreatment with yohimbine (4.2 mg/kg), prazosin (20 mg/kg), tolazoline (20 mg/kg), yohimbine (4.2 mg/kg) plus prazosin (20 mg/kg), atropine (20 mg/kg), dimethyl sulfoxide (DMSO) (7.8 g/kg), allopurinol (50 mg/kg), superoxide dismutase (20,000 U/kg), catalase (20,000 U/kg), BW755C (50 mg/kg), ibuprofen (50 mg/kg), cystathionine (100 mg/kg) plus taurine (100 mg/kg) did not affect the %LW/BW ratio. PLE was increased by yohimbine, yohimbine plus prazosin, and allopurinol, reduced by DMSO, and not changed in other groups. The results indicate that xylazine caused increased-permeability PE characterized by rapid onset, cellular damage and protein-rich pleural fluid. PE may not be mediated by adverse cardiovascular effects of xylazine and oxygen radicals are possibly involved in its etiology. PMID:1902333
Amouzadeh, H R; Sangiah, S; Qualls, C W; Cowell, R L; Mauromoustakos, A
CO2 laser total superficial vulvectomy: an outpatient treatment for wide multifocal vulvar intraepithelial neoplasia grade 3.
The ideal treatment of large multifocal vulvar intraepithelial neoplasia grade 3 (VIN 3) in young patients is still debated. The goal is to prevent development of invasive vulvar cancer while preserving normal vulvar anatomy and function. The authors describe the case of a 37-year-old woman affected by a biopsy-proven VIN 3 involving the entire external genitalia. A total superficial vulvectomy was carried out in 2 closer sessions by CO(2) laser used in an excisional way. Both procedures were performed in an outpatient setting with the patient under local anesthesia and without suturing stitches or skin flaps. Definitive pathologic analysis confirmed VIN 3 with free margins. No intraoperative and postoperative complications were documented. Functional and anatomic outcomes were optimal, and no relapse occurred after 12 months of follow-up. Use of CO(2) laser total superficial vulvectomy shows promise of a safe and adequate treatment in selected young patients with VIN 3 involving the entire external genitalia. PMID:23084682
Fallani, Maria Grazia; Fambrini, Massimiliano; Lozza, Virginia; Bianchi, Claudia; Pieralli, Annalisa
Ospemifene for the treatment of dyspareunia associated with vulvar and vaginal atrophy: potential benefits in bone and breast
Ospemifene is a selective estrogen receptor modulator (SERM), or estrogen receptor agonist/antagonist, that was recently approved by the US Food and Drug Administration for the treatment of dyspareunia associated with vulvar and vaginal atrophy, a chronic condition that affects up to 60% of postmenopausal women. Ospemifene is the first and only nonestrogen compound approved for this indication. Compared with other approved SERMs, such as tamoxifen, toremifene, bazedoxifene, and raloxifene, the estrogen-like effects of ospemifene in the vaginal epithelium are unique. This review first discusses the rationale for developing ospemifene, including its mechanism of action, and then focuses on the clinical development of ospemifene for the treatment of dyspareunia associated with vulvar and vaginal atrophy. Included are discussions of the effects of ospemifene on the endometrium, serum lipids, coagulation markers, bone, and breast cancer. In conclusion, ospemifene is a SERM with a unique estrogen agonist/antagonist tissue profile that was recently approved in the US for the treatment of dyspareunia associated with vulvar and vaginal atrophy in postmenopausal women. Ospemifene warrants further clinical investigation for the treatment and prevention of osteoporosis and breast cancer.
Soe, Lin H; Wurz, Gregory T; Kao, Chiao-Jung; DeGregorio, Michael W
Intensity-modulated radiotherapy for the treatment of vulvar carcinoma: A comparative dosimetric study with early clinical outcome
Objectives: To assess early clinical outcome of intensity-modulated radiation therapy (IMRT) in the treatment of vulvar cancer and compare dosimetric parameters with 3D conformal radiotherapy (3D CRT). Methods: Fifteen patients with vulvar cancer were treated with IMRT. Seven patients were treated with preoperative chemoradiation, and 8 patients were treated with adjuvant postoperative radiation therapy. Median dose was 46 Gy in the preoperative and 50.4 Gy in the postoperative group. Results: The mean volume of small bowel, rectum, and bladder that received doses in excess of 30 Gy with IMRT was reduced when compared with 3D CRT. Treatment was well tolerated, and only 1 patient had acute Grade 3 small-bowel toxicity. Median follow-up was 12 months. In the preoperative group, 5 patients (71%) had clinical complete response and 3 patients (42.8%) had pathologic complete response. In the adjuvant group, 2 patients had recurrences in the treatment field. No patients had late Grade 3 toxicity. The 2-year actuarial disease-specific survival was 100%. Conclusions: Intensity-modulated RT appears to offer advantages over 3D CRT treatment of vulvar cancer by elimination of dose modulation across overlapping regions and reduction of unnecessary dose to the bladder, rectum, and small bowel. Early results with a small number of patients show promising results, with a low incidence of severe toxicity.
Beriwal, Sushil [University of Pittsburgh Cancer Institute, Pittsburgh, PA (United States)]. E-mail: email@example.com; Heron, Dwight E. [University of Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Kim, Hayeon [University of Pittsburgh Cancer Institute, Pittsburgh, PA (United States); King, Gwendolyn [University of Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Shogan, Jeffrey [University of Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Bahri, Sanjeev [University of Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Gerszten, Kristina [University of Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Lee, Joe [D3 Advanced Radiation Planning, Pittsburgh, PA (United States); Kelley, Joseph [University of Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Edwards, Robert P. [University of Pittsburgh Cancer Institute, Pittsburgh, PA (United States)
... A make up remover that contains mineral oil, petroleum jelly, and paraffi n also can be used ( ... washcloth and put it against your vulva. Refrigerated petroleum jelly (Vaseline) and cold plain yogurt put on ...
[Massive ovarian edema in a 13-year-old girl].
Massive ovarian edema is a rare tumor-like condition found in young women resulting from accumulation of fluid mostly due to partial or intermittent torsion of the ovary or secondary, to a preexisting ovarian lesion. We report a case of a 13-year-old girl presenting with an ovarian mass measuring 16�cm. CA-12-5 levels were slightly elevated. Concerns regarding underlying malignancy led to salpingo-oophorectomy. Pathological evaluation revealed a massive ovarian edema and multiple thromboses of ovarian veins. Differentiating massive ovarian edema from malignant ovarian tumor is crucial to prevent patients from undergoing unnecessary surgery. PMID:23649810
Sailer, V; Huss, S; Wardelmann, E; M�ller, A M
Reliability and Feasibility of Methods to Quantitatively Assess Peripheral Edema
Objective: To evaluate methods to assess peripheral edema for reliability, feasibility and correlation with the classic clinical assessment of pitting edema. Design: Cross-sectional observational study. Setting: Large primary care clinic in Marshfield, Wisconsin, USA. Participants: Convenience sample of 20 patients with type 2 diabetes and a range of edema severity, including patients without edema. Methods: Eight methods of edema assessment were evaluated: (1) clinical assessment of pit depth and recovery at three locations, (2) patient questionnaire, (3) ankle circumference, (4) figure-of-eight (ankle circumference using eight ankle/foot landmarks), (5) edema tester (plastic card with holes of varying size pressed to the ankle with a blood pressure cuff), (6) modified edema tester (edema tester with bumps), (7) indirect leg volume (by series of ankle/leg circumferences), and (8) foot/ankle volumetry by water displacement. Patients were evaluated independently by three nurse examiners. Results: Water displacement and ankle circumference had high inter-examiner agreement (intraclass correlation coefficient 0.93, 0.96 right; 0.97, 0.97 left). Agreement was inconsistent for figure-of-eight (0.64, 0.86), moderate for indirect leg volume (0.53, 0.66), and low for clinical assessments at all locations. Agreement was low for the edema testers but varied by the pressure administered. Correlation with the classic, subjective clinical assessment was good for the nurse-performed assessments and patient questionnaire. Ankle circumference and patient questionnaires each took 1 minute to complete. Other tools took >5 minutes to complete. Conclusions: Water displacement and ankle circumference showed excellent reliability; however, water displacement is a time-consuming measure and may pose implementation challenges in the clinical and clinical trial environments. Patient-reported level and frequency of edema, based on an unvalidated questionnaire, was generally well correlated with the physician assessment of edema severity and may prove to be another reliable and accurate method of assessing edema. Additional study is needed to evaluate the validity and responsiveness of these methods.
Brodovicz, Kimberly G.; McNaughton, Kristin; Uemura, Naoto; Meininger, Gary; Girman, Cynthia J.; Yale, Steven H.
Comparison of human papillomavirus detections in urine, vulvar, and cervical samples from women attending a colposcopy clinic.
While urine-based sampling for human papillomavirus (HPV) is being explored as a simple and noninvasive approach for cervical cancer screening, data comparing HPV genotyping in urine and those in cellular sampling of the cervix and vulva, and their correlation with rigorously confirmed cervical disease status, are sparse. We performed HPV genotyping on voided-urine and clinician-collected vulvar and cervical samples from 72 women undergoing colposcopy. Although urine-based HPV carcinogenic HPV detection was lower (58.3%) than cervical (73.6%) and vulvar (72.1%) detection (P = 0.05 and 0.07, respectively), the agreement of urine HPV with cervical and vulvar HPV was moderate (kappa = 0.55) and substantial (kappa = 0.62), respectively. Urine-based carcinogenic HPV detection had a clinical sensitivity of 80.8% (95% confidence interval [CI] = 60.7 to 93.5) and a specificity of 53.3% (95% CI = 37.9 to 68.3) for diagnosing cervical intraepithelial neoplasia grades 2/3 (CIN2/3) on histology; 90.0% of CIN3 was positive for urine HPV. The corresponding sensitivity and specificity values for vulvar sampling were 92% (95% CI = 74 to 99) and 40.5% (95% CI = 25.6 to 56.7), and those for cervical sampling were 96.2% (95% CI = 80.4 to 99.9) and 40% (95% CI = 25.7 to 55.7), respectively. HPV16 was the most common carcinogenic genotype detectable in 25% of urine, 33.8% of vulvar, and 31.9% of cervical samples overall, with prevalence increasing with cervical disease grade, regardless of the sampling method. Stronger cervical HPV PCR signal strengths were associated with increased frequency of urine HPV detection. In summary, the relatively lower detection rates but comparable clinical performance of urine-based HPV sampling underscore the need for larger studies to evaluate urine-based sampling for cervical cancer screening, epidemiologic studies, and postvaccination HPV disease surveillance. PMID:24197879
Sahasrabuddhe, Vikrant V; Gravitt, Patti E; Dunn, S Terence; Brown, David; Allen, Richard A; Eby, Yolanda J; Smith, Katie; Zuna, Rosemary E; Zhang, Roy R; Gold, Michael A; Schiffman, Mark; Walker, Joan L; Castle, Philip E; Wentzensen, Nicolas
Comparison of Human Papillomavirus Detections in Urine, Vulvar, and Cervical Samples from Women Attending a Colposcopy Clinic
While urine-based sampling for human papillomavirus (HPV) is being explored as a simple and noninvasive approach for cervical cancer screening, data comparing HPV genotyping in urine and those in cellular sampling of the cervix and vulva, and their correlation with rigorously confirmed cervical disease status, are sparse. We performed HPV genotyping on voided-urine and clinician-collected vulvar and cervical samples from 72 women undergoing colposcopy. Although urine-based HPV carcinogenic HPV detection was lower (58.3%) than cervical (73.6%) and vulvar (72.1%) detection (P = 0.05 and 0.07, respectively), the agreement of urine HPV with cervical and vulvar HPV was moderate (kappa = 0.55) and substantial (kappa = 0.62), respectively. Urine-based carcinogenic HPV detection had a clinical sensitivity of 80.8% (95% confidence interval [CI] = 60.7 to 93.5) and a specificity of 53.3% (95% CI = 37.9 to 68.3) for diagnosing cervical intraepithelial neoplasia grades 2/3 (CIN2/3) on histology; 90.0% of CIN3 was positive for urine HPV. The corresponding sensitivity and specificity values for vulvar sampling were 92% (95% CI = 74 to 99) and 40.5% (95% CI = 25.6 to 56.7), and those for cervical sampling were 96.2% (95% CI = 80.4 to 99.9) and 40% (95% CI = 25.7 to 55.7), respectively. HPV16 was the most common carcinogenic genotype detectable in 25% of urine, 33.8% of vulvar, and 31.9% of cervical samples overall, with prevalence increasing with cervical disease grade, regardless of the sampling method. Stronger cervical HPV PCR signal strengths were associated with increased frequency of urine HPV detection. In summary, the relatively lower detection rates but comparable clinical performance of urine-based HPV sampling underscore the need for larger studies to evaluate urine-based sampling for cervical cancer screening, epidemiologic studies, and postvaccination HPV disease surveillance.
Gravitt, Patti E.; Dunn, S. Terence; Brown, David; Allen, Richard A.; Eby, Yolanda J.; Smith, Katie; Zuna, Rosemary E.; Zhang, Roy R.; Gold, Michael A.; Schiffman, Mark; Walker, Joan L.; Castle, Philip E.; Wentzensen, Nicolas
Pitting edema of the four extremities of rapid appearance.
We report the case of a 70 year old white man with rapid onset edema of the four extremities without any other systemic symptoms. Cardiac failure, nephrotic syndrome and hepatic dysfunction were ruled out. Rheumatoid factor was slightly elevated at 33 UI/ml and sedimentation rate was within normal range. Ultrasound examination of the upper limb revealed increased blood flow (400 ml/min) at the level of the brachial artery and edema of the tenosynovial sheaths. A diagnosis of remitting seronegative symmetrical synovitis and pitting edema (RS3PE) was made and prednisone 15 mg/day was prescribed with rapid disappearance of the edema and reduction of the forearm blood flow. PMID:15968900
Coiteux, I; Depairon, M; Hayoz, D
Mechanism of cerebral edema in children with diabetic ketoacidosis
ObjectivesCerebral edema during diabetic ketoacidosis (DKA) has been attributed to osmotic cellular swelling during treatment. We evaluated cerebral water distribution and cerebral perfusion during DKA treatment in children.
Nicole S. Glaser; Sandra L. Wootton-Gorges; James P. Marcin; Michael H. Buonocore; Joseph DiCarlo; E. Kirk Neely; Patrick Barnes; Jenny Bottomly; Nathan Kuppermann
Cerebral Edema after Laser Radiation. An Electron Microscopic Study.
National Technical Information Service (NTIS)
Cerebral edema was studied with the electron microscope in rats around a focal area of cortical necrosis produced by LASER radiation. Swollen astrocytic processes without much enlargement of intercellular spaces were observed in the edematous cortex. In t...
P. W. Lampert J. L. Fox K. M. Earle
Late corneal edema due to retained foldable lens fragment
Late onset of corneal edema after cataract surgery is an unusual complication. We report a case of corneal edema presenting one month after cataract surgery. During implantation of the foldable lens, one haptic of the intraocular lens fractured at the optic haptic junction. This caused lens decentration, necessitating an intraocular lens exchange ten days later. The patient was recovering well but presented again two weeks later with a drop in vision due to corneal edema. A retained haptic of the intraocular lens was seen in the inferior anterior chamber angle. After surgical removal of the retained haptic the corneal edema fully resolved. Retained intraocular lens fragments can cause corneal endothelial damage, which may be reversible with an early diagnosis and intervention.
Gokhale, Nikhil S
High altitude pulmonary edema among "Amarnath Yatris"
Background: Annual pilgrimage (Yatra) to the cave shrine of Shri Amarnath Ji� is a holy ritual among the Hindu devotees of Lord Shiva. Located in the Himalayan Mountain Range (altitude 13,000 ft) in south Kashmir, the shrine is visited by thousands of devotees and altitude sickness is reportedly common. Materials and Methods: More than 600,000 pilgrims visited the cave shrine in 2011 and 2012 with 239 recorded deaths. Thirty one patients with suspected altitude sickness were referred from medical centers en-route the cave to Sher-i-Kashmir Institute of Medical Sciences, a tertiary-care center in capital Srinagar (5,000 ft). The clinical features and the response to treatment were recorded. Results: Thirty-one patients (all lowlanders, 19 male; age 18-60 years, median 41) had presented with acute onset breathlessness of 1-4 days (median 1.9 d) starting within 12-24 h of a rapid ascent; accompanied by cough (68%), headache (8%), dizziness and nausea (65%). Sixteen patients had associated encephalopathy. Clinical features on admission included tachypnea (n = 31), tachycardia (n = 23), bilateral chest rales (n = 29), cyanosis (n = 22) and grade 2-4 encephalopathy. Hypoxemia was demonstrable in 24 cases and bilateral infiltrates on radiologic imaging in 29. Ten patients had evidence of high-altitude cerebral edema. All patients were managed with oxygen, steroids, nifedipine, sildenafil and other supportive measures including invasive ventilation (n = 3). Three patients died due to multiorgan dysfunction. Conclusions: Altitude sickness is common among Amaranath Yatris from the plains and appropriate educational strategies should be invoked for prevention and prompt treatment.
Koul, Parvaiz A.; Khan, Umar Hafiz; Hussain, Tajamul; Koul, Ajaz Nabi; Malik, Sajjad; Shah, Sanaullah; Bazaz, Sajjad Rajab; Rashid, Wasim; Jan, Rafi Ahmad
Treatment of Brain Edema in Acute Liver Failure
Opinion statement��Cerebral edema is very common in patients with acute liver failure and encephalopathy. In severe cases, it produces brain\\u000a tissue shift and potentially fatal herniation. Brain swelling in acute liver failure is produced by a combination of cytotoxic\\u000a (cellular) and vasogenic edema. Accumulation of ammonia and glutamine leads to disturbances in the regulation of cerebral\\u000a osmolytes, increased free radical
Alejandro A. Rabinstein
Autoimmune angioneurotic edema in a patient with Helicobacter pylori infection.
Association of acquired autoimmune angioneurotic edema with other diseases is increasing. However, the precise mechanism by which antibodies to C1-esterase inhibitor (C1-INH) are produced, is not elucidated. We describe a patient with IgA antibodies against C1-INH without other autoimmune markers. Our patient had gastritis and Helicobacter pylori infection, proven by biopsy. This case suggests that H. pylori infection can act as triggering factor for acquired autoimmune angioneurotic edema. PMID:19191890
Mukeba, Didier; Chandrikakumari, Kavitha; Giot, Jean-Baptiste; Leonard, Philippe; Meuris, Christelle; Frippiat, Frederic; Moutschen, Michel
Insulin edema in a child with diabetes mellitus type 1.
Despite the essential role of insulin in the management of patients with diabetes mellitus type 1, insulin use can cause a variety of adverse effects, such as hypoglycemia and weight gain. Herein, we describe an adolescent girl with type 1 diabetes mellitus diagnosed one year ago, who presented with edema of the lower extremities approximately two weeks after an increase in the insulin dose; other causes of edema were excluded. Spontaneous recovery was observed in the patient. PMID:23094546
Rostami, Parastoo; Sotoudeh, Arya; Nakhaeimoghadam, Maryam; Rabbani, Ali; Rezaei, Nima
Angioneurotic edema: a rare case of hypersensitivity to metoclopramide
The case of a 30-year-old woman who had already experienced two incidents of angioneurotic edema and urticaria caused by drugs during the acute gastroenteritis. The allergological workup revealed hypersensitivity to metoclopramide. This case documents that metoclopramide, a drug commonly used to inhibit the vomiting, may cause not only bronchospastic reaction in an asthmatic patient but also angioneurotic edema of the tongue and larynx as well as urticaria. No similar cases in the literature were found.
Zakrzewski, Aleksander; Matuszewski, Tomasz; Kruszewski, Jerzy
MR imaging of edema accompanying benign and malignant bone tumors
To evaluate the incidence, quantity, and presentation of intra- and extraosseous edema accompanying benign and malignant primary\\u000a bone lesions, the magnetic resonance (MR) studies of 63 consecutive patients with histologically proven primary bone tumors\\u000a were reviewed. MR scans were assessed for the presence and quantity of marrow and soft tissue edema and correlated with peroperative\\u000a findings, resected specimens and follow-up
Herman M. Kroon; Johan L. Bloem; Herma C. Holscher; Henk-Jan van der Woude; Monique Reijnierse; Anthoni H. M. Taminiau
The radiologic distinction of cardiogenic and noncardiogenic edema.
Improvement in the ability to determine the specific cause of any given case of pulmonary edema would lead to more rapid and definitive treatment. "Wedge" pressures and measurements of cardiac output derived from Swan-Ganz catheterization assist in making this determination, but the procedure is invasive, expensive, associated with complications, and not infrequently inaccurate. A plain chest film is, however, almost invariably available in all patients with pulmonary edema, and as shown in this study, the cause of the edema can be determined with a high degree of accuracy by careful attention to certain radiographic features. An independent two-observer study was performed on 216 chest radiographs of 61 patients with cardiac disease, 30 with renal failure or overhydration, and 28 with capillary permeability edema. Three principal and seven ancillary features have been identified, all of which are statistically significant and permit the cause of the edema to be determined correctly in a high percentage of cases. The three principal features are distribution of pulmonary flow, distribution of pulmonary edema, and the width of the vascular pedicle. The ancillary features are pulmonary blood volume, peribronchial cuffing, septal lines, pleural effusions, air bronchograms, lung volume, and cardiac size. Differing constellations of these features occur, each of which is characteristic of a specific type of edema. Overall accuracy of diagnosis in this study ranged from 86% to 89%. The highest accuracy was obtained in distinguishing capillary permeability edema from all other varieties (91%), and the lowest in distinguishing chronic cardiac failure from renal failure (81%). PMID:3872571
Milne, E N; Pistolesi, M; Miniati, M; Giuntini, C
Acute idiopathic scrotal edema: ultrasonographic findings at an emergency unit
We evaluated the US findings in acute idiopathic scrotal edema (AISE) in order to identify diagnostic features that may help\\u000a to avoid unnecessary surgical intervention. We investigated 12 boys with AISE diagnosed according to the clinical course and\\u000a US findings. We assessed the thickness, compressibility, and vascularity of the scrotal wall, the extent of edema, and enlargement\\u000a of inguinal lymph
Aleum Lee; Seong Jin Park; Hae Kyung Lee; Hyun Sook Hong; Boem Ha Lee; Dae Ho Kim
Diagnosis, prevention and management of postoperative pulmonary edema.
Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema. The aims were to review the possible etiologic and diagnostic challenges in timely detection of postoperative pulmonary edema and to discuss the various management strategies for prevention of this postoperative complication so as to decrease morbidity and mortality. The various search engines for preparation of this manuscript were used which included Entrez (including Pubmed and Pubmed Central), NIH.gov, Medknow.com, Medscape.com, WebMD.com, Scopus, Science Direct, MedHelp.org, yahoo.com and google.com. Manual search was carried out and various text books and journals of anesthesia and critical care medicine were also searched. From the information gathered, it was observed that postoperative cardiogenic pulmonary edema in patients with serious cardiovascular diseases is most common followed by noncardiogenic pulmonary edema which can be due to fluid overload in the postoperative period or it can be negative pressure pulmonary edema (NPPE). NPPE is an important clinical entity in immediate post-extubation period and occurs due to acute upper airway obstruction and creation of acute negative intrathoracic pressure. NPPE carries a good prognosis if promptly diagnosed and appropriately treated with or without mechanical ventilation. PMID:23439791
Bajwa, Sj Singh; Kulshrestha, A
Diagnosis, Prevention and Management of Postoperative Pulmonary Edema
Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema. The aims were to review the possible etiologic and diagnostic challenges in timely detection of postoperative pulmonary edema and to discuss the various management strategies for prevention of this postoperative complication so as to decrease morbidity and mortality. The various search engines for preparation of this manuscript were used which included Entrez (including Pubmed and Pubmed Central), NIH.gov, Medknow.com, Medscape.com, WebMD.com, Scopus, Science Direct, MedHelp.org, yahoo.com and google.com. Manual search was carried out and various text books and journals of anesthesia and critical care medicine were also searched. From the information gathered, it was observed that postoperative cardiogenic pulmonary edema in patients with serious cardiovascular diseases is most common followed by noncardiogenic pulmonary edema which can be due to fluid overload in the postoperative period or it can be negative pressure pulmonary edema (NPPE). NPPE is an important clinical entity in immediate post-extubation period and occurs due to acute upper airway obstruction and creation of acute negative intrathoracic pressure. NPPE carries a good prognosis if promptly diagnosed and appropriately treated with or without mechanical ventilation.
Bajwa, SJ Singh; Kulshrestha, A
Mouse Monoclonal Antibodies to Anthrax Edema Factor Protect against Infection ?
Bacillus anthracis is the causative agent of anthrax, and the tripartite anthrax toxin is an essential element of its pathogenesis. Edema factor (EF), a potent adenylyl cyclase, is one of the toxin components. In this work, anti-EF monoclonal antibodies (MAb) were produced following immunization of mice, and four of the antibodies were fully characterized. MAb 3F2 has an affinity of 388 pM, was most effective for EF detection, and appears to be the first antibody reported to neutralize EF by binding to the catalytic CB domain. MAb 7F10 shows potent neutralization of edema toxin activity in vitro and in vivo; it targets the N-terminal protective antigen binding domain. The four MAb react with three different domains of edema factor, and all were able to detect purified edema factor in Western blot analysis. None of the four MAb cross-reacted with the lethal factor toxin component. Three of the four MAb protected mice in both a systemic edema toxin challenge model and a subcutaneous spore-induced foreleg edema model. A combination of three of the MAb also significantly delayed the time to death in a third subcutaneous spore challenge model. This appears to be the first direct evidence that monoclonal antibody-mediated neutralization of EF alone is sufficient to delay anthrax disease progression.
Leysath, Clinton E.; Chen, Kuang-Hua; Moayeri, Mahtab; Crown, Devorah; Fattah, Rasem; Chen, Zhaochun; Das, Suman R.; Purcell, Robert H.; Leppla, Stephen H.
Evaluation of brain edema using magnetic resonance proton relaxation times
Experimental and clinical studies on the evaluation of water content in cases of brain edema were performed in vivo, using MR proton relaxation times (longitudinal relaxation time, T1; transverse relaxation time, T2). Brain edema was produced in the white matter of cats by the direct infusion method. The correlations between proton relaxation times obtained from MR images and the water content of white matter were studied both in autoserum-infused cats and in saline-infused cats. The correlations between T1 as well as T2 and the water content in human vasogenic brain edema were also examined and compared with the data obtained from the serum group. T1 and T2 showed good correlations with the water content of white matter not only in the experimental animals but also in the clinical cases. The quality of the edema fluid did not influence relaxation time and T1 seemed to represent almost solely the water content of the tissue. T2, however, was affected by the nature of existence of water and was more sensitive than T1 in detecting extravasated edema fluid. It seems feasible therefore to evaluate the water content of brain edema on the basis of T1 values.
Fu, Y.; Tanaka, K.; Nishimura, S. (Baba Memorial Hospital, Osaka (Japan))
A gelatin matrix-thrombin tissue sealant (FloSeal) application in the management of groin breakdown after inguinal lymphadenectomy for vulvar cancer.
The rate of groin breakdown after radical wide vulvar excision and inguinal lymphadenectomy for vulvar cancer remains significant despite conservative surgical approaches. An 86-year-old Latin American woman underwent wide radical excision and bilateral inguinal lymphadenectomy for vulvar cancer. The postoperative course was complicated by bilateral groin wound separation and high output lymphorrhea. The patient responded to the application of a gelatin matrix-thrombin tissue sealant (FloSeal) to the bases of each groin with resolution in lymphorrhea and formation of granulation tissue. The application of a gelatin matrix-thrombin tissue sealant (FloSeal) may be a viable treatment in the management of groin breakdown in selected patients when conventional therapy produces suboptimal results. PMID:15304156
Han, L Y; Schimp, V; Oh, J C; Ramirez, P T
An update on vulvar intraepithelial neoplasia: terminology and a practical approach to diagnosis.
There are two distinct types of vulvar intraepithelial neoplasia (VIN), which differ in their clinical presentation, aetiology, pathogenesis and histological/immunophenotypical features. One form driven by high-risk human papilloma virus infection usually occurs in young women and has been termed classic or usual VIN (uVIN). The other, not related to viral infection, occurs in postmenopausal women with chronic skin conditions such as lichen sclerosus and lichen simplex chronicus and is termed differentiated or simplex-type VIN. The latter is the precursor lesion of the most common type of squamous cell carcinoma (SCC) in the vulva, namely keratinizing SCC (representing 60% of cases). In contrast, uVIN usually gives rise to basaloid or warty SCC (40% of cases). The histological features of uVIN are similar to those of high grade lesions encountered in other lower anogenital tract sites (hyperchomatic nuclei with high nuclear to cytoplasmic ratios and increased mitotic activity). However, differentiated VIN has very subtle histopathological changes and often escapes diagnosis. Since uVIN is driven by high-risk human papilloma virus infections, p16 immunohistochemistry is diffusely positive in these lesions and is characterized with a high Ki-67 proliferation index. In contrast, differentiated or simplex-type VIN is consistently negative for p16 and the majority of the cases harbour TP53 mutations, correlating with p53 positivity by immunohistochemistry. PMID:24399036
Reyes, M Carolina; Cooper, Kumarasen
Increased gray matter density in young women with chronic vulvar pain.
Provoked vestibulodynia (PVD) is a common form of chronic vulvar pain with unknown aetiology. Central pain regulatory mechanisms have been suggested to be disrupted in PVD, and consequently, PVD may be associated with anatomical changes in pain modulatory brain areas. Here, we compared total gray matter volumes and regional gray matter densities between 14 medication-free young women with relatively short-standing PVD (1 to 9 yrs) and 14 control subjects using whole brain voxel-based morphometry (VBM). VBM revealed that PVD subjects had significantly higher gray matter densities in pain modulatory and stress-related areas, i.e. the parahippocampal gyrus/hippocampus and basal ganglia (globus pallidus, caudate nucleus, and substantia nigra). In several of these regions, gray matter was related to clinical symptoms, namely lowered pain thresholds and increased pain catastrophizing scores. No region showed decreased gray matter density in the PVD group. These results point at the morphological alterations in supra-spinal pain modulatory circuitry, which might contribute to the clinical symptoms of patients with PVD. Previous VBM studies in older subjects with a longstanding chronic pain condition have demonstrated gray matter decreases in similar areas. We therefore speculate that gray matter density might increase in young pain patients with short disease duration and decrease in older subjects with longstanding disease, similarly to some psychiatric conditions, in which bi-directional changes of gray matter have been observed. PMID:18930351
Schweinhardt, P; Kuchinad, A; Pukall, C F; Bushnell, M C
Vulvar vestibulitis syndrome: an important factor in the evaluation of lifelong vaginismus?
The aim of the study was to investigate the prevalence of vulvar vestibulitis syndrome (VVS) in a sample of women suffering from lifelong vaginismus (N=91). Lifelong vaginismus is defined as "having a history of never having been able to experience penile entry of the vagina". The results with respect to VVS are compared with the results of women who are suffering from pain during intercourse (superficial dyspareunia) (N=84). Both patients groups were recruited from two treatment outcome studies. Using a standard physical examination, erythema was found in 77%, pain "on touch" in 69% and erythema and pain on the same location was seen in 56% of the patients with lifelong vaginismus. Furthermore, it was found that erythema (94%), pain (98%) and erythema and pain on the same location (92%) were more frequently found in patients with dyspareunia compared to women with lifelong vaginismus. It is concluded that pain is an integral part of the experiences in the majority of women with lifelong vaginismus. PMID:16457419
Ter Kuile, Moniek M; Van Lankveld, Jacques J D M; Vlieland, Corrie Vliet; Willekes, Christine; Weijenborg, Philomeen T M
MIB-1 immunostaining is a beneficial adjunct test for accurate diagnosis of vulvar condyloma acuminatum.
The histopathologic diagnosis of vulvar condyloma acuminatum is often based on architectural features that are not specific for human papillomavirus (HPV) infection. Because HPV-associated lesions show increased cellular proliferation, the authors evaluated the usefulness of MIB-1 immunostaining as an aid in the differential diagnosis of cases equivocal for condyloma. The MIB-1 immunostaining pattern was correlated with HPV DNA detection in condyloma acuminatum (CON-A; n = 15), "consistent with condyloma" (c/w CON-A; n = 26), fibroepithelial polyp (FEP; n = 14), and squamous papilloma (n = 10). HPV was detected in 100% of the CON-A cases, and all cases demonstrated MIB-1-positive nuclei in the upper two thirds of the epithelial thickness. With this definition of MIB-1 positivity, there was complete concordance between MIB-1 positivity and HPV detection for all cases (kappa = 0.88). Of the cases c/w CON-A, 17 of 26 (65%) were positive for both MIB-1 and HPV, and could be reclassified as CON-A, whereas 35% were identified as an overdiagnosis based on negative results. In addition, two cases of FEP were MIB-1 and HPV positive, and thus were identified as an underdiagnosis. These results suggest significant overdiagnosis of cases equivocal for condyloma, and indicate that MIB-1 immunostaining is a beneficial adjunctive test when the morphologic features are suggestive but not diagnostic for CON-A. PMID:11023101
Pirog, E C; Chen, Y T; Isacson, C
Preoperative Intensity Modulated Radiation Therapy and Chemotherapy for Locally Advanced Vulvar Carcinoma: Analysis of Pattern of Relapse
Purpose: To examine clinical outcomes and relapse patterns in locally advanced vulvar carcinoma treated using preoperative chemotherapy and intensity modulated radiation therapy (IMRT). Methods and Materials: Forty-two patients with stage I-IV{sub A} (stage I, n=3; stage II, n=13; stage III, n=23; stage IV{sub A}, n=3) vulvar cancer were treated with chemotherapy and IMRT via a modified Gynecological Oncology Group schema using 5-fluorouracil and cisplatin with twice-daily IMRT during the first and last weeks of treatment or weekly cisplatin with daily radiation therapy. Median dose of radiation was 46.4 Gy. Results: Thirty-three patients (78.6%) had surgery for resection of vulva; 13 of these patients also had inguinal lymph node dissection. Complete pathologic response was seen in 48.5% (n=16) of these patients. Of these, 15 had no recurrence at a median time of 26.5 months. Of the 17 patients with partial pathological response, 8 (47.1%) developed recurrence in the vulvar surgical site within a median of 8 (range, 5-34) months. No patient had grade ?3 chronic gastrointestinal/genitourinary toxicity. Of those having surgery, 8 (24.2%) developed wound infections requiring debridement. Conclusions: Preoperative chemotherapy/IMRT was well tolerated, with good pathologic response and clinical outcome. The most common pattern of recurrence was local in patients with partial response, and strategies to increase pathologic response rate with increasing dose or adding different chemotherapy need to be explored to help further improve outcomes.
Beriwal, Sushil, E-mail: firstname.lastname@example.com [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States)] [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Shukla, Gaurav; Shinde, Ashwin; Heron, Dwight E. [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States)] [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Kelley, Joseph L.; Edwards, Robert P.; Sukumvanich, Paniti; Richards, Scott; Olawaiye, Alexander B.; Krivak, Thomas C. [Division of Gynecologic Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States)] [Division of Gynecologic Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States)
Edema can be a handicap in treatment of anorexia nervosa.
Anorexia and bulimia nervosa are common in western civilized countries. They are among the psychiatric disorders in that they are often accompanied by a variety of life-threatening physical abnormalities. These patients need a close follow-up of the pediatrician in collaboration with the psychiatrist since the changes in bodily functions affect the psychiatric therapy. The challenge to the physician is to use the traditional tools of medicine to diagnose and treat these physical abnormalities using careful medical history, a complete physical examination and appropriate laboratory testing. Peripheral edema is seen as a physical finding in anorexia nervosa (AN) and it is not rare. The estimated frequency is up to 20% among adolescent patients. Peripheral edema in this setting can be easily confused as weight gain. There are five possible mechanisms for its occurrence: hypoproteinemia, electrolyte imbalance, hormonal changes, rapid refeedings, and abuse of laxative, diuretics and diet pills. Patients with eating disorders may ingest a large number of drugs in an attempt to control their weight. We present a case of a female adolescent with AN and peripheral edema who terminated her psychiatric treatment during the refeeding phase because of the unbearable anxiety caused by this edema that affected her body image dramatically. With this case study, we point out the importance of assessing peripheral edema and discriminating it from true weight gain. PMID:20196395
Derman, Orhan; Kili�, Emine Zinnur
Photoacoustic diagnosis of edema in rat burned skin
NASA Astrophysics Data System (ADS)
Diagnosis of edema, abnormal accumulation of water in tissue, is important for managing various traumatic injuries and diseases. However, there is no established method for real-time, noninvasive monitoring of edema. In severe extensive burn injuries, edema develops both topically and systemically due to the increased permeability of blood vessels. In this study, we examined photoacoustic (PA) monitoring of edema formed in rat burn models. Deep dermal burn with a 20% total body surface area was made in the dorsal skin of rats. Burn and its adjacent nonburn tissues were irradiated with 6-ns light pulses at 1430 nm, which is one of the absorption peak wavelengths of water in the near infrared. The PA signal amplitude increased until 12 - 24 hr postburn, and thereafter it gradually decreased to its initial level; the latter phase (after 24 hr postburn) coincided with a diuretic phase in the rats. There was a significant correlation between the PA signal amplitudes and water contents in the tissue measured by wet/dry weight method. These findings demonstrate the validity of PA measurement for real-time, noninvasive monitoring of edema.
Yoshida, Ken; Sato, Shunichi; Hatanaka, Kosuke; Saitoh, Daizoh; Ashida, Hiroshi; Sakamoto, Toshihisa; Obara, Minoru
A study of leg edema in immobile patients.
Background:?Our objectives were to elucidate the pathophysiology of leg edema in immobile patients and to discuss reasonable management of this condition. Methods and Results:?The 30 patients with leg edema had visited our clinic between April 2009 and March 2013; they suffered from severe gait disturbance, had no significant venous abnormalities detected using duplex ultrasound, and did not have any systemic diseases that could cause leg edema. Here, we review their symptoms, examinations, and treatments. Among 59 edematous legs of the 30 patients, 30 legs (51%) had symptoms that indicated advanced chronic venous insufficiency. The ankle range of motion and calf : ankle circumference ratio were abnormal in only 3 (5%) and 10 (17%) of the legs, respectively. The severity of edema and subcutaneous inflammation, which was confirmed using ultrasonography, was significantly influenced by gravity. Air plethysmography and lymphangioscintigraphy were completed in 15 and 10 patients, respectively, neither of which revealed any significant abnormalities. Reasonable success for all patients was achieved by compression therapy and physical therapy without medications. Conclusions:?It was assumed that leg edema in these immobile patients was mainly caused by venous stasis because of the immobility itself, not because of anatomical problems. The patients were successfully managed by compression and physical therapy alone.??(Circ J?2014; 78: 1733-1739). PMID:24790031
Suehiro, Kotaro; Morikage, Noriyasu; Murakami, Masanori; Yamashita, Osamu; Ueda, Koshiro; Samura, Makoto; Hamano, Kimikazu
Regression of diabetic macular edema after subcutaneous exenatide.
The aim of this study is to report a case of complete regression of diabetic macular edema after subcutaneous injection of exenatide in a patient with type 2 diabetes mellitus. This study is an interventional case report. Blood investigations, complete ophthalmic examinations and optical coherence tomography were performed. A 55-year-old female affected by poorly controlled type 2 diabetes mellitus presented with visual impairment due to macular edema in the right eye. The left eye showed mild edema without visual loss. Best-corrected visual acuity (BCVA) was 20/80 and 20/20, respectively. The patient was encouraged to improve metabolic control, and the antidiabetic therapy was modified combining exenatide 10�?g subcutaneously twice daily to her regimen of oral metformin. The patient did not receive any ocular treatment. A complete tomographic resolution of macular edema was observed after 1�month and BCVA improved to 20/63. These findings were confirmed for the entire 6-month follow-up duration. No ocular or non-ocular adverse events were recorded. This is the first reported case of complete regression of macular edema in a diabetic patient after subcutaneous injection of exenatide. PMID:23925692
Sarao, Valentina; Veritti, Daniele; Lanzetta, Paolo
The Co-Existence of Vulvar Lichen Sclerosus, Ulcerated Calcinosis Cutis, and Dermatomyositis: Coincidence or Immunological Mechanism?
Calcinosis cutis is a condition characterized by the deposition of calcium salts in the skin and subcutaneous tissues, and patients suffering from it encounter various connective tissue disorders, such as dermatomyositis (DM), scleroderma, and systemic lupus erythematosus. Although calcinosis cutis is frequently accompanied by juvenile dermatomyositis, rare cases have been reported in adult patients with DM. On the other hand, lichen sclerosus (LS) is a chronic inflammatory disease of the skin and mucosal surfaces. In the present report, we present a rare case of a 71-year-old patient with DM accompanied by ulcerated calcinosis cutis and vulvar LS.
Celik, Ebru; Sar?kaya, Gokhan; Yenin, Julide Zehra; Atik, Esin
Vulvar and perianal condyloma superimposed inflammatory linear verrucous epidermal nevus: a case report and review of the literature.
Inflammatory linear verrucous epidermal nevus (ILVEN) is a benign cutaneous hamartoma characterized by intensely erythematous, pruritic, and inflammatory papules that occur as linear bands along the lines of Blaschko. There is a considerable clinical and histological resemblance between ILVEN and linear psoriasis, lichen striatus, linear lichen planus, and invasion of epidermal nevus by psoriasis. The pathogenesis of ILVEN is unknown. It is regarded as a genetic dyskeratotic disease reflecting genetic mosaicism. Here, a case of vulvar and perianal condyloma superimposed ILVEN is presented. PMID:24396613
Avcio?lu, S�meyra Nerg?z; Altinkaya, S�nd�z �zlem; K���k, Mert; Y�ksel, Hasan; Demircan-Sezer, Selda; U�ar, Gonca
Cystoid Macular Edema Induced by Low Doses of Nicotinic Acid
Cystoid macular edema (CME) is a condition that involves the macula, causing painless vision loss. In this paper, we report a case of niacin-induced bilateral cystoid macular edema (CME) in a middle-age woman taking low dose of niacin (18?mg of nicotinic acid). Optical coherence tomography (OCT) showed retinal thickening and cystoid spaces in both eyes, whereas fluorescein angiography (FA; HRA 2, Heidelberg Engineering) revealed the absence of fluorescein leakage also in later phases. Four weeks after discontinuation of therapy there were a complete disappearance of macular edema at funduscopic examination and an improvement of visual acuity in both eyes. Furthermore OCT showed a normal retinal profile in both eyes. In our opinion considering the wide availability of niacin, medical monitoring and periodical examination should be considered during niacin administration. To our knowledge, this is the first report in the literature that described the very low-dose niacin-induced bilateral niacin maculopathy.
Domanico, Daniela; Carnevale, Carmela; Fragiotta, Serena; Verboschi, Francesca; Altimari, Simona; Vingolo, Enzo Maria
Cystoid macular edema induced by low doses of nicotinic Acid.
Cystoid macular edema (CME) is a condition that involves the macula, causing painless vision loss. In this paper, we report a case of niacin-induced bilateral cystoid macular edema (CME) in a middle-age woman taking low dose of niacin (18?mg of nicotinic acid). Optical coherence tomography (OCT) showed retinal thickening and cystoid spaces in both eyes, whereas fluorescein angiography (FA; HRA 2, Heidelberg Engineering) revealed the absence of fluorescein leakage also in later phases. Four weeks after discontinuation of therapy there were a complete disappearance of macular edema at funduscopic examination and an improvement of visual acuity in both eyes. Furthermore OCT showed a normal retinal profile in both eyes. In our opinion considering the wide availability of niacin, medical monitoring and periodical examination should be considered during niacin administration. To our knowledge, this is the first report in the literature that described the very low-dose niacin-induced bilateral niacin maculopathy. PMID:23662229
Domanico, Daniela; Carnevale, Carmela; Fragiotta, Serena; Verboschi, Francesca; Altimari, Simona; Vingolo, Enzo Maria
Bilateral developing reexpansion pulmonary edema treated with extracorporeal membrane oxygenation.
A right-side spontaneous pneumohemothorax developed in a 16-year-old boy who was transferred from a local medical department to our emergency department 12 hours later. After an emergency operation to remove the blood clot, right-side reexpansion pulmonary edema developed, with about 3100 mL of foamy and bloody fluid drainage from the right-side endotracheal tube. The patient was sent to the intensive care unit with differential lung ventilation, but developed left-side pulmonary edema resulting in worsening oxygen saturation. Further extracorporeal membrane oxygenation support was used. The patient recovered gradually, and the endobronchial tube was removed 5 days later. PMID:20338351
Tung, Yung-Wei; Lin, Frank; Yang, Ming-Shiang; Wu, Ching-Wen; Cheung, Kam-Sun
Interobserver variability and the effect of education in the histopathological diagnosis of differentiated vulvar intraepithelial neoplasia.
No published data concerning intraobserver and interobserver variability in the histopathological diagnosis of differentiated vulvar intraepithelial neoplasia (DVIN) are available, although it is widely accepted to be a subtle and difficult histopathological diagnosis. In this study, the reproducibility of the histopathological diagnosis of DVIN is evaluated. Furthermore, we investigated the possible improvement of the reproducibility after providing guidelines with histological characteristics and tried to identify histological characteristics that are most important in the recognition of DVIN. A total number of 34 hematoxylin and eosin-stained slides were included in this study and were analyzed by six pathologists each with a different level of education. Slides were reviewed before and after studying a guideline with histological characteristics of DVIN. Kappa statistics were used to compare the interobserver variability. Pathologists with a substantial agreement were asked to rank items by usefulness in the recognition of DVIN. The interobserver agreement during the first session varied between 0.08 and 0.54, which slightly increased during the second session toward an agreement between -0.01 and 0.75. Pathologists specialized in gynecopathology reached a substantial agreement (kappa 0.75). The top five of criteria indicated to be the most useful in the diagnosis of DVIN included: atypical mitosis in the basal layer, basal cellular atypia, dyskeratosis, prominent nucleoli and elongation and anastomosis of rete ridges. In conclusion, the histopathological diagnosis of DVIN is difficult, which is expressed by low interobserver agreement. Only in experienced pathologists with training in gynecopathology, kappa values reached a substantial agreement after providing strict guidelines. Therefore, it should be considered that specimens with an unclear diagnosis and/or clinical suspicion for DVIN should be revised by a pathologist specialized in gynecopathology. When adhering to suggested criteria the diagnosis of DVIN can be made easier. PMID:23370772
van den Einden, Loes C G; de Hullu, Joanne A; Massuger, Leon F A G; Grefte, Johanna M M; Bult, Peter; Wiersma, Anne; van Engen-van Grunsven, Adriana C H; Sturm, Bart; Bosch, Steven L; Hollema, Harry; Bulten, Johan
Tumor Proteomics by Multivariate Analysis on Individual Pathway Data for Characterization of Vulvar Cancer Phenotypes*
Vulvar squamous cell carcinoma (VSCC) is the fourth most common gynecological cancer. Based on etiology VSCC is divided into two subtypes; one related to high-risk human papilloma virus (HPV) and one HPV negative. The two subtypes are proposed to develop via separate intracellular signaling pathways. We investigated a suggested link between HPV infection and relapse risk in VSCC through in-depth protein profiling of 14 VSCC tumor specimens. The tumor proteomes were analyzed by liquid-chromatography tandem mass spectrometry. Relative protein quantification was performed by 8-plex isobaric tags for relative and absolute quantification. Labeled peptides were fractionated by high-resolution isoelectric focusing prior to liquid-chromatography tandem mass spectrometry to reduce sample complexity. In total, 1579 proteins were regarded as accurately quantified and analyzed further. For classification of clinical groups, data analysis was performed by comparing protein level differences between tumors defined by HPV and/or relapse status. Further, we performed a biological analysis on individual tumor proteomes by matching data to known biological pathways. We here present a novel analysis approach that combines pathway alteration data on individual tumor level with multivariate statistics for HPV and relapse status comparisons. Four proteins (signal transducer and activator of transcription-1, myxovirus resistance protein 1, proteasome subunit alpha type-5 and legumain) identified as main classifiers of relapse status were validated by immunohistochemistry (IHC). Two of the proteins are interferon-regulated and on mRNA level known to be repressed by HPV. By both liquid-chromatography tandem mass spectrometry and immunohistochemistry data we could single out a subgroup of HPV negative/relapse-associated tumors. The pathway level data analysis confirmed three of the proteins, and further identified the ubiquitin-proteasome pathway as altered in the high risk subgroup. We show that pathway fingerprinting with resolution on individual tumor level adds biological information that strengthens a generalized protein analysis.
Sandberg, AnnSofi; Lindell, Gunnel; Kallstrom, Brita Nordstrom; Branca, Rui Mamede; Danielsson, Kristina Gemzell; Dahlberg, Mats; Larson, Barbro; Forshed, Jenny; Lehtio, Janne
Ospemifene 12-month safety and efficacy in postmenopausal women with vulvar and vaginal atrophy
Objective Assessment of 12-month safety of ospemifene 60 mg/day for treatment of postmenopausal women with vulvar and vaginal atrophy (VVA). Methods In this 52-week, randomized, double-blind, placebo-controlled, parallel-group study, women 40�80 years with VVA and an intact uterus were randomized 6 : 1 to ospemifene 60 mg/day or placebo. The primary objective was 12-month safety, particularly endometrial; 12-week efficacy was assessed. Safety assessments included endometrial histology and thickness, and breast and gynecological examinations. Efficacy evaluations included changes from baseline to week 12 in percentage of superficial and parabasal cells and vaginal pH. Results Of 426 randomized subjects, 81.9% (n = 349) completed the study with adverse events the most common reason for discontinuation (ospemifene 9.5%; placebo 3.9%). Most (88%) treatment-emergent adverse events with ospemifene were considered mild or moderate. Three cases (1.0%) of active proliferation were observed in the ospemifene group. For one, active proliferation was seen at end of study week 52, and diagnosed as simple hyperplasia without atypia on follow-up biopsy 3 months after the last dose. This subsequently resolved with progestogen treatment and dilatation and curettage. In six subjects (five ospemifene (1.4%), one placebo (1.6%)) endometrial polyps were found (histopathology); however, only one (ospemifene) was confirmed as a true polyp during additional expert review. Endometrial histology showed no evidence of carcinoma. Statistically significant improvements were seen for all primary and secondary efficacy measures and were sustained through week 52 with ospemifene vs. placebo. Conclusions The findings of this 52-week study confirm the tolerance and efficacy of oral ospemifene previously reported in short- and long-term studies.
Epidemiology of vulvar vestibulitis syndrome: an exploratory case-control study
BACKGROUND: Vulvar vestibulitis syndrome (VVS) is a chronic, persistent syndrome characterised by vestibular pain, tenderness, and erythema. The aetiology of VVS is unknown and few of the hypothesised risk factors have been tested in controlled studies. METHODS: Using a matched case-control study design, medical, sexual, health behaviour, and diet history of 28 women with VVS were compared with 50 friend controls without VVS to identify possible causal factors. RESULTS: Cases were more likely than controls to report every vaginal and urinary symptom at the time of interview measured, particularly vaginal soreness or pain (60.7%) and pain during intercourse (64.3%). There were no significant differences between cases and controls with respect to sexual behaviour. Cases were more likely than controls to report self reported history of physician diagnosed bacterial vaginosis (OR = 22.2, 95% CI = 2.8, 177.2, p value = 0.0001), vaginal yeast infections (OR = 4.9, 95% CI = 1.4, 18.0, p value = 0.01), and human papillomavirus (OR = 7.1, 95% CI = 0.6, 81.2, p value = 0.08). There were no differences between cases and controls with respect to dietary intake of oxalate. Cases were more likely than controls to report poor health status (OR = 5.7, 95% CI = 1.1, 28.7, p value = 0.02) and history of depression for 2 weeks or more during the past year (OR = 4.4, 95% CI = 1.6, 12.3, p value = 0.002). CONCLUSION: Self reported history of bacterial vaginosis, yeast infections, and human papillomavirus were strongly associated with VVS. An infectious origin for VVS should be pursued in larger controlled studies, using questionnaire and laboratory measures. ???
Sarma, A. V.; Foxman, B.; Bayirli, B.; Haefner, H.; Sobel, J. D.
Potent neutralization of anthrax edema toxin by a humanized monoclonal antibody that competes with calmodulin for edema factor binding.
This study describes the isolation and characterization of a neutralizing monoclonal antibody (mAb) against anthrax edema factor, EF13D. EF13D neutralized edema toxin (ET)-mediated cyclic AMP (cAMP) responses in cells and protected mice from both ET-induced footpad edema and systemic ET-mediated lethality. The antibody epitope was mapped to domain IV of EF. The mAb was able to compete with calmodulin (CaM) for EF binding and displaced CaM from EF-CaM complexes. EF-mAb binding affinity (0.05-0.12 nM) was 50- to 130-fold higher than that reported for EF-CaM. This anti-EF neutralizing mAb could potentially be used alone or with an anti-PA mAb in the emergency prophylaxis and treatment of anthrax infection. PMID:19651602
Chen, Zhaochun; Moayeri, Mahtab; Zhao, Huaying; Crown, Devorah; Leppla, Stephen H; Purcell, Robert H
Primary Tumor Vascularity, HIF-1? and VEGF expression in vulvar squamous cell carcinomas: their relationships with clinicopathological characteristics and prognostic impact
Background Increased vascularity is a crucial event in the tumor progression and has prognostic significance in various cancers. However, the ultimate role of angiogenesis in the pathogenesis and clinical outcome of vulvar carcinoma patients is still not settled. Methods Tumor vascularity using CD34 stained slides measured by Chalkley counting method as well as hypoxia-inducible factor (HIF)-1? and vascular endothelial growth factor (VEGF) immunoexpression was examined in 158 vulvar squamous cell carcinomas. Associations between vascular Chalkley count, HIF-1? and VEGF expression and clinicopathological factors and clinical outcome were evaluated. Results High CD34 Chalkley count was found to correlate with larger tumor diameter (P = 0.002), deep invasion (P < 0.001) and HIF-1? (P = 0.04), whereas high VEGF expression correlate significantly with poor tumor differentiation (P = 0.007). No significant association between CD34 Chalkley counts and VEGF expression and disease-specific survival was observed. High HIF-1? expression showed better disease specific survival in both univariate and multivariate analyses (P = 0.001). Conclusions A significant association between high tumor vascularity and larger tumor size as well as deeper tumor invasion suggests an important role of angiogenesis in the growth and progression of vulvar carcinomas. HIF-1? expression in vulvar carcinomas was a statistically independent prognostic factor.
Targeting Human Papillomavirus to Reduce the Burden of Cervical, Vulvar and Vaginal Cancer and Pre-Invasive Neoplasia: Establishing the Baseline for Surveillance
Background Infection with high-risk human papillomavirus (HPV) is causally related to cervical, vulvar and vaginal pre-invasive neoplasias and cancers. Highly effective vaccines against HPV types 16/18 have been available since 2006, and are currently used in many countries in combination with cervical cancer screening to control the burden of cervical cancer. We estimated the overall and age-specific incidence rate (IR) of cervical, vulvar and vaginal cancer and pre-invasive neoplasia in Denmark, Iceland, Norway and Sweden in 2004�2006, prior to the availability of HPV vaccines, in order to establish a baseline for surveillance. We also estimated the population attributable fraction to determine roughly the expected effect of HPV16/18 vaccination on the incidence of these diseases. Methods Information on incident cervical, vulvar and vaginal cancers and high-grade pre-invasive neoplasias was obtained from high-quality national population-based registries. A literature review was conducted to define the fraction of these lesions attributable to HPV16/18, i.e., those that could be prevented by HPV vaccination. Results Among the four countries, the age-standardised IR/105 of cervical, vaginal and vulvar cancer ranged from 8.4�13.8, 1.3�3.1 and 0.2�0.6, respectively. The risk for cervical cancer was highest in women aged 30�39, while vulvar and vaginal cancers were most common in women aged 70+. Age-standardised IR/105 of cervical, vulvar and vaginal pre-invasive neoplasia ranged between 138.8?183.2, 2.5?8.8 and 0.5?1.3, respectively. Women aged 20?29 had the highest risk for cervical pre-invasive neoplasia, while vulvar and vaginal pre-invasive neoplasia peaked in women aged 40?49 and 60?69, respectively. Over 50% of the observed 47,820 incident invasive and pre-invasive cancer cases in 2004?2006 can be attributed to HPV16/18. Conclusion In the four countries, vaccination against HPV 16/18 could prevent approximately 8500 cases of gynecological cancer and pre-cancer annually. Population-based cancer and vaccination registries are essential to assess the predicted public health effects of HPV vaccination.
Nygard, Mari; Hansen, Bo Terning; Dillner, Joakim; Munk, Christian; Oddsson, Kristjan; Tryggvadottir, Laufey; Hortlund, Maria; Liaw, Kai-Li; Dasbach, Erik J.; Kjaer, Susanne Kruger
Fingolimod-associated macular edema: incidence, detection, and management.
Fingolimod (FTY-720), a sphingosine-1-phosphate receptor modulator, is the first US Food and Drug Administration (FDA)-approved oral agent for the treatment of relapsing forms of multiple sclerosis (MS). Two recent phase III clinical studies (TRANSFORMS [Trial Assessing Injectable Interferon vs FTY720 Oral in RRMS] and FREEDOMS [FTY720 Research Evaluating Effects of Daily Oral Therapy in MS]) demonstrated a significant reduction in the annualized relapse rate in patients with relapsing-remitting MS, compared to once weekly interferon ?-1a and placebo. Macular edema was a prominent adverse event reported in these and prior studies of fingolimod. Thirteen of 2,564 (0.5%) patients treated with fingolimod in FREEDOMS and TRANSFORMS developed macular edema. Fingolimod-associated macular edema (FAME) appears to be dose-dependent (observed in only 2 patients taking the FDA-approved 0.5 mg dose) and typically resolves upon cessation of therapy. Although a relatively common condition in ophthalmology, most neurologists have not encountered macular edema in clinical practice. The purpose of this review is to educate the neurologist on the etiology, clinical manifestations, diagnostic modalities, and treatment approaches in patients with FAME. We also discuss the use of fingolimod in patients with uveitis and diabetes mellitus, highlight the guidelines for surveillance ophthalmic examination, and outline the key distinguishing features between FAME and optic neuritis. PMID:22371414
Jain, Nieraj; Bhatti, M Tariq
[Late pneumomediastinum revealed by acute pulmonary edema in hemodialysis].
Central venous catheterization occupies an important place in the treatment of end stage renal disease pending the creation of an arteriovenous fistula. However, this procedure is not devoid of complications. We report a case of late pneumomediastinum revealed by an acute pulmonary edema in a young patient on hemodialysis, and we discuss its characteristics. PMID:24656891
El Amrani, Mohamed; El Kabbaj, Driss; Benyahia, Mohammed
Management of upper airway edema caused by hereditary angioedema
Hereditary angioedema is a rare disorder with a genetic background involving mutations in the genes encoding C1-INH and of factor XII. Its etiology is unknown in a proportion of cases. Recurrent edema formation may involve the subcutis and the submucosa - the latter can produce obstruction in the upper airways and thereby lead to life-threatening asphyxia. This is the reason
Henriette Farkas
Alkane-induced edema formation and cutaneous barrier dysfunction.
Certain mineral oils and hydrocarbons require repeated topical application to cause irritation. A structure activity relationship of pure n-alkanes was undertaken in a mouse ear edema model to investigate the mechanism of cumulative irritancy. Alkanes were applied twice daily over a 4-day period. Dodecane was found to be non-irritating, while tridecane elicited a response only at 96 h. Tetradecane was the strongest irritant with significant increases (p less than 0.05) in ear thickness observed at 48 h. Hexadecane, octadecane, and eicosane exhibited progressively decreasing activity. Permeability of the ears to hydrocortisone was monitored in vitro during tridecane- and tetradecane-induced irritation. Significant increases in permeability were observed 24 h before edema formation. A positive correlation was found between the extent of edema formation and enhancement of permeability. Loss of barrier function would result in increased cutaneous availability of the alkanes. Increased permeability prior to edema formation indicates that induction of barrier dysfunction may be a factor in the mechanism of alkane-induced irritation. PMID:3190267
Moloney, S J; Teal, J J
Negative-pressure pulmonary edema in the otolaryngology patient
It is estimated that 11% of all patients requiring active intervention for acute upper airway obstruction develop negative-pressure pulmonary edema. This pathologic process typically has a benign and rapidly resolving clinical course with the prompt use of mechanical ventilation and positive and expiratory pressure. A review of the literature, however, has revealed a morbidity and mortality rate of 11% to
The pathophysiology of brain edema in acute liver failure
Brain edema leading to intracranial hypertension is a cause of death in acute liver failure (ALF). The pathogenesis of this unique complication has been investigated in man, in experimental models and in isolated cell systems. From this experience, an integrated view has emerged, pointing at several mechanisms that contribute to cerebral swelling; an osmotic derangement in astrocytes, changes in cellular
Andres T. Blei
Acute nonhemodynamic pulmonary edema with nifedipine in primary pulmonary hypertension.
A 34-year-old man with primary pulmonary hypertension developed acute nonhemodynamic pulmonary edema after a loading dose of nifedipine. Changes of the vascular permeability induced by the drug acting on the arteriolar wall of the capillary system could be an explanation. PMID:1864141
Prigogine, T; Waterlot, Y; Gottignies, P; Verhoeven, A; Decroly, P
Implications of the Lymphatic System in CVI-Associated Edema
Lymph drainage is intimately linked with venous drainage in health and disease. Evidence exists to support the view that lymphatics frequently fail in venous disease, particularly in its advanced stages. The implications of this are to increase the risk of infection and the amount of edema, events which can only further the morbidity of venous disease.
P. S. Mortimer
Effects of sexual arousal on genital and non-genital sensation: a comparison of women with vulvar vestibulitis syndrome and healthy controls.
The relationship between sexual arousal and sensory perception has been a topic largely neglected within the realm of human sexuality research. The present study assessed the influence of sexual arousal on genital and non-genital sensation in women. It also examined the theory that painful intercourse is associated with insufficient sexual arousal. A total of 20 healthy women and 20 women with Vulvar Vestibulitis Syndrome (VVS) underwent genital and non-genital sensory testing at baseline and in response to erotic and neutral stimulus films. Touch and pain thresholds were assessed at the vulvar vestibule, inside the labia minora, and on the volar surface of the forearm. Sexual arousal was assessed via the measurement of surface skin temperature changes of the labia minora using a labial thermistor clip. Participants also completed questionnaires pertaining to mood, pain, and sexual functioning. In response to the erotic stimulus, both groups evidenced a significant increase in physiological sexual arousal and vulvar sensitivity. Women with VVS reported a significantly lower desire to engage in intercourse after having viewed the erotic film and reported lower levels of desire and arousal on questionnaire measures. Women with VVS also exhibited significantly more genital and non-genital pain sensitivity than healthy women across all conditions, in addition to more catastrophizing, hypervigilance, and fear of pain. Contrary to some theories, these data suggest that women with VVS are not lacking in physiological sexual arousal, and that physiological sexual arousal may actually increase vulvar sensation. Lack of subjective sexual arousal, however, may yet be implicated in vulvar pain during intercourse. PMID:17136588
Payne, Kimberley A; Binik, Yitzchak M; Pukall, Caroline F; Thaler, Lea; Amsel, Rhonda; Khalif�, Samir
Intraoperative intravitreal triamcinolone decreases macular edema after vitrectomy with phacoemulsification
Background The purpose of this study was to evaluate the incidence and amount of macular edema by optical coherence tomography (OCT) after combined small gauge sutureless vitrectomy with phacoemulsification and intravitreal triamcinolone. Methods This retrospective case series included 194 consecutive eyes undergoing nonemergent vitrectomy with phacoemulsification and intravitreal triamcinolone. Ninety-one eyes had preoperative and postoperative OCT available and were included in the analysis. The eyes were evaluated for retinal thickness with preoperative and postoperative OCT, and for preoperative and postoperative best-corrected visual acuity. The main outcome measures were retinal thickness, OCT appearance, and best-corrected visual acuity. Results The incidence of macular edema in all eyes preoperatively was 64.8% and postoperatively was 50.5%. Mean central subfield and center point thickness in eyes with macular edema preoperatively were 361 ?m and 349 ?m, respectively, and postoperatively were 315 ?m and 304 ?m, respectively. In eyes without preoperative macular edema, mean preoperative central subfield and center point thickness were, respectively, 210 ?m and 181 ?m versus 220 ?m and 192 ?m postoperatively. Best corrected visual acuity improved from 20/190 preoperatively to 20/150 at postoperative month 1 and 20/110 at month 6. Postoperative intraocular pressure ? 25 mmHg was observed in 7.7% of eyes, none of which required surgical intervention for steroid-induced glaucoma. Conclusion Use of intravitreal triamcinolone with combined vitrectomy and phacoemulsification may play an important role in modulating postoperative macular edema. Adverse pressure rise is infrequent and usually limited.
Parke, D Wilkin; Sisk, Robert A; Murray, Timothy G
Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid
PURPOSE: To evaluate the role of vitrectomy in eyes with diffuse diabetic macular edema associated with a taut posterior hyaloid.METHODS: Records of 55 eyes of 50 patients with diabetic retinopathy and diffuse clinically significant diabetic macular edema who underwent vitrectomy with stripping of the premacular posterior hyaloid were reviewed. In all 55 eyes, diffuse diabetic macular edema was present on
Scott D Pendergast; Tarek S Hassan; George A Williams; Morton S Cox; Raymond R Margherio; Philip J Ferrone; Bruce R Garretson; Michael T Trese
PAF, ceramide and pulmonary edema: alveolar flooding and a flood of questions
Lung edema commonly occurs in human diseases. One form involves increased vascular permeability and the flooding of protein-rich edema fluid into the alveoli, and is a major component of lethal syndromes of acute lung injury. The molecular mechanisms are incompletely characterized. A recent study using experimental models identified a previously unrecognized pathway to lung edema that involved the inflammatory phospholipid
Guy A Zimmerman; Thomas M McIntyre
Within days of ascent to high altitude when symptoms of acute mountain sickness (AMS) are common, pulmonary and cerebral edema may also develop. Although peripheral edema of the hands, face or feet may also appear, its association with AMS is unclear. In addition, persons with high altitude pulmonary edema often report an antidiuresis. Hence, altitude sickness appears to result from
The use of Hypertonic Saline in the Treatment of Post-Traumatic Cerebral Edema: A Review
Effective methods for treating cerebral edema have recently become a matter of both extensive research and significant debate within the neurosurgery and trauma surgery communities. The pathophysiologic progression and outcome of different forms of cerebral edema associated with traumatic brain injury have yet to be fully elucidated. There are heterogeneous factors influencing the onset and progress of post-traumatic cerebral edema,
Jeffrey E. Catrambone; Wenzhuan He; Charles J. Prestigiacomo; Tracy K. McIntosh; Peter W. Carmel; Allen Maniker
Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema
Objective: To investigate the relation between outcomes of children with diabetic ketoacidosis (DKA)-related cerebral edema and baseline clinical features and therapeutic interventions for treatment of cerebral edema. Study design: All children ?18 years old with DKA and cerebral edema (n = 61) were retrospectively identified from 10 pediatric centers between 1982 and 1997. Demographic, biochemical, and therapeutic data were collected.
James P. Marcin; Nicole Glaser; Peter Barnett; Ian McCaslin; David Nelson; Jennifer Trainor; Jeffrey Louie; Francine Kaufman; Kimberly Quayle; Mark Roback; Richard Malley; Nathan Kuppermann
Pharmacological study of edema induced by venom of the snake Bothrops asper (terciopelo) in mice
The effect of several drugs on the edema-forming activity of Bothrops asper venom was studied plethysmographically using the mouse foot pad assay. Bothrops asper venom induced a dose-dependent edema which developed rapidly and peaked 1 hr after envenomation. Incubation of venom with EDTA before injection resulted in a significant reduction of edema. In addition, pretreatment with prazosin, indomethacin, dexamethasone, yohimbine
Fernando Chaves; Milagro Barboza; Jos�Mar�a Guti�rrez
Use of the Gamow Bag by EMT-basic park rangers for treatment of high-altitude pulmonary edema and high-altitude cerebral edema.
As part of an emergency medical system protocol, national park service rangers certified at the level of an emergency medical technician-basic (EMT-B) are taught to recognize and treat high-altitude pulmonary edema and high-altitude cerebral edema. In Sequoia and Kings Canyon National Parks, this is done with the assistance of physician on-line medical control as a backup. High-altitude pulmonary edema and high-altitude cerebral edema are both potentially fatal altitude illnesses that can be particularly problematic in the backcountry, where evacuation may be delayed. We report a case of high-altitude pulmonary edema and high-altitude cerebral edema occurring at moderate altitude that was successfully treated by park rangers with the Gamow Bag. PMID:15473460
Freeman, Kimberly; Shalit, Marc; Stroh, Geoffrey
From symptoms to leg edema: efficacy of Daflon 500 mg.
This article reviews the mechanisms by which micronized purified flavonoid fraction (MPFF; Daflon 500 mg) acts on symptoms as well as on edema in patients with chronic venous disease, in the light of new advances in the understanding of the pathophysiology of this chronic condition. Deterioration of venous wall tone followed by valve dysfunction leading eventually to varicose veins are the key pathophysiologic features that produce venous hypertension. Both mechanical and biological factors are responsible for the deterioration of the venous wall in large veins. These are decreased shear stress and hypoxia of the media and of the endothelium, which act as triggering factors for biochemical reactions leading to inflammation. There is a body of evidence that inflammation in chronic venous insufficiency (CVI) plays a role right from the early stages of venous dysfunction and venous valve restructuring. The whole process of venous wall stretching and dilation is painful and may present as leg heaviness, a sensation of swelling, and paresthesia. Daflon 500 mg relieves symptoms, edema, and red blood cell aggregation, which cause paresthesia and restless legs. At the level of the microcirculation, dysfunction of microvessels is observed, characterized by an increase in capillary permeability followed by skin changes. The earliest manifestation of microcirculatory disorder is edema. At this level, Daflon 500 mg acts favorably on microcirculatory complications by normalizing the synthesis of prostaglandins and free radicals. It decreases bradykinin-induced microvascular leakage and inhibits leukocyte activation, trapping, and migration. Its efficacy in decreasing CVI edema and ankle swelling has been proven in rigorous studies that are reviewed in this paper. Daflon 500 mg, a well-established oral flavonoid that consists of 90% micronized diosmin and 10% flavonoids expressed as hesperidin, may be prescribed from the very beginning of the disease for the relief of pain and edema, and in any CVI patient presenting with symptoms as well. Daflon 500 mg is thus the first-line treatment for edema and symptoms of CVI at any stage of the disease. At advanced disease stages, Daflon 500 mg may be used in conjunction with sclerotherapy, surgery, and/or compression therapy or as an alternative treatment when other treatments are not indicated or not feasible. PMID:12934755
Nicolaides, Andrew N
A dosimetric evaluation of dose escalation for the radical treatment of locally advanced vulvar cancer by intensity-modulated radiation therapy
The purpose of this planning study was to determine whether intensity-modulated radiation therapy (IMRT) reduces the radiation dose to organs at risk (OAR) when compared with 3D conventional radiation therapy (3D-CRT) in patients with vulvar cancer treated by irradiation. This study also investigated the use of sequential IMRT boost (seq-IMRT) and simultaneous integrated boost (SIB-IMRT) for dose escalation in the treatment of locally advanced vulvar cancer. Five vulvar cancer patients treated in the postoperative setting and 5 patients treated with definitive intent (def-group) were evaluated. For the postoperative group, 3D-CRT and IMRT plans to a total dose (TD) of 45 Gy were generated. For the def-group, 4 plans were generated: a 3D-CRT and an IMRT plan to a TD of 56.4 Gy, a SIB-IMRT plan to a TD of 56 Gy, and a SIB-IMRT with dose escalation (SIB-IMRT-esc): TD of 67.2 Gy. Mean dose and dose-volume histograms were compared using Student's t-test. IMRT significantly (all p < 0.05) reduced the D{sub mean}, V30, and V40 for all OAR in the adjuvant setting. The V45 was also significantly reduced for all OAR except the bladder. For patients treated in the def-group, all IMRT techniques significantly reduced the D{sub mean}, V40, and V45 for all OAR. The mean femur doses with SIB-IMRT and SIB-IMRT-esc were 47% and 49% lower compared with 3D-CRT. SIB-IMRT-esc reduced the doses to the OAR compared with seq-3D-CRT but increased the D{sub max.} for the small bowel, rectum, and bladder. IMRT reduces the dose to the OAR compared with 3D-CRT in patients with vulvar cancer receiving irradiation to a volume covering the vulvar region and nodal areas without compromising the dosimetric coverage of the target volume. IMRT for vulvar cancer is feasible and an attractive option for dose escalation studies.
Bloemers, Monique C.W.M., E-mail: firstname.lastname@example.com [Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam (Netherlands); Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec (Canada); Portelance, Lorraine [Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec (Canada); Ruo, Russell; Parker, William [Department of Medical Physics, McGill University Health Centre, Montreal, Quebec (Canada); Souhami, Luis [Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec (Canada)
Methylprednisolone Therapy in Acute Hemorrhagic Edema of Infancy
We present a case of an 18-month-old boy who showed severe clinical signs indicative of acute hemorrhagic edema of infancy (AHEI) with painful purpuric skin affection primarily of the face and marked edema of the ears. The histological findings were diagnostic for leukocytoclastic vasculitis and thus met the histological criteria for AHEI. Indicative of infection as causative agent for the condition were symptoms of gastroenteritis. High-dose intravenous corticosteroids led to a fast resolution of symptoms and normalization of laboratory parameters. AHEI is usually not described as being very responsive to corticosteroids. The case presented here indicates that severe cases of AHEI can be treated with high-dose intravenous corticosteroids resulting in significant relief and shortening of the symptoms. Clinical followup showed no underlying malignancy or other severe chronic systemic diseases thus confirming earlier reports that AHEI is not associated with such conditions. The differential diagnoses with AHEI are discussed.
Risikesan, Jeyanthini; Koppelhus, Uffe; Steiniche, Torben; Deleuran, Mette; Herlin, Troels
Diabetic papillopathy with macular edema treated with intravitreal ranibizumab
We report a case of diabetic papillopathy that demonstrated a resolution of optic disk swelling and rapid visual recovery when intravitreal ranibizumab was administered. A 51-year-old male presented with acute painless visual loss in his right eye. His vision was 20/320 in the right eye and 20/50 in the left eye. Fundus examination of the right eye showed nonproliferative diabetic retinopathy with macular edema and a swollen optic disk. Fluorescein angiography showed dye leakage from the right optic disk. Optical coherent tomography revealed a significant increase in retinal nerve fiber-layer thickness. Magnetic resonance imaging of the brain was normal. The patient received a single intravitreal ranibizumab (0.5 mg) injection. Two weeks following injection, there was marked regression of the disk swelling and improvement of macular edema, with vision improving to 20/100. Three months following injection, there was complete resolution of the optic disk swelling. No further treatment was required.
Kim, Moosang; Lee, Jang-Hun; Lee, Seung-Jun
Anti-VEGF therapy for diabetic macular edema.
Vascular endothelial growth factor (VEGF) plays a pivotal role in the development of diabetic macular edema (DME), the leading cause of vision loss among working-aged individuals. A decade of clinical trials demonstrated that drugs that bind soluble VEGF restore the integrity of the blood-retinal barrier, resolve macular edema, and improve vision in most patients with DME. Four drugs (pegaptanib, ranibizumab, bevacizumab, and aflibercept) effectively treat DME when administered by intravitreal injections. Only ranibizumab has received U.S. Food and Drug Administration (FDA) approval for DME, but bevacizumab is commonly used off-label, and an FDA application for aflibercept is pending. Effective treatment requires repeated injections, although recent data suggest that the treatment burden diminishes after 1 year. Intravitreal therapy is generally safe, although the incidence of systemic thromboembolic events varies among trials. PMID:24919750
Stewart, Michael W
Inhibition of carrageenan edema formation by organotin compounds.
The effects of a single p.o. dose of 0.3-10 mg/kg of organotin compounds such as dibutyltin dichloride (Bu2SnCl2) and triphenyltin chloride (Ph3SnCl) on the development of edema after subplantar injection of 0.5 mg of carrageenan in 0.05 ml of pyrogen-free saline were examined as compared with those of hydrocortisone. Bu2SnCl2, Ph3SnCl and hydrocortisone did not significantly inhibit the development of the first phase of edema at any dose level, but produced more than 90, 70 and 90% inhibition of the second phase, respectively, at a dose of 10 mg/kg 1 hr before the irritant. Moreover, these inhibitions of the second phase were dose-dependent. PMID:6508808
Arakawa, Y; Wada, O
Paraneoplastic remitting seronegative symmetrical synovitis with pitting edema.
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a syndrome that may be associated with many conditions, including malignancy. Three further cases of paraneoplastic RS3PE are described and the literature is reviewed. Paraneoplastic RS3PE is more frequently associated with solid tumors, in particular adenocarcinoma. The two clinical characteristics suggestive of paraneoplastic RS3PE are systemic sign/symptoms and the poor response to corticosteroid therapy. PMID:10609077
Cantini, F; Salvarani, C; Olivieri, I
'Zamboni disease'. Pulmonary edema in an ice hockey player.
A 17-year-old previously well ice hockey player experienced acute shortness of breath and cough productive of clear frothy sputum about 1.5 hours following an ice hockey match. Noncardiogenic pulmonary edema was found to develop as a result of the inhalation of the oxides of nitrogen. The latter was produced by a Zamboni machine that is used to resurface the ice on a rink. Several other players were affected but less severely. PMID:7503608
Morgan, W K
Alkane-induced edema formation and cutaneous barrier dysfunction
Certain mineral oils and hydrocarbons require repeated topical application to cause irritation. A structure activity relationship of pure n-alkanes was undertaken in a mouse ear edema model to investigate the mechanism of cumulative irritancy. Alkanes were applied twice daily over a 4-day period. Dodecane was found to be non-irritating, while tridecane elicited a response only at 96 h. Tetradecane was
S. J. Moloney; J. J. Teal
Ethchlorvynol-induced pulmonary edema in rats. An ultrastructural study.
Studies of ethchlorvynol (ECV)-induced pulmonary edema were undertaken for determination of the structural basis of increased microvascular permeability. Rats were administered an intravenous bolus dose of 15 mg/kg ECV and killed at time intervals between 5 minutes and 72 hours. Oyster glycogen and ferritin were used as permeability probes for identification of the sites of altered microvascular permeability. Edema fluid containing ferritin begins to accumulate in the alveolar interstitium 10 minutes after EVC . Thirty minutes after ECV, marked intersitial edema fluid is present containing both permeability probes. The absence of any appreciable transendothelial movement of either probe via vesicles and the presence of open endothelial junctions led the authors to propose the latter as the principal determinant of the increase in permeability. In addition to open endothelial junctions, prominent subendothelial blebs occur. These blebs develop in an otherwise intact endothelium and increase in frequency and size with time following their appearance at 10 minutes. Ferritin and glycogen progressively accumulate within the blebs. At 15 minutes the concentration of ferritin in blebs appears to equal that in plasma, whereas glycogen is absent or sparsely present in a few blebs. At 60 minutes both permeability probes have become concentrated in the blebs. The mechanism of formation of the blebs and concentration in them of the permeability probes cannot yet be specified. The lesion caused by ECV is completely reversible, so that by 72 hours after ECV there is complete resolution of interstitial edema, disappearance of the subendothelial blebs, and closure of endothelial junctions. A small amount of exudate remaining in the alveoli is cleared by 72 hours. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11
Wysolmerski, R.; Lagunoff, D.; Dahms, T.
Negative-pressure pulmonary edema following a lateral internal sphincterotomy.
Negative-pressure pulmonary edema (NPPE) is an infrequent but known postoperative complication following endotracheal intubation and general anesthesia. We report a case of a healthy 24-year-old man requiring intensive care unit management for NPPE following a routine surgical procedure. This article discusses how rare but serious the complication of NPPE can be; it also describes the diagnosis, evaluation, and treatment from one institution's experience. PMID:21882792
Schlussel, Andrew T; Yheulon, Christopher G; Gagliano, Ronald A
Perspectives on Neonatal Hypoxia\\/Ischemia-Induced Edema Formation
Neonatal hypoxia\\/ischemia (HI) is the most common cause of developmental neurological, cognitive and behavioral deficits in\\u000a children, with hyperoxia (HHI) treatment being a clinical therapy for newborn resuscitation. Although cerebral edema is a\\u000a common outcome after HI, the mechanisms leading to excessive fluid accumulation in the brain are poorly understood. Given\\u000a the rigid nature of the bone-encased brain matter, knowledge
Diana Carolina Ferrari; Olivera Nesic; Jose Regino Perez-Polo
Post-coital burning pain and pain at micturition: early symptoms of partial vaginismus with or without vulvar vestibulitis?
Twenty-four women with partial vaginismus with or without vulvar vestibulitis participated in a semi-structured telephone interview concerning early signs and development of their pain symptoms during/after intercourse. At the onset of the problem, pain after intercourse was more common than pain during penetration. Pain intensity during penetration increased from the onset of the problem to when the women ceased having intercourse. Pain during penetration lasted for 1 minute, and was most often described as sharp/incisive/bursting, while pain after intercourse had a duration of 2 hours and was described as burning and/or smarting. Post-coital pain during micturition was described by 70% of the women. PMID:18770111
Engman, Maria; Wijma, Klaas; Wijma, Barbro
Olanzapine as a cause of peripheric edema in an elderly man.
Edema can be observed as side-effect of many medications, of which calcium channel blockers are the best known. Elderly people use many more medications than their younger counterparts and are usually more prone to developing medication-induced side-effects. Atypical antipsychotics have occasionally been shown to induce peripheric edema. Age is put forward as a risk factor for olanzapine-induced edema. We present here the case of an elderly man who developed upper- and lower-limb edema during use of olanzapine to emphasize its relatively frequent association with edema in the elderly. PMID:23740642
Ak?n, Sibel; Bahat, G�listan; Tufan, Fatih; Saka, B�lent; Oztop, Nida; Erten, Nilg�n; Karan, Mehmet Akif
Edema and elasticity of a fronto-temporal decompressive craniectomy
Background: Decompressive craniectomy is undertaken for relief of brain herniation caused by acute brain swelling. Brain stiffness can be estimated by palpating the decompressive cranial defect and can provide some relatively subjective information to the neurosurgeon to help guide care. The goal of the present study was to objectively evaluate transcutaneous stiffness of the cranial defect using a tactile resonance sensor and to describe the values in patients with a decompressive window in order to characterize the clinical association between brain edema and stiffness. Methods: Data were prospectively collected from 13 of 37 patients who underwent a decompressive craniectomy in our hospital during a 5-year period. Transcutaneous stiffness was measured as change in frequency and as elastic modulus. Results: Stiffness variables of the decompressive site were measured without any adverse effect and subsequent calculations revealed change in frequency = 101.71 � 36.42 Hz, and shear elastic modulus = 1.99 � 1.11 kPa. Conclusions: The elasticity of stiffness of a decompressive site correlated with brain edema, cisternal cerebrospinal fluid pressure, and brain shift, all of which are related to acute brain edema.
Takada, Daikei; Nagai, Hidemasa; Moritake, Kouzo; Akiyama, Yasuhiko
An accurate and simple method for measurement of paw edema.
Several methods for measuring inflammation are available that rely on the parameters changing during inflammation. The most commonly used methods estimate the volume of edema formed. In this study, we present a novel method for measuring the volume of pathologically or artificially induced edema. In this model, a liquid column is placed on a balance. When an object is immersed, the liquid applies a force F to attempt its expulsion. Physically, F is the weight (W) of the volume of liquid displaced by that part of the object inserted into the liquid. A balance is used to measure this force (F=W).Therefore, the partial or entire volume of any object, for example, the inflamed hind paw of a rat, can be calculated thus, using the specific gravity of the immersion liquid, at equilibrium mass/specific gravity=volume (V). The extent of edema at time t (measured as V) will be V(t)-V(o). This method is easy to use, materials are of low cost and readily available. It is important that the rat paw (or any object whose volume is being measured) is kept from contacting the wall of the column containing the fluid whilst the value on the balance is read. PMID:11091125
Fereidoni, M; Ahmadiani, A; Semnanian, S; Javan, M
High-altitude pulmonary edema at a ski resort.
Medical records of 150 patients with high-altitude pulmonary edema seen over a 39-month period in a Colorado Rocky Mountain ski area at 2,928 m (9,600 ft) (mean age 34.4 years; 84% male) were reviewed. The mean time to the onset of symptoms was 3 +/- 1.3 days after arrival. Common symptoms were dyspnea, cough, headache, chest congestion, nausea, fever, and weakness. Orthopnea, hemoptysis, and vomiting were rare, occurring in 7%, 6%, and 16%, respectively. Symptoms of cerebral edema occurred in 14%. A temperature exceeding 100 degrees F occurred in 20%, and 17% had a systolic blood pressure of 150 mm of mercury or higher. Blood pressures were higher in patients older than 50 years (142 mm of mercury). Rales were present in 85%, and a pulmonary infiltrate was present in 88%; both were most commonly bilateral or on the right side. The amount of infiltrate was mild. Men appeared to be more susceptible than women to high-altitude pulmonary edema. Pulse oximetry in 45 patients showed a mean oxygen saturation of 74% (38% to 93%). Treatment methods depended on severity and included a return to quarters for portable nasal oxygen, an overnight stay in the clinic for continuing oxygen, or a descent to Denver for recovery or admission to a hospital. All patients received oxygen for 2 to 4 hours in the clinic. There were no deaths or complications. Images Figure 2. Figure 3.
Hultgren, H N; Honigman, B; Theis, K; Nicholas, D
Genital Warts and Vulvar Intraepithelial Neoplasia: Natural History and Effects of Treatment and Human Immunodeficiency Virus Infection
Objective To describe the natural history of genital warts and vulvar intraepithelial neoplasia (VIN) in women with human immunodeficiency virus (HIV). Methods A cohort of 2,791 HIV infected and 953 uninfected women followed for up to 13 years had genital examinations at 6-month intervals, with biopsy for lesions suspicious for VIN. Results The prevalence of warts was 4.4% (5.3% for HIV seropositive women and 1.9% for seronegative women, P < 0.0001). The cumulative incidence of warts was 33% (95% C.I. 30, 36%) in HIV seropositive and 9% (95% C.I. 6, 12%) in seronegative women (P < 0.0001). In multivariable analysis, lower CD4 lymphocyte count, younger age, and current smoking were strongly associated with risk for incident warts. Among 501 HIV seropositive and 43 seronegative women, warts regressed in 410 (82%) seropositive and 41 (95%) seronegative women (P = 0.02), most in the first year after diagnosis. In multivariable analysis, regression was negatively associated with HIV status and lower CD4 count as well as older age. Incident VIN of any grade occurred more frequently among HIV seropositive than seronegative women: 0.42 (0.33 � 0.53) vs 0.07 (0.02 � 0.18)/100 person-years (P < 0.0001). VIN2+ was found in 58 women (55 with and 3 without HIV, P < 0.001). Two women with HIV developed stage IB squamous cell vulvar cancers. Conclusion While genital warts and VIN are more common among HIV seropositive than seronegative women, wart regression is common even in women with HIV, and cancers are infrequent.
Massad, L. Stewart; Xie, Xianhong; Darragh, Teresa; Minkoff, Howard; Levine, Alexandra M.; Watts, D. Heather; Wright, Rodney L.; D'Souza, Gypsyamber; Colie, Christine; Strickler, Howard D.
Daflon 500 mg: symptoms and edema clinical update.
Patients suffering from any class of the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification of chronic venous disease (CVD) may be symptomatic (C0s-C6s). Leg heaviness, discomfort, itching, cramps, pain, paresthesia, and edema (C3) are the most frequent manifestations of CVD and a major reason for medical consultation. Daflon 500 mg (micronized purified flavonoid fraction [MPFF]) is an effective treatment for symptoms and edema in CVD as demonstrated in several randomized controlled studies. A 2-month, double-blind study in 40 patients established the superiority of Daflon 500 mg over placebo with regard to symptoms and objective signs. This was confirmed in another double-blind, placebo-controlled trial (2 months' treatment, 160 patients), and in the Reflux assEssment and quaLity of lIfe improvEment with micronized Flavonoids (RELIEF) study. The latter included 5,052 patients in 23 countries, using a visual analog scale for evaluating pain, leg heaviness, cramps, and a sensation of swelling. All symptoms showed significant and progressive improvement. The quality-of-life results (scores on the ChronIc Venous Insufficiency quality of life Questionnaire [CIVIQ]) paralleled those of symptoms. The decrease in the ankle and calf circumferences was significantly greater (p < 0.001) in the group of patients treated with Daflon 500 mg in two studies, and correlated well with the improvement in the sensation of swelling (p < 0.001). This was confirmed with more sophisticated measurement techniques as in the RELIEF study or in a trial assessing edema with an optoelectronic volumeter in 20 patients. A further double-blind, randomized, controlled study established a statistically significant difference in favor of Daflon 500 mg in comparison with diosmin, both on symptoms and edema. The therapeutic efficacy of Daflon 500 mg on CVD symptoms and edema has been demonstrated in double-blind, randomized, controlled studies. Further studies using a new approach may define the most precise and validated methodology for application in future research in phlebology. PMID:16193223
Ramelet, Albert-Adrien
Alterations in classical and nonclassical HLA expression in recurrent and progressive HPV-induced usual vulvar intraepithelial neoplasia and implications for immunotherapy.
Immunotherapy of usual vulvar intraepithelial neoplasia (uVIN) is promising; however, many patients still fail to show clinical responses, which could be explained by an immune escape through alterations in human leukocyte antigen (HLA) expression. Therefore, we analyzed a cohort of patients with a primary (n = 43) and subsequent recurrent uVIN lesion (n = 20), vaccine-treated uVIN patients (n = 12), patients with human papillomavirus (HPV)-induced vulvar carcinoma (n = 21) and healthy controls (n = 26) for the expression of classical HLA-class I/II and nonclassical HLA-E/-G and MHC class I chain-related molecule A (MICA). HLA-class I was downregulated in 70% of uVIN patients, including patients with a clinical response to immunotherapy. Downregulation of HLA-class I is probably reversible, as only 15% of the uVIN cases displayed loss of heterozygosity (LOH) and HLA-class I could be upregulated in uVIN keratinocyte cultures by interferon ?. HLA-class I downregulation is more frequently associated with LOH in vulvar carcinomas (25-55.5%). HLA-class II was found to be focally expressed in 65% of uVIN patients. Of the nonclassical molecules, MICA was downregulated in 80% of uVIN whereas HLA-E and -G were expressed in a minority of cases. Their expression was more prominent in vulvar carcinoma. No differences were found between the alterations observed in paired primary and recurrent uVIN. Importantly, downregulation of HLA-B/C in primary uVIN lesions was associated with the development of recurrences and progression to cancer. We conclude that downregulation of HLA is frequently observed in premalignant HPV-induced lesions, including clinical responders to immunotherapy, and is associated with worse clinical outcome. However, in the majority of cases downregulation may still be reversible. PMID:24415578
van Esch, E M G; Tummers, B; Baartmans, V; Osse, E M; Ter Haar, N; Trietsch, M D; Hellebrekers, B W J; Holleboom, C A G; Nagel, H T C; Tan, L T; Fleuren, G J; van Poelgeest, M I E; van der Burg, S H; Jordanova, E S
Anti-HPV16 E2 protein T-cell responses and viral control in women with usual vulvar intraepithelial neoplasia and their healthy partners
T-cell responses (proliferation, intracellular cytokine synthesis and IFN? ELISPOT) against human papillomavirus 16 (HPV16) E2 peptides were tested during 18 months in a longitudinal study in eight women presenting with HPV16-related usual vulvar intraepithelial neoplasia (VIN) and their healthy male partners. In six women, anti-E2 proliferative responses and cytokine production (single IFN? and\\/or dual IFN?\\/IL2 and\\/or single IL2) by CD4+
Remi Cheynier
Expression of the human papillomavirus type 16 genome in SK-v cells, a line derived from a vulvar intraepithelial neoplasia
The SK-v cells, established from a premalignant vulvar lesion, contain human papillomavirus type 16 (HPV- 16) sequences integrated at a single cellular site and derive from a cell clone present in vivo. Transcription of the HPV-16 genome in SK-v cells was analysed by cDNA heteroduplex mapping and sequencing, and by RNase mapping. Viral sequences were shown to be transcribed into
S. Schneider-Maunoury; G. Pehau-Arnaudet; F. Breitburd; G. Orth
A randomized comparison of group cognitive�behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis
This study compared group cognitive�behavioral therapy (12-week trial), surface electromyographic biofeedback (12-week trial), and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Subjects were 78 women randomly assigned to one of three treatment conditions and assessed at pretreatment, posttreatment and 6-month follow-up via gynecological examinations, structured interviews and standard questionnaires pertaining to pain (Pain Rating Index and Sensory
Sophie Bergeron; Yitzchak M. Binik; Samir Khalif�; Kelly Pagidas; Howard I. Glazer; Marta Meana; Rhonda Amsel
Spontaneous regression of grade 3 vulvar intraepithelial neoplasia associated with human papillomavirus-16-specific CD4(+) and CD8(+) T-cell responses.
Cell-mediated immunity directed against human papillomavirus 16 (HPV-16) antigens was studied in six patients affected with grade 3 vulvar intraepithelial neoplasia (VIN3, also known as bowenoid papulosis). Five of the patients presented with a chronic and persistent disease that relapsed after destructive treatments. They showed no detectable anti-HPV blood T-cell responses and no T-cell intraepidermal vulvar infiltrate containing both CD4+ and CD8+ lymphocytes. The last patient had a complete clearance of viral lesions, 8 months after disease onset and 2 months after electrocoagulation of <50% of the VIN3 lesions. She showed high frequency anti-E6 and anti-E7 effector blood T cells by ex vivo ELISpot-IFNgamma assay before clinical regression. Immunohistochemical study of her vulvar biopsy revealed a marked dermal infiltrate containing a majority of CD4+ T lymphocytes and an epidermal infiltrate made up of both CD4(+) and CD8(+) T cells. This seems to be the first evidence of an association between spontaneous regression of VIN3 lesions and HPV-specific T-cell responses detectable in the blood. Hence, an increase of HPV-specific effector T lymphocyte responses by vaccine-based therapeutic strategies might be useful to clear the lesions in bowenoid papulosis disease. PMID:15574788
Bourgault Villada, Isabelle; Moyal Barracco, Micheline; Villada, Isabelle Bourgault; Barracco, Micheline Moyal; Ziol, Marianne; Chaboissier, Aude; Barget, Nathalie; Berville, Sophie; Paniel, Bernard; Jullian, Eric; Clerici, Thierry; Maill�re, Bernard; Guillet, Jean G�rard
Acute Pulmonary Edema Caused by a Giant Atrial Myxoma
Atrial myxoma is the most common primary cardiac tumor. Its clinical presentation spreads from asymptomatic incidental mass to serious life-threatening cardiovascular complications. We report the case of a 44-year-old man with evening fever and worsening dyspnea in the last weeks, admitted to our hospital for acute pulmonary edema. The cardiac auscultation was very suspicious for mitral valve stenosis, but the echocardiography revealed a huge atrial mass with a diastolic prolapse into mitral valve orifice causing an extremely high transmitral gradient pressure. Awareness of this uncommon acute presentation of atrial myxoma is necessary for timely diagnosis and prompt surgical intervention.
Agricola, Eustachio; Marini, Claudia; Margonato, Alberto
Multifocal electroretinography in diabetic retinopathy and diabetic macular edema.
In this review article, we first present a brief overview of the vascular and neural components of diabetic retinopathy. Next, the multifocal electroretinogram (mfERG) technique, which can map neuroretinal function noninvasively, is described. Findings in diabetic retinal disease using the mfERG are reviewed. We then describe the progress that has been made to predict the onset and progression of diabetic retinopathy and edema in specific retinal locations, using quantitative models based on the mfERG. Finally, we consider the implications for the future of these predictive models. PMID:25005120
Bearse, Marcus A; Ozawa, Glen Y
Protein and electrolyte changes in experimental cerebral edema.
Analysis of protein and electrolyte data in cryogenic cerebral edema in the rhesus monkey has led to the conclusion that, in the first 24 hours (h) after injury, the edematous process is not homogenous, but compartmentalized. This involves, first of all, a division into intra- and extracellular compartments. The intracellular compartment is further divided into a compartment containing water, electrolytes, and serum proteins, and a compartment containing only excess sodium. The extracellular compartment is also subdivided into a compartment containing albumin, globulin, and electrolytes, and a compartment containing only albumin and electrolytes. Anatomically, the latter is most likely the pre-existing normal extracellular space. PMID:7062083
Clasen, R A; Bezkorovainy, A; Pandolfi, S
Pathology Case Study: History of Fatigue and Edema
NSDL National Science Digital Library
This is a case study presented by the University of Pittsburgh Department of Pathology in which a man presented with fatigue and two weeks of increasing edema. Visitors are given both the microscopic and gross descriptions, laboratory findings, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in hepatopathology.
Adamson, Ann T.
Topical Nonsteroidal Anti-Inflammatory Drugs for Macular Edema
Nonsteroidal anti-inflammatory drugs (NSAIDs) are nowadays widely used in ophthalmology to reduce eye inflammation, pain, and cystoid macular edema associated with cataract surgery. Recently, new topical NSAIDs have been approved for topical ophthalmic use, allowing for greater drug penetration into the vitreous. Hence, new therapeutic effects can be achieved, such as reduction of exudation secondary to age-related macular degeneration or diabetic maculopathy. We provide an updated review on the clinical use of NSAIDs for retinal diseases, with a focus on the potential future applications.
Parmeggiani, Francesco; Romano, Mario R.; dell'Omo, Roberto
Routine Diagnostic Venous Ultrasound and LAS for Leg Edema of Unknown Cause
Objective: To verify the diagnostic efficiency of venous duplex ultrasound and lymphangioscintigraphy (LAS) in establishing the cause of leg edema and to clarify the pathology of these leg edemas. Materials and Methods: Between April 2009, and March 2010, 62 patients with leg edema of unknown origin were referred to the Edema Clinic of the Yamaguchi University Graduate School of Medicine. All patients underwent a venous duplex ultrasound scan and LAS. Results: Of 62 patients, lymphatic insufficiency, venous insufficiency or both was diagnosed in 42 (68%), and lymphedema, in 29 (47%). Venous duplex ultrasound detected obvious venous disorders in only 13 (21%), and for 20 patients, the ultrasound and LAS did not reveal any abnormalities; however, for 15 of the 20 (24% of all patients), venous edema was attributed to functional causes. Conclusion: Venous duplex ultrasound and LAS assisted in the diagnosis of leg edema of unknown origin and also proved useful in establishing treatment strategies.
Pathogenesis of pulmonary edema associated with the adult respiratory distress syndrome.
Pulmonary edema is common cause of acute respiratory failure and can be seen in not only cardiac but also noncardiac diseases. The pathophysiologic mechanism for the development of acute pulmonary edema in any clinical situation can usually be explained alterations in the forces governing the transvascular flux of fluid in the pulmonary microvasculature, according to the Starling equation. "Cardiac" pulmonary edema is primarily due to an increase in the capillary hydrostatic pressure of sufficient magnitude to overcome the forces maintaining fluid within the vessel and the ability of the lymphatics to drain the transudated fluid. On the other hand, pulmonary edema occurring in association with noncardiac disease (e.g., sepsis, aspiration or shock) is secondary to an increase in the permeability of the pulmonary microvasculature and is referred to as noncardiogenic pulmonary edema or the adult respiratory distress syndrome. This article examines the mechanisms for the development of pulmonary edema and discusses the differences between the cardiac and noncardiac types.
Sibbald, W. J.; Anderson, R. R.; Holliday, R. L.
Expression of Na-K-Cl cotransporter and edema formation are age dependent after ischemic stroke
Age is the most important independent risk factor for stroke; however aging animals are rarely used in stroke studies. Previous work demonstrated that young male mice had more edema formation after an induced stroke than aging animals. An important contributor to cerebral edema formation is the Na-K-Cl cotransporter (NKCC). We examined the expression of NKCC in young (10-12 week) and aging (15-16 months) C57BL6 male mice after middle cerebral artery occlusion (MCAO) and investigated the effect of pharmacological inhibition of NKCC with Bumetanide on cerebral edema formation. Both immunofluorescent staining and Western blotting analysis showed that NKCC expression was significantly higher in the ischemic penumbra of young compared to aging mice after stroke. Edema formation was significantly more robust in young mice and was reduced with Bumetanide. Bumetanide had no effect on cerebral edema in aging mice after MCAO. This suggests that NKCC expression and edema formation are age dependent after ischemic stroke.
Liu, Fudong; Akella, Padmastuti; Benashski, Sharon E.; Xu, Yan; McCullough, Louise D.
He-Ne laser treatment for 16 cases of nonspecific edema
NASA Astrophysics Data System (ADS)
Nonspecific edema is a syndrome which is caused by a metabolism disorder of sodium and water. The people who suffer with this are mostly women about 25 - 50 years old. When it happens periodic edema, abdominal distension acratia, and obesity accompany the disease. Through several means of examination, no organic disease was found in the heart, liver, or kidney. Now 16 edema cases have been irradiated with laser and the result is satisfactory. The results are reported in this paper.
Xia, Wenlou; Liu, Sixian; Cao, Guangyi; Chen, Zhifu; Zhang, Haishui; Wei, Wei; Xia, Xinshe; Sia, Guangyu
Platelet involvement in rat paw edema induced by 2-methoxy-PAF
PAF-acether (PAF) or 2-methoxy-PAF (2-MX) caused a dose-dependent paw edema showing a 1: 25 ratio between their inflammatory activities. 2-MX caused a thrombocytopenia, whereas PAF did not alter the number of these cells. Both phospholipids induced reductions in total leukocyte count. Rat antiplatelet serum produced platelet depletion by PAF-induced paw edema was unaffected. The edema of 2-MX was significantly reduced
P. M. R. Silva; R. S. B. Cordeiro; M. A. Martins; M. G. M. O. Henriques; B. B. Vargaftig
Role of vasopressin and its antagonism in stroke related edema.
Although many approaches have been tried in the attempt to reduce the devastating impact of stroke, tissue plasminogen activator for thromboembolic stroke is the only proved, effective acute stroke treatment to date. Vasopressin, an acute-phase reactant, is released after brain injury and is partially responsible for the subsequent inflammatory response via activation of divergent pathways. Recently there has been increasing interest in vasopressin because it is implicated in inflammation, cerebral edema, increased intracerebral pressure, and cerebral ion and neurotransmitter dysfunctions after cerebral ischemia. Additionally, copeptin, a byproduct of vasopressin production, may serve as a promising independent marker of tissue damage and prognosis after stroke, thereby corroborating the role of vasopressin in acute brain injury. Thus, vasopressin antagonists have a potential role in early stroke intervention, an effect thought to be mediated via interactions with aquaporin receptors, specifically aquaporin-4. Despite some ambiguity, vasopressin V1a receptor antagonism has been consistently associated with attenuated secondary brain injury and edema in experimental stroke models. The role of the vasopressin V2 receptor remains unclear, but perhaps it is involved in a positive feedback loop for vasopressin expression. Despite the encouraging initial findings we report here, future research is required to characterize further the utility of vasopressin antagonists in treatment of stroke. � 2014 Wiley Periodicals, Inc. PMID:24823792
Ameli, Pouya A; Ameli, Neema J; Gubernick, David M; Ansari, Saeed; Mohan, Shekher; Satriotomo, Irawan; Buckley, Alexis K; Maxwell, Christopher W; Nayak, Vignesh H; Shushrutha Hedna, Vishnumurthy
Rhodiola crenulata Extract Alleviates Hypoxic Pulmonary Edema in Rats.
Sudden exposure of nonacclimatized individuals to high altitude can easily lead to high altitude illnesses. High altitude pulmonary edema (HAPE) is the most lethal form of high altitude illness. The present study was designed to investigate the ability of Rhodiola crenulata extract (RCE), an herbal medicine traditionally used as an antiacute mountain sickness remedy, to attenuate hypoxia-induced pulmonary injury. Exposure of animals to hypobaric hypoxia led to a significant increase in pathological indicators for pulmonary edema, including the lung water content, disruption of the alveolar-capillary barrier, and protein-rich fluid in the lungs. In addition, hypobaric hypoxia also increased oxidative stress markers, including (ROS) production, (MDA) level, and (MPO) activity. Furthermore, overexpression of plasma (ET-1), (VEGF) in (BALF), and (HIF-1 ? ) in lung tissue was also found. However, pretreatment with RCE relieved the HAPE findings by curtailing all of the hypoxia-induced lung injury parameters. These findings suggest that RCE confers effective protection for maintaining the integrity of the alveolar-capillary barrier by alleviating the elevated ET-1 and VEGF levels; it does so by reducing hypoxia-induced oxidative stress. Our results offer substantial evidence to support arguments in favor of traditional applications of Rhodiola crenulata for antihigh altitude illness. PMID:23710233
Lee, Shih-Yu; Li, Min-Hui; Shi, Li-Shian; Chu, Hsin; Ho, Cheng-Wen; Chang, Tsu-Chung
Structure-based redesign of an edema toxin inhibitor
Edema Factor toxin (EF) of Bacillus anthracis (NIAID category A), and several other toxins from NIAID category B Biodefense target bacteria are adenylyl cyclases or adenylyl cyclase agonists that catalyze the conversion of ATP to 3?,5?-cyclic adenosine monophosphate (cAMP). We previously identified compound 1 (3-[(9-Oxo-9H-fluorene-1-carbonyl)-amino]-benzoic acid), that inhibits EF activity in cultured mammalian cells, and reduces diarrhea caused by enterotoxigenic Escherichia coli (ETEC) at an oral dosage of 15 ?g/mouse. Here, molecular docking was used to predict improvements in potency and solubility of new derivatives of compound 1 in inhibiting edema toxin-(ET) catalyzed stimulation of cyclic AMP production in murine monocyte-macrophage cells (RAW 264.7). Structure-activity relationship (SAR) analysis of the bioassay results for 22 compounds indicated positions important for activity. Several derivatives demonstrated superior pharmacological properties compared to our initial lead compound, and are promising candidates to treat anthrax infections and diarrheal diseases induced by toxin-producing bacteria.
Chen, Deliang; Ma, Lili; Kanalas, John J.; Gao, Jian; Pawlik, Jennifer; Jimenez, Maria Estrella; Walter, Mary A.; Peterson, Johnny W.; Gilbertson, Scott R.; Schein, Catherine H.
Rhodiola crenulata Extract Alleviates Hypoxic Pulmonary Edema in Rats
Sudden exposure of nonacclimatized individuals to high altitude can easily lead to high altitude illnesses. High altitude pulmonary edema (HAPE) is the most lethal form of high altitude illness. The present study was designed to investigate the ability of Rhodiola crenulata extract (RCE), an herbal medicine traditionally used as an antiacute mountain sickness remedy, to attenuate hypoxia-induced pulmonary injury. Exposure of animals to hypobaric hypoxia led to a significant increase in pathological indicators for pulmonary edema, including the lung water content, disruption of the alveolar-capillary barrier, and protein-rich fluid in the lungs. In addition, hypobaric hypoxia also increased oxidative stress markers, including (ROS) production, (MDA) level, and (MPO) activity. Furthermore, overexpression of plasma (ET-1), (VEGF) in (BALF), and (HIF-1?) in lung tissue was also found. However, pretreatment with RCE relieved the HAPE findings by curtailing all of the hypoxia-induced lung injury parameters. These findings suggest that RCE confers effective protection for maintaining the integrity of the alveolar-capillary barrier by alleviating the elevated ET-1 and VEGF levels; it does so by reducing hypoxia-induced oxidative stress. Our results offer substantial evidence to support arguments in favor of traditional applications of Rhodiola crenulata for antihigh altitude illness.
Li, Min-Hui; Shi, Li-Shian; Ho, Cheng-Wen
Current management of salicylate-induced pulmonary edema.
Salicylate-induced pulmonary edema (SIPE) can occur in both acute and chronic users of aspirin or salicylate products. The medical history, especially when it reveals the use of salicylates, is critical when considering this diagnosis. Unfortunately, the neurologic and systemic effects of salicylate toxicity may hinder the ability to obtain a reliable medical history. SIPE should be considered in patients who present with pulmonary edema and neurological changes, anion-gap metabolic acidosis, or possible sepsis. Some patients may be treated for "pseudosepsis" or other conditions, thereby delaying the diagnosis of salicylate intoxication. Misdiagnosis and possibly delayed diagnosis of SIPE can lead to a significant increase in morbidity and mortality. Serum and urine alkalinization by administration of intravenous sodium bicarbonate are commonly utilized therapeutic strategies. Finally, hemodialysis is a therapy which should be considered early in the course of treatment. The objective of this review was to emphasize the importance of rapid diagnosis and appropriate treatment in patients with SIPE, and summarize the current literature as it relates to the adult population. PMID:21297545
Glisson, James K; Vesa, Telciane S; Bowling, Mark R
Dichotomal role of TNF in experimental pulmonary edema reabsorption.
Distinct from its receptor binding sites, TNF carries a lectin-like domain, situated at the tip of the molecule, which specifically binds oligosaccharides, such as N,N'-diacetylchitobiose. In view of the apparently conflicting data concerning TNF actions in pulmonary edema, we investigated the contribution of, on the one hand, the receptor binding sites and, in contrast, the lectin-like domain of the cytokine on pulmonary fluid reabsorption in in situ and in vivo flooded rat lungs. Receptor binding sites were blocked with the human soluble TNFR type 1 construct (sTNFR1), whereas the lectin-like domain was blunted with the oligosaccharide N,N'-diacetylchitobiose. We observed that in situ, TNF failed to stimulate alveolar liquid clearance, but did so together with the sTNFR1, and this activity was neutralized by N,N'-diacetylchitobiose. In vivo TNF inhibited liquid clearance, but activated it when complexed with the sTNFR1. A TNF-derived peptide mimic of the lectin-like domain activated fluid reabsorption in flooded lungs, and this activity was blunted by co-treatment with TNF. Our results thus indicate that in these models the receptor binding sites of TNF inhibit, whereas its lectin-like domain activates, edema reabsorption. PMID:16116234
Braun, Clemens; Hamacher, J�rg; Morel, Denis R; Wendel, Albrecht; Lucas, Rudolf
Ibuprofen prevents synthetic smoke-induced pulmonary edema
Multiple potentially injurious agents are present in smoke but the importance of each of these agents in producing lung injury as well as the mechanisms by which the lung injury is produced are unknown. In order to study smoke inhalation injury, we developed a synthetic smoke composed of a carrier of hot carbon particles of known size to which a single known common toxic agent in smoke, in this case HCI, could be added. We then exposed rats to the smoke, assayed their blood for the metabolites of thromboxane and prostacyclin, and intervened shortly after smoke with the cyclooxygenase inhibitors indomethacin or ibuprofen to see if the resulting lung injury could be prevented. Smoke exposure produced mild pulmonary edema after 6 h with a wet-to-dry weight ratio of 5.6 +/- 0.2 SEM (n = 11) compared with the non-smoke-exposed control animals with a wet-to-dry weight ratio of 4.3 +/- 0.2 (n = 12), p less than 0.001. Thromboxane B, and 6-keto-prostaglandin F1 alpha rose to 1660 +/- 250 pg/ml (p less than 0.01) and to 600 +/- 100 pg/ml (p greater than 0.1), respectively, in the smoke-injured animals compared with 770 +/- 150 pg/ml and 400 +/- 100 pg/ml in the non-smoke-exposed control animals. Indomethacin (n = 11) blocked the increase in both thromboxane and prostacyclin metabolites but failed to prevent lung edema.
Shinozawa, Y.; Hales, C.; Jung, W.; Burke, J.
In vivo photoacoustic tomography of mouse cerebral edema induced by cold injury
NASA Astrophysics Data System (ADS)
For the first time, we have implemented photoacoustic tomography (PAT) to image the water content of an edema in vivo. We produced and imaged a cold-induced cerebral edema transcranially, then obtained blood vessel and water accumulation images at 610 and 975 nm, respectively. We tracked the changes at 12, 24, and 36 h after the cold injury. The blood volume decreased after the cold injury, and the maximum area of edema was observed 24 h after the cold injury. We validated PAT of the water content of the edema through magnetic Resonance Imaging and the water spectrum from the spectrophotometric measurement.
Xu, Zhun; Zhu, Quing; Wang, Lihong V.
Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome in a Chronic Hemodialysis Patient
A 75-year-old male who was undergoing chronic hemodialysis developed abrupt-onset pitting edema and pain in the dorsum of both hands and feet. Biochemical analysis disclosed increased C-reactive protein, and negative rheumatoid factor and antinuclear antibody. Radiological examination showed no bony erosion. Computed tomography and gallium scintigraphy revealed no active infection or neoplasms. The clinical diagnosis was remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. The pitting edema and inflammatory response quickly subsided after low-dose prednisolone therapy. This case demonstrates that RS3PE syndrome could be a differential diagnosis in elderly patients undergoing dialysis who develop pitting edema and joint pain.
Yamada, Shunsuke; Fuyuno, Seiya; Eriguchi, Masahiro; Tsuruya, Kazuhiko; Kitazono, Takanari
Burn plasma transfer induces burn edema in healthy rats.
Thermal injuries greater than 20% body surface area (BSA) result in systemic shock with generalized edema in addition to local tissue destruction. Burn shock is induced by a variety of mediators, mainly immunomodulative cytokines. This experimental study evaluates if burn shock can be induced in healthy rats by transfer of burn plasma (BP) with mediators. Thermal injury was induced by hot water (100 degrees C water, 12 s, 30% BSA) in male syngenic Wistar rats. Donor rats were killed 4 h posttrauma, and BP was harvested. Burn plasma was transferred to healthy animals by continuous intravenous infusion in three types of dilution (100%, 10%, and 1%). Positive controls were directly examined 4 h after thermal injury, and negative control rats had a continuous infusion done with sham burn (SB) plasma (37 degrees C water, 12 s, 30% BSA). Afterwards, intravital fluorescence microscopy was performed in postcapillary mesenteric venules at 0, 60, and 120 min. Edema formation was assessed by relative changes over time in fluorescence intensity of fluorescein isothiocyanate-albumin in the intravascular versus the extravascular space. The interactions of leucocytes and endothelium were evaluated by quantification of leukocyte sticking. Additionally, microhemodynamic (volumetric blood flow, erythrocyte velocity, venular wall shear rate, venular diameters) and macrohemodynamic parameters (blood pressure, heart frequency, temperature) were assessed online (arterial catheter). For statistics, an ANOVA was performed with Bonferroni adjustment procedure. Differences were considered significant when P < 0.05. There are no statistically significant differences in microhemodynamics or macrohemodynamics between study groups. Burn plasma infusion and thermal injury lead to significant increases in fluorescein isothiocyanate-albumin extravasation, whereas SB plasma shows no significant changes. Even BP diluted in 0.9% saline (10% and 1%) results in a similar transvascular flux of plasma proteins as direct thermal injury. Differences between positive controls and BP infusion are not significant, whereas all groups are statistically different from the SB group (P<0.05). Leukocyte sticking is significantly increased in all groups except the SB group, and the number of adherent leukocytes is dose dependent. The present study demonstrates that as early as 4 h after thermal injury, there are sufficient factors (e.g., cytokines) in BP to induce systemic burn shock in healthy rats even in diluted plasma (1%). However, the "key" cytokines are not identified at this point. The burned tissue is no longer required for burn shock induction, and the pathophysiologic process seems to be self-perpetuating as early as 4 h posttrauma. Leukocytes are activated by thermal injury and BP infusion. The role of leukocyte-endothelium interactions for edema formation remains uncertain and requires further investigation. PMID:18323747
Kremer, Thomas; Ab�, Dorothe�; Weihrauch, Marc; Peters, Christopher; Gebhardt, Martha Maria; Germann, Guenter; Heitmann, Christoph; Walther, Andreas
Involvement of nitric oxide pathways in neurogenic pulmonary edema induced by vagotomy
OBJECTIVE: The objective of this study was to evaluate the involvement of peripheral nitric oxide (NO) in vagotomy-induced pulmonary edema by verifying whether the nitric oxide synthases (NOS), constitutive (cNOS) and inducible (iNOS), participate in this mechanism. INTRODUCTION: It has been proposed that vagotomy induces neurogenic pulmonary edema or intensifies the edema of other etiologies. METHODS: Control and vagotomized rats were pretreated with 0.3�mg/kg, 3.0�mg/kg or 39.0�mg/kg of L-NAME, or with 5.0�mg/kg, 10.0�mg/kg or 20.0�mg/kg of aminoguanidine. All animals were observed for 120 minutes. After the animals' death, the trachea was catheterized in order to observe tracheal fluid and to classify the severity of pulmonary edema. The lungs were removed and weighed to evaluate pulmonary weight gain and edema index. RESULTS: Vagotomy promoted pulmonary edema as edema was significantly higher than in the control. This effect was modified by treatment with L-NAME. The highest dose, 39.0�mg/kg, reduced the edema and prolonged the survival of the animals, while at the lowest dose, 0.3�mg/kg, the edema and reduced survival rates were maintained. Aminoguanidine, regardless of the dose inhibited the development of the edema. Its effect was similar to that observed when the highest dose of L-NAME was administered. It may be that the non-selective blockade of cNOS by the highest dose of L-NAME also inhibited the iNOS pathway. CONCLUSION: Our data suggest that iNOS could be directly involved in pulmonary edema induced by vagotomy and cNOS appears to participate as a protector mechanism.
Blanco, Eleonora; Martins-Pinge, Marli; Oliveira-Sales, Elizabeth; Busnardo, Cristiane
Treatment failure in patients with HPV 16-induced vulvar intraepithelial neoplasia: understanding different clinical responses to immunotherapy.
Failure of the immune system to launch a strong and effective immune response to high-risk HPV is related to viral persistence and the development of anogenital (pre)malignant lesions such as vulvar intraepithelial neoplasia (VIN). Different forms of immunotherapy, aimed at overcoming the inertia of the immune system, have been developed and met with clinical success. Unfortunately these, in principal successful, therapeutic approaches also fail to induce clinical responses in a substantial number of cases. In this review, the authors summarize the traits of the immune response to HPV in healthy individuals and in patients with HPV-induced neoplasia. The potential mechanisms involved in the escape of HPV-induced lesions from the immune system indicate gaps in our knowledge. Finally, the interaction between the immune system and VIN is discussed with a special focus on the different forms of immunotherapy applied to treat VIN and the potential causes of therapy failure. The authors conclude that there are a number of pre-existing conditions that determine the patients' responsiveness to immunotherapy. An immunotherapeutic strategy in which different aspects of immune failure are attacked by complementary approaches, will improve the clinical response rate. PMID:22913259
van Esch, Edith M G; Welters, Marij J P; Jordanova, Ekaterina S; Trimbos, J Baptist M Z; van der Burg, Sjoerd H; van Poelgeest, Mari�tte I E
Peripheral Edema Occurring during Treatment with Risperidone Combined with Citalopram
An 80-year-old female presented with symptoms of depression, worthlessness, hopelessness, loss of energy, insomnia, impatience, and forgetfulness associated with persecutory delusion that had begun about one year before her visit. She was diagnosed with major depression with psychotic signs and began treatment with risperidone (2?mg/night) and citalopram (20?mg/day). After 20 days, she returned and reported partial improvement in her symptoms, although she had developed severe swelling of the hands and feet. The results of liver and renal function tests and rheumatologic tests were found to be within normal limits. Risperidone was discontinued for a week, and the swelling resolved completely. Risperidone was then administered again, and the swelling returned so that the patient had to discontinue taking the drug. The reappearance of edema on rechallenge is strong evidence implicating risperidone as the cause of the swelling.
Hosseini, Seyed Hamzeh; Ahmadi, Amirhossein
Cardiac resynchronization therapy in acute pulmonary edema: A case report
We are reporting a case of 71-year old lady with a dual chamber demand pacemaker, who developed acute pulmonary edema due to an acute left ventricular (LV) dysfunction and worsening in mitral valve regurgitation after atrioventricular nodal ablation for uncontrolled atrial fibrillation. This was attributed to right ventricular apical pacing leading to LV dyssynchronization. Patient dramatically improved within 12-24 h after upgrading her single chamber pacemaker to biventricular pacing. Our case demonstrates that biventricular pacing can be an effective modality of treatment of acute congestive heart failure. In particular, it can be used when it is secondary to LV dysfunction and severe mitral regurgitation attributed to significant dyssynchrony created by right ventricular pacing in patients with atrioventricular nodal ablation for chronic atrial fibrillation.
Barsoum, Emad A; Bhat, Tariq; Asti, Deepak; Kowalski, Marcin; Vazzana, Thomas
Automatic assessment of macular edema from color retinal images.
Diabetic macular edema (DME) is an advanced symptom of diabetic retinopathy and can lead to irreversible vision loss. In this paper, a two-stage methodology for the detection and classification of DME severity from color fundus images is proposed. DME detection is carried out via a supervised learning approach using the normal fundus images. A feature extraction technique is introduced to capture the global characteristics of the fundus images and discriminate the normal from DME images. Disease severity is assessed using a rotational asymmetry metric by examining the symmetry of macular region. The performance of the proposed methodology and features are evaluated against several publicly available datasets. The detection performance has a sensitivity of 100% with specificity between 74% and 90%. Cases needing immediate referral are detected with a sensitivity of 100% and specificity of 97%. The severity classification accuracy is 81% for the moderate case and 100% for severe cases. These results establish the effectiveness of the proposed solution. PMID:22167598
Deepak, K Sai; Sivaswamy, Jayanthi
Proton-nuclear magnetic resonance relaxation times in brain edema
Proton relaxation times of protein solutions, bovine brain, and edematous feline brain tissue were studied as a function of water concentration, protein concentration, and temperature. In accordance with the fast proton exchange model for relaxation, a linear relation could be established between R1 and the inverse of the weight fraction of tissue water. This relation also applied to R2 of gray matter and of protein solutions. No straightforward relation with water content was found for R2 of white matter. Temperature-dependent studies indicated that in this case, the slow exchange model for relaxation had to be applied. The effect of macromolecules in physiological relevant concentrations on the total relaxation behavior of edematous tissue was weak. Total water content changes predominantly affected the relaxation rates. The linear relation may have high clinical potential for assessment of the status of cerebral edema on the basis of T1 and T2 readings from MR images.
Kamman, R.L.; Go, K.G.; Berendsen, H.J. (Univ. of Groningen (Netherland))
Pulmonary Edema in Healthy Subjects in Extreme Conditions
There are several pieces of evidence showing occurrence of pulmonary edema (PE) in healthy subjects in extreme conditions consisting of extreme psychophysical demand in normal environment and psychophysical performances in extreme environment. A combination of different mechanisms, such as mechanical, hemodynamic, biochemical, and hypoxemic ones, may underlie PE leading to an increase in lung vascular hydrostatic pressure and lung vascular permeability and/or a downregulation of the alveolar fluid reabsorption pathways. PE can be functionally detected by closing volume measurement and lung diffusing capacity test to different gases or directly visualized by multiple imaging techniques. Among them chest ultrasonography can detect and quantify the extravascular lung water, creating �comet-tail� ultrasound artefacts (ULCs) from water-thickened pulmonary interlobular septa. In this paper the physiopathological mechanisms of PE, the functional and imaging techniques applied to detect and quantify the phenomenon, and three models of extreme conditions, that is, ironman athletes, climbers and breath-hold divers, are described.
Garbella, Erika; Catapano, Giosue; Pratali, Lorenza; Pingitore, Alessandro
Cystoid macular edema in a patient with Danon disease.
To report a patient with Danon retinopathy with cystoid macular edema treated with topical dorzolamide 2% eye drops and oral acetazolamide. A 37-year-old Caucasian man with Danon disease treated with topical and oral carbonic anhydrase inhibitors participated in the study. Examinations performed before and during treatment included visual acuity (VA), spectral-domain optical coherence tomography, and electroretinography. Following total 48 weeks of treatment, VA decreased from 20/30 OD, 20/200 OS, to 20/40 OD, CF OS. The mean central retinal thickness was unchanged from baseline 263 ?m OD , 226 ?m OS, after treatment 283 ?m OD and 202 ?m OS. In our case, carbonic anydrase inhibitors were not effective. However, a general recommendation cannot be given based on a single case. PMID:23571262
Mack, Heather G
Pulmonary edema of environmental origin--newer concepts
Pulmonary edema of non-cardiac origin is usually an urgent clinical problem, which has recently increased in frequency throughout the world in the past few years. This is partly due to sociological factors and to pre-eminent advances in industrial technology. Recent severe massive toxic gas explosions have had national and worldwide implications. Therefore, urgent and appropriate therapy is of utmost importance in most of these patients. The use of high flow oxygen with Constant Positive Pressure Breathing are the main inhalational therapeutic approaches. Newer modalities of treatment include: (1) earlier Fiberoptic bronchoscopy in those individuals afflicted with aspiration problems and (2) certain specific chemical blocking agents for the management of phosgene intoxication and hydrogen sulfide toxicity. Preventive environmental measures are also important.
Cordasco, E.M.; Demeter, S.R.; Kester, L.; Cordasco, M.A.; Lammert, G.; Beerel, F.
Cost-Effectiveness of Treatment of Diabetic Macular Edema
Background Macular edema is the most common cause of visual loss among patients with diabetes. Objective To determine the cost-effectiveness of different treatments of diabetic macular edema (DME). Design Markov model. Data Sources Published literature and expert opinion. Target Population Patients with clinically significant DME. Time Horizon Lifetime. Perspective Societal. Intervention Laser treatment, intraocular injections of triamcinolone or a vascular endothelial growth factor (VEGF) inhibitor, or a combination of both. Outcome Measures Discounted costs, gains in quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Results of Base-Case Analysis All treatments except laser monotherapy substantially reduced costs, and all treatments except triamcinolone monotherapy increased QALYs. Laser treatment plus a VEGF inhibitor achieved the greatest benefit, gaining 0.56 QALYs at a cost of $6975 for an ICER of $12 410 per QALY compared with laser treatment plus triamcinolone. Monotherapy with a VEGF inhibitor achieved similar outcomes to combination therapy with laser treatment plus a VEGF inhibitor. Laser monotherapy and triamcinolone monotherapy were less effective and more costly than combination therapy. Results of Sensitivity Analysis VEGF inhibitor monotherapy was sometimes preferred over laser treatment plus a VEGF inhibitor, depending on the reduction in quality of life with loss of visual acuity. When the VEGF inhibitor bevacizumab was as effective as ranibizumab, it was preferable to because of its lower cost. Limitation Long-term outcome data for treated and untreated diseases are limited. Conclusion The most effective treatment of DME is VEGF inhibitor injections with or without laser treatment. This therapy compares favorably with cost-effective interventions for other conditions. Primary Funding Source Agency for Healthcare Research and Quality.
Pershing, Suzann; Enns, Eva A.; Matesic, Brian; Owens, Douglas K.; Goldhaber-Fiebert, Jeremy D.
Biologically effective dose for permanent prostate brachytherapy taking into account postimplant edema
Purpose: To study the influence of radiobiologic and physical parameters and parameters related to edema on the biologically effective dose (BED) for permanent prostate implants and to determine the optimal timing of seed reconstruction for BED calculation.Methods and Materials: On the basis of the linear-quadratic model, an expression for the BED was derived, including the edema parameters. A set of
Marion P. R. Van Gellekom; Marinus A. Moerland; Henk B. Kal; Jan J. Battermann
Evaluation of the prevalence of concomitant idiopathic cyclic edema and cellulite.
The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cyclic edema was based on a clinical history and fluid retention throughout the day, in particular difficulty in removing rings on waking in the morning which improves later in the day. All patients with cyclic edema were treated with 75 mg aminaphtone three times daily. Statistical analysis considered the frequency of edema. Of the 82 women evaluated with ages between 18 and 58 years old (mean of 34.9 years) 41 (50.0%) were diagnosed with idiopathic cyclic edema. Idiopathic cyclic edema is an aggravating factor for cellulite and is frequently associated with the more advanced stages of the disease. Its control is essential in the treatment of cellulite. PMID:21850194
de Godoy, Jos� Maria Pereira; de Godoy, Maria de F�tima Guerreiro
Amantadine Induced Corneal Edema in a Patient with Primary Progressive Freezing of Gait
Amantadine is commonly used for Parkinsonism. However amantadine can induce adverse corneal reaction. Here we report a patient with primary progressive freezing of gait who had severe corneal edema associated with amantadine, which was reversible after discontinuation of the amantadine. This report alerts neurologists for this reversible but potentially critical corneal edema in patients with Parkinsonism who are receiving amantadine.
Kim, Young Eun; Yun, Ji Young; Yang, Hui-Jun; Kim, Han-Joon; Kim, Mee Kum; Wee, Won Ryang; Jeon, Beom S.
Importance of anesthesia for the genesis of neurogenic pulmonary edema in spinal cord injury
There are reports describing both provocation and inhibition of neurogenic pulmonary edema by anesthetic drugs. Therefore, we compared the effect of two types of anesthesia on the formation of neurogenic pulmonary edema in rats with balloon-induced acute spinal cord injury. Animals with sham procedure (group 1) were anesthesized by intraperitoneal sodium pentobarbital. In the experimental groups, rats were submitted to
Manoel Baldoino Leal Filho; Rosana Celestina Morandin; Amanda Roberta de Almeida; Elizabeth Cristina Cambiucci; Guilherme Borges; Jose Antonio Rocha Gontijo; Konradin Metze
Aquaporin4 deletion in mice reduces brain edema after acute water intoxication and ischemic stroke
Cerebral edema contributes significantly to morbidity and death associated with many common neurological disorders. However, current treatment options are limited to hyperosmolar agents and surgical decompression, therapies introduced more than 70 years ago. Here we show that mice deficient in aquaporin-4 (AQP4), a glial membrane water channel, have much better survival than wild-type mice in a model of brain edema
Miki Fujimura; Tonghui Ma; Nobuo Noshita; Ferda Filiz; Andrew W. Bollen; Pak Chan; A. S. Verkman; Geoffrey T. Manley
Assessment of lung water by magnetic resonance in three types of pulmonary edema
Summary Pulmonary edema was produced in nine mongrel dogs by: (a) saline lavage; (b) intravenous injection of oleic acid; and (c) intravenous injection of propranolol followed by ureteral ligation. The resulting effect could be characterized by varying the protein concentration in the pulmonary edema fluid. After induction, all dogs were killed and 20 samples from each passively deflated lung were
Simon Vinitski; Robert M. Steiner; H. Ronald Wexler; Matthew Rifkin
Evaluation of the Prevalence of Concomitant Idiopathic Cyclic Edema and Cellulite
The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cyclic edema was based on a clinical history and fluid retention throughout the day, in particular difficulty in removing rings on waking in the morning which improves later in the day. All patients with cyclic edema were treated with 75 mg aminaphtone three times daily. Statistical analysis considered the frequency of edema. Of the 82 women evaluated with ages between 18 and 58 years old (mean of 34.9 years) 41 (50.0%) were diagnosed with idiopathic cyclic edema. Idiopathic cyclic edema is an aggravating factor for cellulite and is frequently associated with the more advanced stages of the disease. Its control is essential in the treatment of cellulite.
de Godoy, Jose Maria Pereira; de Godoy, Maria de Fatima Guerreiro
Pseudo-Subarachnoid Hemorrhage: A Potential Imaging Pitfall Associated with Diffuse Cerebral Edema
Summary: We report CT findings in seven patients with diffuse cerebral edema and increased attenuation in the basilar cisterns resembling subarachnoid hemorrhage. On the basis of autopsy (three cases) and lumbar puncture (four cases) findings, true subarachnoid hemorrhage was reasonably excluded. Pathophysiologic changes that occur with diffuse cerebral edema are explored, with proposed explanations for the appearance of a pseudo-subarachnoid
Curtis A. Given II; Jonathan H. Burdette; Allen D. Elster; Daniel W. Williams
Scanning laser ophthalmoscope fundus perimetry before and after laser photocoagulation for clinically significant diabetic macular edema
PURPOSE: To prospectively evaluate functional and funduscopic changes after laser treatment in patients with diabetic retinopathy and clinically significant macular edema by scanning laser ophthalmoscope fundus perimetry.METHODS: Thirty eyes of 30 patients with clinically significant macular edema as a result of diabetic retinopathy were prospectively examined before and at least 3 months after focal laser treatment with automatic fundus threshold
Klaus Rohrschneider; Stefan B�ltmann; Roland Gl�ck; Friedrich E Kruse; Thomas Fendrich; Hans E V�lcker
RNase therapy assessed by magnetic resonance imaging reduces cerebral edema and infarction size in acute stroke.
Ischemic stroke causes cell necrosis with the exposure of extracellular ribonucleic acid (RNA) and other intracellular material. As shown recently, extracellular RNA impaired the blood-brain-barrier and contributed to vasogenic edema-formation. Application of ribonuclease 1 (RNase 1) diminished edema-formation and also reduced lesion volume in experimental stroke. Here we investigate whether reduction of lesion volume is due to the reduction of edema or of other neuroprotective means. Neuroprotective and edema protective effects of RNase 1 pretreatment were assessed using a temporary middle cerebral artery occlusion (MCAO) model in rats. Lesion volume was assessed on magnetic resonance imaging (MRI). T2-relaxation-time and midline-shift as well as brain water content (wet-dry-method) were measured to quantify edema formation. The impact of edema formation on infarct volume was evaluated in craniectomized animals. Exogenous RNase 1 was well tolerated and reduced edema-formation and infarct size (26.7% +/- 10.7% vs. 41.0% +/- 10.3%; p<0.01) at an optimal dose of 42 microg/kg as compared to placebo. Craniectomized animals displayed a comparable edema reduction but no reduction in infarct size. The present study introduces a hitherto unrecognized mechanism of ischemic brain damage and a novel neuroprotective approach towards acute stroke treatment. PMID:19355922
Walberer, Maureen; Tschernatsch, Marlene; Fischer, Silvia; Ritschel, Nouha; Volk, Kai; Friedrich, Carolin; Bachmann, Georg; Mueller, Clemens; Kaps, Manfred; Nedelmann, Max; Blaes, Franz; Preissner, Klaus T; Gerriets, Tibo
Intravenous Immunoglobulin Reduces Infarct Volume but Not Edema Formation in Acute Stroke
Objectives: Intravenous immunoglobulin (IVIG) is used for treatment of immunodeficiencies and autoimmune disorders. Recently, IVIG has also been shown to reduce infarct size in acute stroke. Since edema treatment can provide secondary neuroprotective effects, we conducted the present study to evaluate whether edema reduction is the underlying cause of the neuroprotective properties of IVIG in experimental stroke. Methods: Male Wistar
Maureen Walberer; Max Nedelmann; Nouha Ritschel; Clemens Mueller; Marlene Tschernatsch; Erwin Stolz; Georg Bachmann; Franz Blaes; Tibo Gerriets
Fluid distribution in progressive pulmonary edema: a low-temperature scanning-electron-microscopy study
High pressure pulmonary edema is a common medical disorder caused by venous hypertension following left ventricular heart failure. Abnormal fluid accumulation in the alveolar air spaces results in a life-threatening loss of respiratory function. The primary component of the fluid is water and therefore the study of water distribution in the alveolus can provide insight into high pressure pulmonary edema pathology. The new method of freeze-fracture, low temperature SEM has been developed and applied to the study of pulmonary edema. This method combines freeze-fracture sample preservation with SEM observation and retains pulmonary fluids in the frozen hydrated state for direct three-dimensional SEM imaging of alveoli. Quantitative measurements of alveolar structures resulting from high-pressure pulmonary edema were made from SEM micrographs. From these measurements a model for alveolar fluid distribution resulting from progressive high pressure edema was made.
Hook, G.R.
Sentinel node procedure in vulvar squamous cell carcinoma: a histomorphologic review of 32 cases. The significance of anucleate structures on immunohistochemistry.
The sentinel lymph node (SLN) procedure is used in our institute in the setting of an observational multicenter study investigating the reliability of the sentinel node procedure in vulvar carcinoma (GROINSS-V: The Groningen International Study on Sentinel Nodes in Vulvar Cancer). One of our patients had a groin recurrence where the SLN had been reported as negative. After reviewing this SLN, it contained several anucleate, keratin-positive structures on immunohistochemistry, and in the same area on hematoxylin and eosin coloring, one single cell with a nucleus interpreted as a tumor cell. Our objective was to assess how frequently these anucleate structures occur and whether such nodes should be regarded as positive. The sentinel nodes from 32 patients with early-stage vulvar squamous cell carcinoma were reviewed. Seventy-seven SLN's were identified. In ten patients, the SLN was positive and a bilateral inguinofemoral lymph node dissection was subsequently performed. In two of these ten patients, both with a macrometastasis on SLN, further metastatic disease was present in the dissection specimen. Anucleate keratin-positive structures were seen on immunohistochemistry in 14 SLN's (18%), usually along with metastasis or single tumor cells, but in five nodes this was the only abnormality (mean follow-up period of 26.28 months). Anucleate keratin-positive structures are a common finding in immunohistochemical examination of SLN's. Our findings suggest that they are of no clinical significance and the SLN should be regarded as negative. When an atypical cell with a nucleus is present, the SLN should be classified as positive and further management should be accordingly. PMID:18081794
Tjin Asjoe, F M; van Bekkum, E; Ewing, P; Burger, C W; Ansink, A C
Effects of Chloride Flux Modulators in an in Vitro-model of Brain Edema Formation
Brain edema is a serious consequence of hemispheric stroke and traumatic brain injury and contributes significantly to patient mortality. In the present study, we measured water contents in hippocampal slices as an in vitro-model of edema formation. Excitotoxic conditions induced by N-methyl-d-aspartate (NMDA, 300 ?M), as well as ischemia induced by oxygen-glucose deprivation (OGD) caused cellular edema formation as indicated by an increase of slice water contents. In the presence of furosemide, an inhibitor of the Na,K,Cl-cotransporter, NMDA-induced edema were reduced by 64% while OGD-induced edema were unaffected. The same observation, i.e. reduction of excitotoxic edema formation but no effect on ischemia-induced edema, was made with chloride transport inhibitors such as DIDS and niflumic acid. Under ischemic conditions, modulation of GABAA receptors by bicuculline, a GABA antagonist, or by diazepam, a GABAergic agonist, did not significantly affect edema formation. Further experiments demonstrated that low chloride conditions prevented NMDA-induced, but not OGD-induced water influx. Omission of calcium ions had no effect. Our results show that NMDA-induced edema formation is highly dependent on chloride influx as it was prevented by low-chloride conditions and by various compounds that interfere with chloride influx. In contrast, OGD-induced edema observed in brain slices were not affected by modulators of chloride fluxes. The results are discussed with reference to ionic changes occurring during tissue ischemia. Section: Neurophysiology, Neuropharmacology and other forms of Intercellular Communication.
Kumar, Vikas; Naik, Runa S.; Hillert, Markus; Klein, Jochen
Involvement of COX2-thromboxane pathway in TCDD-induced precardiac edema in developing zebrafish.
The cardiovascular system is one of the most characteristic and important targets for developmental toxicity by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in fish larvae. However, knowledge of the mechanism of TCDD-induced edema after heterodimerization of aryl hydrocarbon receptor type 2 (AHR2) and AHR nuclear translocator type 1 (ARNT1) is still limited. In the present study, microscopic analysis with a high-speed camera revealed that TCDD increased the size of a small cavity between the heart and body wall in early eleutheroembryos, a toxic effect that we designate as precardiac edema. A concentration-response curve for precardiac edema at 2days post fertilization (dpf) showed close similarity to that for conventional pericardial edema at 3dpf. Precardiac edema caused by TCDD was reduced by morpholino knockdown of AHR2 and ARNT1, as well as by an antioxidant (ascorbic acid). A selective inhibitor of cyclooxygenase type 2 (COX2), NS398, also markedly inhibited TCDD-induced precardiac edema. A thromboxane receptor (TP) antagonist, ICI-192,605 almost abolished TCDD-induced precardiac edema and this effect was canceled by U46619, a TP agonist, which was not influential in the action of TCDD by itself. Knockdown of COX2b and thromboxane A synthase 1 (TBXS), but not COX2a, strongly reduced TCDD-induced precardiac edema. Knockdown of COX2b was without effect on mesencephalic circulation failure caused by TCDD. The edema by TCDD was also inhibited by knockdown of c-mpl, a thrombopoietin receptor necessary for thromobocyte production. Finally, induction of COX2b, but not COX2a, by TCDD was seen in eleutheroembryos at 3dpf. These results suggest a role of the COX2b-thromboxane pathway in precardiac edema formation following TCDD exposure in developing zebrafish. PMID:24858302
Teraoka, Hiroki; Okuno, Yuki; Nijoukubo, Daisuke; Yamakoshi, Ayumi; Peterson, Richard E; Stegeman, John J; Kitazawa, Takio; Hiraga, Takeo; Kubota, Akira
Small changes in lung function in runners with marathon-induced interstitial lung edema.
The purpose of this study was to assess lung function in runners with marathon-induced lung edema. Thirty-six (24 males) healthy subjects, 34 (SD 9) years old, body mass index 23.7 (2.6) kg/m(2) had posterior/anterior (PA) radiographs taken 1 day before and 21 (6) minutes post marathon finish. Pulmonary function was performed 1-3 weeks before and 73 (27) minutes post finish. The PA radiographs were viewed together, as a set, and evaluated by two experienced readers separately who were blinded as to time the images were obtained. Radiographs were scored for edema based on four different radiological characteristics such that the summed scores for any runner could range from 0 (no edema) to a maximum of 8 (severe interstitial edema). Overall, the mean edema score increased significantly from 0.2 to 1.0 units (P < 0.01), and from 0.0 to 2.9 units post exercise in the six subjects that were edema positive (P = 0.03). Despite a 2% decrease in forced vital capacity (FVC, P = 0.024) and a 12% decrease in alveolar-membrane diffusing capacity for carbon monoxide (DmCO, P = 0.01), there was no relation between the change in the edema score and the change in DmCO or FVC. In conclusion, (1) mild pulmonary edema occurs in at least 17% of subjects and that changes in pulmonary function cannot predict the occurrence or severity of edema, (2) lung edema is of minimal physiological significance as marathon performance is unaffected, exercise-induced arterial hypoxemia is unlikely, and postexercise pulmonary function changes are mild. PMID:24973330
Zavorsky, Gerald S; Milne, Eric N C; Lavorini, Federico; Rienzi, Joseph P; Cutrufello, Paul T; Kumar, Sridhar S; Pistolesi, Massimo
Hyaluronidase injection for the treatment of eyelid edema: a retrospective analysis of 20 patients
Background Hyaluronidase (Hylase Dessau�) is a hyaluronic acid-metabolizing enzyme, which has been shown to loosen the extracellular matrix, thereby improving the diffusion of local anesthetics. Lower eyelid edema is a common post-interventional complication of cosmetic procedures performed in the lid region, such as the injection of hyaluronic acid fillers for tear-trough augmentation. The purpose of this study was to validate the efficacy of hyaluronidase in the management of lower eyelid edema. Methods We performed a retrospective analysis with 20 patients with lower eyelid edema. Most patients (n?=?14) presented with edema following hyaluronic acid injection (tear-trough augmentation), whereas the minority (n?=?6) were treated due to idiopathic edema (malar edema or malar mounds). Patients were treated by local infiltration of approximately 0.2�ml to 0.5�ml of hyaluronidase (Hylase Dessau� 20�IU to 75�IU) per eyelid. Photographs were taken prior to and seven days after infiltration. Results Hyaluronidase was found to reduce effectively and rapidly or resolve eyelid edema after a single injection. No relevant adverse effects were observed. However, it must be noted that a hyaluronidase injection may also dissolve injected hyaluronic acid fillers and may therefore negatively affect tear-trough augmentations. While the effects of a treatment for edema due to tear-trough augmentation were permanent, malar edema and malar mounds reoccurred within two to three weeks. Conclusion The infiltration of hyaluronidase is rapid, safe and currently the only effective option for the management of eyelid edema. No relevant adverse effects were observed.
Coexisting high-grade vulvar intraepithelial neoplasia (VIN) and condyloma acuminatum: independent lesions due to different HPV types occurring in immunocompromised patients.
The majority of vulvar intraepithelial neoplasia (VIN) is high-grade and is related to high-risk human papillomavirus (HRHPV) (most commonly HPV 16). It is considered to be the precursor of HRHPV-related vulvar squamous cell carcinoma. Vulvar condyloma acuminatum is low-risk HPV (LRHPV)-related (most commonly types 6 and 11) and has virtually no risk of neoplastic progression. While infection with multiple LRHPV and HRHPV types has been reported for cervical squamous intraepithelial lesions, coexisting vulvar condyloma and adjacent high-grade VIN have not been well characterized. Eleven cases of concurrent condyloma acuminatum and adjacent flat high-grade VIN and 3 cases of high-grade VIN with prominent condylomatous architecture were analyzed using immunohistochemical analysis of p16 expression, in situ hybridization (ISH) for HPV detection [HPV 6/11, HPV 16, HPV 18, and HPV wide spectrum (types 6, 11, 16, 18, 31, 33, 35, 45, 51, 52) probes], and HPV typing by a polymerase chain reaction (PCR)-based method (in select cases). All patients had underlying immunosuppressive conditions (human immunodeficiency virus infection or posttransplant therapy). Among the 11 cases of concurrent high-grade VIN and condyloma, the lesions were directly adjacent to one another in 5 cases (with 2 of these demonstrating an intimate admixture of lesions), and in 6 cases the lesions were found in separate tissue sections from the same specimen. Diffuse/strong p16 expression was seen in all high-grade VIN lesions, whereas patchy/weak staining was found in all condylomata. All condylomata contained HPV 6 or 11 as detected by ISH. HRHPV was detected in all of the accompanying high-grade VIN lesions. Ten contained HPV 16 (9 by ISH, 1 by PCR), with the remaining case containing multiple HPV types by PCR. All condylomatous high-grade VIN lesions demonstrated diffuse/strong p16 expression and had evidence of HRHPV (1 with HPV 16 by ISH, 1 with HPV 18 by ISH, and 1 with multiple HPV types by PCR), with no detection of HPV 6 or 11 by ISH. The restriction of LRHPV to condylomatous components and HRHPV to high-grade VIN components of adjacent lesions suggests these are independent lesions caused by different HPV types. Diffuse p16 expression can highlight small foci of high-grade VIN, which may be overlooked in more abundant condylomatous tissue from immunosuppressed patients. The presence of only HRHPV in those VIN lesions with high-grade cytologic features but prominent condylomatous architecture supports their classification as forms of pure high-grade VIN and distinguishes them from condyloma acuminatum. PMID:23026935
Maniar, Kruti P; Ronnett, Brigitte M; Vang, Russell; Yemelyanova, Anna
Poly(ADP-ribose) polymerase activation and brain edema formation by hemoglobin after intracerebral hemorrhage in rats
Brain edema induced by intracerebral hemorrhage (ICH) is a serious problem in the treatment of ICH. However, the mechanisms\\u000a of brain edema formation following ICH are not well-understood. We have found that hemoglobin plays an important role in edema\\u000a development after ICH. In this study, we sought to explore the mechanism of brain edema formation caused by hemoglobin.\\u000a \\u000a Hemoglobin was
X. Bao; G. Wu; S. Hu; F. Huang
Effect of ifenprodil, a polyamine site NMDA receptor antagonist, on brain edema formation following asphyxial cardiac arrest in rats
Objective: Brain edema occurs in experimental and clinical cardiac arrest (CA) and is predictive of a poor neurological outcome. N-Methyl-d-aspartate (NMDA) receptors contribute to brain edema elicited by focal cerebral ischemia\\/reperfusion (I\\/R). Ifenprodil, a NMDA receptor antagonist, attenuates brain edema and injury size in rats after focal cerebral I\\/R. We assessed the hypothesis that ifenprodil reduces CA-elicited brain edema. Methods:
Feng Xiao; Sibile Pardue; Thomas Arnold; Donna Carden; J. Steven Alexander; Jared Monroe; Christopher D Sharp; Richard Turnage; Steven Conrad
Pathogenesis of pulmonary edema associated with intracisternal endotoxin in dogs.
To examine the role of central nervous system injury in the pathogenesis of pulmonary edema, we injected Escherichia coli endotoxin (5 mg/kg) into the cisterna magna of six dogs (group E) and compared, over 4 h, both the pulmonary edema and cerebrospinal fluid (CSF) abnormalities with those in six control dogs (group C). In group E, intracisternal endotoxin raised intracranial pressure from 21 +/- 6 to 38 +/- 8 cmH2O (P less than 0.001), CSF total protein from 18 +/- 6 to 54 +/- 19 mg/dl (P less than 0.001), and CSF malondialdehyde from 0.12 +/- 0.11 to 0.61 +/- 0.35 nmol/ml (P less than 0.05); all were unchanged in group C. When the pulmonary wedge pressure was maintained at 10 mmHg by fluid infusion, extravascular thermal volume in group E increased from 7.2 +/- 1.2 to 12.0 +/- 2.7 ml/kg (P less than 0.005) at 4 h when the excised lungs weighed 13.6 +/- 1.5 g/kg; in group C, extravascular thermal volume did not increase, and the excised lungs weighed less (10.8 +/- 1.3 g/kg, P less than 0.05) than those in group E. The dry weights of the lungs were not different between groups, and the alveolar lining fluid-to-plasma albumin ratio in both groups remained low, 0.1-0.2. Fluid infusion in group E (9.2 +/- 2.9 liters) caused colloid oncotic pressure to decrease 4.5 +/- 2.8 mmHg; colloid oncotic pressure fell less (0.8 +/- 1.9 mmHg, P less than 0.001) in group C as less fluid (2.2 +/- 1.5 liters, P less than 0.001) was required to maintain pulmonary wedge pressure.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2189863
Nahum, A; Wood, L D; Crawford, G; Ripper, R; Segil, L; Sznajder, J I
T2 quantification for improved detection of myocardial edema
Background T2-Weighted (T2W) magnetic resonance imaging (MRI) pulse sequences have been used to detect edema in patients with acute myocardial infarction and differentiate acute from chronic infarction. T2W sequences have suffered from several problems including (i) signal intensity variability caused by phased array coils, (ii) high signal from slow moving ventricular chamber blood that can mimic and mask elevated T2 in sub-endocardial myocardium, (iii) motion artifacts, and (iv) the subjective nature of T2W image interpretation. In this work we demonstrate the advantages of a quantitative T2 mapping technique to accurately and reliably detect regions of edematous myocardial tissue without the limitations of qualitative T2W imaging. Methods Methods of T2 mapping were evaluated on phantoms; the best of these protocols was then optimized for in vivo imaging. The optimized protocol was used to study the spatial, view-dependent, and inter-subject variability and motion sensitivity in healthy subjects. Using the insights gained from this, the utility of T2 mapping was demonstrated in a porcine model of acute myocardial infarction (AMI) and in three patients with AMI. Results T2-prepared SSFP demonstrated greater accuracy in estimating the T2 of phantoms than multi-echo turbo spin echo. The T2 of human myocardium was found to be 52.18 � 3.4 ms (range: 48.96 ms to 55.67 ms), with variability between subjects unrelated to heart rate. Unlike T2W images, T2 maps did not show any signal variation due to the variable sensitivity of phased array coils and were insensitive to cardiac motion. In the three pigs and three patients with AMI, the T2 of the infarcted region was significantly higher than that of remote myocardium. Conclusion Quantitative T2 mapping addresses the well-known problems associated with T2W imaging of the heart and offers the potential for increased accuracy in the detection of myocardial edema.
Accuracy of preoperative vulva biopsy and the outcome of surgery in vulvar intraepithelial neoplasia 2 and 3.
To assess the accuracy of preoperative vulva biopsy and the outcome of surgery in vulvar intraepithelial neoplasia (VIN) 2 and 3. In this study 186 consecutive patients with VIN 2 and 3, who were treated with local wide excision or skinning vulvectomy at the Department of Obstetrics and Gynecology, Medical University of Vienna, between 1996 and 2008, were enrolled. Accuracy of preoperative vulva biopsy was assessed by evaluating the rates of correct diagnosis, underdiagnosis, and occult cancer. Histologic findings of preoperative vulva biopsy and surgery were compared. To assess risk factors for incomplete resection, univariate and multivariate analyses were performed, by using the presence of multifocal VIN, histologic grade, patients' age, surgeons' expertise, and lesion diameter as independent variables. VIN 2 and 3 were correctly diagnosed by preoperative vulva biopsy in 55.8% (29/52) and 88.1% (118/134) patients, respectively. Underdiagnosis occurred in 44.2% (23/52) and 11.9% (16/134) of preoperative vulva biopsies with an occult cancer rate of 3.8% (2/52) and 11.9% (16/134) for VIN 2 and 3, respectively. Complete resection was achieved in 43.0% (80/186) of patients. Presence of multifocal VIN was the only factor that was associated with incomplete resection in our study population in univariate and multivariate analyses (P=0.001, P=0.001). Mean patients' age at the time of diagnosis was 51.1 (SD: 15.7) years, multifocal lesions were present in 36.0% (67/186), and the median lesion diameter was 15.0 mm (interquartile range: 10.0-30.0). A significant number of VIN 2 and 3 were underdiagnosed by preoperative vulva biopsy. The rate of incomplete resection after surgery is notable. PMID:19851204
Polterauer, Stephan; Catharina Dressler, Anne; Grimm, Christoph; Seebacher, Veronika; Tempfer, Clemens; Reinthaller, Alexander; Hefler, Lukas
Characterization of the microbial community colonizing the anal and vulvar pores of helminths from the hindgut of zebras.
Scanning and transmission electron microscopy were used to examine the adherence and in situ morphology of the microbial community colonizing the anal and vulvar pores of the subfamily Cyathostominae (Nematoda: Strongylidae) from the colon of Burchell's zebra (Equus burchelli antiquorum). Two different morphological types of asporogenous rod were prominent in the microbial community. One was a thin, septate, filamentous organism (0.4 to 0.5 micron by 2 to 3 microns) with blunt ends, which was more prominent at the site of attachment. The other was a larger (1.8 to 2.4 microns by 5 to 10 microns) multicellular rod with round ends in the form of a trichome. Spiral- and vibrio-shaped bacteria were also present in the thin sections. The septate filaments were shown to contain a cell spacer similar to those described in Methanospirillum hungatei. Attachment to the cuticle was by means of an amorphous electron-dense material with fibrillar appearance and not by specialized holdfast segments. Ten isolates were obtained from a habitat-simulating medium on which a homogenate from the posterior region was plated. Antibodies were raised to whole cells of five rod-shaped isolates in rabbits and fluorescein isothiocyanate labeled. Positive bright-yellow fluorescence was obtained with one of the clostridial isolates. The results are discussed with reference to other bacteria with similar morphology, the nature of this unique interrelationship between the microbial community and its parasitic host inside the equine hindgut, and the possibility of biological control of parasitic helminths. Images
Mackie, R I; Krecek, R C; Els, H J; van Niekerk, J P; Kirschner, L M; Baecker, A A
Glioma-related edema: new insight into molecular mechanisms and their clinical implications
Glioma-related edema (GRE) is a significant contributor to morbidity and mortality from glioma. GRE is a complicated process involving not only peritumoral edema but also the water content of the tumor body. In terms of etiology, this condition derives from both GRE in the untreated state and GRE secondary to clinical intervention, and different cell types contribute to distinct components of GRE. Peritumoral edema was previously believed to loosen glioma tissue, facilitating tumor-cell invasion; however, the nutrition hypothesis of the tumor microecosystem suggests that tumor cells invade for the sake of nutrition. Edema is the pathologic consequence of the reconstructed trophic linkage within the tumor microecosystem. Glioma cells induce peritumoral brain edema via an active process that supplies a suitable niche for peritumoral invasive cells, suggesting that glioma-related peritumoral brain edema is determined by the invasive property of tumor cells. There are differences between pivotal molecular events and reactive molecular events in the development of GRE. Molecular therapy should target the former, as targeting reactive molecular events will produce undesired or even adverse results. At present, brain glioma angiogenesis models have not been translated into a new understanding of the features of brain images. The effect of these models on peritumoral brain edema is unclear. Clinical approaches should be transformed on the basis of new knowledge of the molecular mechanism underlying GRE. Exploring clinical assessment methods, optimizing the existing control strategy of GRE, and simultaneously developing new treatments are essential.
Lin, Zhi-Xiong
Analysis of lymphatic drainage in various forms of leg edema using two compartment lymphoscintigraphy.
The anatomical and functional status of the epifascial and subfascial lymphatic compartments was analyzed using two compartment lymphoscintigraphy in five groups of patients (total 55) with various forms of edema of the lower extremities. Digital whole body scintigraphy enabled semiquantitative estimation of radiotracer transport with comparison of lymphatic drainage between those individuals without (normal) and those with leg edema by calculating the uptake of the radiopharmaceutical transported to regional lymph nodes. A visual assessment of the lymphatic drainage pathways of the legs was also performed. In patients with cyclic idiopathic edema, an accelerated rate of lymphatic transport was detected (high lymph volume overload or dynamic insufficiency). In those with venous (phlebo) edemas, high volume lymphatic overload (dynamic insufficiency) of the epifascial compartment was scintigraphically detected by increased tracer uptake in regional nodes. In patients with deep femoral venous occlusion (post-thrombotic syndrome). subfascial lymphatic transport was uniformly markedly reduced (safety valve lymphatic insufficiency). On the other hand, in the epifascial compartment, lymph transport was accelerated. In those patients with recurrent or extensive skin ulceration, lymph transport was reduced. Patients with lipedema (obesity) scintigraphically showed no alteration in lymphatic transport. This study demonstrates that lymphatic drainage is notably affected (except in obesity termed lipedema) in various edemas of the leg. Lymphatic drainage varied depending on the specific compartment and the pathophysiologic mechanism accounting for the edema. Two compartment lymphoscintigraphy is a valuable diagnostic tool for accurate assessment of leg edema of known and unknown origin. PMID:9664268
Br�utigam, P; F�ldi, E; Schaiper, I; Krause, T; Vanscheidt, W; Moser, E
The Effect of TIP on Pneumovirus-Induced Pulmonary Edema in Mice
Background Pulmonary edema plays a pivotal role in the pathophysiology of respiratory syncytial virus (RSV)-induced respiratory failure. In this study we determined whether treatment with TIP (AP301), a synthetic cyclic peptide that mimics the lectin-like domain of human TNF, decreases pulmonary edema in a mouse model of severe human RSV infection. TIP is currently undergoing clinical trials as a therapy for pulmonary permeability edema and has been shown to decrease pulmonary edema in different lung injury models. Methods C57BL/6 mice were infected with pneumonia virus of mice (PVM) and received TIP or saline (control group) by intratracheal instillation on day five (early administration) or day seven (late administration) after infection. In a separate set of experiments the effect of multiple dose administration of TIP versus saline was tested. Pulmonary edema was determined by the lung wet-to-dry (W/D) weight ratio and was assessed at different time-points after the administration of TIP. Secondary outcomes included clinical scores and lung cellular response. Results TIP did not have an effect on pulmonary edema in different dose regimens at different time points during PVM infection. In addition, TIP administration did not affect clinical severity scores or lung cellular response. Conclusion In this murine model of severe RSV infection TIP did not affect pulmonary edema nor course of disease.
van den Berg, Elske; Bem, Reinout A.; Bos, Albert P.; Lutter, Rene; van Woensel, Job B. M.
Prostatic edema in {sup 125}I permanent prostate implants: Dynamical dosimetry taking volume changes into account
The purpose of this study is to determine the impact of edema on the dose delivered to the target volume. An evaluation of the edema characteristics was first made, and then a dynamical dosimetry algorithm was developed and used to compare its results to a standard clinical (static) dosimetry. Source positions and prostate contours extracted from 66 clinical cases on images taken at different points in time (planning, implant day, post-implant evaluation) were used, via the mean interseed distance, to characterize edema [initial increase ({delta}r{sub 0}), half-life ({tau})]. An algorithm was developed to take into account the edema by summing a time series of dose-volume histograms (DVHs) with a weight based on the fraction of the dose delivered during the time interval considered. The algorithm was then used to evaluate the impact of edema on the dosimetry of permanent implants by comparing its results to those of a standard clinical dosimetry. The volumetric study yielded results as follows: the initial prostate volume increase was found to be 1.58 (ranging from 1.15 to 2.48) and the edema half-life, approximately 30 days (range: 3 to 170 days). The dosimetric differences in D{sub 90} observed between the dynamic dosimetry and the clinical one for a single case were up to 15 Gy and depended on the edema half-life and the initial volume increase. The average edema half-life, 30 days, is about 3 times longer than the previously reported 9 days. Dosimetric differences up to 10% of the prescription dose are observed, which can lead to differences in the quality assertion of an implant. The study of individual patient edema resorption with time might be necessary to extract meaningful clinical correlation or biological parameters in permanent implants.
Leclerc, Ghyslain; Lavallee, Marie-Claude; Roy, Rene; Vigneault, Eric; Beaulieu, Luc [Departement de Physique, de Genie Physique et d'Optique, Universite Laval, Quebec, G1K 7P4 (Canada) and Centre de Recherche en Cancerologie, CHUQ-Hotel-Dieu de Quebec, Quebec, G1R 2J6 (Canada); Department de Physique, de Genie Physique et d'Optique, Universite Laval, Quebec, G1K 7P4 (Canada); Centre de Recherche en Cancerologie, CHUQ-Hotel-Dieu de Quebec, Quebec, G1R 2J6, (Canada); Department de Physique, de Genie Physique et d'Optique, Universite Laval, Quebec, G1K 7P4, Canada, and Centre de Recherche en Cancerologie, CHUQ - Hotel-Dieu de Quebec, Quebec, G1R 2J6 (Canada)
Treatment of systemic hypertension is important for improvement of macular edema associated with retinal vein occlusion
Background We report our findings in three cases of unilateral macular edema associated with retinal vein occlusion (RVO) that improved after successful treatment of systemic hypertension alone. Methods All three cases had systemic hypertension but no diabetes mellitus or other ocular diseases associated with macular edema. All patients were treated only with medication for systemic hypertension. Optical coherence tomography was performed to determine the foveal thickness before and after treatment. Results Case one was a 72-year-old woman with a central RVO who had macular edema in her left eye and a visual acuity (VA) of 20/50. Her blood pressure (BP) was 169/96 mmHg. One month after the initiation of a calcium blocker to treat her systemic hypertension, her BP was decreased, macular edema was reduced, and her VA improved to 20/20. Case two was a 62-year-old woman with branch RVO. Her VA was 20/40 and her BP was 165/97 mmHg. Six weeks after initiation of medication to treat her systemic hypertension, her RVO-related macular edema had decreased and her VA improved to 20/20. Case three was a 71-year-old man with branch RVO. His VA was 20/50 and his BP was 165/87 mmHg. One month after initiation of treatment for systemic hypertension, his RVO-related macular edema had disappeared and his VA improved to 20/20. All three cases had nonischemic RVO by fluorescein angiography, and they did not develop ischemic changes for at least 1 year. Conclusion The reduction of macular edema following a decrease in the systemic hypertension suggests that the edema was most likely caused by leakage of fluids from the blood vessels. We recommend that the blood pressure should be measured in all patients with macular edema before initiating intravitreal anti-VEGF therapy.
Kida, Teruyo; Morishita, Seita; Kakurai, Keigo; Suzuki, Hiroyuki; Oku, Hidehiro; Ikeda, Tsunehiko
Microcystic macular edema detection in retina OCT images
NASA Astrophysics Data System (ADS)
Optical coherence tomography (OCT) is a powerful imaging tool that is particularly useful for exploring retinal abnormalities in ophthalmological diseases. Recently, it has been used to track changes in the eye associated with neurological diseases such as multiple sclerosis (MS) where certain tissue layer thicknesses have been associated with disease progression. A small percentage of MS patients also exhibit what has been called microcystic macular edema (MME), where uid collections that are thought to be pseudocysts appear in the inner nuclear layer. Very little is known about the cause of this condition so it is important to be able to identify precisely where these pseudocysts occur within the retina. This identi cation would be an important rst step towards furthering our understanding. In this work, we present a detection algorithm to nd these pseudocysts and to report on their spatial distribution. Our approach uses a random forest classi er trained on manual segmentation data to classify each voxel as pseudocyst or not. Despite having a small sample size of ve subjects, the algorithm correctly identi es 84.6% of pseudocysts as compared to manual delineation. Finally, using our method, we show that the spatial distribution of pseudocysts within the macula are generally contained within an annulus around the fovea.
Swingle, Emily K.; Lang, Andrew; Carass, Aaron; Ying, Howard S.; Calabresi, Peter A.; Prince, Jerry L.
Cistoid macular edema as first manifestation of sarcoidosis.
The purpose of this study is to report a case of cystoid macular edema (CME) as a rare first manifestation of ocular sarcoidosis after cataract surgery. A 60-year-old male developed a CME following uneventful phacoemulsification cataract extraction on his left eye. It resolved with conventional medical therapy. One year later the patient was diagnosed with bilateral CME. Oral corticosteroid therapy produced a significant regression. His medical and ocular histories were unremarkable and all tests for etiological diagnosis were negative. There were inflammation recurrences in his left eye, which were also treated with steroids. Optical coherence tomography showed complete resolution of foveal thickening without improvement in vision. Four years later, the patient presented with CME in both eyes. The laboratory tests included high angiotensin-converting enzyme levels and a gallium scan which were also consistent with sarcoidosis. Azathioprine was needed for management of ocular involvement, but it was withheld due to side-effects. At the present time, the CME is controlled with low-dose corticoids. Ocular involvement in sarcoidosis occurs in 20-50�% of patients. CME is not often the initial manifestation of the disease, but ocular sarcoidosis may present with a wide variety of ocular symptoms in all parts of the eye. Therefore, sarcoidosis should be kept in mind when evaluating a patient with ocular inflammation. PMID:24322273
Cabrillo-Estevez, Lucia; Juan-Marcos, Lourdes de; Kyriakou, Danai; Hern�ndez-Galilea, Emiliano
Bevacizumab for the management of diabetic macular edema.
Diabetic retinopathy (DR) is a leading cause of vision loss in the working-age population and is relatedto 1%-5% of cases of blindness worldwide. Diabetic macular edema (DME) is the most frequent cause of DR vision loss and is an important public health problem. Recent studies have implicated vascular endothelial growth factor (VEGF) in DR and DME pathogenesis, as well as provided evidence of the benefits of anti-VEGF agents for the management of such conditions. Despite the benefits of intravitreal ranibizumab injection for the management of DME, the cost-effectiveness of intravitreal bevacizumab therapy has gained increasing interest in the scientific community. This review summarizes the studies examining bevacizumab for the management of DME, focusing on the efficacy and duration of the clinical benefits of decreasing DME and the improvement of best-corrected visual acuity (BCVA). There is strong evidence that intravitreal bevacizumab injection therapy has a good cost-effective profile in the management of DME and may be associated with laser photocoagulation; however, its clinical superiority in terms of the duration of DME regression and the improvement of BCVA compared with intravitreal ranibizumab and other intravitreal anti-VEGF therapies remains unclear and deserves further investigation. PMID:23593532
Stefanini, Francisco Rosa; Arevalo, J Fernando; Maia, Maur�cio
Anti-VEGF for the Management of Diabetic Macular Edema
Diabetic retinopathy (DR) is an important cause of vision loss around the world, being the leading cause in the population between 20 and 60 years old. Among patients with DR, diabetic macular edema (DME) is the most frequent cause of vision impairment and represents a significant public health issue. Macular photocoagulation has been the standard treatment for this condition reducing the risk of moderate visual loss by approximately 50%. The role of vascular endothelial growth factor (VEGF) in DR and DME pathogenesis has been demonstrated in recent studies. This review addresses and summarizes data from the clinical trials that investigated anti-VEGF for the management of DME and evaluates their impact on clinical practice. The literature searches were conducted between August and October 2013 in PubMed and Cochrane Library with no date restrictions and went through the most relevant studies on pegaptanib, ranibizumab, bevacizumab, and aflibercept for the management of DME. The efficacy and safety of intravitreal anti-VEGF as therapy for DME have recently been proved by various clinical trials providing significantly positive visual and anatomical results. Regarding clinical practice, those outcomes have placed intravitreal injection of anti-VEGF as an option that must be considered for the treatment of DME.
Stefanini, Francisco Rosa; Badaro, Emmerson; Falabella, Paulo; Koss, Michael; Farah, Michel Eid; Maia, Mauricio
Lower extremity edema in patients with early ovarian cancer
Background The objective of this study was to investigate clinical manifestations of lower extremity edema (LEE) in early ovarian cancer. Methods Patients with early ovarian cancer who underwent staging surgery between January 2001 and December 2010. Medical records for LEE and/or responses to the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) were evaluated. Results Patients had a median age of 46�years. Twenty-nine patients (40.8%) had past (13 patients, 44.8%) and/or current patient-reported LEE (16 patients, 55.2%). Symptoms reported on the GCLQ in over 20% of respondents were numbness, firmness/tightness, swelling, heaviness, limited movement of knee, and aching. GCLQ total symptoms score was significantly higher in patients with current LEE. Most of the LEE (25/29, 86.2%) developed within 12�months after surgery and LEE lasted more than 6�months in approximately two-thirds of the patients (18/29, 62.1%). Only half of the patients (52.1%) indicated knowledge of lymphedema: 86.2% of LEE patients and 28.6% of patients with no LEE. Conclusions Although a significant proportion of patients with ovarian cancer have LEE after surgery, most are not aware of lymphedema until they develop. Education and analyses for LEE and lymphedema are needed in patients with ovarian cancer.
[Case of pulmonary edema due to excessive hypertension following extubation].
A 54-year-old man had emergency laparoscopic chelecystectomy for acute cholecystitis. General inflammatory change (CRP 26.6 mg x dl(-1), WBC 26,800) was noted preoperatively. Anesthesia was induced with propofol and remifentanil and maintained with sevoflurane in oxygen and remifentanil. Operation was performed uneventfully within 128 min. At the end of the surgery, 0.1 mg of fentanyl was administrated. After confirming adequate respiration and oxygenation, endotracheal tube was removed. At that period, hypertension (SBP 220 mmHg) and tachycardia (HR 122 beats x min(-1)) developed. Soon thereafter, he became agitated and complained of dyspnea with desaturation (Spo2 < 70%). After reintubation, massive pinkish babbly secretion flowed out from the endotracheal tube. Chest X-ray revealed diffuse bilateral infiltration of the lungs without cardiomegaly. He was transferred to the intensive care unit for mechanical ventilation. His condition improved progressively and was extubated on the POD 6. The cause of pulmonary edema is thought to be profound centralization of circulating volume associated with catecholamine-induced vasoconstriction due to rapid disappearance of remifentanil effect. Adequate analgesia is necessary during remifentanil-based anesthesia especially in patients suffering from general inflammatory changes. PMID:21229687
Takabayashi, Reina; Tajiri, Osamu; Ito, Hiroyuki; Yago, Yasuko
Intravitreal Diclofenac for Refractory Uveitic Cystoid Macular Edema
Purpose To evaluate the effect of a single dose of intravitreal diclofenac on best- corrected visual acuity (BCVA) and central macular thickness (CMT) in patients with refractory uveitic cystoid macular edema (CME). Methods In this prospective non-comparative case series, 8 eyes of 8 patients with refractory CME secondary to chronic intermediate uveitis received a single intravitreal injection of diclofenac (500 �g/0.1ml) in addition to other systemic (oral prednisolone and methotraxate) and topical (betamethasone) remission maintaining drugs. Outcome measures were changes in BCVA and CMT after treatment. Results Mean BCVA remained relatively unchanged at 12, 24 and 36 weeks (0.69, 0.70 and 0.64 LogMAR, respectively) as compared to baseline (0.71 LogMAR). Mean CMT, however, decreased from 488 �m at baseline to 416 and 456 �m at 24 and 36 weeks, respectively. None of the changes were statistically significant. Conclusion In eyes with refractory uveitic CME, intravitreal injection of diclofenac insignificantly reduced CMT but this was not associated with visual improvement.
Ramezani, Alireza; Fard Esmaeilpour, Nassim; Eskandari, Armen; Rabbanikhah, Zahra; Soheilian, Roham; Soheilian, Masoud
Incidence of cystoid macular edema after uncomplicated phacoemulsification.
We determined the incidence and causes of clinical and angiographic cystoid macular edema (CME) after uncomplicated phacoemulsification and intraocular lens implantation in otherwise normal eyes. This study comprised 252 eyes of 252 patients who had uncomplicated phacoemulsification with continuous curvilinear capsulorhexis and in-the-bag acrylic intraocular lens implantation. The presence of clinical and angiographic CME was evaluated 45 days after surgery, using fundus fluorescein angiography. Age, sex, cataract type, iris color, and real phacoemulsification time of the patients were also recorded. The mean age of the patients was 69.86 (range 60-82) years). Clinical CME was not detected in any eye at any postoperative visit. There were 23 cases with angiographic CME (9.1%). There were no significant differences between the groups who were later found to be angiographically CME-positive or CME-negative in any variable recorded (p >0.05). The incidences of clinical and angiographic CME after uncomplicated phacoemulsification were 0 and 9.1%, respectively. These results indicate that the occurrence of clinical CME has greatly reduced after uncomplicated phacoemulsification operations, but the incidence of angiographic CME is still nearly equal to the incidence of the extracapsular technique. PMID:14573973
Mentes, Jale; Erakgun, Tansu; Afrashi, Filiz; Kerci, Gokhan
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome).
A 63-year-old man presented with acute symmetrical polysynovitis associated with pitting edema of both the hands and feet. He was seronegative for rheumatoid factor and no radiologically evident erosion was noted in the joints of his hands and feet. Evaluation excluded congestive heart failure, nephrotic syndrome, and hypothyroidism as the cause of edema. Treatment with nonsteroidal anti-inflammatory drugs and low-dose steroids induced complete remission. The clinical manifestations of this patients were consistent with those of a distinctive, although rare, form of arthritis called remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. This syndrome has a good prognosis in elderly patients. PMID:10463003
Hung, S C; Kung, Y Y; Lin, H Y
Fluoroquinolones reduce carrageenan-induced edema in rats and the involvement of the glucocorticoid receptor system.
We studied the effect of fluoroquinolones (FQs) on carrageenan-induced edema in the rat footpad. Ciprofloxacin, gatifloxacin, sparfloxacin, norfloxacin, and enoxacin (s.c., 100 mg/kg), which have piperazinyl and/or cyclopropyl groups, inhibited carrageenan-induced edema, whereas levofloxacin, tosufloxacin, and pazufloxacin did not. The reduction of edema by ciprofloxacin, sparfloxacin, and enoxacin was abolished by pretreatment with mifepristone, an antagonist of the glucocorticoid receptor. These results suggest that FQs with piperazinyl and/or cyclopropyl groups can modify biological responses through enhancing the glucocorticoid-glucocorticoid receptor system. PMID:19396522
Ogino, Hiromi; Yamada, Kaori; Yuhara, Mizuki; Tsuchida, Saori; Maezawa, Kayoko; Kizu, Junko; Hori, Seiji
Hypertrophic lichen sclerosus with dyskeratosis and parakeratosis--a common presentation of vulvar lichen sclerosus not associated with a significant risk of malignancy.
Epithelial hyperplasia, individual necrotic keratocytes, and parakeratosis are common findings in lichen sclerosus. When those changes are prominent, they may pose diagnostic problems, especially because such lesions often show no or only minimal sclerosis. Necrotic keratocytes are often numerous and are found in all reaches of the epidermis, presenting themselves as eosinophilic globules with or without remnants of pyknotic nuclei. Because those changes tend to be accentuated focally above dermal papillae, they often give rise to narrow columns of parakeratosis in the overlying cornified layer. Within those columns, individual necrotic keratocytes with pyknotic nuclei are preserved as distinct dyskeratotic parakeratotic cells. That constellation of findings is fairly characteristic of hypertrophic lichen sclerosus. It was found, at least subtle and focally, in 14 of 70 consecutive biopsy specimens of lichen sclerosus, most of which came from the vulva of elderly women. Although similar cases have been described as differentiated vulvar intraepithelial neoplasia (VIN) in the literature, there was no significant nuclear atypia, no crowding of nuclei, and no significant mitotic activity in any of those lesions. Follow-up of at least 5 years in 8 patients revealed no development of squamous cell carcinoma. Hypertrophic lichen sclerosus with dyskeratosis and parakeratosis seems to be a relatively common presentation of vulvar lichen sclerosus not associated with a significant risk of malignancy. PMID:23328790
Weyers, Wolfgang
Does lichen sclerosus play a central role in the pathogenesis of human papillomavirus negative vulvar squamous cell carcinoma? The itch-scratch-lichen sclerosus hypothesis.
In the past decade, two types of vulvar squamous cell carcinoma (SCC) have been delineated, Human papillomavirus (HPV) positive and negative. Clinicopathologic, virologic, cytomorphometric, and genetic differences support the view that these two types of carcinoma are fundamentally different and that HPV-negative carcinoma is not simply carcinoma where viral DNA has not been able to be identified. The traditional view of HPV-negative carcinoma is that it is caused by chronic tissue damage from itching and scratching. However, itching and scratching alone do not explain the close association of carcinoma with lichen sclerosus, nor the absence of such an association with other itchy conditions such as eczema or psoriasis. These observations point to a role for lichen sclerosus in the pathogenesis of vulvar carcinoma. Most observations about the etiology of lichen sclerosus can be grouped into its immunogenetic or genital predisposition, or the K�bner phenomenon. In the itch-scratch-lichen sclerosus hypothesis, lichen sclerosus is postulated to occur as a K�bner phenomenon in women with the susceptible immunophenotype who scratch because of genital irritants such as urine, vaginal secretions and smegma, and psychological factors. Lichen sclerosus, itself a very itchy condition, contributes to a vicious cycle of itching and scratching which leads to superimposed lichen simplex chronicus, squamous cell hyperplasia, and ultimately carcinoma. The itch-scratch-lichen sclerosus hypothesis reconciles the traditional itch-scratch hypothesis with the strong clinicopathologic association of lichen sclerosus with carcinoma. PMID:11240748
Scurry, J.
Costs and Quality of Life in Diabetic Macular Edema: Canadian Burden of Diabetic Macular Edema Observational Study (C-REALITY)
Purpose. To characterize the economic and quality of life burden of diabetic macular edema (DME) in Canadian patients. Patients and Methods. 145 patients with DME were followed for 6 months with monthly telephone interviews and medical chart reviews at months 0, 3, and 6. Visual acuity in the worst-seeing eye was assessed at months 0 and 6. DME-related healthcare costs were determined over 6 months, and vision-related (National Eye Institute Visual Functioning Questionnaire) and generic (EQ-5D) quality of life was assessed at months 0, 3, and 6. Results. Mean age of patients was 63.7 years: 52% were male and 72% had bilateral DME. At baseline, visual acuity was categorized as normal/mild loss for 63.4% of patients, moderate loss for 10.4%, and severe loss/nearly blind for 26.2%. Mean 6-month DME-related costs/patient were as follows: all patients (n = 135), $2,092; normal/mild loss (n = 88), $1,776; moderate loss (n = 13), $1,845; and severe loss/nearly blind (n = 34), $3,007. Composite scores for vision-related quality of life declined with increasing visual acuity loss; generic quality of life scores were highest for moderate loss and lowest for severe loss/nearly blind. Conclusions. DME-related costs in the Canadian healthcare system are substantial. Costs increased and vision-related quality of life declined with increasing visual acuity severity.
Gonder, John R.; Walker, Valery M.; Barbeau, Martin; Zaour, Nancy; Zachau, Bryan H.; Hartje, James R.; Li, Ruihong
Using ultrasound lung comets in the diagnosis of high altitude pulmonary edema: fact or fiction?
High altitude pulmonary edema is a life-threatening condition that remains a concern for climbers and clinicians alike. Within the last decade, studies have shown ultrasonography to be valuable in the accurate diagnosis of a variety of lung pathologies, including cardiogenic pulmonary edema, pleural effusion, pneumothorax, and lung consolidation. Recently, studies conducted in remote areas have demonstrated that ultrasound lung comets can be used as a measure of subacute pulmonary edema and high altitude pulmonary edema in climbers ascending to altitude. This clinical review article provides an overview of lung ultrasonography and its relevance as a diagnostic aid to respiratory pathology. In addition, we describe a standardized technique for identifying ultrasound lung comets and its utility in recognizing the presence of extravascular lung water, as well as the results of studies that have used this approach at sea level and high altitude. PMID:23453728
Wimalasena, Yashvi; Windsor, Jeremy; Edsell, Mark
Massive ovarian edema associated with a broad ligament leiomyoma: a case report and review.
Massive ovarian edema is a rare disorder in which there is marked accumulation of interstitial fluid in the stroma of the ovary. Grossly, the involved ovary is an enlarged solid mass with a smooth tan-white surface, easily confused with a neoplasm. Microscopically, it features diffuse interstitial edema sparing follicles and outer cortex, dilated lymphatic vessels, thick-walled veins, fibromatosis, and luteinized stromal cells. It is believed that massive ovarian edema arises from interference in lymphatic drainage and venous return of the ovary secondary to partial torsion among other etiologies. Herein we provide the first description of unilateral ovarian edema in association with a large leiomyoma in the ipsilateral broad ligament. It is important to recognize the various presentations of this benign entity and to consider it in the differential diagnosis of an adnexal mass in a reproductive age woman. PMID:24901402
Harrison, Beth T; Berg, Robert E; Mittal, Khush
Activity of some Mexican medicinal plant extracts on carrageenan-induced rat paw edema.
The extracts obtained from 14 plants of the Mexican medicinal flora were assessed for anti-inflammatory activity by carrageenan-induced rat paw edema model. The i.p. administration of the extracts at a dose of 400 mg/kg produced a high reduction of edema with 70% of the plant extracts. Oenothera rosea methanol extract, Sphaeralcea angustifolia chloroform extract, Acaciafarnesiana, Larrea tridentata and Rubus coriifolius methanol extracts as well as the aqueous extract of Chamaedora tepejilote were demonstrated to be particularly active against the induced hind-paw edema. Moderate inhibition of edema formation was also demonstrated with the methanol extracts of Astianthus viminalis, Brickellia paniculata, C. tepejilote and Justicia spicigera. PMID:15330501
Meckes, M; David-Rivera, A D; Nava-Aguilar, V; Jimenez, A
1. Bilateral cervical vagotomy in rabbits soon leads to death, usually within 8 to 24 hours. 2. Gradually increasing dyspnea, crises with expulsion of frothy, serous or sanguineous fluid from the mouth and nose, and terminal asphyxia are the important clinical features. 3. Postmortem examination reveals severe acute pulmonary edema and congestion, variable amounts of bronchopneumonia, and evidences of aspiration of food and secretions. This picture is similar to that found in the lungs in the bulbar form of poliomyelitis. 4. These changes are brought about by a combination of factors secondary to bilateral vagotomy: laryngeal paralysis (aspiration of food, slow asphyxia); loss of the vagal innervation of the lungs. 5. Laryngeal paralysis is not an essential factor in the production of severe pulmonary edema and death following bilateral cervical vagotomy. 6. To denote the pathogenesis of this type of edema, the term neuropathic pulmonary edema is employed. PMID:19870671
Farber, S
Triethyltin (TET) is a neurotoxicant that produces severe but transient cerebral edema, characterized ultrastructurally by vacuolation of the intraperiod line of central nervous system (CNS) myelin. ET has been reported to depress levels of myelin basic protein (MBP), a glycoprot...
Relationship between repolarization abnormalities and myocardial edema in atypical Tako-Tsubo syndrome.
In typical "apical" Tako-Tsubo syndrome (TTS), an association between dynamic T-wave inversion/QTc interval prolongation and myocardial edema as evidenced by cardiac magnetic resonance has been reported. We describe a patient with atypical "mid-ventricular" TTS who showed T-waves inversion/QTc prolongation confined to the lateral leads. Cardiac magnetic resonance revealed transmural myocardial edema with the highest signal intensity in the mid-lateral wall, in accordance with the ECG location of repolarization abnormalities. This finding indicates that the association of dynamic T-wave inversion/QTc interval prolongation with myocardial edema is demonstrable also in atypical variant of TTS and contributes to support the emerging concept of a cause-effect relationship between transient myocardial edema and dynamic repolarization changes. PMID:23809207
Zorzi, Alessandro; Perazzolo Marra, Martina; Migliore, Federico; De Lazzari, Manuel; Tarantini, Giuseppe; Iliceto, Sabino; Corrado, Domenico
Aplastic anemia induced disc edema and visual loss in pregnancy: a case report
Introduction A case of aplastic anemia diagnosed during pregnancy, which developed bilateral disc edema and acute pre-retinal hemorrhage leading to vision loss. Case Presentation A 20 year old primagravid female developed acute vision loss in her right eye, during hospitalization for treatment of aplastic anemia diagnosed during her pregnancy. Her best-corrected visual acuity (BCVA) was hand motions and fundus evaluation revealed a large pre-macular hemorrhage in the right eye (OD) and bilateral disc edema. Neuro-imaging studies did not reveal any signs of intracranial mass lesion or edema. Conclusion There was resolution of the disc edema with improvement in the pre-macular hemorrhage resulting in 20/50 vision in the right eye, following supportive transfusions. Ophthalmic manifestations developing in a pregnant patient with aplastic anemia can be successfully managed with supportive care including red blood cell and platelet transfusions.
Gupta, Shailesh K; Brar, Vikram S; Keshavamurthy, Ravi; Chalam, Kakarla V
Brain edema development after MRI-guided focused ultrasound treatment.
The aim of this study was to investigate a potential technique for image-guided minimally invasive neurosurgical interventions. Focused ultrasound (FUS) delivers thermal energy without an invasive probe, penetrating the dura mater, entering through the cerebrospinal fluid (CSF) space, or harming intervening brain tissue. We applied continuous on-line monitoring by MRI to demonstrate the effect of the thermal intervention on the brain tissue. For this, seven rabbits had a part of their skull removed to create access for the FUS beam into the brain through an acoustic window of 11 mm in diameter. Dura was left intact and skin was sutured. One week later, the rabbits were sonicated for 3 seconds with 21 W acoustic power, and the FUS focus was visualized with a temperature-sensitive T1-weighted MRI pulse sequence. The tissue reaction was documented over 7 days with T2-weighted images of the brain. The initial area of the central low signal intensity in the axial plane was .4+/-.3 mm2, and for the bright hyperintensity surrounding the lesion, it was 2.3+/-.6 mm2 (n = 7). In the coronal plane, the corresponding values were .4+/-.1 mm2 and 3.4+/-.9 mm2 (n = 5). The developing brain edema culminated 48 hours later and thereafter diminished during the next 5 days. Histology revealed a central necrosis in the white matter surrounded by edematous tissue with inflammatory cells. In summary, the image-guided thermal ablation technique described here produced a relatively small lesion in the white matter at the targeted location. This was accomplished without opening the dura or the need for a stereotactical device. MRI allowed on-line monitoring of the lesion setting and the deposition of thermal energy and demonstrated the tissue damage after the thermal injury. PMID:9500273
M�rocz, I A; Hynynen, K; Gudbjartsson, H; Peled, S; Colucci, V; J�lesz, F A
Biochemical and morphological alterations in xylazine-induced pulmonary edema.
Sprague-Dawley rats were given 42 mg/kg xylazine intramuscularly, and lungs were lavaged with phosphate-buffered saline 3, 6, and 12 hr later. Total protein, lactate dehydrogenase (LDH), xanthine oxidase (XO), tumor necrosis factor (TNF), and interleukin 1 (IL-1) were measured in bronchoalveolar lavage fluid (BALF). Protein concentration, LDH, XO, and TNF levels were increased (p < 0.05) in the BALF from xylazine-treated rats as compared to controls. IL-1 level was unchanged at 3 and 6 hr and was reduced (p < 0.05) at 12 hr. Another group of rats was given 42 mg/kg xylazine intramuscularly, and lungs were fixed 0.5 and 12 hr later. Histologically, severe pulmonary edema (PE) involving the alveoli and perivascular stroma was observed. Fibrin, increased numbers of eosinophils, and macrophages with foamy cytoplasm were present in the alveoli of all treated animals. Ultrastructurally, endothelial damage, characterized by thinning, detachment from basement membranes, or bleb formation, was observed. The lesions were similar in both xylazine groups, differing mainly in severity with the 12-hr group having more severe lesions than the 0.5-hr group. To determine whether endothelial injury is caused by direct toxicity of xylazine, bovine pulmonary artery endothelial cells (BPAECs) were incubated with xylazine (0.3, 3, and 30 micrograms) for 0.5 or 3 hr. Xylazine did not have any effects on BPAECs, as indicated by phase-contrast microscopy and dye-exclusion viability assay. These results indicate that xylazine-induced PE is due to increased permeability resulting from endothelial injury, which is not caused by direct effect of xylazine on pulmonary endothelium. While oxygen radicals and TNF are possibly involved, IL-1 does not appear to play a role in xylazine-induced PE. PMID:8052803
Amouzadeh, H R; Qualls, C W; Wyckoff, J H; Dzata, G K; Sangiah, S; Mauromoustakos, A; Stein, L E
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome: A case report
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare form of paraneoplastic tenosynovitis, which is more prone to occur in elderly males. A 78-year-old male had a past history of gastric cancer 23 years ago and underwent subtotal gastrectomy then. He led a fair life after the surgery. However, fever, edema in four extremities, gait disturbance, and liver
Yi-Ming Chen; Liang-Kung Chen; Shinn-Jang Hwang; Der-Yuan Chen; Hidenori Arai
Remitting seronegative symmetrical synovitis with pitting edema following acute intracranial hemorrhage
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is an unusual inflammatory arthritis with unknown\\u000a pathogenic mechanism, and is characterized by an acute onset of symmetrical synovitis with pitting edema of the hands or feet.\\u000a Numerous diseases are associated with RS3PE, including neoplasia, infection, Parkinson�s disease, and other rheumatic diseases.\\u000a Neoplasia is the most common condition associated with RS3PE. We
Deng-Ho Yang; Deh-Ming Chang; Jenn-Haung Lai; Guo-Shu Huang; Wei-Chou Chang; Tsung-Yun Hou
Lifesaving decompressive craniectomy for diffuse cerebral edema during an episode of new-onset diabetic ketoacidosis
Purpose��Diabetic ketoacidosis (DKA), a well-known complication of diabetes mellitus, is associated with severe diffuse cerebral edema\\u000a leading to brain herniation and death. Survival from an episode of symptomatic cerebral edema has been associated with debilitating\\u000a neurological sequelae, including motor deficits, visual impairment, memory loss, seizures, and persistent vegetative states.\\u000a A review of the literature reveals scant information regarding the potential
Ha Son Nguyen; James D. Callahan; Aaron A. Cohen-Gadol
CD14 and NFAT mediate lipopolysaccharide-induced skin edema formation in mice
Inflammation is a multistep process triggered when innate immune cells � for example, DCs � sense a pathogen or injured cell or tissue. Edema formation is one of the first steps in the inflammatory response; it is fundamental for the local accumulation of inflammatory mediators. Injection of LPS into the skin provides a model for studying the mechanisms of inflammation and edema formation. While it is known that innate immune recognition of LPS leads to activation of numerous transcriptional activators, including nuclear factor of activated T cells (NFAT) isoforms, the molecular pathways that lead to edema formation have not been determined. As PGE2 regulates many proinflammatory processes, including swelling and pain, and it is induced by LPS, we hypothesized that PGE2 mediates the local generation of edema following LPS exposure. Here, we show that tissue-resident DCs are the main source of PGE2 and the main controllers of tissue edema formation in a mouse model of LPS-induced inflammation. LPS exposure induced expression of microsomal PGE synthase-1 (mPGES-1), a key enzyme in PGE2 biosynthesis. mPGES-1 activation, PGE2 production, and edema formation required CD14 (a component of the LPS receptor) and NFAT. Therefore, tissue edema formation induced by LPS is DC and CD14/NFAT dependent. Moreover, DCs can regulate free antigen arrival at the draining lymph nodes by controlling edema formation and interstitial fluid pressure in the presence of LPS. We therefore suggest that the CD14/NFAT/mPGES-1 pathway represents a possible target for antiinflammatory therapies.
Zanoni, Ivan; Ostuni, Renato; Barresi, Simona; Gioia, Marco Di; Broggi, Achille; Costa, Barbara; Marzi, Roberta; Granucci, Francesca
The brain in acute liver failure. A tortuous path from hyperammonemia to cerebral edema
Acute liver failure (ALF) is a condition with an unfavourable prognosis. Multiorgan failure and circulatory collapse are frequent\\u000a causes of death, but cerebral edema and intracranial hypertension (ICH) are also common complications with a high risk of\\u000a fatal outcome. The underlying pathogenesis has been extensively studied and although the development of cerebral edema and\\u000a ICH is of a complex and
Peter Nissen Bjerring; Martin Eefsen; Bent Adel Hansen; Fin Stolze Larsen
Are sildenafil and theophylline effective in the prevention of high-altitude pulmonary edema?
High-altitude pulmonary edema reflects a potentially life-threatening condition affecting susceptible persons in the second night after ascent to altitudes above 2500m. Currently, nifedipine is the only pharmacological intervention approved for both, prevention and treatment of high-altitude pulmonary edema. We evaluated the application of the phosphodiesterase-V inhibitor sildenafil combined with the non-selective phosphodiesterase-inhibitor theophylline as preventive agents. In theory, the proposed
A Kleinsasser; A Loeckinger
Acute hemorrhagic edema of infancy: a worrisome presentation, but benign course
Acute hemorrhagic edema of infancy (AHEI) is a benign type of leukocytoclastic vasculitis. It is a benign phenomenon although it manifests with fever, large palpable purpuric skin lesions, and edema. The presentation of AHEI can often resemble that of Henoch-Sch�nlein purpura. Since AHEI is a self-limited disease, conservative management is the most commonly followed approach. Our patient had complete resolution of AHIE without medical treatment.
Alhammadi, Ahmed H; Adel, Ashraf; Hendaus, Mohamed A
Chest Tube Suction-Associated Unilateral Negative Pressure Pulmonary Edema in a Lung Transplant Patient
We describe a 29-yr-old male, status post-bilateral lung transplant,whodevelopedunilateralnegativepressure pulmonary edema induced by chest tube suction in as- sociation with bilateral bronchial anastomotic stric- tures. We conclude that negative pressure pulmonary edema may occur secondary to high levels of negative pressure applied to the intrapleural space via chest tubes in the presence of partial large airway obstruc- tion. Post-lung transplant
Stavros G. Memtsoudis; Peter Rosenberger; Nicholas Sadovnikoff
Transthoracic lung ultrasound in normal dogs and dogs with cardiogenic pulmonary edema: a pilot study.
Pulmonary edema is the most common complication of left-sided heart failure in dogs and early detection is important for effective clinical management. In people, pulmonary edema is commonly diagnosed based on transthoracic ultrasonography and detection of B line artifacts (vertical, narrow-based, well-defined hyperechoic rays arising from the pleural surface). The purpose of this study was to determine whether B line artifacts could also be useful diagnostic predictors for cardiogenic pulmonary edema in dogs. Thirty-one normal dogs and nine dogs with cardiogenic pulmonary edema were prospectively recruited. For each dog, presence or absence of cardiogenic pulmonary edema was based on physical examination, heartworm testing, thoracic radiographs, and echocardiography. A single observer performed transthoracic ultrasonography in all dogs and recorded video clips and still images for each of four quadrants in each hemithorax. Distribution, sonographic characteristics, and number of B lines per thoracic quadrant were determined and compared between groups. B lines were detected in 31% of normal dogs (mean 0.9 � 0.3 SD per dog) and 100% of dogs with cardiogenic pulmonary edema (mean 6.2 � 3.8 SD per dog). Artifacts were more numerous and widely distributed in dogs with congestive heart failure (P < 0.0001). In severe cases, B lines increased in number and became confluent. The locations of B line artifacts appeared consistent with locations of edema on radiographs. Findings from the current study supported the use of thoracic ultrasonography and detection of B lines as techniques for diagnosing cardiogenic pulmonary edema in dogs. PMID:24620777
Rademacher, Nathalie; Pariaut, Romain; Pate, Julie; Saelinger, Carley; Kearney, Michael T; Gaschen, Lorrie
[Volumetric verification of edema protection with Serrapeptase after third molar osteotomy].
Preventive edema protection using Serrapeptase after standardized one-stage osteotomy procedures of 4 third molars was verified by means of an opto-electronic measuring instrument. This measuring technique proved to be a sensitive tool for demonstrating the efficacy of Serrapeptase in reducing postoperative edema. Although statistically significant, the reduction of soft tissue swelling was only approximately 15% when compared with a patient group without Serrapeptase medication. PMID:1816962
Merten, H A; M�ller, K; Drubel, F; Halling, F
Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients.
Laryngeal edema is a frequent complication of intubation. It often presents shortly after extubation as post-extubation stridor and results from damage to the mucosa of the larynx. Mucosal damage is caused by pressure and ischemia resulting in an inflammatory response. Laryngeal edema may compromise the airway necessitating reintubation. Several studies show that a positive cuff leak test combined with the presence of risk factors can identify patients with increased risk for laryngeal edema. Meta-analyses show that pre-emptive administration of a multiple-dose regimen of glucocorticosteroids can reduce the incidence of laryngeal edema and subsequent reintubation. If post-extubation edema occurs this may necessitate medical intervention. Parenteral administration of corticosteroids, epinephrine nebulization and inhalation of a helium/oxygen mixture are potentially effective, although this has not been confirmed by randomized controlled trials. The use of non-invasive positive pressure ventilation is not indicated since this will delay reintubation. Reintubation should be considered early after onset of laryngeal edema to adequately secure an airway. Reintubation leads to increased cost, morbidity and mortality. PMID:20017891
Wittekamp, Bastiaan H J; van Mook, Walther N K A; Tjan, Dave H T; Zwaveling, Jan Harm; Bergmans, Dennis C J J
Molecular Mechanisms of Ischemic Cerebral Edema: Role of Electroneutral Ion Transport
NSDL National Science Digital Library
The brain achieves homeostasis of its intracellular and extracellular fluids by precisely regulating the transport of solute and water across its major cellular barriers: endothelia of the blood-brain barrier (BBB), choroid plexus epithelia, and neuroglial cell membranes. Cerebral edema, the pathological accumulation of fluid in the brain��s intracellular and extracellular spaces, is a major cause of morbidity and mortality following stroke and other forms of ischemic brain injury. Until recently, mechanisms of cerebral edema formation have been obscure; consequently, its treatment has been empiric and suboptimal. Here, we provide a paradigm for understanding ischemic cerebral edema, showing that its molecular pathogenesis is a complex yet step-wise process that results largely from impaired astrocytic cell volume regulation and permeability alterations in the cerebral microvasculature, both of which arise from pathological changes in the activities of specific ion channels and transporters. Recent data has implicated the bumetanide-sensitive NKCC1, an electroneutral cotransporter expressed in astrocytes and the BBB, in cerebral edema formation in several different rodent models of stroke. Pharmacological inhibition or genetic deficiency of NKCC1 decreases ischemia-induced cell swelling, BBB breakdown, cerebral edema, and neurotoxicity. Combination pharmacological strategies that include NKCC1 as a target might thus prove beneficial for the treatment of ischemic, and potentially other types of, cerebral edema.
Kristopher Kahle (Massachusetts General Hospital and Harvard Medical School Neurosurgery)
Rapamycin alleviates brain edema after focal cerebral ischemia reperfusion in rats.
Abstract Brain edema is a major consequence of cerebral ischemia reperfusion. However, few effective therapeutic options are available for retarding the brain edema progression after cerebral ischemia. Recently, rapamycin has been shown to produce neuroprotective effects in rats after cerebral ischemia reperfusion. Whether rapamycin could alleviate this brain edema injury is still unclear. In this study, the rat stroke model was induced by a 1-h left transient middle cerebral artery occlusion using an intraluminal filament, followed by 48?h of reperfusion. The effects of rapamycin (250??g/kg body weight, intraperitoneal; i.p.) on brain edema progression were evaluated. The results showed that rapamycin treatment significantly reduced the infarct volume, the water content of the brain tissue and the Evans blue extravasation through the blood-brain barrier (BBB). Rapamycin treatment could improve histological appearance of the brain tissue, increased the capillary lumen space and maintain the integrity of BBB. Rapamycin also inhibited matrix metalloproteinase 9 (MMP9) and aquaporin 4 (AQP4) expression. These data imply that rapamycin could improve brain edema progression after reperfusion injury through maintaining BBB integrity and inhibiting MMP9 and AQP4 expression. The data of this study provide a new possible approach for improving brain edema after cerebral ischemia reperfusion by administration of rapamycin. PMID:24773551
Guo, Wei; Feng, Guoying; Miao, Yanying; Liu, Guixiang; Xu, Chunsheng
An orally active TRPV4 channel blocker prevents and resolves pulmonary edema induced by heart failure.
Pulmonary edema resulting from high pulmonary venous pressure (PVP) is a major cause of morbidity and mortality in heart failure (HF) patients, but current treatment options demonstrate substantial limitations. Recent evidence from rodent lungs suggests that PVP-induced edema is driven by activation of pulmonary capillary endothelial transient receptor potential vanilloid 4 (TRPV4) channels. To examine the therapeutic potential of this mechanism, we evaluated TRPV4 expression in human congestive HF lungs and developed small-molecule TRPV4 channel blockers for testing in animal models of HF. TRPV4 immunolabeling of human lung sections demonstrated expression of TRPV4 in the pulmonary vasculature that was enhanced in sections from HF patients compared to controls. GSK2193874 was identified as a selective, orally active TRPV4 blocker that inhibits Ca(2+) influx through recombinant TRPV4 channels and native endothelial TRPV4 currents. In isolated rodent and canine lungs, TRPV4 blockade prevented the increased vascular permeability and resultant pulmonary edema associated with elevated PVP. Furthermore, in both acute and chronic HF models, GSK2193874 pretreatment inhibited the formation of pulmonary edema and enhanced arterial oxygenation. Finally, GSK2193874 treatment resolved pulmonary edema already established by myocardial infarction in mice. These findings identify a crucial role for TRPV4 in the formation of HF-induced pulmonary edema and suggest that TRPV4 blockade is a potential therapeutic strategy for HF patients. PMID:23136043
Thorneloe, Kevin S; Cheung, Mui; Bao, Weike; Alsaid, Hasan; Lenhard, Stephen; Jian, Ming-Yuan; Costell, Melissa; Maniscalco-Hauk, Kristeen; Krawiec, John A; Olzinski, Alan; Gordon, Earl; Lozinskaya, Irina; Elefante, Lou; Qin, Pu; Matasic, Daniel S; James, Chris; Tunstead, James; Donovan, Brian; Kallal, Lorena; Waszkiewicz, Anna; Vaidya, Kalindi; Davenport, Elizabeth A; Larkin, Jonathan; Burgert, Mark; Casillas, Linda N; Marquis, Robert W; Ye, Guosen; Eidam, Hilary S; Goodman, Krista B; Toomey, John R; Roethke, Theresa J; Jucker, Beat M; Schnackenberg, Christine G; Townsley, Mary I; Lepore, John J; Willette, Robert N
Isoproterenol improves ability of lung to clear edema in rats exposed to hyperoxia.
Exposure of adult rats to 100% O(2) results in lung injury and decreases active sodium transport and lung edema clearance. It has been reported that beta-adrenergic agonists increase lung edema clearance in normal rat lungs by upregulating alveolar epithelial Na(+)-K(+)-ATPase function. This study was designed to examine whether isoproterenol (Iso) affects lung edema clearance in rats exposed to 100% O(2) for 64 h. Active Na(+) transport and lung edema clearance decreased by approximately 44% in rats exposed to acute hyperoxia. Iso (10(-6) M) increased the ability of the lung to clear edema in room-air-breathing rats (from 0.50 +/- 0.02 to 0.99 +/- 0. 05 ml/h) and in rats exposed to 100% O(2) (from 0.28 +/- 0.03 to 0. 86 +/- 0.09 ml/h; P < 0.001). Disruption of intracellular microtubular transport of ion-transporting proteins by colchicine (0. 25 mg/100 g body wt) inhibited the stimulatory effects of Iso in hyperoxia-injured rat lungs, whereas the isomer beta-lumicolchicine, which does not affect microtubular transport, did not inhibit active Na(+) transport stimulated by Iso. Accordingly, Iso restored the lung's ability to clear edema after hyperoxic lung injury, probably by stimulation of the recruitment of ion-transporting proteins (Na(+)-K(+)-ATPase) from intracellular pools to the plasma membrane in rat alveolar epithelium. PMID:10409555
Sald�as, F J; Comellas, A; Ridge, K M; Lecuona, E; Sznajder, J I
Autofluorescence Imaging for Diagnosis and Follow-up of Cystoid Macular Edema
Lipofuscin results from digestion of photoreceptor outer segments by the retinal pigment epithelium (RPE) and is the principal compound that causes RPE fluorescence during autofluorescence imaging. Absorption of the 488-nanometer blue light by macular pigments, especially by the carotenoids lutein and zeaxanthin, causes normal macular hypo-autofluorescence. Fundus autofluorescence imaging is being increasingly employed in ophthalmic practice to diagnose and monitor patients with a variety of retinal disorders. In macular edema for example, areas of hyper-autofluorescence are usually present which are postulated to be due to dispersion of macular pigments by pockets of intraretinal fluid. For this reason, the masking effect of macular pigments is reduced and the natural autofluorescence of lipofuscin can be observed without interference. In cystic types of macular edema, e.g. cystoid macular edema due to retinal vein occlusion, diabetic macular edema and post cataract surgery, hyper-autofluorescent regions corresponding to cystic spaces of fluid accumulation can be identified. In addition, the amount of hyper-autofluorescence seems to correspond to the severity of edema. Hence, autofluorescence imaging, as a noninvasive technique, can provide valuable information on cystoid macular edema in terms of diagnosis, follow-up and efficacy of treatment.
Ebrahimiadib, Nazanin; Riazi-Esfahani, Mohammad
Great lakes embryo mortality, edema, and deformities syndrome (GLEMEDS) in colonial fish?eating birds: Similarity to chick?edema disease
Several species of colonial fish?eating birds nesting in the Great Lakes basin, including herring gulls, common terns and double?crested cormorants, have exhibited chronic impairment of reproduction. In addition to eggshell thinning caused by high levels of DDT and metabolites, the reproductive impairment is characterized by high embryonic and chick mortality, edema, growth retardation, and deformities, hence the name Great Lakes
Michael Gilbertson; Timothy Kubiak; James Ludwig; Glen Fox
Stereotactic Aspiration-Thrombolysis of Intracerebral Hemorrhage and its Impact on Perihematoma Brain Edema
Background Recent reports suggest that when thrombolytic agents are administered within the clot, lysis rate accelerates at the expense of increased risk of worsening edema. To test this hypothesis, we report on the volumetric analysis of (1) the intraparenchymal hematoma and, (2) perihematomal edema in a cohort of ICH patients treated with intraclot rtPA. Methods A convenience sample of highly selected ICH patients underwent frameless stereotactic aspiration and thrombolysis (FAST) of the clot. Two milligrams of rtPA were administered every 12 h until ICH volume ?10 cc, or catheter fenestrations were no longer in continuity with the clot. ICH and perihematomal edema volumes were calculated from CT scans. Using random effects linear regression we estimated the rate of hematoma and edema volume resolution as well as their relationship during the first 8 days of lytic therapy. Results Fifteen patients were treated, mean age: 60.7 years, median time from ictus to FAST: 1 (range 0�3) day. Using a random effects model that considered volume resolution over the first 8 days following lytic therapy we found that the both percentage hematoma and percentage perihematoma edema resolution per day were quadratic with respect to time. Percentage residual hematoma volume on day K = 97.7% ? [24.36%*K] + [1.89%*K2]; P < 0.001 for both terms. Percentage residual edema on day K = 97.4% ? [13.94%*K] + [1.30%*K2]; P < 0.001 for K and P = 0.01 for K2. Examination of each patient�s volume data suggests that there exists a strong direct relationship between perihematoma edema volume and same day hematoma volume. Conclusions In this cohort of ICH patients treated using FAST, volumetric analysis of ICH and perihematomal edema seems to suggest that local use of rtPA does not exacerbate brain edema formation. Furthermore, there seems to be a strong association between reduction in ICH volume and reduction in edema volume, as would be expected following the concept of �hemotoxicity� postulated by some investigators.
Barrett, Ryan J.; Keyl, Penelope M.; Hanley, Daniel F.; Johnson, Robert R.
Pentoxifylline attenuates TNF-? protein levels and brain edema following temporary focal cerebral ischemia in rats.
Cerebral edema is the most common cause of neurological deterioration and mortality during acute ischemic stroke. Despite the clinical importance of cerebral ischemia, the underlying mechanisms remain poorly understood. Recent studies suggest a role for TNF-? in the brain edema formation. To further investigate whether TNF-? would play a role in brain edema formation, we examined the effects of pentoxifylline (PTX, an inhibitor of TNF-? synthesis) on the brain edema and TNF-? levels in a model of transient focal cerebral ischemia. The right middle cerebral artery (MCA) of rats was occluded for 60 min using the intraluminal filament method. The animals received PTX (60 mg/kg) immediately, 1, 3, or 6h post-ischemic induction. Twenty-four hours after induction of ischemic injury, permeability of the blood-brain barrier (BBB) and brain edema were determined by in situ brain perfusion of Evans Blue (EB) and wet-to-dry weight ratio, respectively. TNF-? protein levels in ischemic cortex were also measured at 1, 4, and 24h after the beginning of an ischemic stroke by using an enzyme-linked immunosorbent assay method. The administration of PTX up to 6h after occlusion of the MCA significantly reduced the brain edema. Moreover, PTX significantly reduced the concentration of TNF-? in ischemic brain cortex up to 4h post-transient focal stroke (P<0.002). Finally, treatment by PTX led to a significant decrease in EB extravasations (P<0.001). Our data demonstrate that PTX administration up to 6h after ischemia can reduce brain edema in a model of transient focal cerebral ischemia. The beneficial effects of PTX may be mediated, at least in part, through a decline in TNF-? production and BBB breakdown. PMID:21219888
Vakili, Abedin; Mojarrad, Somye; Akhavan, Maziar Mohammad; Rashidy-Pour, Ali
Chloride transport-driven alveolar fluid secretion is a major contributor to cardiogenic lung edema.
Alveolar fluid clearance driven by active epithelial Na(+) and secondary Cl(-) absorption counteracts edema formation in the intact lung. Recently, we showed that impairment of alveolar fluid clearance because of inhibition of epithelial Na(+) channels (ENaCs) promotes cardiogenic lung edema. Concomitantly, we observed a reversal of alveolar fluid clearance, suggesting that reversed transepithelial ion transport may promote lung edema by driving active alveolar fluid secretion. We, therefore, hypothesized that alveolar ion and fluid secretion may constitute a pathomechanism in lung edema and aimed to identify underlying molecular pathways. In isolated perfused lungs, alveolar fluid clearance and secretion were determined by a double-indicator dilution technique. Transepithelial Cl(-) secretion and alveolar Cl(-) influx were quantified by radionuclide tracing and alveolar Cl(-) imaging, respectively. Elevated hydrostatic pressure induced ouabain-sensitive alveolar fluid secretion that coincided with transepithelial Cl(-) secretion and alveolar Cl(-) influx. Inhibition of either cystic fibrosis transmembrane conductance regulator (CFTR) or Na(+)-K(+)-Cl(-) cotransporters (NKCC) blocked alveolar fluid secretion, and lungs of CFTR(-/-) mice were protected from hydrostatic edema. Inhibition of ENaC by amiloride reproduced alveolar fluid and Cl(-) secretion that were again CFTR-, NKCC-, and Na(+)-K(+)-ATPase-dependent. Our findings show a reversal of transepithelial Cl(-) and fluid flux from absorptive to secretory mode at hydrostatic stress. Alveolar Cl(-) and fluid secretion are triggered by ENaC inhibition and mediated by NKCC and CFTR. Our results characterize an innovative mechanism of cardiogenic edema formation and identify NKCC1 as a unique therapeutic target in cardiogenic lung edema. PMID:23645634
Solymosi, Esther A; Kaestle-Gembardt, Stefanie M; Vad�sz, Istv�n; Wang, Liming; Neye, Nils; Chupin, C�cile Julie Adrienne; Rozowsky, Simon; Ruehl, Ramona; Tabuchi, Arata; Schulz, Holger; Kapus, Andras; Morty, Rory E; Kuebler, Wolfgang M
Interventions for the treatment of uveitic macular edema: a systematic review and meta-analysis
Background Uveitic macular edema is the major cause of reduced vision in eyes with uveitis. Objectives To assess the effectiveness of interventions in the treatment of uveitic macular edema. Search strategy Cochrane Central Register of Controlled Trials, Medline, and Embase. There were no language or data restrictions in the search for trials. The databases were last searched on December 1, 2011. Reference lists of included trials were searched. Archives of Ophthalmology, Ophthalmology, Retina, the British Journal of Ophthalmology, and the New England Journal of Medicine were searched for clinical trials and reviews. Selection criteria Participants of any age and sex with any type of uveitic macular edema were included. Early, chronic, refractory, or secondary uveitic macular edema were included. We included trials that compared any interventions of any dose and duration, including comparison with another treatment, sham treatment, or no treatment. Data collection and analysis Best-corrected visual acuity and central macular thickness were the primary outcome measures. Secondary outcome data including adverse effects were collected. Conclusion More results from randomized controlled trials with long follow-up periods are needed for interventions for uveitic macular edema to assist in determining the overall long-term benefit of different treatments. The only intervention with sufficiently robust randomized controlled trials for a meta-analysis was acetazolamide, which was shown to be ineffective in improving vision in eyes with uveitic macular edema, and is clinically now rarely used. Interventions showing promise in this disease include dexamethasone implants, immunomodulatory drugs and anti-vascular endothelial growth-factor agents. When macular edema has become refractory after multiple interventions, pars plana vitrectomy could be considered. The disease pathophysiology is uncertain and the course of disease unpredictable. As there are no clear guidelines from the literature, interventions should be tailored to the individual patient.
Karim, Rushmia; Sykakis, Evripidis; Lightman, Susan; Fraser-Bell, Samantha
Dopamine restores lung ability to clear edema in rats exposed to hyperoxia.
Exposure to hyperoxia causes lung injury, decreases active sodium transport and lung edema clearance in rats. Dopamine (DA) increases lung edema clearance by stimulating vectorial Na+ flux and Na, K-ATPase function in rat alveolar epithelium. This study was designed to test whether DA (10(-)5 M) would increase lung edema clearance in rats exposed to 100% O2 for 64 h. Active Na+ transport and lung edema clearance decreased by approximately 44% in rats exposed to acute hyperoxia (p < 0.001). DA increased lung edema clearance in room air breathing rats (from 0.50 +/- 0.02 to 0.75 +/- 0.06 ml/h) and in rats exposed to 100% O2 (from 0.28 +/- 0.03 to 0. 67 +/- 0.03 ml/h). Disruption of cell microtubular transport system by colchicine blocked the stimulatory effect of DA on active Na+ transport in control and hyperoxic rats, whereas the isomer beta-lumicolchicine, which does not affect cell microtubular transport, did not inhibit the stimulatory effects of dopamine. The Na,K-ATPase alpha1-subunit protein abundance increased in the basolateral membranes of alveolar type II (ATII) cells incubated with 10(-)5 M DA for 15 min, probably by recruiting Na+ pumps from intracellular pools. Colchicine, but not beta-lumicolchicine, prevented the recruitment of alpha1 subunits to the plasma membrane by DA. Accordingly, DA restored lung ability to clear edema in hyperoxic-injured rat lungs. Conceivably, dopamine induces recruitment of Na+ pumps from intracellular pools to the plasma membrane of alveolar epithelial cells and thus increases lung edema clearance. PMID:9927383
Sald�as, F J; Lecuona, E; Comellas, A P; Ridge, K M; Sznajder, J I
Oxygen resuscitation does not ameliorate neonatal hypoxia/ischemia-induced cerebral edema.
Neonatal hypoxia/ischemia (HI) is a common cause of cognitive and behavioral deficits in children with hyperoxia treatment (HHI) being the current therapy for newborn resuscitation. HI induces cerebral edema that is associated with poor neurological outcomes. Our objective was to characterize cerebral edema after HI and determine the consequences of HHI (40% or 100% O(2)). Dry weight analyses showed cerebral edema 1 to 21 days after HI in the ipsilateral cortex; and 3 to 21 days after HI in the contralateral cortex. Furthermore, HI increased blood-brain barrier (BBB) permeability 1 to 7 days after HI, leading to bilateral cortical vasogenic edema. HHI failed to prevent HI-induced increase in BBB permeability and edema development. At the molecular level, HI increased ipsilateral, but not contralateral, AQP4 cortical levels at 3 and up to 21 days after HI. HHI treatment did not further affect HI-induced changes in AQP4. In addition, we observed developmental increases of AQP4 accompanied by significant reduction in water content and increase permeability of the BBB. Our results suggest that the ipsilateral HI-induced increase in AQP4 may be beneficial and that its absence in the contralateral cortex may account for edema formation after HI. Finally, we showed that HI induced impaired motor coordination 21 days after the insult and HHI did not ameliorate this behavioral outcome. We conclude that HHI treatment is effective as a resuscitating therapy, but does not ameliorate HI-induced cerebral edema and impaired motor coordination. PMID:20143414
Ferrari, Diana Carolina; Nesic, Olivera B; Perez-Polo, J Regino
Changes in microvascular permeability with acceleration of edema in dog lungs.
Elevation of left atrial pressure to 25-40 mmHg causes continuous pulmonary edema formation in dog lungs. However, after 5-120 min, the rate of edema formation often increases (acceleration of edema). Acceleration of edema could be associated with an increase in microvascular membrane permeability because an increase in permeability would cause fluid to filter through the microvascular membrane more rapidly. To test the hypothesis that acceleration is associated with increased permeability, we used the continuous weight-gain technique to estimate the pulmonary microvascular membrane filtration coefficient (Kf) before and after acceleration of edema in 10 dogs. Acceleration occurred 36 +/- 38 (SD) min after elevation of left atrial pressure to 35.2 +/- 5.4 mmHg. Rate of weight gain increased from 0.47 +/- 0.17 g/min before acceleration to 0.88 +/- 0.26 g/min (P less than 0.05) after acceleration of pulmonary edema. Kf was increased from initial values of 0.058 +/- 0.027 to 0.075 +/- 0.029 ml.min-1.mmHg-1 (P less than 0.05) after acceleration. In five additional dogs we cannulated lung lymphatics and determined the lymph to plasma protein concentration ratio (CL/CP) before and after acceleration. CL/CP increased from base-line values of 0.37 +/- 0.07 to 0.44 +/- 0.06 (P less than 0.05) after acceleration. Both the increase in Kf and CL/CP data support the hypothesis that acceleration of edema is due, in part, to a slight increase in microvascular membrane permeability. However, the findings could also have been caused by an increase in interstitial conductance, washout of interstitial proteins, or alveolar flooding. PMID:2309906
Butler, B D; Drake, R E; Sneider, W D; Allen, S J; Gabel, J C
Edema and Tetraparesis in a Miniature Pig after Allogeneic Hematopoietic Cell Transplantation
A 3-mo-old, 12-kg, intact, miniature pig presented with severe neurologic signs on day 8 after hematopoietic cell transplantation. This pig had received an immunosuppressive regimen before transplantation that included an antiCD3 immunotoxin for T-cell depletion, 100 cGy of total-body irradiation, and cyclosporine for 45 d. The pig began exhibiting erythematous lesions on posttransplantation day 7. He also demonstrated increased conscious proprioceptive deficits and recumbency but normal mentation. Neurologic signs worsened over several days; the pig became lethargic but remained afebrile. Conjunctival swelling developed on posttransplantation day 9, which subsequently spread to the animal's head, ears and hocks by day 10. Analgesics were given for pain, and cyclosporine levels were decreased. Despite the measures taken, neurologic signs progressed. Given the worsening subcutaneous edema and neurologic status, Escherichia coli infection was suspected, and treatment with a third-generation cephalosporin was instituted. The clinical signs resolved within 12 h after the start of antibiotics. �Shiga-like� toxin from E. coli can cause peracute toxemia and induce ataxia, paralysis, and recumbency. Other common and pathognomonic findings include periocular edema and variable edema in other subcutaneous regions. A fecal sample demonstrated an overgrowth of gram-negative, lactose-fermenting colonies. On the basis of the clinical presentation, exclusion of other potential conditions compatible with edema and neurologic diseases, physical exam findings, microbiology and the resolution of signs after therapy, the pig was diagnosed with edema disease.
Crepeau, Rebecca; Matar, Abraham; Spitzer, Thomas R; Robson, Simon; Pathiraja, Vimukthi; Sachs, David H; Huang, Christene A; Duran-Struuck, Raimon
Assessment of lung water by magnetic resonance in three types of pulmonary edema.
Pulmonary edema was produced in nine mongrel dogs by: (a) saline lavage; (b) intravenous injection of oleic acid; and (c) intravenous injection of propranolol followed by ureteral ligation. The resulting effect could be characterized by varying the protein concentration in the pulmonary edema fluid. After induction, all dogs were killed and 20 samples from each passively deflated lung were obtained. Proton T1 and T2 values were measured on a Praxis II NMR spectrometer operated at 10.7 MHz and 37 degrees C. The water content of all samples was determined gravimetrically. Correlation between T1 or T2 measured in vitro and the ratio of wet to dry weight was highly significant (r greater than 0.95, P less than 0.001) in each pathological state. Regression curves indicate that although all three types of pulmonary edema can be characterized by slightly different slopes, the differences are statistically insignificant. Moreover, the slopes of previous studies, when recast in the same format, are very similar to our findings despite the use of different magnetic field strengths and different animal models. This study indicates that quantitation of pulmonary edema is possible, but in vitro measurements do not give useful information for characterizing the etiology of pulmonary edema. PMID:3253274
Vinitski, S; Steiner, R M; Wexler, H R; Rifkin, M
Lung edema due to hydrogen peroxide is independent of cyclooxygenase products
Active oxygen species can cause lung injury. Although a direct action on endothelial cells is proposed, the possibility exists that they might cause injury via mediators. We considered that active oxygen species would stimulate the generation of cyclooxygenase metabolites, which then alter pulmonary vasoreactivity and cause edema. We chemically produced hydrogen peroxide by adding glucose oxidase to a plasma- and cell-free, but ..beta..-D-glucose-containing, solution, which perfused isolated rat lungs. Addition of glucose oxidase to the perfusate caused a marked decrease in pulmonary vasoreactivity, accompanied by an increase in the concentrations of prostacyclin, thromboxane A/sub 2/, and prostaglandin F/sub 2..cap alpha../. Pretreatment with catalase, a specific scavenger of hydrogen peroxide, preserved pulomonary vasoreactivity, inhibited the increase of the concentration of the measured prostaglandins, and prevented edema formation. Indomethacin effectively blocked lung prostaglandin production but neither prevented the decrease in vasoreactivity nor inhibited edema formation. From these data we conclude the hydrogen peroxide impaired pulmonary vasoreactivity and subsequently caused edema. Depsite the fact that hydrogen peroxide stimulated lung prostaglandin production, cyclooxygenase-derived products neither caused the decrease in vasoreactivity nor the development of edema.
Burghuber, O.; Mathias, M.M.; McMurtry, I.F.; Reeves, J.T.; Voelkel, N.F.
Xanthine oxidase-derived hydrogen peroxide contributes to ischemia reperfusion-induced edema in gerbil brains.
The contribution of toxic O2 metabolites to cerebral ischemia reperfusion injury has not been determined. We found that gerbils subjected to temporary unilateral carotid artery occlusion (ischemia) consistently developed neurologic deficits during ischemia with severities that correlated with increasing degrees of brain edema and brain H2O2 levels after reperfusion. In contrast, gerbils treated just before reperfusion (after ischemia) with dimethylthiourea (DMTU), but not urea, had decreased brain edema and brain H2O2 levels. In addition, gerbils fed a tungsten-rich diet for 4, 5, or 6 wk developed progressive decreases in brain xanthine oxidase (XO) and brain XO + xanthine dehydrogenase (XD) activities, brain edema, and brain H2O2 levels after temporary unilateral carotid artery occlusion and reperfusion. In contrast to tungsten-treated gerbils, allopurinol-treated gerbils did not have statistically significant decreases in brain XO or XO + XD levels, and reduced brain edema and brain H2O2 levels occurred only in gerbils developing mild but not severe neurologic deficits during ischemia. Finally, gerbils treated with DMTU or tungsten all survived, while greater than 60% of gerbils treated with urea, allopurinol, or saline died by 48 h after temporary unilateral carotid artery occlusion and reperfusion. Our findings indicate that H2O2 from XO contributes to reperfusion-induced edema in brains subjected to temporary ischemia. Images
Patt, A; Harken, A H; Burton, L K; Rodell, T C; Piermattei, D; Schorr, W J; Parker, N B; Berger, E M; Horesh, I R; Terada, L S
Correlations between edema and the immediate and prolonged painful consequences of inflammation: therapeutic implications?
The precise relationship between the degree of pan and the degree of inflammation in the individual remains debated. A quantitative analysis simultaneously applied to the immediate and prolonged painful consequences of inflammation has not yet been done. Thus, the correlations between edema, nociception and hypersensitivity following an inflammatory insult were assessed in rodents. To better understand the therapeutic value of modifying specific aspects of inflammation, the effects of anti-inflammatory drug were compared to the results. Inbred strains of mice and outbred rats received an intraplantar injection of honeybee venom and the between group and within-group correlations were calculated for spontaneous nociceptive measures, thermal and mechanical hypersensitivity, and edema and temperature. The effect of indomethacin on the pain and the inflammation measures was examined. Edema correlated with spontaneous flinching, licking and lifting of the inject paw, and not with thermal or mechanical hypersensitivity. Indomethacin affected edema and spontaneous nociception dose-dependently, and affected hypersensitivity only at the highest dose test (P <0.005). These results suggest that edema may contribute only to immediate spontaneous nociceptive responses to an inflammatory insult, and not to the more clinically relevant prolonged hypersensitivity. This analysis represents a method for determine which inflammatory processes are the most promising therapeutic targets against the multiple painful consequences of inflammation.
Chesler, Elissa J [ORNL; Lariviere, William R [University of Pittsburgh; Zhen, Li [Institute for Biomedical Sciences of Pain, Beijing, China; Shang, G [Institute for Biomedical Sciences of Pain, Beijing, China; Chen, Ya [Institute for Biomedical Sciences of Pain, Beijing, China; Yu, Yao [Institute for Biomedical Sciences of Pain, Beijing, China; Lu, Zhuo [Institute for Biomedical Sciences of Pain, Beijing, China; Chang, Ying [Institute for Biomedical Sciences of Pain, Beijing, China; Luo, Ceng [Institute for Biomedical Sciences of Pain, Beijing, China; Li, KaiCheng [Institute for Biomedical Sciences of Pain, Beijing, China; Chen, Jun [Institute for Biomedical Sciences of Pain, Beijing, China
Edema-inducing activity of phospholipase A 2 purified from human synovial fluid and inhibition by aristolochic acid
A neutral-active, Ca2+-dependent phospholipase A2 (PLA2) purified 11,000-fold from human synovial fluid (HSF) induced edema when injected into the mouse foot pad. The edema produced by HSF-PLA2 was dose-dependent and was positively correlated with the dose-dependent in vitro expression of PLA2 activity. Maximum edema was achieved within 45 min after the injection and persisted for atleast 6 h. Aristolochic acid
B. S. Vishwanath; A. A. Fawzy; R. C. Franson
Noninvasive quantification of brain edema and the space-occupying effect in rat stroke models using magnetic resonance imaging
BACKGROUND AND PURPOSE: Brain edema is a life-threatening consequence of stroke and leads to an extension of the affected tissue. The space-occupying effect due to brain edema can be quantified in rat stroke models with the use of MRI. The present study was performed to test 2 hypotheses: (1) Can quantification of the space-occupying effect due to brain edema serve
Tibo Gerriets; Erwin Stolz; Maureen Walberer; Clemens Muller; Alexander Kluge; A. Bachmann; Marc Fisher; Manfred Kaps; Georg Bachmann
Ipsilateral reexpansion pulmonary edema after drainage of a spontaneous pneumothorax: a case report.
We report a case of ipsilateral reexpansion pulmonary edema occurring after the insertion of a chest tube in a patient with spontaneous pneumothorax. The patient received supplemental oxygen via a non-rebreather face mask to compensate for hypoxemia. 24 hours after the acute event, the patient recovered completely without residual hypoxemia. Reexpansion pulmonary edema after the insertion of a thoracic drainage for pneumothorax or pleural effusion is a rare complication with a high mortality rate up to 20%. It should be considered in case of hypoxemia following the insertion of a chest tube. The exact pathophysiology leading to this complication is not known. Risk factors for reexpansion pulmonary edema should be evaluated and considered prior to the insertion of chest tubes. Treatment is supportive. PMID:17903268
Conen, Anna; Joos, Ladina; Bingisser, Roland
Ipsilateral reexpansion pulmonary edema after drainage of a spontaneous pneumothorax: a case report
We report a case of ipsilateral reexpansion pulmonary edema occurring after the insertion of a chest tube in a patient with spontaneous pneumothorax. The patient received supplemental oxygen via a non-rebreather face mask to compensate for hypoxemia. 24 hours after the acute event, the patient recovered completely without residual hypoxemia. Reexpansion pulmonary edema after the insertion of a thoracic drainage for pneumothorax or pleural effusion is a rare complication with a high mortality rate up to 20%. It should be considered in case of hypoxemia following the insertion of a chest tube. The exact pathophysiology leading to this complication is not known. Risk factors for reexpansion pulmonary edema should be evaluated and considered prior to the insertion of chest tubes. Treatment is supportive.
Conen, Anna; Joos, Ladina; Bingisser, Roland
Remission of Hypnic Headache Associated with Idiopathic Cyclic Edema with the Use of Aminaphtone
Headache is one of the chief complaints among patients visiting primary care physicians. The aim of the current study is to report on a case of daily intermittent headaches in a patient with idiopathic cyclic edema. Over three years the patient suffered from headaches that started and improved at specific times. They began at about 5 to 6 o�clock in the morning and spontaneously disappeared 3 to 4 hours after getting up and thus were directly associated to sleep. The patient complained of generalized edema and had weight differences of about two kilograms between 7 a.m. and 5 p.m. A hypothesis of idiopathic cyclic edema was reached and the patient was prescribed aminaphtone which cured the headaches within two days after initiating treatment.
de Godoy, Jose Maria Pereira
Remission of hypnic headache associated with idiopathic cyclic edema with the use of aminaphtone.
Headache is one of the chief complaints among patients visiting primary care physicians. The aim of the current study is to report on a case of daily intermittent headaches in a patient with idiopathic cyclic edema. Over three years the patient suffered from headaches that started and improved at specific times. They began at about 5 to 6 o'clock in the morning and spontaneously disappeared 3 to 4 hours after getting up and thus were directly associated to sleep. The patient complained of generalized edema and had weight differences of about two kilograms between 7 a.m. and 5 p.m. A hypothesis of idiopathic cyclic edema was reached and the patient was prescribed aminaphtone which cured the headaches within two days after initiating treatment. PMID:21258572
de Godoy, Jos� Maria Pereira
Volcano like pattern in optical coherence tomography in chronic diabetic macular edema
In this article we herein report an interesting vitreo-macular interface abnormality associated with chronic diabetic cystoid macular edema. It is an observational case study of three diabetic patients examined in the diabetic clinic. All the patients had proliferative diabetic retinopathy with chronic macular edema. A serial cross sectional OCT examination and tracking of both the longitudinal progression of macular thickening and vitreo-macular interface revealed cystoid macular edema with a characteristic hyperreflective vitreous shadow emerging from the vitreofoveal interface. All the patients had dehiscence of inner retinal layers. This particular morphological feature at the vitreo-foveolar interface, which we name as �volcano sign�, has not been described earlier. The probable mechanism of such a finding probably could be due to slow progressive leakage of chronic cytoid fluid into the vitreous with condensation of the overlying vitreous. Vitreo-macular traction followed by posterior vitreous detachment probably would have contributed to such a morphological event.
Pai, Sivakami A.; Hussain, Nazimul; Hebri, Sudhira P.; Lootah, Afra M.; Dekhain, Moza A.
A comparative study of treatment for brain edema: magnesium sulphate versus dexamethasone sodium phosphate.
Treatments for brain edema are important and one of the major options is corticosteroids. Cell membrane stabilization and prevention of formation of free radicals are the main mechanisms of action of steroids in edema treatment. As an alternative therapeutic agent, magnesium sulphate has been used for its neuroprotective effect in various injury models. In our animal model of brain injury, cold has been used in Sprague-Dawley rats. After brain injury, magnesium sulphate (600 mg/kg) or dexamethasone sodium phosphate (0.2 mg/kg) were administered to experimental groups. The degree of brain edema and lipid peroxidation was evaluated using the wet-dry weight method, the determination of malondialdehyde (MDA) levels and an ultrastructural grading system. Magnesium sulphate treatment was found to be the most effective choice due to the absence of side effects and comparable efficacy to corticosteroids. PMID:18061457
Turkoglu, Omer Faruk; Eroglu, Hakan; Okutan, Ozerk; Tun, M Kagan; Bodur, Ebru; Sargon, Mustafa F; Oner, Levent; Beskonakli, Etem
Cerebral edema following iodine-131 therapy for thyroid carcinoma metastatic to the brain
Brain metastases are rare in well-differentiated thyroid carcinoma but when present they can lead to the patient's death. Iodine-131 therapy for intracerebral thyroid carcinoma metastases causes radiation-induced acute cerebral edema that can lead to CNS complications and even death. We present a case in which a patient with intracerebral /sup 131/I uptake developed seizures, slurred speech, and muscle weakness 12 hr following /sup 131/I therapy. The patient's CT scan, post-therapy, confirmed an intracranial metastasis with a significant amount of surrounding edema. Radiotherapists, when using external beam radiation to treat intracerebral metastases, commonly place these patients on steroids, glycerol, or mannitol prior to instituting therapy, to prevent complications from radiation-induced cerebral edema. This technique could be applied to /sup 131/I therapy of intracranial thyroid carcinoma metastases as well.
Datz, F.L.
Volcano like pattern in optical coherence tomography in chronic diabetic macular edema.
In this article we herein report an interesting vitreo-macular interface abnormality associated with chronic diabetic cystoid macular edema. It is an observational case study of three diabetic patients examined in the diabetic clinic. All the patients had proliferative diabetic retinopathy with chronic macular edema. A serial cross sectional OCT examination and tracking of both the longitudinal progression of macular thickening and vitreo-macular interface revealed cystoid macular edema with a characteristic hyperreflective vitreous shadow emerging from the vitreofoveal interface. All the patients had dehiscence of inner retinal layers. This particular morphological feature at the vitreo-foveolar interface, which we name as "volcano sign", has not been described earlier. The probable mechanism of such a finding probably could be due to slow progressive leakage of chronic cytoid fluid into the vitreous with condensation of the overlying vitreous. Vitreo-macular traction followed by posterior vitreous detachment probably would have contributed to such a morphological event. PMID:24843311
Pai, Sivakami A; Hussain, Nazimul; Hebri, Sudhira P; Lootah, Afra M; Dekhain, Moza A
New insights of aquaporin 5 in the pathogenesis of high altitude pulmonary edema
Background High altitude pulmonary edema (HAPE) affects individuals and is characterized by alveolar flooding with protein-rich edema as a consequence of blood-gas barrier disruption. In this study, we hypothesized that aquaporin 5 (AQP5) which is one kind of water channels may play a role in preservation of alveolar epithelial barrier integrity in high altitude pulmonary edema (HAPE). Methods Therefore, we established a model in Wildtype mice and AQP5 ?/? mice were assingned to normoxic rest (NR), hypoxic rest (HR) and hypoxic exercise (HE) group. Mice were produced by training to walk at treadmill for exercising and chamber pressure was reduced to simulate climbing an altitude of 5000�m for 48�hours. Studies using BAL in HAPE mice to demonstrated that edema is caused leakage of albumin proteins and red cells across the alveolarcapillary barrier in the absence of any evidence of inflammation. Results In this study, the Lung wet/dry weight ratio and broncholalveolar lavage protein concentrations were slightly increased in HE AQP5 ?/? mice compared to wildtype mice. And histologic evidence of hemorrhagic pulmonary edema was distinctly shown in HE group. The lung Evan�s blue permeability of HE group was showed slightly increased compare to the wildtype groups, and HR group was showed a medium situation from normal to HAPE development compared with NR and HE group. Conclusions Deletion of AQP5 slightly increased lung edema and lung injury compared to wildtype mice during HAPE development, which suggested that the AQP5 plays an important role in HAPE formation induced by high altitude simulation.
Unilateral pitting edema of the leg as a manifestation of Graves' disease: a case report
Introduction Graves� hyperthyroidism has a number of well-recognized but relatively rare extrathyroid manifestations such as thyroid acropachy, pretibial myxedema, and congestive heart failure. Case presentation A 38-year-old Caucasian woman presented to the out-patient clinic with symptoms of hyperthyroidism lasting for approximately five months. Remarkably, she had developed pitting edema of her left leg four months before. She had gone through a conventional assessment, but the reason for the edema was not revealed. At presentation to the endocrinology clinic, the skin of both legs was of normal color and pitting edema on her left leg was of a diffuse nature and spread from her toes to two thirds of her leg. The skin surface of her left leg was smooth and had no elevations or discoloration, whereas her right leg appeared normal. Based on signs and symptoms of thyrotoxicosis and suppressed thyroid-stimulating hormone level (less than 0.001mIU/L, local reference of 0.4 to 4), treatment of 10mg of thiamazole three times a day was started. Additional blood tests revealed marked Graves� hyperthyroidism with elevated free T4 and anti-thyroid receptor antibodies. Within a month, the free T4 level was normalized and the edema was completely cleared and never reappeared during the treatment course of 12?months. Conclusions To the best of our knowledge, this is the first description of unilateral treatment-responsive leg edema as a manifestation of Graves� hyperthyroidism. However, the pathophysiological mechanism underlying this case of edema remains unclear.
Effect of Edema on Postimplant Dosimetry in Prostate Brachytherapy Using CT/MRI Fusion
Purpose: To investigate the time course of prostatic edema and the effect on the dose-volume histograms of the prostate for patients treated with brachytherapy. Methods and Materials: A total of 74 patients with prostate cancer were enrolled in this prospective study. A transrectal ultrasound-based preplan was performed 4 weeks before implantation and computed tomography/magnetic resonance imaging fusion-based postimplant dosimetry was performed on the day after implantation (Day 1) and 30 days after implantation (Day 30). The prostate volume, prostate volume covered by 100% of the prescription dose (V{sub 100}), and dose covering 90% of the prostate (D{sub 90}) were evaluated with prostatic edema over time. Results: Prostatic edema was greatest on Day 1, with the mean prostate volume 36% greater than the preplan transrectal ultrasound-based volume; it thereafter decreased over time. It was 9% greater than preplan volume on Day 30. The V{sub 100} increased 5.7% from Day 1 to Day 30, and the D{sub 90} increased 13.1% from Day 1 to Day 30. The edema ratio (postplan/preplan) on Day 1 of low-quality implants with a V{sub 100} of <80% was significantly greater than that of intermediate- to high-quality implants (>80% V{sub 100}; p = 0.0272). The lower V{sub 100} on Day 1 showed a greater increase from Day 1 to Day 30. A V{sub 100} on Day 1 of >92% is unlikely to increase >0% during the interval studied. Conclusion: Low-quality implants on Day 1 were highly associated with edema; however, such a low-quality implant on Day 1, with significant edema, tended to improve by Day 30. If a high-quality implant (V100 >92%) can be obtained on Day 1, a re-examination is no longer necessary.
Tanaka, Osamu [Department of Radiology, Gifu University School of Medicine, Gifu (Japan); Division of Radiation Oncology, Gifu University Hospital, Gifu City (Japan)], E-mail: email@example.com; Hayashi, Shinya; Matsuo, Masayuki [Department of Radiology, Gifu University School of Medicine, Gifu (Japan); Division of Radiation Oncology, Gifu University Hospital, Gifu City (Japan); Nakano, Masahiro; Uno, Hiromi [D