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Microlymphatics and lymph flow.
A careful review of several different organs shows that with the information available today the beginnings of the microlymphatics in the tissue consist of endothelialized tubes only. Lymphatic smooth muscle within the collecting lymphatics appears further downstream, in some organs only outside the parenchyma. This particular anatomic picture has been observed in many different mammalian organs and in humans. The nonmuscular, so-called initial, lymphatics are the site of interstitial fluid absorption that requires only small and transient pressure gradients from the interstitium into the initial lymphatics. A fundamental question concerns the mechanism that causes expansion and compression of the initial lymphatics. I presented several realistic proposals based on information currently on hand relevant to the tissue surrounding the initial lymphatics. To achieve a continuous lymphatic output, periodic (time variant) tissue stresses need to be applied. They include arterial pressure pulsations; arteriolar vasomotion; intestinal smooth muscle contractions and motilities; skeletal muscle contraction; skin tension; and external compression, such as during walking, running, or massage, respiration, bronchiole constriction, periodic tension in tendon, contraction and relaxation of the diaphragm, tension in the pleural space during respiration, and contractions of the heart. The nonmuscular initial lymphatic system drains into a set of contractile collecting lymphatics, which by way of intrinsic smooth muscle propel lymph fluid. The exact transition between noncontractile and contractile lymphatics has been established only in a limited number of organs and requires further exploration. Retrograde flow of lymph fluid is prevented by valves. There are the usual macroscopic bileaflet valves in the initial and collecting lymphatics and also microscopic lymphatic endothelial valves on the wall of the initial lymphatics. The latter appear to prevent convective reflow into the interstitium during lymphatic compression. Many of the lymph pump mechanisms have been proposed in the past, and most authors agree that these mechanisms influence lymph flow. However, the decisive experiments have not been carried out to establish to what degree these mechanisms are sufficient to explain lymph flow rates in vivo. Because individual organs have different extrinsic pumps at the level of the initial lymphatics, future experiments need to be designed such that each pump mechanism is examined individually so as to make it possible to evaluate the additive effect on the resultant whole organ lymph flow.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2217560
Schmid-Schönbein, G W
Pilomatrix Carcinoma with Lymph Node and Pulmonary Metastases
\\u000a \\u000a Case Report:\\u000a A 72-year-old male patient developed a locally recurrent pilomatrix carcinoma (PC) of the right upper shank. Within a 2-year\\u000a period he also developed bilateral pulmonary as well as inguinal, cervical and paraaortic lymph node metastases. After external-beam\\u000a radiation therapy (EBRT) alone, sole interstitial high-dose-rate (HDR) brachytherapy (BRT) or postoperative EBRT with interstitial\\u000a HDR-BRT boost, the patient demonstrated regressive
Nikolaos Tselis; Reinhard Heyd; Hans-Georg Vogt; Nikolaos Zamboglou
Local immunity in lung-associated lymph nodes in a murine model of pulmonary histoplasmosis.
Local immunity against acute pulmonary histoplasmosis was studied in the lung-associated lymph nodes of normal nonimmune mice infected intratracheally with live Histoplasma capsulatum yeasts. The phenotypes and distribution of cells in lung-associated lymph nodes and spleens were determined by flow cytometry. In addition, the immune responsiveness of these cells was evaluated by in vitro blastogenesis. Anti-H. capsulatum antibodies in serum and H. capsulatum antigen in tissue were measured by immunoassays. Cellular immune responses were greater in the lymph nodes than in the spleens. In lymph nodes 7 days after infection, a marked increase in the number of B lymphocytes caused the percentage to rise to 43%, compared with 26% in controls, and it remained elevated throughout the course of infection. A CD3+ cell that did not express CD4 or CD8 increased in number until it constituted 21% of lymph node cells, compared with 5% in controls, by day 14. The numbers of CD4+ and CD8+ T lymphocytes were modestly increased from days 7 to 35, but their percentages dropped because of the greater numbers of B lymphocytes and CD3+4-8- cells. Macrophages consistently constituted 2 to 3% of lymph node cells during the study. In spleens 7 days after infection, the percentage of macrophages in infected mice rose to 21%, compared with 9% in controls, but the total spleen cell number did not increase until day 14, when all cell subsets were nearly double in number. The in vitro blastogenic response of lymph node cells to H. capsulatum peaked at day 7, but spleen cell response was minimal during the course of infection. Histoplasma-specific serum immunoglobulin G antibodies reached peak levels by day 21 and remained high to the end of the study. In contrast, levels of antigen-specific immunoglobulin M antibodies were very low. These data suggest that antigen-specific immune responses occur in lung-associated lymph nodes and that this draining lymph node response may be an important component in host defense against Histoplasma lung infection.
Fojtasek, M F; Sherman, M R; Garringer, T; Blair, R; Wheat, L J; Schnizlein-Bick, C T
Investigation of lymph flow dynamics using methods of speckle interferometry
NASA Astrophysics Data System (ADS)
For some human diseases both the blood and lymph microcirculation parameters change. These parameters are of great importance in diagnostics. As distinct from blood flow from the lymph motion is more complicated and diverse. Lymph flow in microvessels is non-stationary and randomly varies in time. At present, the existing measuring methods of these flows are not fully developed and are mostly of qualitative character. In this paper the blood and the lymph motion have been considered from the viewpoint of nonlinear dynamics. The speckle-interferometric method has been proposed for the investigation of the dynamic characteristics of biofluids. The method has been applied in the investigation of blood and lymph flows in microvessels. Using the method of the focused Gaussian beam diffraction, the following parameters were defined: V that is the value characterizing the time- averaged velocity of biofluid and (Sigma) V that is the parameter indicating the deviation degree of the spectral envelope from the Gaussian curve. The value of (Sigma) V contains an information about the velocity range in the flow and, besides, indicates the spatial-temporal velocity changes in region being investigated. Investigations of the lymph flow dynamics also have been carried out under the influence of the lymphotropic agent. It has been shown that lymph vessels may act at different stages when both the structure of the lymph flow and its temporal dynamics change qualitatively.
Bednov, Andrey A.; Ulyanov, Sergey S.; Tuchin, Valery V.; Brill, Grigory E.; Zakharova, Ekateryna I.
Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer
Objective: We reviewed our experience with iatrogenic chylothorax after pulmonary resections for lung cancer to evaluate our treatment strategy and to identify factors that predict the need for reoperation. Methods: From July 1992 through February 2000, a total of 1110 patients underwent pulmonary resection (at least lobectomy) and systematic mediastinal lymph node dissection for lung cancer at our division. Twenty-seven
Kimihiro Shimizu; Junji Yoshida; Mituyo Nishimura; Kazuya Takamochi; Rie Nakahara; Kanji Nagai
[Elemental analysis of hilar and mediastinal lymph nodes in idiopathic pulmonary fibrosis].
Elemental analysis of hilar and mediastinal lymph node tissues was performed to determine whether some inhaled atmospheric elements are implicated in the pathogenesis of idiopathic pulmonary fibrosis (IPF). IPF was divided into two types; typical and atypical, according to our criteria. Lymph nodes were selected as the study material rather than lung tissue, because inhaled elements are concentrated in the hilar and mediastinal lymph nodes, and increase in lung weight due to fibrosis may influence the estimated values of element per unit weight of lung tissue. The hilar and mediastinal lymph nodes collected from 40 IPF cases and 43 non-IPF control cases were examined to determine the concentration of 13 elements in 100 mg dry tissue, using the X-ray fluorescent analysis method. For aluminium, 50 mg dry tissue was examined by an atomic absorption analysis method. Among the 14 elements, Ni in IPF lymph nodes showed a significantly higher level than in control nodes (mean +/- SD: 8.2 +/- 21.3 ppm versus 1.1 +/- 2.1 ppm, respectively. p < 0.01). No difference in each of the examined elements was noted between smokers and non-smokers or between typical and atypical IPF cases. Exogenous elements such as Ni may play a role as triggering substances in the pathogenesis of IPF. PMID:1289625
Hashimoto, H; Tajima, H; Mizoguchi, I; Iwai, K
Thymus and pulmonary lymph node response to acute and subchronic ozone inhalation in the mouse
Ozone is an oxidant gas which primarily injures the centroacinar portion of the lung. While the classical lesion of oxidant-mediated lung damage is relatively well described, the effect of this form of injury on the lymphocytic arm of the pulmonary defense system is less clear. In the present experiments Cd-1 female mice were exposed to ozone at a level of 0.7 ppm for 20 hr per day for 1-28 days and the lymphocyte response was observed in the pulmonary lymph nodes and the thymus. In the mediastinal lymph nodes a marked hyperplastic response was observed that was prominent in the paracortex and was characterized by the presence of blastic forms. In contrast, the thymus underwent an atrophic response characterized by cellular loss in the cortical region. Prior surgical adrenalectomy of ozone-exposed animals eliminated part, but not all of the thymic atrophy response, indicating that adrenal-mediated stress alone did not account for all the observed effect. Thymectomy of animals prior to ozone exposure produced a 40% reduction in the mediastinal lymph node response, suggesting that a part of the node hyperplasia is thymus dependent. The results of these experiments indicate that lymphoid organs are altered following oxidant-mediated lung damage in the mouse. The changes are observed in the absence of exogenous antigenic stimulation and suggest that lymphoid cells are in integral aspect of the host response to high-level ozone inhalation.
Dziedzic, D.; White, H.J.
The role of increased pulmonary blood flow in pulmonary arterial hypertension
Chronic increased pulmonary blood flow is considered a pre-requisite for the induction of advanced vascular lesions in pulmonary arterial hypertension in congenital heart defects. The aim of the present study was to characterise the effects of increased pulmonary flow induced by an aortocaval shunt in the monocrotaline rat model for pulmonary hypertension in terms of survival, haemodynamics, pathology and histology.
M. E. van Albada; R. G. Schoemaker; M. S. Kemna; A. H. Cromme-Dijkhuis; R. van Veghel; R. M. F. Berger; G. Salameh; M. R. Karamsetty; R. R. Warburton; J. R. Klinger; N. S. Hill
Pulmonary flow profile and distensibility following acute pulmonary embolism
Objective Proof of concept study evaluating CMR as screening tool for chronic thromboembolic pulmonary hypertension (CTEPH) in patients treated for acute pulmonary embolism (PE). Materials and methods Right and left ventricular function of 15 consecutive patients treated for PE and 10 consecutive patients in whom PE was excluded was estimated at baseline by cardiac CT and at 6 months follow-up by CMR. Additionally, during the follow-up visit, pulmonary artery (PA) hemodynamics were studied by CMR and the presence of pulmonary hypertension by echocardiography. Results CT measured right ventricular ejection fraction (RVEF) was lower in patients with PE compared to patients without PE at time of diagnosis (median 47%, interquartile range 39-53 vs. 55%, 52-58; p = 0.014). After 6 months follow up, the RVEF between patients treated for PE and patients without PE were not statistically significant different (55%, 52-60 versus 54%, 51-57; p = 0.57), as were distensibility index (0.18 ± 0.18 versus 0.25 ± 0.18, p = 0.20), mean velocity (14.1 ± 3.9 cm/s versus 14.0 ± 2.5 cm/s, p = 0.81), peak velocity (86.5 ± 22 cm/s versus 89.6 ± 13 cm/s, p = 0.43) and time to peak PA blood flow velocity (142 ± 49 ms versus 161 ± 29 ms, p = 0.14). One patient was diagnosed with CTEPH and CMR revealed poor right systolic function, decreased PA distensibility and flow velocity, and a systolic notch in the PA flow profile consistent with persistent PA obstruction. Conclusion In this small series, right ventricular performance and PA flow profiles of patients treated for 6 months after PE are equivalent to those parameters in normal patients.
Dynamic Contrast-Enhanced Magnetic Resonance Imaging of Tumor-Induced Lymph Flow1,2
The growth of metastatic tumors in mice can result in markedly increased lymph flow through tumor-draining lymph nodes (LNs), which is associated with LN lymphangiogenesis. A dynamic magnetic resonance imaging (MRI) assay was developed, which uses low-molecular weight gadolinium contrast agent to label the lymphatic drainage, to visualize and quantify tumor-draining lymph flow in vivo in mice bearing metastatic melanomas.
Alanna Ruddell; Maria I. Harrell; Satoshi Minoshima; Kenneth R. Maravilla; Brian M. Iritani; Steven W. White; Savannah C. Partridge
Measurement of Pulmonary Flow Reserve and Pulmonary Index of Microcirculatory Resistance for Detection of Pulmonary Microvascular Obstruction
BackgroundThe pulmonary microcirculation is the chief regulatory site for resistance in the pulmonary circuit. Despite pulmonary microvascular dysfunction being implicated in the pathogenesis of several pulmonary vascular conditions, there are currently no techniques for the specific assessment of pulmonary microvascular integrity in humans. Peak hyperemic flow assessment using thermodilution-derived mean transit-time (Tmn) facilitate accurate coronary microcirculatory evaluation, but remain unvalidated
Rahn Ilsar; Chirapan Chawantanpipat; Kim H. Chan; Timothy A. Dobbins; Richard Waugh; Annemarie Hennessy; David S. Celermajer; Martin K. C. Ng; Jose A. L. Calbet
The Measurement of Skin Lymph Flow by Isotope Clearance—Reliability, Reproducibility, Injection Dynamics, and the Effect of Massage
The measurement of skin lymph flow was investigated using an isotope clearance technique (ICT). Multiple lymph flow determinations were undertaken in the skin of anaesthetized large white pigs to test for reproducibility, ascertain the most suitable tracer, study the influence of injection dynamics, and observe the effect of massage as a stimulus to lymph flow. Blood clearance of tracer was
Peter S. Mortimer; Rose Simmonds; Mohi Rezvani; Michael Robbins; John W. Hopewell; Terence J. Ryan
A study of the effect of sartorius transposition on lymph flow after ilioinguinal node dissection.
Ilioinguinal dissection is associated with a high rate of lymphatic complications. Prolonged lymph flow causes greatest concern and preventive strategies are needed. A retrospective study of 28 consecutive patients undergoing groin dissection for melanoma metastases was performed to evaluate the influence of sartorius muscle transposition on lymph flow. Modification of the surgical technique with transposition of the sartorius muscle was not associated with reduced drainage time (P = 0.66). A 2-staged approach, with initial sentinel lymph node resection and lymph node dissection in a second operation, however, lead to shortened duration of the lymph flow (P = 0.01). Prolonged lymphorrhea was more frequent in older (P = 0.03), obese (P = 0.02) patients affected by diabetes mellitus (P = 0.03) and hypertension (P = 0.04). PMID:18724134
Erba, Paolo; Wettstein, Reto; Rieger, Ulrich M; Haug, Martin; Pierer, Gerhard; Kalbermatten, Daniel F
Altered lymphatics in an ovine model of congenital heart disease with increased pulmonary blood flow
Abnormalities of the lymphatic circulation are well recognized in patients with congenital heart defects. However, it is not known how the associated abnormal blood flow patterns, such as increased pulmonary blood flow (PBF), might affect pulmonary lymphatic function and structure. Using well-established ovine models of acute and chronic increases in PBF, we cannulated the efferent lymphatic duct of the caudal mediastinal node and collected and analyzed lymph effluent from the lungs of lambs with acutely increased PBF (n = 6), chronically increased PBF (n = 6), and age-matched normal lambs (n = 8). When normalized to PBF, we found that lymph flow was unchanged following acute increases in PBF but decreased following chronic increases in PBF. The lymph:plasma protein ratio decreased with both acute and chronic increases in PBF. Lymph bioavailable nitric oxide increased following acute increases in PBF but decreased following chronic increases in PBF. In addition, we found perturbations in the transit kinetics of contrast material through the pleural lymphatics of lambs with chronic increases in PBF. Finally, there were structural changes in the pulmonary lymphatic system in lambs with chronic increases in PBF: lymphatics from these lambs were larger and more dilated, and there were alterations in the expression of vascular endothelial growth factor-C, lymphatic vessel endothelial hyaluronan receptor-1, and Angiopoietin-2, proteins known to be important for lymphatic growth, development, and remodeling. Taken together these data suggest that chronic increases in PBF lead to both functional and structural aberrations of lung lymphatics. These findings have important therapeutic implications that warrant further study.
Datar, Sanjeev A.; Johnson, Eric G.; Oishi, Peter E.; Johengen, Michael; Tang, Eric; Aramburo, Angela; Barton, Jubilee; Kuo, Hsuan-Chang; Bennett, Stephen; Xoinis, Konstantine; Reel, Bhupinder; Kalkan, Gokhan; Sajti, Eniko; Osorio, Oscar; Raff, Gary W.; Matthay, Michael A.
Investigation of statistical properties of lymph-flow dynamics using speckle microscopy
NASA Astrophysics Data System (ADS)
At different pathological stages, the changes both of blood and lymph microcirculation parameters are observed. These parameters are of great importance in diagnostics. The type of these changes may indicate both the kind and the degree of disease. Investigation of the behavior of dynamic characteristics of these flows at different stages is of special interest. In this paper the peculiarities both of blood and lymph motion have been considered. The further development of speckle-interferometrical method has been carried out for the investigation of the dynamic characteristics of blood and lymph flows in microvessels. Analysis of two dynamic parameters which had been introduced in previous papers concerning this problem, is made in this paper. The influence of lymphotropic agent both on lymph flow and its dynamic characteristics is also discussed.
Bednov, Andrey A.; Zakharova, Ekateryna I.; Tuchin, Valery V.; Ul'Yanov, Sergey S.; Brill, Grigory E.
Size-dependent uptake of particles by pulmonary antigen-presenting cell populations and trafficking to regional lymph nodes.
The respiratory tract is an attractive target organ for novel diagnostic and therapeutic applications with nano-sized carriers, but their immune effects and interactions with key resident antigen-presenting cells (APCs) such as dendritic cells (DCs) and alveolar macrophages (AMs) in different anatomical compartments remain poorly understood. Polystyrene particles ranging from 20 nm to 1,000 nm were instilled intranasally in BALB/c mice, and their interactions with APC populations in airways, lung parenchyma, and lung-draining lymph nodes (LDLNs) were examined after 2 and 24 hours by flow cytometry and confocal microscopy. In the main conducting airways and lung parenchyma, DC subpopulations preferentially captured 20-nm particles, compared with 1,000-nm particles that were transported to the LDLNs by migratory CD11blow DCs and that were observed in close proximity to CD3? T cells. Generally, the uptake of particles increased the expression of CD40 and CD86 in all DC populations, independent of particle size, whereas 20-nm particles induced enhanced antigen presentation to CD4? T cells in LDLNs in vivo. Despite measurable uptake by DCs, the majority of particles were taken up by AMs, irrespective of size. Confocal microscopy and FACS analysis showed few particles in the main conducting airways, but a homogeneous distribution of all particle sizes was evident in the lung parenchyma, mostly confined to AMs. Particulate size as a key parameter determining uptake and trafficking therefore determines the fate of inhaled particulates, and this may have important consequences in the development of novel carriers for pulmonary diagnostic or therapeutic applications. PMID:23492193
Blank, Fabian; Stumbles, Philip A; Seydoux, Emilie; Holt, Patrick G; Fink, Alke; Rothen-Rutishauser, Barbara; Strickland, Deborah H; von Garnier, Christophe
Inhibition of the active lymph pump by flow in rat mesenteric lymphatics and thoracic duct
NASA Technical Reports Server (NTRS)
There are only a few reports of the influence of imposed flow on an active lymph pump under conditions of controlled intraluminal pressure. Thus, the mechanisms are not clearly defined. Rat mesenteric lymphatics and thoracic ducts were isolated, cannulated and pressurized. Input and output pressures were adjusted to impose various flows. Lymphatic systolic and diastolic diameters were measured and used to determine contraction frequency and pump flow indices. Imposed flow inhibited the active lymph pump in both mesenteric lymphatics and in the thoracic duct. The active pump of the thoracic duct appeared more sensitive to flow than did the active pump of the mesenteric lymphatics. Imposed flow reduced the frequency and amplitude of the contractions and accordingly the active pump flow. Flow-induced inhibition of the active lymph pump followed two temporal patterns. The first pattern was a rapidly developing inhibition of contraction frequency. Upon imposition of flow, the contraction frequency immediately fell and then partially recovered over time during continued flow. This effect was dependent on the magnitude of imposed flow, but did not depend on the direction of flow. The effect also depended upon the rate of change in the direction of flow. The second pattern was a slowly developing reduction of the amplitude of the lymphatic contractions, which increased over time during continued flow. The inhibition of contraction amplitude was dependent on the direction of the imposed flow, but independent of the magnitude of flow. Nitric oxide was partly but not completely responsible for the influence of flow on the mesenteric lymph pump. Exposure to NO mimicked the effects of flow, and inhibition of the NO synthase by N (G)-monomethyl-L-arginine attenuated but did not completely abolish the effects of flow.
Gashev, Anatoliy A.; Davis, Michael J.; Zawieja, David C.; Delp, M. D. (Principal Investigator)
Coanda effect on ductal flow in the pulmonary artery.
The Coanda effect (the tendency of a jet stream to adhere to a boundary wall), and the relevant anatomy, may explain the location of ductal jets within the main pulmonary artery. With the usual insertion of the duct close to the left pulmonary artery, during right ventricular ejection, the ductal jet adheres to the left wall of the main pulmonary artery. When right ventricular ejection is absent in pulmonary atresia, the ductal jet streams down the right wall of the pulmonary artery to the pulmonary valve, reverses, and maintains a parallel column back toward the bifurcation. If the reversed flow is mistaken for ejection from the right ventricle, the diagnosis of pulmonary atresia may be missed. PMID:10082354
Guntheroth, W; Miyaki-Hull, C
Effect of phosphodiesterase III inhibitor (Olprinone) on thoracic duct lymph flow in anesthetized sheep with experimentally induced heart failure by endothelin-1.
We investigated the short-term effects of a phosphodiesterase III inhibitor (Olprinone) on hemodynamics and thoracic duct lymph flow in anesthetized open-chest sheep with heart failure induced by endothelin-1 (cardiogenic shock). Ultrasound transit-time flow probes were attached to the thoracic duct, the ascending aorta and the renal artery. Arterial, pulmonary and central venous pressures were monitored. Endothelin-1 was infused intravenously at a dosage that reduced cardiac output to 50% or more of baseline (n=11). The effects of Olprinone were examined (n=5) by intravenous infusion after endothelin-1 administration. Other sheep (n=6) were used as controls. Olprinone significantly increased cardiac output that had been decreased by endothelin-1 and further increased thoracic duct flow that had been increased by endothelin-1. Increased arterial and pulmonary pressures induced by endothelin-1 administration were rapidly decreased by Olprinone. Renal arterial flow and central venous pressure were, however, unchanged by Olprinone. Overall, Olprinone acutely improved experimental cardiogenic shock (heart failure) induced by endothelin-1, and maintained thoracic duct lymph flow at a high level after endothelin-1 administration. PMID:12570323
Tomoyasu, M; Onizuka, M; Inagaki, M; Sato, Y; Yamamoto, T; Ishikawa, S; Mitsui, T
In vivo photothermal flow cytometry: imaging and detection of individual cells in blood and lymph flow.
Flow cytometry is a well-established, powerful technique for studying cells in artificial flow in vitro. This review covers a new potential application of this technique for studying normal and abnormal cells in their native condition in blood or lymph flow in vivo. Specifically, the capabilities of the label-free photothermal (PT) technique for detecting and imaging cells in the microvessel network of rat mesentery are analyzed from the point of view of overcoming the problems of flow cytometry in vivo. These problems include, among others, the influences of light scattering and absorption in vessel walls and surrounding tissues, instability of cell velocity, and cells numbers and positions in a vessel's cross-section. The potential applications of this new approach in cell biochemistry and medicine are discussed, including molecular imaging; studying the metabolism and pathogenesis of many diseases at a cellular level; and monitoring and quantifying metastatic and apoptotic cells, and/or their responses to therapeutic interventions (e.g., drug or radiation), in natural biological environments. PMID:16408292
Zharov, Vladimir P; Galanzha, Ekaterina I; Tuchin, Valery V
Recording of lymph flow dynamics in microvessels using correlation properties of scattered coherent radiation
The direction-sensitive method of microflow velocity measurements based on the space - time correlation properties of the dynamic speckle field is described and used for in vivo monitoring of lymph flow in the vessels of rat mesentery. The results of measurements are compared with the data obtained from functional video microscopy of the microvessel region. (laser biology and medicine)
Fedosov, I V; Tuchin, Valerii V; Galanzha, E I [N.G. Chernyshevskii Saratov State University, Saratov (Russian Federation); Solov'eva, A V; Stepanova, T V [Saratov State Medical University, Saratov (Russian Federation)
Pulmonary vascular-bronchial interactions: acute reduction in pulmonary blood flow alters lung mechanics
BACKGROUND—Postoperative pulmonary hypertension in children after congenital heart surgery is a risk factor for death and is associated with severe acute changes in both pulmonary vascular resistance and lung mechanics.?OBJECTIVE—To examine the impact of changes in pulmonary blood flow on lung mechanics in preoperative children with congenital heart disease, in order to assess the cause-effect relation of pulmonary vascular-bronchial interactions.?DESIGN—Prospective, cross sectional study.?SETTING—Cardiac catheterisation laboratory, general anaesthesia with mechanical ventilation.?INTERVENTIONS—Variation of pulmonary blood flow (Qp) by either balloon occlusion of an atrial septal defect before interventional closure, or by complete occlusion of the pulmonary artery during balloon pulmonary valvuloplasty for pulmonary valve stenosis.?MAIN OUTCOME MEASURES—Ventilatory tidal volume (Vt), dynamic respiratory system compliance (Cdyn), respiratory system resistance (Rrs).?RESULTS—28 occlusions were examined in nine patients with atrial septal defect (median age 9.5 years) and 22 in eight patients with pulmonary stenosis (median age 1.2 years). Normalisation of Qp during balloon occlusion of atrial septal defect caused no significant change in airway pressures and Rrs, but there was a small decrease in Vt (mean (SD): 9.61 (0.85) to 9.52 (0.97) ml/kg; p < 0.05) and Cdyn (0.64 (0.11) to 0.59 (0.10) ml/cm H2O*kg; p < 0.01). These changes were more pronounced when there was complete cessation of Qp during balloon valvuloplasty in pulmonary stenosis, with a fall in Vt (9.71 (2.95) to 9.32 (2.84) ml/kg; p < 0.05) and Cdyn (0.72 (0.29) to 0.64 (0.26) ml/cm H2O*kg; p < 0.001), and there was also an increase in Rrs (25.1 (1.7) to 28.8 (1.6) cm H2O/litre*s; p < 0.01). All these changes exceeded the variability of the baseline measurements more than threefold.?CONCLUSIONS—Acute changes in pulmonary blood flow are associated with simultaneous changes in lung mechanics. While these changes are small they may represent a valid model to explain the pathophysiological impact of spontaneous changes in pulmonary blood flow in clinically more critical situations in children with congenital heart disease.???Keywords: pulmonary blood flow; lung mechanics; catheter intervention; cardiopulmonary interaction
Schulze-Neick, I; Penny, D; Derrick, G; Dhillon, R; Rigby, M; Kelleher, A; Bush, A; Redington, A
Pulmonary lymphatic mapping in dogs: use of technetium sulfur colloid and isosulfan blue for pulmonary sentinel lymph node mapping in dogs.
Lung cancer is the most frequent cause of cancer death in the United States. The pattern of regional lymph node involvement is a major prognostic factor in a patient with nonsmall cell lung cancer. The accuracy of information obtained about the lymph node status of lung cancer patients can be potentially increased by sentinel node lymphatic mapping. This technique has been well studied in melanoma and breast cancer. It may be useful in increasing the detection of micrometastases and in decreasing the morbidity from complete mediastinal lymphadenectomy. We report an animal pilot study of pulmonary lymphatic mapping. The aim of our study was to gain experience in the surgical techniques for pulmonary sentinel node lymphatic mapping in an animal model prior to its application in humans. Technetium sulfur colloid and isosulfan blue dye were injected into different lobes of the lung followed by attempts to identify the sentinel node draining that specific portion of the lung. Technetium sulfur colloid identified the sentinel node in five of six dogs within 20 min after the radiotracer was injected into the lung parenchyma. Isosulfan blue dye identified the sentinel node in three of six dogs within 5 min. Both the agents are potentially useful, but we found greater technical ease in identifying the sentinel node with technetium sulfur colloid. Two single-institution pilot studies in humans have been performed. A multicentered study to validate and further refine this technique is necessary. Advanced pathologic techniques such as immunohistochemistry and reverse transcriptase-polymerase chain reaction can be used to enhance the accuracy of staging. This may facilitate proper application of novel therapeutic strategies to improve the current dismal prognosis of this disease. PMID:12449726
Nwogu, Chukwumere E; Kanter, Peter M; Anderson, Timothy M
The measurement of skin lymph flow by isotope clearance--reliability, reproducibility, injection dynamics, and the effect of massage
The measurement of skin lymph flow was investigated using an isotope clearance technique (ICT). Multiple lymph flow determinations were undertaken in the skin of anaesthetized large white pigs to test for reproducibility, ascertain the most suitable tracer, study the influence of injection dynamics, and observe the effect of massage as a stimulus to lymph flow. Blood clearance of tracer was also investigated. Results demonstrated that lymphatic clearance is a monoexponential function with good reproducibility under controlled laboratory conditions. 99mTc-colloid (TCK17 Cis) compared favorably with 131I-human serum albumin as a tracer and both performed better than colloid gold (198Au). Lymph flow was significantly faster in one pig than in the other. No difference existed between left and right sides or between caudal and rostral sites on each flank, but clearance was significantly slower in thigh than flank skin. Sub-epidermal injections cleared faster and more consistently than either deep or subcutaneous injections. Neither injection volume nor needle tract backflow of tracer influenced results, but local massage significantly enhanced clearance. Escape of 99mTc-colloid by the blood was negligible. These results indicate that skin lymph flow can be reliably measured when conditions are controlled. Extrinsic factors such as massage strongly influence lymph flow. Greater sensitivity in detecting degrees of lymphatic insufficiency may be achieved if a standardized stimulus to lymph flow is administered during isotope clearance measurement.
Mortimer, P.S.; Simmonds, R.; Rezvani, M.; Robbins, M.; Hopewell, J.W.; Ryan, T.J. (Slade Hospital, Oxford (England))
In Vivo Multispectral Photoacoustic Lymph Flow Cytometry with Natural Cell Focusing and Multicolor Nanoparticle Probes
Background Compared to blood tests, cell assessment in lymphatics is not well-established. The goal of this work was to develop in vivo lymph tests using the principles of flow cytometry. Methods Cells in living animals were counted by laser (420-2300 nm) generation of photoacoustic (PA) signals in individual cells hydrodynamically focused by lymph valves into a single file flow, and using endogenous absorption as intrinsic cell-specific markers, or gold nanorods, nanoshells, and carbon nanotubes as multicolor probes. PA data was verified by high-speed transmission, photothermal, and fluorescent imaging. Results Counting melanoma and immune-related cells in normal, apoptotic, and necrotic stages in lymphatics in vivo was demonstrated to have the unprecedented sensitivity as one metastatic cell among millions of normal cells. The time-resolved PA spectral identification of flowing cells was achieved using multicolor labels and laser pulses of different wavelengths and time delays. Conclusions Multispectral, non-invasive, portable flow cytometery can be used for preclinical studies on animals with the potential of translation to humans for in vivo PA mapping of colorless lymph vessels and sentinel nodes with simultaneous single cell detection and metastasis assessment without labeling or use of contrast dyes and/or novel low-toxic multicolor probes with different absorption spectra.
Galanzha, Ekaterina I.; Shashkov, Evgeny V.; Tuchin, Valery V.; Zharov, Vladimir P.
Cerebral blood flow during treatment for pulmonary hypertension
AIM—To determine if the haemodynamics of systemic and cerebral circulation are changed during treatment for persistent pulmonary hypertension of the newborn (PPHN).?METHODS—Fifteen term newborn piglets with hypoxia induced pulmonary hypertension were randomly assigned either tolazoline infusion (Tz), hyperventilation alkalosis (HAT), and inhaled nitric oxide (iNO). Mean pulmonary arterial pressure (PAP), mean systemic arterial pressure (SAP), and cerebral blood flow volume (CBF) were measured.? RESULTS—During hypoxic breathing, PAP increased significantly in all groups. After treatment PAP decreased significantly in all groups, but no significant difference was observed between groups. SAP decreased significantly only in the Tz group, and CBF reduced significantly only in the HAT group. On the other hand, iNO did not change SAP or CBF.?CONCLUSION—Inhaled NO might be ideal for the resolution of pulmonary hypertension.??
Kusuda, S.; Shishida, N.; Miyagi, N.; Hirabayashi, M.; Kim, T.
Photothermal imaging of moving cells in lymph and blood flow in vivo
NASA Astrophysics Data System (ADS)
The in vivo capabilities of a new, integrated optical system for studying lymph and blood flow were explored, including imaging of moving red and white blood cells. This system combined transmission microscopy with different dual-beam photothermal (PT) techniques, such as PT imaging, PT thermolens method, and PT deflection velocimetry. All of these PT techniques are based on irradiation of rat mesenteric microvessels with a short laser pulse and on detection of temperature-dependent variations of the refractive index with a second, probe laser beam. In general, the concept of in vivo PT flow cytometry was developed, with a focus on real-time monitoring of moving blood cells in their natural states without labeling (e.g., fluorescent), including obtaining PT images of the cells and determining their flow velocity and response to different interventions. Preliminary experiments revealed many potential applications of this integrated system: (1) quantitation of lymph and blood flow without probes; (2) imaging of moving red and white blood cells; (3) visualization and tracking of PT nanoprobes and sensitizers; (4) comparison of laser-tissue interactions in vivo and in vitro, especially optimization of laser treatment of vascular lesions (port-wine stains, lymphatic malformations, etc.); and (5) determination of the link between in vitro and in vivo cytotoxicity studies.
Zharov, Vladimir P.; Galanzha, Ekaterina I.; Tuchin, Valery V.
Flow cytometric pattern recognition of lymph node biopsies with lymphomas that lack lineage characteristics.
Although immunophenotyping (IPT) using flow cytometry is a routine technique that is applied in many laboratories as a diagnostic tool for lymphadenopathy, some diagnostic challenges persist. In this review, we will discuss pitfalls in the daily practice of lymph node diagnostics with the focus on general characteristics as lymphoid scatter patterns and lineage specific antigens that are used to define lymphoid populations. The absence of these characteristics on proliferating lymphoid cells can potentially lead to a wrong diagnosis. At the same time, this provides evidence for malignant transformation. Sporadic examples of reactive lymphoid proliferations with similar phenotypes are also discussed, illustrating the need for correlating IPT with morphology and clinical features. PMID:24750671
Hebeda, K; Preijers, F
Local lymph node assay: differentiating allergic and irritant responses using flow cytometry.
The murine local lymph node assay (LLNA) is a method for assessing the contact sensitization potential of chemicals. Based on events that occur during the induction phase of a contact sensitization response, the LLNA measures the in vivo proliferation of cells in the draining lymph nodes (DLNs) of mice following topical exposure to chemicals. In terms of predictive identification of important skin sensitizers, the LLNA has been shown to be at least as sensitive as, and much more reliable than, current guinea pig tests. However, proliferation has also been observed following treatment with some irritants. In an attempt to distinguish allergic from irritant-induced proliferation, flow cytometric techniques have been used to examine the phenotype of lymphocyte subsets in the DLNs as well as markers of T-lymphocyte activation and memory. Mice were treated on the ears for 3 consecutive days with allergens or irritants. The DLNs were harvested 72 h after the final treatment. Single-cell suspensions were prepared, counted, and stained for analysis of the percentages of T cells and B cells and T-cell expression of two adhesion molecules that have been associated with differentiating naďve and activated/memory T cells, CD62L (L-selectin) and CD44 (H-cam). Increases in lymph node cellularity were observed in both allergen- and irritant-treated mice relative to naďve and vehicle-treated animals. Mice treated with allergens showed a preferential increase in the percentage of B220(+) B cells compared with irritant-treated mice. Treatment with allergens, but not irritants, resulted in a selective increase in the percentages of CD4(+) and CD8(+) cells expressing the T-cell activation/memory phenotype CD62L(lo)CD44(hi). Taken together, flow cytometric analysis of cell phenotype and expression of T-cell activation/memory markers may provide important information for differentiating allergen- and irritant-induced proliferative responses in the DLNs of chemically treated mice. PMID:10525437
Gerberick, G F; Cruse, L W; Ryan, C A
Characterizing pulmonary blood flow distribution measured using arterial spin labeling
The arterial spin labeling (ASL) method provides images in which, ideally, the signal intensity of each image voxel is proportional to the local perfusion. For studies of pulmonary perfusion, the relative dispersion (RD, standard deviation/mean) of the ASL signal across a lung section is used as a reliable measure of flow heterogeneity. However, the RD of the ASL signals within the lung may systematically differ from the true RD of perfusion because the ASL image also includes signals from larger vessels, which can reflect the blood volume rather than blood flow if the vessels are filled with tagged blood during the imaging time. Theoretical studies suggest that the pulmonary vasculature exhibits a lognormal distribution for blood flow and thus an appropriate measure of heterogeneity is the geometric standard deviation (GSD). To test whether the ASL signal exhibits a lognormal distribution for pulmonary blood flow, determine whether larger vessels play an important role in the distribution, and extract physiologically relevant measures of heterogeneity from the ASL signal, we quantified the ASL signal before and after an intervention (head-down tilt) in six subjects. The distribution of ASL signal was better characterized by a lognormal distribution than a normal distribution, reducing the mean squared error by 72% (p < 0.005). Head-down tilt significantly reduced the lognormal scale parameter (p = 0.01) but not the shape parameter or GSD. The RD increased post-tilt and remained significantly elevated (by 17%, p < 0.05). Test case results and mathematical simulations suggest that RD is more sensitive than the GSD to ASL signal from tagged blood in larger vessels, a probable explanation of the change in RD without a statistically significant change in GSD. This suggests that the GSD is a useful measure of pulmonary blood flow heterogeneity with the advantage of being less affected by the ASL signal from tagged blood in larger vessels.
Henderson, A. Cortney; Prisk, G. Kim; Levin, David L.; Hopkins, Susan R.; Buxton, Richard B.
LASER BIOLOGY AND MEDICINE: Recording of lymph flow dynamics in microvessels using correlation properties of scattered coherent radiation
NASA Astrophysics Data System (ADS)
The direction-sensitive method of microflow velocity measurements based on the space — time correlation properties of the dynamic speckle field is described and used for in vivo monitoring of lymph flow in the vessels of rat mesentery. The results of measurements are compared with the data obtained from functional video microscopy of the microvessel region.
Fedosov, I. V.; Tuchin, Valerii V.; Galanzha, E. I.; Solov'eva, A. V.; Stepanova, T. V.
LASER BIOLOGY AND MEDICINE: Recording of lymph flow dynamics in microvessels using correlation properties of scattered coherent radiation
The direction-sensitive method of microflow velocity measurements based on the space --- time correlation properties of the dynamic speckle field is described and used for in vivo monitoring of lymph flow in the vessels of rat mesentery. The results of measurements are compared with the data obtained from functional video microscopy of the microvessel region.
I. V. Fedosov; Valerii V. Tuchin; E. I. Galanzha; A. V. Solov'eva; T. V. Stepanova
Simulation model for flow of neutrophils in pulmonary capillary network.
The concentration of neutrophils in the pulmonary microvasculature is higher than in systemic large vessels. It is thought that the high concentration of neutrophils facilitates their effective recruitment to sites of inflammation. Thus, in order to understand the role of neutrophils in the immune system, it is important to clarify their flow characteristics in the pulmonary microvasculature. In previous studies, we numerically investigated the motion of a neutrophil through a single capillary segment modeled by a moderate axisymmetric constriction in a straight pipe, developing a mathematical model for the prediction of the transit time of the cell through the segment. In the present study, this model was extended for application to network simulation of the motion of neutrophils. First, we numerically investigated shape recovery of a neutrophil after expulsion from a narrow capillary segment. This process was modeled in two different phases: elastic recovery and viscous recovery. The resulting model was combined with the previously developed models to simulate motion of the cells and plasma flow in a capillary network. A numerical simulation of the motion of neutrophils and plasma flow in a simple lattice capillary network showed that neutrophils were widely dispersed in the network with an increased concentration. PMID:16055978
Shirai, Atsushi; Fujita, Ryo; Hayase, Toshiyuki
Phasic hemodynamics and reverse blood flows in the aortic isthmus and pulmonary arteries of preterm lambs with pulmonary vascular dysfunction.
Time-domain representations of the fetal aortopulmonary circulation were carried out in lamb fetuses to study hemodynamic consequences of congenital diaphragmatic hernia (CDH) and the effects of endothelin-receptor antagonist tezosentan (3 mg/45 min). From the isthmic aortic and left pulmonary artery (PA) flows (Q) and isthmic aortic, PA, and left auricle pressures (P) on day 135 in 10 controls and 7 CDH fetuses (28 ewes), discrete-triggered P and Q waveforms were modelized as Pt and Qt functions to obtain basic hemodynamic profiles, pulsatile waves [P, Q, and entry impedance (Ze)], and P and Q hysteresis loops. In the controls, blood propelling energy was accounted for by biventricular ejection flow waves (kinetic energy) with low Ze and by flow-driven pressure waves (potential energy) with low Ze. Weak fetal pulmonary perfusion was ensured by reflux (reverse flows) from PA branches to the ductus anteriosus and aortic isthmus as reverse flows. Endothelin-receptor antagonist blockade using tezosentan slightly increased the forward flow but largely increased diastolic backward flow with a diminished left auricle pre- and postloading. In CHD fetuses, the static component overrode phasic flows that were detrimental to reverse flows and the direction of the diastolic isthmic flow changed to forward during the diastole period. Decreased cardiac output, flattened pressure waves, and increased forward Ze promoted backward flow to the detriment of forward flow (especially during diastole). Additionally, the intrapulmonary arteriovenous shunting was ineffective. The slowing of cardiac output, the dampening of energetic pressure waves and pulsatility, and the heightening of phasic impedances contributed to the lowering of aortopulmonary blood flows. We speculate that reverse pulmonary flow is a physiological requirement to protect the fetal pulmonary circulation from the prominent right ventricular stream and to enhance blood flow to the fetal heart and brain. PMID:18820030
Rolland, Pierre-Henri; de Lagausie, Pascal; Stathopoulos, Euletheris; Leprčtre, Olivier; Viudes, Gilles; Gorincour, Guillaume; Hery, Géraldine; de Magnée, Catherine; Paut, Olivier; Guys, Jean-Michel
Generating a Pulsatile Pulmonary Flow after Fontan Operation by Means of Computational Fluid Dynamics (CFD)
This study considers blood flow in total cavopulmonary connection (TCPC) morphology, which is created in Fontan surgical procedure in patients with single ventricle heart disease. Ordinary process of TCPC operation reduces pulmonary blood flow pulsatility; because of right ventricle being bypassed. This phenomenon causes a lot of side effects for patients. A cardiac surgeon has suggested that keeping main pulmonary
Mostafa Ghoreyshi
In vivo multispectral, multiparameter, photoacoustic lymph flow cytometry with natural cell focusing, label-free detection and multicolor nanoparticle probes.
Compared with blood tests, cell assessment in lymphatics is not well-established. The goal of this work was to develop in vivo lymph tests using the principles of flow cytometry. Cells in living animals were counted by laser (420-2,300 nm) generation of photoacoustic (PA) signals in individual cells hydrodynamically focused by lymph valves into a single file flow, and using endogenous absorption as intrinsic cell-specific markers, or gold nanorods, nanoshells, and carbon nanotubes as multicolor probes. PA data were verified by high-speed transmission, photothermal, and fluorescent imaging. Counting of melanoma and immune-related cells in normal, apoptotic, and necrotic states in lymphatics in vivo was demonstrated to have the unprecedented sensitivity as one metastatic cell among millions of white blood cells. The time-resolved PA spectral identification of flowing cells was achieved using multicolor labels and laser pulses of different wavelengths and time delays. Multiparameter, noninvasive, portable flow cytometer can be used for preclinical studies on animals with the potential of translation to humans for in vivo PA mapping of colorless lymph vessels and sentinel nodes with simultaneous single cell detection and metastasis assessment without labeling or use of contrast dyes and/or novel low-toxic multicolor probes with different absorption spectra. PMID:18677768
Galanzha, Ekaterina I; Shashkov, Evgeny V; Tuchin, Valery V; Zharov, Vladimir P
Pulmonary blood flow distribution in sheep: effects of anesthesia, mechanical ventilation, and change in posture
NASA Technical Reports Server (NTRS)
BACKGROUND: Recent studies providing high-resolution images of pulmonary perfusion have questioned the classical zone model of pulmonary perfusion. Hence the present work was undertaken to provide detailed maps of regional pulmonary perfusion to examine the influence of anesthesia, mechanical ventilation, and posture. METHODS: Pulmonary perfusion was analyzed with intravenous fluorescent microspheres (15 microm) in six sheep studied in four conditions: prone and awake, prone with pentobarbital-anesthesia and breathing spontaneously, prone with anesthesia and mechanical ventilation, and supine with anesthesia and mechanical ventilation. Lungs were air dried at total lung capacity and sectioned into approximately 1,100 pieces (about 2 cm3) per animal. The pieces were weighed and assigned spatial coordinates. Fluorescence was read on a spectrophotometer, and signals were corrected for piece weight and normalized to mean flow. Pulmonary blood flow heterogeneity was assessed using the coefficient of variation of flow data. RESULTS: Pentobarbital anesthesia and mechanical ventilation did not influence perfusion heterogeneity, but heterogeneity increased when the animals were in the supine posture (P < 0.01). Gravitational flow gradients were absent in the prone position but present in the supine (P < 0.001 compared with zero). Pulmonary perfusion was distributed with a hilar-to-peripheral gradient in animals breathing spontaneously (P < 0.05). CONCLUSIONS: The influence of pentobarbital anesthesia and mechanical ventilation on pulmonary perfusion heterogeneity is small compared with the effect of changes in posture. Analysis of flow gradients indicate that gravity plays a small role in determining pulmonary blood flow distribution.
Walther, S. M.; Domino, K. B.; Glenny, R. W.; Hlastala, M. P.
Generating a Pulsatile Pulmonary Flow after Fontan Operation by Means of Computational Fluid Dynamics (CFD)
NASA Astrophysics Data System (ADS)
This study considers blood flow in total cavopulmonary connection (TCPC) morphology, which is created in Fontan surgical procedure in patients with single ventricle heart disease. Ordinary process of TCPC operation reduces pulmonary blood flow pulsatility; because of right ventricle being bypassed. This phenomenon causes a lot of side effects for patients. A cardiac surgeon has suggested that keeping main pulmonary artery (MPA) partially open, would increase pulmonary flow pulsations. MPA gets closed in ordinary TCPC operation. The purpose of current study is to verify the effects of keeping MPA partially open on pulmonary flow pulsations, by means of computational fluid dynamics (CFD). 3D geometry is reconstructed from CT Angiography (CTA) scan of a patient who has undergone an ordinary TCPC procedure. The stenosed MPA or pulmonary stenosis (PS) is virtually added to the original geometry. Flow field is studied in six different models in which average antegrade flow (AF) -coming through PS- increases gradually. Results show that adding AF increases flow pulsations in both pulmonary arteries. Moreover, power loss increases with respect to average AF. We conclude that adding AF is an impressive way to increase pulsations of pulmonary flow, but energy losses should be considered too.
Ghoreyshi, Mostafa
Background Alterations in pulmonary blood flow are often associated with the initiation and progression of pulmonary vascular disease. However, the cellular mechanisms involved in mediating flow effects in the pulmonary circulation remain unclear. Depending on the disease condition flow may be extremely low or high. We therefore examined effects of pathologically low and high flow on endothelial production of factors capable of affecting pulmonary vascular tone and structure and on potential underlying mechanisms. Methods Flow effects on pulmonary endothelial release of NO, PGF1a, ET-1 and TxB2, and on expression of total and phosphorylated eNOS and Akt, and VEGF were examined. Additionally, in a co-culture system, effects of flow-exposed endothelial cells on smooth muscle (SM) proliferation and contractile protein were studied. Results Compared to physiological flow, pathologically high and low flow attenuated endothelial release of NO, PGF1a, and enhanced release of ET-1. Physiological flow activated Akt/eNOS pathway while pathological flow depressed it. Pathologically high flow altered VE-cadherin expression. Pathologically high flow on the endothelium upregulated alpha-SM-actin and SM-MHC without affecting SM proliferation. Conclusion Physiological flow leads to production of mediators which favor vasodilation. Pathological flow alters the balance of mediator production which favors vasoconstriction.
Li, Min; Stenmark, Kurt R.; Shandas, Robin; Tan, Wei
Comparison of gene expression of immune mediators in lung and pulmonary lymph node granulomas from cattle experimentally infected with Mycobacterium bovis.
The cellular infiltrates and macrophage activation pathways may differ in granulomas found in the lungs and pulmonary lymph nodes of cattle infected with Mycobacterium bovis. The aim of this study was to compare the histopathology and gene expression profiles of cytokines and immune mediators for cattle which had these lesions in both sites. Ten Friesian-cross, 15-16 month old cattle were challenged intratracheally with 5×10(3)CFU of virulent M. bovis and killed and necropsied at 28 weeks after infection. Seven animals were found to have gross TB granulomas in both their lungs and pulmonary lymph nodes (PLN) and these lesions were fully encapsulated with central necrosis and mineralisation. Neutrophil infiltration was clearly involved in granuloma in lung whereas neutrophils were limited in lesions of PLN. Comparisons were made of immune mediators from these two sites from the same animals as well as those between lesioned PLN tissues and non-lesioned prescapular lymph nodes (PSLN). Gene expressions of the immune mediators were normalised using a housekeeping gene (U1), a monocyte/macrophage marker (CD14) and a common leucocyte marker (CD45). mRNA expression of IFN-?, IL-17A, IRF5(1) and arginase 1 (Arg1) was significantly up-regulated in lung compared to that for PLN (p<0.05), while mRNA expression of IFN-?, IL-12p40, TNF-? and iNOs for PLN was significantly higher than that for PSLN (p<0.05). In addition, IL-10 mRNA expression was significantly higher for lung compared to PLN when normalised for CD45 (p<0.05). The results suggested that the stronger proinflammatory immune response in the lesioned lung may be a consequence of enhanced expression of IRF5 promoting IFN-? and IL-17 production. In contrast, Arg1 expression in the lungs could facilitate the infection through competing with iNOs for l-arginine, preventing generation of nitric oxide for clearance of M. bovis infection. PMID:24852075
Shu, Dairu; Heiser, Axel; Neil Wedlock, D; Luo, Dongwen; de Lisle, Geoffrey W; Buddle, Bryce M
Effects of a localized high-flow anastomosis between aorta and left lower lobe pulmonary artery on great vessel flow and pulmonary arterial reactivity in the contralateral lung
Objectives To assess effects of a localized anastomosis between the aorta and left lower lobe pulmonary artery (LLLPA) on flows through central vessels, and on vascular reactivity of small PAs distal or contralateral to the shunt. Methods Flow rates in major vessels and tensions from small PAs from left and right lower lobes were determined 48 hours after creation of an end-to-side anastomosis of the LLLPA to the aorta. Results Anastomoses increased flow through the LLLPA from 194 ± 6 to 452 ± 18 ml/min immediately after anastomosis and to 756 ± 19 ml/min by the time of harvest (n=88, p<0.05). Flow rates in main PAs from hosts with anastomoses were lower (557 ± 26 versus1033 ± 244 ml/min) while aortic root flows were not different from controls (1370 ± 53 compared to 1120 ± 111 ml/min; p = 0.07). Wet-to-dry weights of the both lungs and aortic flow rates were proportional to shunt flow rates. PA rings harvested from the right (unshunted) lobe of high flow hosts exhibited increased reactivity to the thromboxane agonist U46619 and phenylephrine relative to those of left PAs from the same animal or those of control hosts. Conclusions Our studies are the first to identify enhanced reactivity of PAs in a lung contralateral to a localized high output shunt between an aorta and pulmonary artery. These observations suggest that patients with localized systemic-to-pulmonary shunt could exhibit modified vascular tone in remote pulmonary arteries.
Somberg, Lewis; Nirula, Ram; Bousamra, Michael; Friesema, Jill; Zhu, Daling; Medhora, Meetha; Jacobs, Elizabeth R.
Pathways of lymph and tissue fluid flow during intermittent pneumatic massage of lower limbs with obstructive lymphedema.
Questions remain on the use of sequential pneumatic compression including where does the fluid flow to and whether fluid can be moved to the non-swollen tissues of the hypogastrium and gluteal region? During pneumatic massage of the limb, we studied pathways of lymph and mobile tissue fluid flow using lymphoscintigraphy: a) from the calf and thigh across the inguinal region to the healthy non-swollen tissues of the hypogastrium and b) in the hypogastrium to the lateral and upper abdominal quadrants. To examine if there was effective fluid flow during pneumatic massage, plethysmographic flow measurements were also carried out. We demonstrated that: (i) pneumatic compression moved isotope in lymph remaining in functioning lymphatics and in tissue fluid in the interstitial space toward the inguinal region and femoral channel, (ii) there was no isotope crossing the inguinal crease or moving to the gluteal area, and (iii) isotope injected intradermally in the hypogastrium did not spread during manual massage to the upper and contralateral abdominal quadrants. In conclusion, intermittent pneumatic compression is effective in pushing mobile tissue fluid and relocating large fluid volumes toward the groin. However, the question that still remains is how to facilitate further flow toward the non-swollen tissues and thereby increase local absorption of fluid. PMID:21949974
Olszewski, W L; Cwikla, J; Zaleska, M; Domaszewska-Szostek, A; Gradalski, T; Szopinska, S
Effects of Antenatal Betamethasone on Human Fetal Branch Pulmonary Artery Flow Velocity Waveforms
Objective: To evaluate the effect of antenatal betamethasone on fetal branch pulmonary artery flow velocity waveforms. Methods: Betamethasone 12 mg i.m. in 2 injections 24 h apart was given to 25 pregnant women at risk of preterm delivery. Pulsatility (PI) and resistance (RI) indexes were measured at the proximal, middle and distal segments of the fetal pulmonary artery before and
José L. Bartha; Marta Largo-Heinrich; María J. Machado; Fernando González-Bugatto; Blas Hervías-Vivancos
Doppler echocardiographic evaluation of pulmonary artery flow after modified Fontan operation: importance of atrial contraction
Doppler echocardiography was used to evaluate blood flow in the pulmonary artery in 14 patients 2 to 42 months (mean (SD) 17 (12) months) after a modified Fontan operation incorporating a direct atriopulmonary anastomosis. Preoperatively six patients had tricuspid atresia, six had a double inlet left ventricle, and two had pulmonary atresia with an intact ventricular septum. The postoperative rhythm
S A Qureshi; R Richheimer; R McKay; R Arnold
Pulmonary and systemic blood flow contributions to upper airways in canine lung
The blood flow contributions and drainage patterns of the pulmonary and systemic circulations in the upper airways (trachea and main bronchi) were assessed in anesthetized dogs by injecting 15-{mu}m radiolabeled microspheres into the right and left heart, respectively. After the animals were killed, the tracheal cartilage, tracheal muscle-mucosa, and main bronchi were excised. The tracheal cartilage and tracheal muscle-mucosa were divided into lower, middle, and upper segments for blood flow determinations. The pulmonary contribution to tracheal blood flow was very small, being higher in the lower segments. The systemic contribution to these same tracheal regions was significantly higher, and higher in the upper segments. The pulmonary and systemic circulations each contributed {approximately}50% to the main bronchi blood flow. The pulmonary blood flow contribution alone to the trachea and main bronchi was also determined in subsequent experiments that utilized the isolated lung, and these blood flows were not significantly different from the pulmonary contribution measured in the intact lungs. The present results indicate that the systemic (bronchial) circulation is the primary source of tracheal blood flow and that both the pulmonary and systemic circulations may contribute {approximately}50% of the blood flow to the main bronchi in dog lungs.
Barman, S.A.; Ardell, J.L.; Parker, J.C.; Perry, M.L.; Taylor, A.E. (Univ. of South Alabama, Mobile (USA))
[Preliminary experience with the use of electromagnetic navigation for the diagnosis of peripheral pulmonary nodules and enlarged mediastinal lymph nodes].
Electromagnetic navigation is a new technique that can be used with bronchoscopy to obtain samples of small peripheral nodular lesions and enlarged mediastinal lymph nodes. It is very versatile in that it enables both transbronchial biopsies and fine-needle aspiration to be performed. We describe 2 cases in which navigation with the superDimension/Bronchus system combined with traditional diagnostic techniques facilitated a definitive diagnosis by bronchoscopy. Electromagnetic navigation can obviate the need for more invasive diagnostic procedures such as surgery, thus saving time and money and avoiding complications. PMID:17692247
Seijo, Luis M; Bastarrika, Gorka; Lozano, María Dolores; Zulueta, Javier J
Prenatal diagnosis of tetralogy of fallot with absent pulmonary valve using advanced dynamic flow.
Tetralogy of Fallot with pulmonary valve absence can cause severe respiratory distress immediately after birth; therefore, a prenatal diagnosis is important. In this paper, we report a case using advanced dynamic flow to enhance its diagnosis. PMID:15692204
Liezl, Augusto; Nobuhiro, Hidaka; Yoshihide, Chiba
The effect of pulmonary blood flow changes on oxygen-enhanced lung magnetic resonance imaging.
In this study, we investigated the effects of changes in pulmonary blood flow on oxygen-enhanced lung magnetic resonance imaging. Increased pulmonary blood flow was produced by intravenous infusion of sildenafil (0.2 mg/kg) in 10 New Zealand white rabbits. Decreased pulmonary blood flow was produced by single subcutaneous injection of monocrotaline (60 mg/kg). A velocity-encoded cine magnetic resonance imaging for pulmonary blood flow and an oxygen-enhanced lung magnetic resonance imaging were performed at baseline, during sildenafil infusion, and after monocrotaline injection. We compared the baseline data to those obtained during sildenafil infusion and after monocrotaline injection for pulmonary blood flow changes and signal intensity enhancement ratios of oxygen-enhanced lung magnetic resonance imaging. Wilcoxon's signed rank test was used for statistical analysis. There was a significant difference between pulmonary blood flow at baseline (418.6±108.9 mL/min) and after sildenafil (491.9±118.0 mL/min; P=0.005) or between pulmonary blood flow at baseline and after monocrotaline administration (356.3±85.8 mL/min; P=0.017). However, there was no significant difference between the signal intensity enhancement ratios at baseline (23.8±11.4%) and after sildenafil (24.0±7.9%; P=0.953) or the signal intensity enhancement ratios at baseline and after monocrotaline administration (22.7±10.3%; P=0.374). Changes in pulmonary blood flow had little effect on the signal intensity enhancement ratio of oxygen-enhanced lung magnetic resonance imaging. PMID:22760954
Lee, Hye-Jeong; Park, Jaeseok; Hur, Jin; Kim, Young Jin; Nam, Ji Eun; Choi, Byoung Wook; Choe, Kyu Ok
Digital cine angiographic evaluation of pulmonary blood flow velocity in ventricular septal defect
Forty-one routine right ventricular cineangiograms of children with ventricular septal defect (VSD) were evaluated with a\\u000a digital image processing system. The purpose was to extract from the cineangiogram functional images that would provide information\\u000a about pulmonary blood flow in these patients. The time delay of the contrast bolus between the main pulmonary artery and peripheral\\u000a lung fields was measured and
G. Riediger; L. M. Grävinghoff; K. H. Höhne; E. W. Keck
Flow cytometry CD4(+)CD26 (-)CD38 (+) lymphocyte subset in the microenvironment of Hodgkin lymphoma-affected lymph nodes.
Hodgkin lymphoma (HL) is traditionally diagnosed by the presence of neoplastic Hodgkin and Reed-Sternberg (HRS) cells found in minority within a typical inflammatory microenvironment. It is now recognized that the majority of these T CD4 cells are T regulatory (Treg) and play an important immunosuppressive role and contribute to tumour persistence. Flow cytometric immunophenotyping of lymphocytes was performed on lymph node samples over a 12-year period (2000-2012) to identify the Hodgkin-specific subset and potential biomarkers related to Treg cells. CD3, CD19 and T CD4(+)CD26(-)CD38(+) subsets were measured in the lymphocytic infiltrate of 108 consecutive lymph node samples concurrently diagnosed histologically as HL and in 43 cases of benign reactive lymphoid hyperplasia (BRLH). HL, compared to BRLH, shows statistically significant differences within the reactive microenvironmental population: decreased CD19(+) cells (23 % vs 39 %; p?0.001), increased CD3(+) (74 % vs 58 %; p?0.001) and CD4(+)CD26(-)CD38(+) cells (38 % vs 11.5 %; p?0.001). By using the co-expressed markers CD38 and CD26 for logistic analysis, the obtained receiver operating characteristic (ROC) curves confirm that the CD4(+)CD26(-)CD38(+) subset is strongly expressed in HL (ROC AUC?=?0,8639). Flow cytometric detection of CD4(+)CD26(-)CD38(+) cells seems able to identify the cellular microenvironmental pattern in HL and to distinguish it from BRLH. Although there is extensive experience in flow cytometric analysis of non-HL, it is not routinely applied in cases of HL and our findings suggest that it may be useful in quickly and easily characterizing its cellular para-neoplastic inflammatory background. PMID:24627194
Di Gaetano, Rosa; Gasparetto, Valentina; Padoan, Andrea; Callegari, Barbara; Candiotto, Laura; Sanzari, Maria Colomba; Scapinello, Antonio; Tagariello, Giuseppe
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Local intradermal injections of dye have disclosed the fact that the skin lymphatics in regions of cardiac edema are patent, full of fluid and much widened. Intercommunication between them is ready and dye escapes from them more rapidly than from the vessels of normal skin. A retrograde distribution of dye by way of the lymphatics often occurs and it may pass unseen along the deeper channels to emerge in the skin at unexpected, distant situations. A valvular incompetence of the lymphatics consequent on dilatation would appear to be the cause of these phenomena. In regions of cardiac edema lymph stagnates, despite the fact that the channels are open. In nephritic edema the lymphatic capillaries are wider than normal but not as wide as in cardiac edema. No sign of incompetency of the valves is to be observed. Instead lymph flow is considerably greater than normal, even when edema fluid is accumulating. It was noted to be greater in the periods of fluid equilibrium also and extraordinarily rapid in periods of diuresis.
McMaster, Philip D.
Vancomycin entry into lung lymph in sheep.
The distribution of antibiotics into target tissues is a crucial factor in therapeutic efficacy. To estimate the availability of systemically administered vancomycin to the interstitial fluid in the lung, we have used a sheep model with a chronic pulmonary lymph fistula to collect simultaneously series of plasma and pulmonary lymph specimens during a 6-h period after an intravenous dose of vancomycin (7 mg/kg). After a minor delay in transit from blood to lymph, vancomycin was completely distributed to pulmonary lymph with a ratio of free drug in lymph to free drug in plasma of 0.9. This suggests that vancomycin is an excellent choice for treating pulmonary infections by susceptible organisms.
May, D G; Stratton, C W; Denney, W D; Watts, F L; Bernard, G R; Branch, R A
Quantification of regional pulmonary flow with 99m Tc-MAA SPECT and cine phase contrast MR imaging
The purpose of this study was to evaluate the relationship between left and right pulmonary arterial flow measured by cine\\u000a phase contrast magnetic resonance imaging (cine PCMRI) and the distribution of perfusion on99mTc-MAA SPECT and to determine whether the regional pulmonary flow quantification was feasible with the combined use of these\\u000a techniques. Twenty patients with different pulmonary diseases were evaluated.
Hisato Osada; Kikuo Machida; Norinari Honda
Effects of pulmonary regurgitation on distensibility and flow of the branch pulmonary arteries in tetralogy of Fallot.
Significant pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) may affect flow in the pulmonary artery (PA) side branches. We sought to assess flow changes and distensibility of the PA side branches in vivo and test correlation with the degree of PR and right-ventricular (RV) dilatation. Thirty patients after TOF repair and 16 controls underwent cardiovascular magnetic resonance for quantification of RV volumes and measurement of flow in the PA side branches. RV volumes and function, blood flow volumes, and cross-sectional area of the main, left (LPA), and right (RPA) PA were measured and regurgitant volumes and distensibility calculated. Results were compared between the LPA and the RPA and between patients and controls. Median regurgitation fraction of PR was 41 % (range 22-60 %). Regurgitant fraction was greater in the LPA (40 %) than in the RPA (29 %), resulting in lower net flow into the LPA (p < 0.001). LPA area was significantly greater than that of the RPA (303.9 vs. 232.7 mm(2)/m(2)) (p < 0.0001). The LPA showed lower distensibility than the RPA (39 vs. 44 %). PA side branch distensibility correlated with MPA regurgitant volume (p = 0.001), MPA regurgitant fraction (p = 0.001), and RV end-diastolic volume (p = 0.03). PA side branches have greater distensibility in patients with PR than in normal subjects. Significant PR leads to changes in flow profile and distensibility of the PA side branches. The LPA shows greater regurgitant volume and greater area but lower distensibility than the RPA. PMID:23292337
Voser, Eva M; Kellenberger, Christian J; Buechel, Emanuela R Valsangiacomo
The malnutrition-related increase in early visceralization of Leishmania donovani is associated with a reduced number of lymph node phagocytes and altered conduit system flow.
In a murine model of moderate childhood malnutrition we found that polynutrient deficiency led to a 4-5-fold increase in early visceralization of L. donovani (3 days post-infection) following cutaneous infection and a 16-fold decrease in lymph node barrier function (p<0.04 for all). To begin to understand the mechanistic basis for this malnutrition-related parasite dissemination we analyzed the cellularity, architecture, and function of the skin-draining lymph node. There was no difference in the localization of multiple cell populations in the lymph node of polynutrient deficient (PND) mice, but there was reduced cellularity with fewer CD11c(+)dendritic cells (DCs), fibroblastic reticular cells (FRCs), MOMA-2(+) macrophages, and CD169(+) subcapsular sinus macrophage (p<0.05 for all) compared to the well-nourished (WN) mice. The parasites were equally co-localized with DCs associated with the lymph node conduit network in the WN and PND mice, and were found in the high endothelial venule into which the conduits drain. When a fluorescent low molecular weight (10 kD) dextran was delivered in the skin, there was greater efflux of the marker from the lymph node conduit system to the spleens of PND mice (p<0.04), indicating that flow through the conduit system was altered. There was no evidence of disruption of the conduit or subcapsular sinus architecture, indicating that the movement of parasites into the subcortical conduit region was due to an active process and not from passive movement through a leaking barrier. These results indicate that the impaired capacity of the lymph node to act as a barrier to dissemination of L. donovani infection is associated with a reduced number of lymph node phagocytes, which most likely leads to reduced capture of parasites as they transit through the sinuses and conduit system. PMID:23967356
Ibrahim, Marwa K; Barnes, Jeffrey L; Anstead, Gregory M; Jimenez, Fabio; Travi, Bruno L; Peniche, Alex G; Osorio, E Yaneth; Ahuja, Seema S; Melby, Peter C
Reversed Pulmonary Artery Flow in Isolated Noncompaction of the Ventricular Myocardium
Objective: To investigate the morphology and genetics of a fetus at 22 weeks. This fetus demonstrated progressive fetal hydrops and cardiomegaly with retrograde flow in the pulmonary artery and progressive myocardial deterioration and heart failure. Methods: Postmortem examination, light and electron microscopy of the myocardium, karyotyping, fetal DNA analysis, screening for mutations in the G4.5 gene, ?-dystrobrevin gene, FKBP 12
Sandra Grebe; Fukiko Ichida; Ralph Grabitz; Burkhard Bültmann; Simone Heideman; Constantin S. von Kaisenberg
Pattern of pulmonary venous blood flow in the hypoplastic left heart syndrome in the fetus
OBJECTIVETo determine whether restriction at the atrial septum in the newborn with hypoplastic left heart syndrome can be predicted accurately by examining the pattern of pulmonary venous flow in the fetus. A restrictive atrial septum can contribute to haemodynamic instability before surgery for this lesion and has been associated with an increased mortality.DESIGNPulmonary venous pulsed Doppler tracings were compared between
D J Better; H D Apfel; V Zidere; L D Allan
Effect of cardiac resynchronization therapy on left atrial appendage function and pulmonary venous flow pattern
BackgroundPrevious studies have shown improvement in left ventricular function and development of the reverse remodeling in the left ventricle and left atrium after cardiac resynchronization therapy (CRT). The aim of this study was to investigate the effect of CRT on left atrial appendage (LAA) function and pulmonary venous flow pattern.
Ahmet Vural; Aysen Agacdiken; Dilek Ural; Tayfun Sahin; Guliz Kozdag; Göksel Kahraman; Ertan Ural; Haluk Akbas; Kaya Suzer; Baki Komsuoglu
An in situ optical imaging system for measuring lipid uptake, vessel contraction, and lymph flow in small animal lymphatic vessels
NASA Astrophysics Data System (ADS)
All dietary lipids are transported to venous circulation through the lymphatic system, yet the underlying mechanisms that regulate this process remain unclear. Understanding how the lymphatics functionally respond to changes in lipid load is important in the diagnosis and treatment of lipid and lymphatic related diseases such as obesity, hypercholesterolemia, and lymphedema. Therefore, we sought to develop an in situ imaging system to quantify and correlate lymphatic function as it relates to lipid transport. A custom-built optical set-up provides us with the capability of dual-channel imaging of both high-speed bright-field video and fluorescence simultaneously. This is achieved by dividing the light path into two optical bands. Utilizing high-speed and back-illuminated CCD cameras and post-acquisition image processing algorithms, we have the potential quantify correlations between vessel contraction, lymph flow and lipid concentration of mesenteric lymphatic vessels in situ. Local flow velocity is measured through lymphocyte tracking, vessel contraction through measurements of the vessel walls and lipid uptake through fluorescence intensity tracking of a fluorescent long chain fatty acid analogue, Bodipy FL C16. This system will prove to be an invaluable tool for both scientists studying lymphatic function in health and disease, and those investigating strategies for targeting the lymphatic system with orally delivered drugs.
Kassis, Timothy; Weiler, Michael J.; Dixon, J. Brandon
Effects of posture on blood flow diversion by hypoxic pulmonary vasoconstriction in dogs
NASA Technical Reports Server (NTRS)
We used differential excretion of sulphur hexafluoride from the left and right lung to measure blood flow diversion by hypoxic pulmonary vasoconstriction (HPV) in the prone and supine positions in dogs (n = 9). Gas exchange was assessed using the multiple inert gas elimination technique. Blood flow diversion from the hypoxic (3% oxygen) left lung was mean 70.7 (SD 11.2)% in the supine compared with 57.0 (12.1)% in the prone position (P < 0.02). The supine position was associated with increased perfusion to low VA/Q regions (P < 0.05). The increased flow diversion with hypoxia in the supine position was associated with more ventilation to high VA/Q regions (P < 0.05). We conclude that flow diversion by hypoxic pulmonary vasoconstriction is greater in the supine position. This effect could contribute to the variable response in gas exchange with positioning in patients with ARDS.
Walther, S. M.; Domino, K. B.; Hlastala, M. P.
Three-dimensional convective alveolar flow induced by rhythmic breathing motion of the pulmonary acinus.
Low Reynolds number flows (Re<1) in the human pulmonary acinus are often difficult to assess due to the submillimeter dimensions and accessibility of the region. In the present computational study, we simulated three-dimensional alveolar flows in an alveolated duct at each generation of the pulmonary acinar tree using recent morphometric data. Rhythmic lung expansion and contraction motion was modeled using moving wall boundary conditions to simulate realistic sedentary tidal breathing. The resulting alveolar flow patterns are largely time independent and governed by the ratio of the alveolar to ductal flow rates, Qa/Qd. This ratio depends uniquely on geometrical configuration such that alveolar flow patterns may be entirely determined by the location of the alveoli along the acinar tree. Although flows within alveoli travel very slowly relative to those in acinar ducts, 0.021%
Sznitman, Josué; Heimsch, Fabian; Heimsch, Thomas; Rusch, Daniel; Rösgen, Thomas
... 2.5 cm in length. They are widely distributed throughout the body along the lymphatic pathways where they filter the lymph before it is returned to the blood. Lymph nodes are not present in the central nervous system. There are three superficial regions on each side ...
Background Pulmonary arteriovenous malformations (PAVMs) can occur after the Fontan and are believed to be associated with disproportionate pulmonary distribution of hepatic venous effluent. We studied the impact of total cavo-pulmonary connection (TCPC) geometry and the effect of increased cardiac output (CO) on distribution of inferior vena caval (IVC) return to the lungs. Methods 10 Fontan patients – 5 with extra-cardiac (EC) and 5 with intra-cardiac (IC) configurations of the TCPC previously analyzed for power loss were processed for calculating the distribution of inferior vena caval return to the lungs (2nd order accuracy). One idealized TCPC was similarly analyzed under parametric variation of IVC offset and CO flow split Results Streaming of the IVC return in the idealized TCPC model was dependent on both IVC offset magnitude and CO flow split ratio. For patient-specific TCPCs, preferential streaming of the IVC return was directly proportional to CO flow split ratio in the IC type TCPCs (p < 0.0001). Preferential streaming in EC TCPCs correlated to the IVC offset (p<0.05) and did not correlate to CO flow split. Enhanced mixing in IC is speculated to explain the contrasting results. Exercising tends to reduce streaming towards LPA in IC, while for EC, exercising tends to equalize the streaming. Conclusions EC and IC TCPCs have inherently different streaming characteristics due to contrasting mixing characteristics owing to their geometric differences. PA diameters and IVC offsets may together determine hepatic flow streaming.
Dasi, Lakshmi P.; Whitehead, Kevin; Pekkan, Kerem; de Zelicourt, Diane; Sundareswaran, Kartik; Kanter, Kirk; Fogel, Mark A.; Yoganathan, Ajit P.
Non-invasive assessment of cardiac function and pulmonary vascular resistance in an canine model of acute thromboembolic pulmonary hypertension using 4D flow cardiovascular magnetic resonance
Background The purpose of this study was to quantify right (RV) and left (LV) ventricular function, pulmonary artery flow (QP), tricuspid valve regurgitation velocity (TRV), and aorta flow (QS) from a single 4D flow cardiovascular magnetic resonance (CMR) (time-resolved three-directionally motion encoded CMR) sequence in a canine model of acute thromboembolic pulmonary hypertension (PH). Methods Acute PH was induced in six female beagles by microbead injection into the right atrium. Pulmonary arterial (PAP) and pulmonary capillary wedge (PCWP) pressures and cardiac output (CO) were measured by right heart catheterization (RHC) at baseline and following induction of acute PH. Pulmonary vascular resistance (PVRRHC) was calculated from RHC values of PAP, PCWP and CO (PVRRHC?=?(PAP-PCWP)/CO). Cardiac magnetic resonance (CMR) was performed on a 3 T scanner at baseline and following induction of acute PH. RV and LV end-diastolic (EDV) and end-systolic (ESV) volumes were determined from both CINE balanced steady-state free precession (bSSFP) and 4D flow CMR magnitude images. QP, TRV, and QS were determined from manually placed cutplanes in the 4D flow CMR flow-sensitive images in the main (MPA), right (RPA), and left (LPA) pulmonary arteries, the tricuspid valve (TRV), and aorta respectively. MPA, RPA, and LPA flow was also measured using two-dimensional flow-sensitive (2D flow) CMR. Results Biases between 4D flow CMR and bSSFP were 0.8 mL and 1.6 mL for RV EDV and RV ESV, respectively, and 0.8 mL and 4 mL for LV EDV and LV ESV, respectively. Flow in the MPA, RPA, and LPA did not change after induction of acute PAH (p?=?0.42-0.81). MPA, RPA, and LPA flow determined with 4D flow CMR was significantly lower than with 2D flow (p?0.05). The correlation between QP/TRV and PVRRHC was 0.95. The average QP/QS was 0.96?±?0.11. Conclusions Using both magnitude and flow-sensitive data from a single 4D flow CMR acquisition permits simultaneous quantification of cardiac function and cardiopulmonary hemodynamic parameters important in the assessment of PH.
Non-invasive assessment of pulmonary blood flow using an inert gas rebreathing device in fibrotic lung disease
Background and aimsPulmonary hypertension (PH) is increasingly recognised in patients with diffuse lung disease, and is associated with increased mortality. Cardiac output (CO) is a prognostic marker in PH. Non-invasive assessment of pulmonary blood flow (PBFINNOCOR) with the inert gas rebreathing Innocor device has been validated against CO in PH, but not in PH associated with parenchymal lung disease. PBFINNOCOR
Tamera J Corte; Athol U Wells; Michael A Gatzoulis; Derek Cramer; Simon Ward; Peter S Macdonald; Konstantinos Dimopoulos; Stephen J Wort
Effect of Pulmonary Blood Flow upon Lung Mechanics*
Airway pressure was continuously recorded in an isolated horizontally mounted canine heart-lung preparation during abrupt, stepwise 100-200 ml inflations to 20-25 cm water pressure, and subsequent deflations. With each change in volume there was a steep rise or fall in pressure, followed by stress relaxation to a static equilibrium airway pressure. Comparison was made between the nonperfused state and during perfusion with whole blood at 100 ml/kg dog wt per min, and left atrial pressure of 10 mm Hg. Pressure tracings were similar during deflation in the perfused and the nonperfused lung. During inflation, in the middle range of lung inflation volumes, the peak inflation and equilibrium airway pressures were greater in the nonperfused state; maximum difference of static pressures in nine preparations averaged 146% of perfused values and the average stress relaxation difference from eight of these was 276%. Lung distensibility was the same with packed red cells or plasma perfusates and was not changed by varying the perfusion rate up to 220 ml/kg per min. During cyclic ventilation, dynamic compliance was similarly greater in the perfused than in the nonperfused state in the middle range of inflation volumes. Static distention of the vascular bed produced similar results with progressive improvement in distensibility in mid-inflation range up to a hydrostatic pressure of 15 cm blood. These data suggest that the distended pulmonary vascular bed provides structural airway support which facilitates entry of gas into the terminal respiratory units at diminished pressure.
Giannelli, Stanley; Ayres, Stephen M.; Buehler, M. E.
Numerical Simulation of Flow in Anatomically Realistic Total Cavo-Pulmonary Connections
NASA Astrophysics Data System (ADS)
Total cavo-pulmanory connection (TCPC) is a palliative surgical procudure employed to treat the single ventricle congential heart defects. We simulate the flow in patient-specific TCPC anatomies using two different numerical approaches: a Chimera overset grid method and a sharp-interface, hybrid Cartesian/Immersed Boundary approach. Laboratory experiments have shown that even under steady inflow conditions and at relatively low Reynolds number, the flow in the surgically created pouch, where the flows from the inferior and superior vena cave collide, becomes unstable and gives rise to a chaotic flow that flutters randomly between the left and right pulmonary arteries. Both numerical approaches capture this important feature of the flow and also yield results in good quantitative agreement with PIV measurements. The relative advantages and disantvantages of the two numerical approaches for complex cardiovascular flows will also be discussed. This work was supported by a grant from the National Heart, Lung, and Blood Institute, HL67622.
Gilmanov, Anvar; Ge, Liang; Wang, Chang; de Zelicourt, Diane; Pekkan, Kerem; Sotiropoulos, Fotis; Yoganathan, Ajit P.
Efficacy and safety of flow-directed pulmonary artery catheter thrombolysis for treatment of submassive pulmonary embolism.
OBJECTIVE. The purpose of this study was to assess the efficacy and safety of flow-directed catheter thrombolysis for treatment of submassive pulmonary embolism (PE). MATERIALS AND METHODS. In this single-institution retrospective study, 19 patients (nine men and 10 women; mean age [± SD], 54 ± 13 years) with submassive PE underwent catheter-directed thrombolysis between 2009 and 2013. Presenting symptoms included dyspnea in 18 of 19 (95%) cases. Submassive PE was diagnosed by pulmonary CT arteriography and right ventricular strain. PE was bilateral in 17 of 19 (89%) and unilateral in two of 19 (11%) cases. Thrombolysis was performed via a pulmonary artery (PA) catheter infusing 0.5- 1.0 mg alteplase per hour and was continued to complete or near complete clot dissolution with reduction in PA pressure. IV systemic heparin was administered. Measured outcomes included procedural success, PA pressure reduction, clinical success, survival, and adverse events. RESULTS. Procedural success, defined as successful PA catheter placement, fibrinolytic agent delivery, PA pressure reduction, and achievement of complete or near complete clot dissolution, was achieved in 18 of 19 (95%) cases. Thrombolysis required 57 ± 31 mg of alteplase administered over 89 ± 32 hours. Initial and final PA pressures were 30 ± 10 mm Hg and 20 ± 8 mm Hg (p < 0.001). All 18 (100%) technically successful cases achieved clinical success because all patients experienced symptomatic improvement. Eighteen of 19 (95%) patients survived to hospital discharge; 18 of 19 (95%) and 15 of 16 (94%) patients had documented 1-month and 3-month survival. One fatal case of intracranial hemorrhage was attributed to supratherapeutic anticoagulation because normal fibrinogen levels did not suggest remote fibrinolysis; procedural success was not achieved in this case because of early thrombolysis termination. No other complications were encountered. CONCLUSION. Among a small patient cohort, flow-directed catheter thrombolysis with alteplase effectively dissolved submassive PE and reduced PA pressure. Postprocedure short-term survival was high, and patients undergoing thrombolysis required close observation for bleeding events. PMID:24848835
Gaba, Ron C; Gundavaram, Madhu S; Parvinian, Ahmad; Knuttinen, M Grace; Minocha, Jeet; Owens, Charles A; Bui, James T
Comparison of continuous-flow and pulsatile-flow blood pumps on reducing pulmonary artery pressure in patients with fixed pulmonary hypertension.
Pulmonary hypertension (PH) is considered as a risk factor for morbidity and mortality in patients undergoing heart transplantation. Recently, left ventricular assist device (LVAD) implantation has been increasingly used in reducing pulmonary artery pressure (PAP) in patients with PH unresponsive to medical therapy. Herein, we aimed to compare the efficacy of continuous-flow and pulsatile-flow blood pumps on the improvement of PH in mechanical circulatory support patients. Twenty-seven patients with end-stage heart failure who underwent LVAD implantation surgery were enrolled. Fifteen of them (55.6%) had continuous-flow pump (HeartWare Ventricular Assist System, HeartWare, Inc., Miramar, FL, USA), and 12 of them (44.4%) had pulsatile pump (Berlin Heart EXCOR ventricular assist device, Berlin Heart AG, Berlin, Germany). The efficacy of LVADs on the improvement of PH was compared between continuous-flow and pulsatile pumps by the evaluation of systolic PAP, tricuspid annular plane systolic excursion (TAPSE), right ventricular systolic motion (RVSM), right ventricular ejection fraction (RVEF), and grade of tricuspid insufficiency (TI) for each of the study participants. All of the 15 patients who underwent continuous-flow blood pump implantation surgery (Group 1) were male with a mean age of 46.9 ± 11.7 years, and in pulsatile-flow blood pump implanted participants (Group 2), the mean age was 40.6 ± 16.8 years, all of whom were also male (P=0.259). Mean follow-up was 313.7 ± 241.3 days in Group 1 and 448.7 ± 120.7 days in Group 2 (P=0.139). In Group 1, mean preoperative and postoperative systolic PAP were measured as 51.7 ± 12.2 mm Hg and 22.2 ± 3.4 mm Hg, respectively, while those in Group 2 were 54.5 ± 7.5 mm Hg and 33.9 ± 6.4 mm Hg, respectively. A significantly greater decrease in systolic PAP was noticed in patients with continuous-flow blood pumps (P=0.023); however, no statistically significant difference was found when we considered the change in TAPSE between study groups (P=0.112). A statistical significance in the alteration of RVEF, RVSM, and the grade of TI during study visits was not found between the study groups (P=0.472, P=0.887, and P=0.237, respectively). Although the two studied types of LVADs were found to be effective in reducing PAP in heart transplantation candidates with PH, lesser postoperative systolic PAP values were achieved in patients who underwent continuous-flow pump implantation surgery. PMID:24033601
Ozturk, Pelin; Engin, Aysen Yaprak; Nalbantgil, Sanem; Oguz, Emrah; Ayik, Fatih; Engin, Cagatay; Yagdi, Tahir; Erkul, Sinan; Balcioglu, Ozlem; Ozbaran, Mustafa
Functional assessment of a left coronary-pulmonary artery fistula by coronary flow reserve
We report a 71-year-old man who presented with atypical chest pain. Coronary angiography did not reveal left main or proximal left anterior descending coronary artery stenosis, but a fistulous communication with a stronger tube-like fistula was present originating from the proximal left anterior descending coronary artery and emptying into the main pulmonary artery. Fractional flow reserve and coronary flow reserve measurements were performed to gain more data on the potential functional aspects of this fistula. With the present case, the importance of functional evaluation of these fistulas is demonstrated.
Sasi, Viktor; Forster, Tamas; Ungi, Imre
The role of respiratory flow asynchrony on convective mixing in the pulmonary acinus
NASA Astrophysics Data System (ADS)
Fine aerosol transport in the alveolated regions of the lungs is intrinsically coupled to alveolar flow patterns driven by lung breathing motions. Hence, understanding acinar flow characteristics is critical in determining local aerosol deposition sites. To date, inhaled aerosol dynamics have been mainly investigated using self-similar expanding lung models, although it is known that anisotropic lung motions exist and thus, potentially alter flow characteristics and enhance convective mixing. Using both experimental and numerical approaches, we assess here the influence of respiratory flow asynchrony on convective mixing by investigating alveolar flow patterns and massless particle transport for increasing phase lags between local wall motion and acinar ductal flows. Experimental results using a microfluidic platform, as well as numerical simulations, suggest that alveolar flow patterns are time-dependent in contrast to quasi-steady phenomena that pertain under synchronous conditions. To capture statistics of convective mixing, we numerically track massless tracers over multiple breathing cycles using anatomically inspired models of alveolated airways. By systemically probing various degrees of phase lag, our results underline the strong correlation between the magnitude of particle dispersion and flow asynchrony. In particular, we find that the dispersion of massless particles in acinar ducts is dramatically increased under flow asynchrony, relative to local, isolated alveolar cavity mixing. Despite the simplicity of the present models, our work highlights the critical role of respiratory flow asynchrony in governing the fate of fine inhaled particles in the pulmonary acinus.
Hofemeier, Philipp; Fishler, Rami; Sznitman, Josué
Comprehensive four-dimensional phase-contrast flow assessment in hemi-Fontan circulation: systemic-to-pulmonary collateral flow quantification.
Precise lung perfusion quantification is essential for evaluation of patients with hemi-Fontan surgery. It is possible for two-dimensional cardiac magnetic resonance phase contrast flow (two-dimensional flow) to evaluate non-invasively the systemic-to-pulmonary collateral blood flow. This case report intends to illustrate the benefit of four-dimensional flow over the current two-dimensional flow in the comprehensive assessment of hemi-Fontan patients. PMID:20977828
Valverde, Israel; Rachel, Clough; Kuehne, Titus; Beerbaum, Philipp
In situ enhancement of pulmonary surfactant function using temporary flow reversal
Acute respiratory distress syndrome is a pulmonary disease with a mortality rate of ?40% and 75,000 deaths annually in the United States. Mechanical ventilation restores airway patency and gas transport but leads to ventilator-induced lung injury. Furthermore, surfactant replacement therapy is ineffective due to surfactant delivery difficulties and deactivation by vascular proteins leaking into the airspace. Here, we demonstrated that surfactant function can be substantially improved (up to 50%) in situ in an in vitro pulmonary airway model using unconventional flows that incorporate a short-term retraction of the air-liquid interface, leading to a net decrease in cellular damage. Computational fluid dynamic simulations provided insights into this method and demonstrated the physicochemical hydrodynamic foundation for the improved surfactant microscale transport and mobility. This study may provide a starting point for developing novel ventilation waveforms to improve surfactant function in edematous airways.
Glindmeyer, Henry W.; Smith, Bradford J.
Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial
Objectives To compare standard high flow oxygen treatment with titrated oxygen treatment for patients with an acute exacerbation of chronic obstructive pulmonary disease in the prehospital setting. Design Cluster randomised controlled parallel group trial. Setting Ambulance service in Hobart, Tasmania, Australia. Participants 405 patients with a presumed acute exacerbation of chronic obstructive pulmonary disease who were treated by paramedics, transported, and admitted to the Royal Hobart Hospital during the trial period; 214 had a diagnosis of chronic obstructive pulmonary disease confirmed by lung function tests in the previous five years. Interventions High flow oxygen treatment compared with titrated oxygen treatment in the prehospital (ambulance/paramedic) setting. Main outcome measure Prehospital or in-hospital mortality. Results In an intention to treat analysis, the risk of death was significantly lower in the titrated oxygen arm compared with the high flow oxygen arm for all patients (high flow oxygen n=226; titrated oxygen n=179) and for the subgroup of patients with confirmed chronic obstructive pulmonary disease (high flow n=117; titrated n=97). Overall mortality was 9% (21 deaths) in the high flow oxygen arm compared with 4% (7 deaths) in the titrated oxygen arm; mortality in the subgroup with confirmed chronic obstructive pulmonary disease was 9% (11 deaths) in the high flow arm compared with 2% (2 deaths) in the titrated oxygen arm. Titrated oxygen treatment reduced mortality compared with high flow oxygen by 58% for all patients (relative risk 0.42, 95% confidence interval 0.20 to 0.89; P=0.02) and by 78% for the patients with confirmed chronic obstructive pulmonary disease (0.22, 0.05 to 0.91; P=0.04). Patients with chronic obstructive pulmonary disease who received titrated oxygen according to the protocol were significantly less likely to have respiratory acidosis (mean difference in pH 0.12 (SE 0.05); P=0.01; n=28) or hypercapnia (mean difference in arterial carbon dioxide pressure ?33.6 (16.3) mm Hg; P=0.02; n=29) than were patients who received high flow oxygen. Conclusions Titrated oxygen treatment significantly reduced mortality, hypercapnia, and respiratory acidosis compared with high flow oxygen in acute exacerbations of chronic obstructive pulmonary disease. These results provide strong evidence to recommend the routine use of titrated oxygen treatment in patients with breathlessness and a history or clinical likelihood of chronic obstructive pulmonary disease in the prehospital setting. Trial registration Australian New Zealand Clinical Trials Register ACTRN12609000236291.
Assessing potential errors of MRI-based measurements of pulmonary blood flow using a detailed network flow model
MRI images of pulmonary blood flow using arterial spin labeling (ASL) measure the delivery of magnetically tagged blood to an image plane during one systolic ejection period. However, the method potentially suffers from two problems, each of which may depend on the imaging plane location: 1) the inversion plane is thicker than the imaging plane, resulting in a gap that blood must cross to be detected in the image; and 2) ASL includes signal contributions from tagged blood in conduit vessels (arterial and venous). By using an in silico model of the pulmonary circulation we found the gap reduced the ASL signal to 64–74% of that in the absence of a gap in the sagittal plane and 53–84% in the coronal. The contribution of the conduit vessels varied markedly as a function of image plane ranging from ?90% of the overall signal in image planes that encompass the central hilar vessels to <20% in peripheral image planes. A threshold cutoff removing voxels with intensities >35% of maximum reduced the conduit vessel contribution to the total ASL signal to ?20% on average; however, planes with large contributions from conduit vessels underestimate acinar flow due to a high proportion of in-plane flow, making ASL measurements of perfusion impractical. In other image planes, perfusion dominated the resulting ASL images with good agreement between ASL and acinar flow. Similarly, heterogeneity of the ASL signal as measured by relative dispersion is a reliable measure of heterogeneity of the acinar flow distribution in the same image planes.
Buxton, R. B.; Prisk, G. K.
[Fetal pulmonary venous Doppler flow patterns in hypoplastic left heart syndrome].
Objective: To discuss the value of fetal pulmonary venous Doppler flow patterns in hypoplastic left heart syndrome (HLHS). Methods: Forty-six HLHS and 180 normal singleton fetuses at 24+0 to 37+6 weeks of gestation were enrolled in this study. The blood flow of pulmonary vein (PV) was detected by color Doppler ultrasound. The systolic wave of ventricle (S-wave), diastolic wave of ventricle (D-wave), atrial contraction wave (A-wave) and S/D ratio of PV were measured. The statistical difference in the above parameters between HLHS and normal fetuses was compared. The diagnosis was also confirmed by autopsy in still birth or postnatal follow-up when the baby was alive. Results: The PV blood flow in HLHS fetuses had a high possibility of reversed A wave, and the velocity of S wave and S/D ratio were higher than the matched normal controls (P<0.001). There were 3 types of PV blood flow patterns among all fetuses with HLHS. Both the cases with right to left shunt through foramen ovale (FO) and the cases with restricted left to right shunt at FO showed the triphasic patterns of PV with antegrade S wave, D wave and retrograde A wave. However, the latter had a higher velocity of retrograde A wave (P<0.001), lower D wave (P<0.001), and obviously elevated S wave and S/D ratio (P<0.001). The cases with intact interatrial septum showed short and apparent pulsatile back and forth blood flow in the PV, which displayed as absence of D wave. Conclusion: The 3 types of PV blood flow patterns in the fetuses with HLHS reflect the severity of hypertension in the left atrium, which is extremely vital for the prognosis and the perinatal treatment plan. PMID:25011967
Zhang, Jing; Zhou, Qichang; Zhang, Ming; Peng, Qinghai; Zeng, Shi; Zhou, Jiawei
Redistribution of pulmonary blood flow during unilateral hypoxia in prone and supine dogs
NASA Technical Reports Server (NTRS)
We used fluorescent-labeled microspheres in pentobarbital-anesthetized dogs to study the effects of unilateral alveolar hypoxia on the pulmonary blood flow distribution. The left lung was ventilated with inspired O2 fraction of 1.0, 0.09, or 0.03 in random order; the right lung was ventilated with inspired O2 fraction of 1.0. The lungs were removed, cleared of blood, dried at total lung capacity, then cubed to obtain approximately 1,500 small pieces of lung ( approximately 1.7 cm3). The coefficient of variation of flow increased (P < 0.001) in the hypoxic lung but was unchanged in the hyperoxic lung. Most (70-80%) variance in flow in the hyperoxic lung was attributable to structure, in contrast to only 30-40% of the variance in flow in the hypoxic lung (P < 0.001). When adjusted for the change in total flow to each lung, 90-95% of the variance in the hyperoxic lung was attributable to structure compared with 70-80% in the hypoxic lung (P < 0.001). The hilar-to-peripheral gradient, adjusted for change in total flow, decreased in the hypoxic lung (P = 0.005) but did not change in the hyperoxic lung. We conclude that hypoxic vasoconstriction alters the regional distribution of flow in the hypoxic, but not in the hyperoxic, lung.
Mann, C. M.; Domino, K. B.; Walther, S. M.; Glenny, R. W.; Polissar, N. L.; Hlastala, M. P.
Mechanisms underlying increased reactivity of pulmonary arteries contralateral to a localized high-flow anastomosis
Objectives Our model of a systemic-pulmonary shunt exhibits enhanced reactivity of pulmonary arteries contralateral to a localized shunt between the left lower lobe pulmonary artery (LLPA) and aorta relative to those of ipsilateral or control PAs 48 hours after anastomosis. We examined the contribution of nitric oxide (NO), cyclooxygenase (COX), lipoxygenase (LOX), or cytochrome P450 (CYP) production to mediating this enhanced reactivity. Methods We created a surgical end-to-side anastomosis of the left lower lobe PA to the aorta. 48 hours later we tested tension of PA rings from the right and left lower lobes for contraction to the thromboxane mimetic U46619 in the presence of vehicle or inhibitors of NO synthase (S), COX, CYP, or LOX. Western blots of PA homogenates were probed for eNOS or isoforms metabolizing arachidonic acid (AA). Eicosanoid products from intact PAs rings were detected using labeled AA and HPLC separation. Results Enhanced reactivity of unshunted right PAs over that of left PAs from high flow hosts was not eliminated by inhibitors of NOS, COX, or CYP. Treatment with 2 different LOX inhibitors, nordihydroguaiaretic acid and cinnamyl-3,4-dihydroxy-?-cyanocinnamate, closed the difference in contractility of shunted and unshunted PAs. PAs contralateral to shunts metabolized AA to 12-hydroxyeicosatetraenoic acid (HETE) in greater quantities than analogous PAs from the experimental left or control PAs. Conclusions 48 hours after anastomosis enhanced reactivity of contralateral PAs is attributable in part to increased LOX products as opposed to NO or other eicosanoid products. Ultramini-abstract We examined the role of nitric oxide and eicosanoid products in mediating enhanced reactivity of PAs contralateral to a localized aorto-pulmonary shunt 48 hours after creation. Lipoxygense inhibitors eliminated hyperreactivity of unshunted PAs and these arteries produced more 12-HETE, supporting increased synthesis of proconstrictive lipoxygenase products in these vessels.
Pfister, Sandra; Somberg, Lewis; Lowry, Timothy; Gao, Ying; Medhora, Meetha; Jacobs, Elizabeth R.
Scintigraphy for Pulmonary Capillary Protein Leak.
National Technical Information Service (NTIS)
Pulmonary gamma scintigraphy is a rapid, non-invasive technique for measuring a pulmonary capillary protein leak in ARDS. In these studies, the method demonstrated that the acute anesthetized lung lymph fistula sheep model was associated with a significan...
H. J. Sugerman J. L. Tatum J. I. Hirsch A. M. Strash
Scintigraphy for Pulmonary Capillary Protein Leak.
National Technical Information Service (NTIS)
Pulmonary gamma scintigraphy is a rapid, non-invasive technique for measuring a pulmonary capillary protein leak in ARDS. In these studies, the method demonstrated that the acute anesthetized lung lymph fistula sheep model was associated with a significan...
H. J. Sugerman J. L. Tatum J. I. Hirsch A. M. Strash
The acute effects of low flow oxygen and isosorbide dinitrate on left and right ventricular ejection fractions in chronic obstructive pulmonary disease
The objectives of this study were to determine the effects of low flow oxygen and isosorbide dinitrate on rest and exercise biventricular ejection fractions in patients with chronic obstructive pulmonary disease and to relate these ejection fraction responses to changes in pressure and flow. Nine patients with stable, moderate to severe chronic obstructive pulmonary disease who had no prior history of heart failure performed supine exercise with simultaneous hemodynamic and radionuclide ventriculographic monitoring. Eight patients performed a second exercise during low flow oxygen breathing and five performed a third exercise after ingesting 10 mg oral isosorbide. Oxygen led to a decrease in exercise pulmonary artery pressure in all subjects and a decline in total pulmonary resistance in five of the seven in whom it was measured. Right ventricular ejection fraction increased 0.05 or more only in subjects who had a decrease in total pulmonary resistance. Isosorbide led to an increase in rest and exercise right and left ventricular ejection fractions with simultaneous decreases in pulmonary artery pressure, total pulmonary resistance, blood pressure and arterial oxygen tension. These results suggest that in patients with chronic obstructive pulmonary disease but without a history of right heart failure, the right ventricular systolic functional response to low flow oxygen and isosorbide at rest and exercise is, in part, determined by changes in total pulmonary resistance. The chronic relation between right ventricular ejection fraction and pulmonary hemodynamics in patients with chronic obstructive pulmonary disease remains to be evaluated.
Morrison, D.; Caldwell, J.; Lakshminaryan, S.; Ritchie, J.L.; Kennedy, J.W.
Drug detection in breath: effects of pulmonary blood flow and cardiac output on propofol exhalation.
Breath analysis could offer a non-invasive means of intravenous drug monitoring if robust correlations between drug concentrations in breath and blood can be established. In this study, propofol blood and breath concentrations were determined in an animal model under varying physiological conditions. Propofol concentrations in breath were determined by means of two independently calibrated analytical methods: continuous, real-time proton transfer reaction mass spectrometry (PTR-MS) and discontinuous solid-phase micro-extraction coupled with gas chromatography mass spectrometry (SPME-GC-MS). Blood concentrations were determined by means of SPME-GC-MS. Effects of changes in pulmonary blood flow resulting in a decreased cardiac output (CO) and effects of dobutamine administration resulting in an increased CO on propofol breath concentrations and on the correlation between propofol blood and breath concentrations were investigated in seven acutely instrumented pigs. Discontinuous propofol determination in breath by means of alveolar sampling and SPME-GC-MS showed good agreement (R(2)=0.959) with continuous alveolar real-time measurement by means of PTR-MS. In all investigated animals, increasing cardiac output led to a deterioration of the relationship between breath and blood propofol concentrations (R(2)=0.783 for gas chromatography-mass spectrometry and R(2)=0.795 for PTR-MS). Decreasing pulmonary blood flow and cardiac output through banding of the pulmonary artery did not significantly affect the relationship between propofol breath and blood concentrations (R(2)>0.90). Estimation of propofol blood concentrations from exhaled alveolar concentrations seems possible by means of different analytical methods even when cardiac output is decreased. Increases in cardiac output preclude prediction of blood propofol concentration from exhaled concentrations. PMID:21643859
Kamysek, Svend; Fuchs, Patricia; Schwoebel, Henny; Roesner, Jan P; Kischkel, Sabine; Wolter, Kathi; Loeseken, Christian; Schubert, Jochen K; Miekisch, Wolfram
Acinus-on-a-chip: a microfluidic platform for pulmonary acinar flows.
Convective respiratory flows in the pulmonary acinus and their influence on the fate of inhaled particles are typically studied using computational fluid dynamics (CFD) or scaled-up experimental models. However, experiments that replicate several generations of the acinar tree while featuring cyclic wall motion have not yet been realized. Moreover, current experiments generally capture only flow dynamics, without inhaled particle dynamics, due to difficulties in simultaneously matching flow and particle dynamics. In an effort to overcome these limitations, we introduce a novel microfluidic device mimicking acinar flow characteristics directly at the alveolar scale. The model features an anatomically-inspired geometry that expands and contracts periodically with five dichotomously branching airway generations lined with alveolar-like cavities. We use micro-particle image velocimetry with a glycerol solution as the carrying fluid to quantitatively characterize detailed flow patterns within the device and reveal experimentally for the first time a gradual transition of alveolar flow patterns along the acinar tree from recirculating to radial streamlines, in support of hypothesized predictions from past CFD simulations. The current measurements show that our microfluidic system captures the underlying characteristics of the acinar flow environment, including Reynolds and Womersley numbers as well as cyclic wall displacements and alveolar flow patterns at a realistic length scale. With the use of air as the carrying fluid, our miniaturized platform is anticipated to capture both particle and flow dynamics and serve in the near future as a promising in vitro tool for investigating the mechanisms of particle deposition deep in the lung. PMID:24090494
Fishler, Rami; Mulligan, Molly K; Sznitman, Josué
PPAR-? Regulates Carnitine Homeostasis and Mitochondrial Function in a Lamb Model of Increased Pulmonary Blood Flow
Objective Carnitine homeostasis is disrupted in lambs with endothelial dysfunction secondary to increased pulmonary blood flow (Shunt). Our recent studies have also indicated that the disruption in carnitine homeostasis correlates with a decrease in PPAR-? expression in Shunt lambs. Thus, this study was carried out to determine if there is a causal link between loss of PPAR-? signaling and carnitine dysfunction, and whether the PPAR-? agonist, rosiglitazone preserves carnitine homeostasis in Shunt lambs. Methods and Results siRNA-mediated PPAR-? knockdown significantly reduced carnitine palmitoyltransferases 1 and 2 (CPT1 and 2) and carnitine acetyltransferase (CrAT) protein levels. This decrease in carnitine regulatory proteins resulted in a disruption in carnitine homeostasis and induced mitochondrial dysfunction, as determined by a reduction in cellular ATP levels. In turn, the decrease in cellular ATP attenuated NO signaling through a reduction in eNOS/Hsp90 interactions and enhanced eNOS uncoupling. In vivo, rosiglitazone treatment preserved carnitine homeostasis and attenuated the development of mitochondrial dysfunction in Shunt lambs maintaining ATP levels. This in turn preserved eNOS/Hsp90 interactions and NO signaling. Conclusion Our study indicates that PPAR-? signaling plays an important role in maintaining mitochondrial function through the regulation of carnitine homeostasis both in vitro and in vivo. Further, it identifies a new mechanism by which PPAR-? regulates NO signaling through Hsp90. Thus, PPAR-? agonists may have therapeutic potential in preventing the endothelial dysfunction in children with increased pulmonary blood flow.
Rafikov, Ruslan; Kumar, Sanjiv; Hou, Yali; Oishi, Peter E.; Datar, Sanjeev A.; Raff, Gary; Fineman, Jeffrey R.; Black, Stephen M.
An analysis of estimation of pulmonary blood flow by the single-breath method
NASA Technical Reports Server (NTRS)
The single-breath method represents a simple noninvasive technique for the assessment of capillary blood flow across the lung. However, this method has not gained widespread acceptance, because its accuracy is still being questioned. A rigorous procedure is described for estimating pulmonary blood flow (PBF) using data obtained with the aid of the single-breath method. Attention is given to the minimization of data-processing errors in the presence of measurement errors and to questions regarding a correction for possible loss of CO2 in the lung tissue. It is pointed out that the estimations are based on the exact solution of the underlying differential equations which describe the dynamics of gas exchange in the lung. The reported study demonstrates the feasibility of obtaining highly reliable estimates of PBF from expiratory data in the presence of random measurement errors.
Srinivasan, R.
Assessment of pulmonary\\/systemic blood flow ratio after first-stage palliation for hypoplastic left heart syndrome
Objective: Circulatory maldistribution is believed to be a major cause of early death after first-stage palliation for hypoplastic left heart syndrome. Flow reversal in the reconstructed aorta may reflect the pulmonary\\/systemic blood flow ratio. The purpose of our study was to investigate the utility of arterial PO, arterial oxygen saturation, and a newly developed Doppler-derived flow index in predicting the
Jack Rychik; David M. Bush; Thomas L. Spray; J. William Gaynor; Gil Wernovsky
Pulmonary (cardio) diagnostic system for combat casualty care capable of extracting embedded characteristics of obstructive or restrictive flow
NASA Astrophysics Data System (ADS)
Walter Reed Army Institute of Research and Oak Ridge National Laboratory have developed a prototype pulmonary diagnostic system capable of extracting signatures from adventitious lung sounds that characterize obstructive and/or restrictive flow. Examples of disorders that have been detailed include emphysema, asthma, pulmonary fibrosis, and pneumothorax. The system is based on the premise that acoustic signals associated with pulmonary disorders can be characterized by a set of embedded signatures unique to the disease. The concept is being extended to include cardio signals correlated with pulmonary data to provide an accurate and timely diagnoses of pulmonary function and distress in critically injured soldiers that will allow medical personnel to anticipate the need for accurate therapeutic intervention as well as monitor soldiers whose injuries may lead to pulmonary compromise later. The basic operation of the diagnostic system is as follows: (1) create an image from the acoustic signature based on higher order statistics, (2) deconstruct the image based on a predefined map, (3) compare the deconstructed image with stored images of pulmonary symptoms, and (4) classify the disorder based on a clustering of known symptoms and provide a statistical measure of confidence. The system has produced conformity between adults and infants and provided effective measures of physiology in the presence of noise.
Allgood, Glenn O.; Treece, Dale A.; Pearce, Fred J.; Bentley, Timothy B.
4D phase-contrast flow cardiovascular magnetic resonance: comprehensive quantification and visualization of flow dynamics in atrial septal defect and partial anomalous pulmonary venous return.
The case of an 8-year-old girl with atrial septal defect and associated anomalous pulmonary venous return is presented to illustrate the advantages of four dimensional flow (4D flow) over the current two dimensional flow (2D flow) in terms of time efficiency, easy planning, accurate and individual quantification of the blood sources contributing to the left-to-right shunting from one single acquisition, internal validation of flow measurement accuracy, possibility of reanalysis without rescanning in case of unexpected findings during the postprocessing, and comprehensive understanding of flow insight by use of particle tracing visualization. PMID:20848278
Valverde, Israel; Simpson, John; Schaeffter, Tobias; Beerbaum, Philipp
Caval Contribution to Flow in the Branch Pulmonary Arteries of Fontan Patients With a Novel Application of Magnetic Resonance Presaturation Pulse
Background—A complete understanding of fluid mechanics in Fontan physiology includes knowledge of the caval contributions to right (RPA) and left (LPA) pulmonary arterial blood flow, total systemic venous return, and relative blood flow to each lung. Methods and Results—Ten Fontan patients underwent cine MRI. Three cine scans of the pulmonary arteries were performed: (1) no presaturation pulse, (2) a presaturation
Mark A. Fogel; Paul M. Weinberg; Jack Rychik; Anne Hubbard; Marshall Jacobs; Thomas L. Spray; John Haselgrove
The effect of nasal flow on breathlessness in patients with chronic obstructive pulmonary disease.
Many patients with chronic obstructive pulmonary disease (COPD) receiving supplemental oxygen state that this treatment makes them less short of breath at rest. We postulated that this phenomenon may be related to improved arterial oxygenation, reduced ventilation, or stimulation of nasal receptors caused by the flow of gas. Eight patients who reported this phenomenon were studied in a quiet room. Each patient received zero flow, 2, or 4 L/min of air or oxygen through nasal cannula for 5 min at each level in random order in a single blind manner. At the end of each period, arterial blood gas composition was measured, and breathlessness was assessed with a visual analog scale. The scale was calibrated to read from zero (not at all breathless) to 100 (extremely short of breath). The entire protocol was repeated after application of topical lidocaine to the nasal passages. Results were assessed by analysis of variance. We found no significant effect of inspired oxygen concentration, gas flow, arterial oxygen tension, or arterial carbon dioxide tension on breathlessness. There was, however, a significant increase in breathlessness after nasal anesthesia from 44 +/- 3 SEM to 52 +/- 4 SEM (p less than 0.005). We suggest that the reduction of breathlessness in these patients by nasal oxygen is a placebo effect caused by wearing the nasal cannulas and is unrelated to gas flow or the increased arterial oxygen tension. PMID:3144198
Liss, H P; Grant, B J
Measurement of effective pulmonary blood flow by soluble gas uptake in patients with chronic airflow obstruction.
A study was designed to assess the accuracy and reproducibility of rebreathing and single breath soluble gas uptake measurements of effective pulmonary blood flow (Q) in patients with airways obstruction. Both rebreathing (RB) and single breath (SB) estimates of Q were compared with direct Fick and thermodilution (TD) measurements of cardiac output at rest and during exercise in eight patients with chronic, poorly reversible airflow obstruction with mean FEV1 65% predicted and mean FEV1/FVC 53%. The mean (SD) resting values obtained were QRB 3.47 (0.46), QSB 4.75 (1.15), QFick 4.77 (0.97), and QTD 5.15 (0.98). QRB was significantly lower than the other three estimates, which did not differ significantly from each other. Exercise produced significant increases in all four estimates for the group. The mean exercise values were QRB 6.23 (1.19), QSB 7.62 (1.97), QFick 8.97 (1.96), and QTD 9.09 (1.00), both QRB and QSB being significantly less than QFick and QTD. Analysis of variance of the rest, exercise, and combined data showed highly significant relationships with the TD and Fick measurements for both QRB and QSB over the range of values studied. In addition, the reproducibility of QRB and QSB was assessed in 15 other patients with chronic airflow obstruction (mean FEV1 42% predicted, FEV1/FVC 43%) and in 10 normal subjects. The coefficients of intrasubject variability for a single measurement for QRB were 8.7% in normal subjects and 10.2% in patients and for QSB were 11.7% in normal subjects and 16.1% in patients. The group differences from morning to afternoon, between days, and over a month were not significant in the normal subjects. In the patients QRB was slightly higher in the afternoon than in the morning of the same day, but the differences between days and over a month were not significant for either test. Although both tests detected the increase in pulmonary blood flow during exercise, the single breath test was more accurate at rest. Some underestimation was present for rebreathing at rest and for both tests during exercise, but this can be allowed for. In patients with mild airflow obstruction the reproducibility of the soluble gas uptake methods was similar to that of invasive catheter methods of cardiac output estimation. The single breath test in particular was, however, less reproducible in patients with more severe airflow obstruction, and the rebreathing method may be more useful for detecting increases in pulmonary blood flow in these patients.
Pierce, R J; McDonald, C F; Thuys, C A; Rochford, P D; Barter, C E
Phase-contrast MRI and CFD modeling of apparent łHe gas flow in rat pulmonary airways.
Phase-contrast (PC) magnetic resonance imaging (MRI) with hyperpolarized łHe is potentially useful for developing and testing patient-specific models of pulmonary airflow. One challenge, however, is that PC-MRI provides apparent values of local łHe velocity that not only depend on actual airflow but also on gas diffusion. This not only blurs laminar flow patterns in narrow airways but also introduces anomalous airflow structure that reflects gas-wall interactions. Here, both effects are predicted in a live rat using computational fluid dynamics (CFD), and for the first time, simulated patterns of apparent łHe gas velocity are compared with in vivo PC-MRI. Results show (1) that correlations (R˛) between measured and simulated airflow patterns increase from 0.23 to 0.79 simply by accounting for apparent łHe transport, and (2) that remaining differences are mainly due to uncertain airway segmentation and partial volume effects stemming from relatively coarse MRI resolution. Higher-fidelity testing of pulmonary airflow predictions should therefore be possible with future imaging improvements. PMID:22771528
Minard, Kevin R; Kuprat, Andrew P; Kabilan, Senthil; Jacob, Richard E; Einstein, Daniel R; Carson, James P; Corley, Richard A
L-Carnitine Preserves Endothelial Function in a Lamb Model of Increased Pulmonary Blood Flow
Background In our model of congenital heart disease (CHD) with increased pulmonary blood flow (Shunt), we have recently shown a disruption in carnitine homeostasis, associated with mitochondrial dysfunction and decreased eNOS/Hsp90 interactions that contribute to eNOS uncoupling, increased superoxide levels, and decreased bioavailable NO. Thus, we undertook this study to test the hypothesis that L-carnitine therapy would maintain mitochondrial function, and NO signaling. Methods Thirteen fetal lambs underwent in utero placement of an aortopulmonary graft. Immediately following delivery, lambs received daily treatment with oral L-carnitine or its vehicle. Results L-carnitine-treated lambs had decreased levels of acyl carnitine, and a reduced acyl carnitine: free carnitine ratio compared to vehicle treated Shunt lambs. These changes correlated with increased carnitine acetyl transferase (CrAT) protein and enzyme activity and decreased levels of nitrated CrAT. The lactate: pyruvate ratio was also decreased in L-carnitine-treated lambs. Hsp70 protein levels were significantly decreased and this correlated with increases in eNOS/Hsp90 interactions, NOS activity, NOx levels, and a significant decrease in eNOS-derived superoxide. Further, acetylcholine significantly decreased left pulmonary vascular resistance (PVR) only in L-carnitine-treated lambs. Conclusion L-carnitine therapy may improve the endothelial dysfunction noted in children with CHD, and has important clinical implications that warrant further investigation.
Sharma, Shruti; Aramburo, Angela; Rafikov, Ruslan; Sun, Xutong; Kumar, Sanjiv; Oishi, Peter E.; Datar, Sanjeev A.; Raff, Gary; Xoinis, Kon; Kalkan, Gohkan; Fratz, Sohrab; Fineman, Jeffrey R.; Black, Stephen M.
Swollen glands; Glands - swollen; Lymph nodes - swollen; Lymphadenopathy ... Common areas where the lymph nodes can be felt (with the fingers) include: Groin Armpit Neck (there is a chain of lymph nodes on either side ...
Congenital heart diseases associated with increased pulmonary blood flow commonly lead to the development of pulmonary hypertension. However, most patients who undergo histological evaluation have advanced pulmonary hypertension, and therefore it has been difficult to investigate aberrations in signaling cascades that precede the development of overt vascular remodeling. The purpose of this review is to discuss the role played by oxidative and nitrosative stress in the lung and their impact on the signaling pathways that regulate vasodilation, vessel growth and vascular remodeling in the neonatal lung exposed to increased pulmonary blood flow.
Aggarwal, Saurabh; Gross, Christine; Fineman, Jeffrey R.; Black, Stephen M
Recent Advance in Lymph Dynamic Analysis in Lymphatics and Lymph Nodes
Lymphatics are a unidirectional transport system that carries fluid from the interstitial space and back into the blood stream. Initial lymphatics take up not only fluid but also high-molecular-weight substances, such as plasma proteins and hyaluronan; immune cells, such as lymphocytes, macrophages, and dendritic cells; and colloidal particles, such as carbon particles, bacteria, and tattoo dye. Interstitially injected colloidal particles are known to accumulate in the regional lymph nodes. This phenomenon is applied to find sentinel lymph nodes in cancer patients. Lymph flow rate and composition are influenced by interstitial fluid, lymphatic pump activity, and intra-lymphatic pressure. Lymph composition is changed during its flow downstream. In this review, the main focus is on the mechanisms of lymph formation at the initial lymphatics and lymph transport through the collecting lymphatics and lymph nodes. (*English Translation of J Jpn Coll Angiol, 2008, 48: 113-123.)
Pulmonary arterial hypertension; Sporadic primary pulmonary hypertension; Familial primary pulmonary hypertension; Idiopathic pulmonary arterial hypertension; Primary pulmonary hypertension; PPH; Secondary pulmonary hypertension
Extracranial glioblastoma with synchronous metastases in the lung, pulmonary lymph nodes, vertebrae, cervical muscles and epidural space in a young patient - case report and review of literature
Background Extraneural and extracranial metastases of glioblastoma (GB) are very rarely reported in the literature. They occur in only 0.2% of all GB patients. Case presentation We present a 40 year old caucasian male with secondary GB and first diagnosis of an astrocytoma world health organisation (WHO) grade II through stereotactic biopsy in 2006. He presented a new hemiparesis and a progress of the known mass lesion in 2008. Subtotal tumor resection was performed and the histological examination verified a GB. After combined radio- and chemotherapy the adjuvant temozolomide therapy was not started because of non-compliance. In 2011 a second local relapse was resected and 4 month later the patient presented a fast progressing tetraparesis. Cervical CT and MRI scan showed a mass lesion infiltrating the fifth and sixth vertebra with infiltration of the spinal canal and large paravertebral tumor masses. Emergency surgery was performed. By additional screening further metastases were detected in the thoracal and lumbal spine and surprisingly also in the lung and pulmonary lymphnodes. Palliative radio- and chemotherapy of the pulmonal lesions was completed, further antitumor therapy was rejected. The patient died 10 months after diagnosis of the extraneural metastases. Conclusion Especially young "long-term-survivors" seem to have a higher risk of extraneural metastasis from a GB and appropriate staging should be performed in these cases.
Non-invasive estimation of pulmonary vascular resistance in patients of pulmonary hypertension in congenital heart disease with unobstructed pulmonary flow
Context: Pulmonary vascular resistance (PVR) is a critical and essential parameter during the assessment and selection of modality of treatment in patients with congenital heart disease accompanied by pulmonary arterial hypertension. Aim: The present study was planned to evaluate non-invasive echocardiographic parameters to assess pulmonary vascular resistance. Settings and Design: This prospective observational study included 44 patients admitted in the cardiology and pediatric cardiology ward of our institution for diagnostic or pre-operative catheter based evaluation of pulmonary arterial pressure and PVR. Materials and Methods: Detailed echocardiographic evaluation was carried out including tricuspid regurgitation velocity (TRV) and velocity time integral of the right-ventricular outflow tract (VTIRVOT). These parameters were correlated with catheter-based measurements of PVR. Results: The TRV/VTIRVOT ratio correlated well with PVR measured at catheterization (PVRcath) (r = 0.896, 95% confidence interval [CI] 0.816 to 0.9423, P < 0.001). Using the Bland-Altman analysis, PVR measurements derived from Doppler data showed satisfactory limits of agreement with catheterization estimated PVR. For a PVR of 6 Wood units (WU), a TRV/VTIRVOT value of 0.14 provided a sensitivity of 96.67% and a specificity of 92.86% (area under the curve 0.963, 95% confidence interval 0.858 to 0.997) and for PVR of 8 WU a TRV/VTIRVOT value of 0.17 provided a sensitivity of 79.17% and a specificity of 95% (area under the curve 0. 0.923, 95% confidence interval 0.801 to 0.982). Conclusions: Doppler-derived ratio of TRV/VTIRVOT is a simple, non-invasive index, which can be used to estimate PVR.
Pande, Arindam; Sarkar, Achyut; Ahmed, Imran; Naveen Chandra, GS; Patil, Shailesh Kumar; Kundu, Chanchal Kumar; Arora, Rahul; Samanta, Ajanta
Effect of Supine Posture on Airway Blood Flow and Pulmonary Function in Stable Heart Failure
Background The aim of this study was to determine the relationship between body position, pulmonary function (PF) and bronchial blood flow (Qaw) in a group of heart failure (HF) and control subjects. Methods Thirty-six subjects were studied: 24 stable, ambulatory HF patients (HF: LVEF=27±6%, age=65±9yr) and 12 age- and sex-matched controls (CTRL: LVEF=60±7%, age=62±8yr). Measures of Q?aw (soluble gas method) and PF were collected upright and following 30 min in the supine position. Results Q?aw was similar between groups and remained unchanged with body position. Declines in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) with the supine position were observed in both groups; declines in forced expiratory flow 25–75% (FEF25–75) and FEF 75% (FEF75) with the supine position were observed in the HF group only. Changes in Q?aw were related to changes in PF only in the HF patient groups (?FVC, %predicted, r=?0.45, p<0.04, ?FEV1 r=?0.61, p<0.01, ?FEV1 %predicted, r=?0.45, p<0.04). Conclusion These data demonstrate that relationships between postural changes in Q?aw and PF exist only in the HF population and that the bronchial circulation may contribute to postural PF decline in HF.
Ceridon, Maile L.; Morris, Norman R.; Olson, Thomas P.; Lalande, Sophie; Johnson, Bruce D.
1 1 SEER Lymph Node Codes www.seer.cancer.gov SEER Lymph Node Codes Revisited SEER Program Training Materials October 2002 2 SEER Lymph Node Codes www.seer.cancer.gov EOD Lymph Node Involvement Number of Regional Nodes Positive Number of Regional
Complete thoracoscopic lobectomy and mediastinal lymph node dissection.
To evaluate the complete thoracoscopic lower right lobectomy and mediastinal lymph node. During the surgery, the lower right pulmonary artery and vein, bronchi and lymph nodes were treated using a unidirectional approach. Eight stations (2, 3, 4, 7, 8, 9, 10 and 11) of lymph nodes were dissected completely en bloc. Repeated stretch and flipping was avoided in this procedure, which was beneficial for the unaffected side of the lung. The operation of lymph node dissection was completed thoroughly in accordance with standard principles. PMID:24040551
Cai, Ruijun; Xiong, Gang; Cai, Kaican
Complete thoracoscopic lobectomy and mediastinal lymph node dissection
To evaluate the complete thoracoscopic lower right lobectomy and mediastinal lymph node. During the surgery, the lower right pulmonary artery and vein, bronchi and lymph nodes were treated using a unidirectional approach. Eight stations (2, 3, 4, 7, 8, 9, 10 and 11) of lymph nodes were dissected completely en bloc. Repeated stretch and flipping was avoided in this procedure, which was beneficial for the unaffected side of the lung. The operation of lymph node dissection was completed thoroughly in accordance with standard principles.
Xiong, Gang; Cai, Kaican
Assessment of diastolic function by tissue Doppler echocardiography: comparison with standard transmitral and pulmonary venous flow
NASA Technical Reports Server (NTRS)
The objective of this study was to determine the utility of Doppler tissue echocardiography in the evaluation of diastolic filling and in discriminating between normal subjects and those with various stages of diastolic dysfunction. We measured myocardial velocities in 51 patients with various stages of diastolic dysfunction and in 27 normal volunteers. The discriminating power of each of the standard Doppler indexes of left ventricular filling, pulmonary venous flow, and myocardial velocities was determined with the use of Spearman rank correlation and analysis of variance F statistics. Early diastolic myocardial velocity (E(m)) was higher in normal subjects (16.0 +/- 3.8 cm/s) than in patients with either delayed relaxation (n = 15, 7.5 +/- 2.2 cm/s), pseudonormal filling (n = 26, 7.6 +/- 2.3 cm/s), or restrictive filling (n = 10, 7.4 +/- 2.4 cm/s, P <.0001). E(m ) was the best single discriminator between control subjects and patients with diastolic dysfunction (P =.7, F = 64.5). Myocardial velocities assessed by Doppler tissue echocardiography are useful in differentiating patients with normal from those with abnormal diastolic function. Myocardial velocity remains reduced even in those stages of diastolic dysfunction characterized by increased preload compensation.
Farias, C. A.; Rodriguez, L.; Garcia, M. J.; Sun, J. P.; Klein, A. L.; Thomas, J. D.
Pulmonary venous flows reflect changes in left atrial hemodynamics during mitral balloon valvotomy
NASA Technical Reports Server (NTRS)
Patients with mitral stenosis have usually blunted pulmonary venous (PV) flow, because of decreased mitral valve area and diastolic dysfunction. The authors compared changes in Doppler PV velocities by using transesophageal echocardiography (TEE) against hemodynamics parameters before and after mitral balloon valvotomy to observe relevance of PV velocities and endsystolic left atrial (LA) pressure-volume relationship. In 25 patients (aged 35 +/- 17 years) with mitral stenosis in sinus rhythm, changes in LA pressure and volumes were compared with PV velocities before and after valvotomy. Mitral valve area, mitral gradients, and deceleration time were obtained. Mitral valve area and mitral gradients changed from 1 +/- 0.2 cm2 and 14.6 +/- 5.4 mmHg to 1.9 +/- 0.3 cm2 and 6.3 +/- 1.7 mmHg, respectively (p<0.001). AR peak reverse flow velocity and AR duration decreased from 29 +/- 13 cm/s and 110 =/- 30 msec to 19 +/- 6 cm/s and 80 +/- 29 msec respectively (p<0.001). Transmitral Doppler E wave deceleration time decreased from 327 +/- 85 to 209 +/- 61 s and cardiac output increased from 4.2 +/- 1.0 to 5.2 +/- 1.1 L/minute (p<0.001). The changes in LA pressure were correlated with changes in S/D (r=0.57, p<0.05). The changes in endsystolic LA pressure-volume relationship were also correlated with changes in S/D (r=0.52, p<0.05). Endsystolic LA pressure-volume relationship decreased after mitral balloon valvotomy, as a result of a large decrease in pressure. PV systolic/diastolic (S/D) waves ratio reflects endsystolic LA pressure-volume relationship and may be used as another indicator of successful valvotomy.
Yalcin, Fatih; El-Amrousy, Mahmoud; Muderrisoglu, Haldun; Korkmaz, Mehmet; Flachskampf, Frank; Tuzcu, Murat; Garcia, Mario G.; Thomas, James D.
Influence of Bronchial Blood Flow and Conductance on Pulmonary Function in Stable Systolic Heart Failure
The aim of this study was to determine the relationship between airway blood flow (Q?aw), airway conductance (Gf-aw) and pulmonary function in patients with stable HF. 12 controls (CTRL: age=63±9yr, FVC=98±15%pred, LVEF=61±6%) (all data presented as mean±SD), 16 patients with mild HF (HF-A, NYHA I–II: age=64±9yr, FVC=90±17%pred, LVEF=28±6%), and 14 patients with moderate/severe HF (HF-B, NYHA III–IV: age=65±6yr, FVC=84±12%pred, LVEF=26±6%) were studied. Q?aw was assessed using soluble gas measurements; perfusion pressure across airway bed (?Paw) was estimated from systemic and pulmonary pressure measurements; Gf-aw was calculated as Q?aw/?Paw; PF was assessed by spirometry. While Q?aw was not significantly different between CTRL (61.3±17.9 ?L·min?1·ml?1), HF-A (70.1±26.9 ?L·min?1·ml?1) and HF-B (56.2±14.9 ?L·min?1·ml?1) groups, Gf-aw, was elevated in HF-A (1.1±0.4 ?L·min?1·ml?1·mmHg?1, p<0.03) and tended to be elevated in HF-B (1.2±0.6 ?L·min?1·ml?1·mmHg?1, p=0.07) when compared to CTRL (0.8±0.3 ?L·min?1·ml?1·mmHg?1). Significant positive correlations were found between Gf-aw and RV/TLC for HF-A (r=0.63, p<0.02) and HF-B (r=0.58, p<0.05). These results support the hypothesis that increased bronchial conductance and bronchial congestion may be related to greater small airway obstruction and as such may play a role in the PF abnormalities and symptoms of congestion commonly observed in HF patients.
Ceridon, Maile L.; Morris, Norman R.; Hulsebus, Minelle L.; Olson, Thomas P.; Lalande, Sophie; Johnson, Bruce D.
Minimal residual disease detection by flow cytometry and PARR in lymph node, peripheral blood and bone marrow, following treatment of dogs with diffuse large B-cell lymphoma.
The most promising techniques for detecting minimal residual disease (MRD) in canine lymphoma are flow cytometry (FC) and polymerase chain reaction amplification of antigen receptor genes (PARR). However, the agreement between these methods has not been established. MRD was monitored by FC and PARR following treatment of dogs affected with diffuse large B-cell lymphoma (DLBCL), comparing results in lymph node (LN), peripheral blood (PB) and bone marrow (BM) samples. The prognostic impact of MRD on time to relapse (TTR) and lymphoma-specific survival (LSS) was also assessed. Fourteen dogs with previously untreated DLBCL were enrolled into the study; 10 dogs eventually relapsed, while four dogs with undetectable MRD were still in remission at the end of the study. At diagnosis, the concordance rate between FC and PARR was 100%, 78.6%, and 64.3% for LN, PB and BM, respectively. At the end of treatment, the agreement rates were 35.7%, 50%, and 57.1% for LN, PB and BM, respectively. At least one of the follow-up samples from dogs experiencing relapse was PARR(+); conversely, FC was not able to detect MRD in seven of the dogs that relapsed. PARR was more sensitive than FC in predicting TTR, whereas the combination of PARR and FC was more sensitive than either technique alone in predicting LSS using PB samples. The results suggest that immunological and molecular techniques should be used in combination when monitoring for MRD in canine DLBCL. PMID:24698669
Aresu, Luca; Aricň, Arianna; Ferraresso, Serena; Martini, Valeria; Comazzi, Stefano; Riondato, Fulvio; Giantin, Mery; Dacasto, Mauro; Guadagnin, Eleonora; Frayssinet, Patrick; Rouquet, Nicole; Drigo, Michele; Marconato, Laura
Noninvasive assessment of left atrial maximum dP/dt by a combination of transmitral and pulmonary venous flow
NASA Technical Reports Server (NTRS)
OBJECTIVES: The study assessed whether hemodynamic parameters of left atrial (LA) systolic function could be estimated noninvasively using Doppler echocardiography. BACKGROUND: Left atrial systolic function is an important aspect of cardiac function. Doppler echocardiography can measure changes in LA volume, but has not been shown to relate to hemodynamic parameters such as the maximal value of the first derivative of the pressure (LA dP/dt(max)). METHODS: Eighteen patients in sinus rhythm were studied immediately before and after open heart surgery using simultaneous LA pressure measurements and intraoperative transesophageal echocardiography. Left atrial pressure was measured with a micromanometer catheter, and LA dP/dt(max) during atrial contraction was obtained. Transmitral and pulmonary venous flow were recorded by pulsed Doppler echocardiography. Peak velocity, and mean acceleration and deceleration, and the time-velocity integral of each flow during atrial contraction was measured. The initial eight patients served as the study group to derive a multilinear regression equation to estimate LA dP/dt(max) from Doppler parameters, and the latter 10 patients served as the test group to validate the equation. A previously validated numeric model was used to confirm these results. RESULTS: In the study group, LA dP/dt(max) showed a linear relation with LA pressure before atrial contraction (r = 0.80, p < 0.005), confirming the presence of the Frank-Starling mechanism in the LA. Among transmitral flow parameters, mean acceleration showed the strongest correlation with LA dP/dt(max) (r = 0.78, p < 0.001). Among pulmonary venous flow parameters, no single parameter was sufficient to estimate LA dP/dt(max) with an r2 > 0.30. By stepwise and multiple linear regression analysis, LA dP/dt(max) was best described as follows: LA dP/dt(max) = 0.1 M-AC +/- 1.8 P-V - 4.1; r = 0.88, p < 0.0001, where M-AC is the mean acceleration of transmitral flow and P-V is the peak velocity of pulmonary venous flow during atrial contraction. This equation was tested in the latter 10 patients of the test group. Predicted and measured LA dP/dt(max) correlated well (r = 0.90, p < 0.0001). Numerical simulation verified that this relationship held across a wide range of atrial elastance, ventricular relaxation and systolic function, with LA dP/dt(max) predicted by the above equation with r = 0.94. CONCLUSIONS: A combination of transmitral and pulmonary venous flow parameters can provide a hemodynamic assessment of LA systolic function.
Nakatani, S.; Garcia, M. J.; Firstenberg, M. S.; Rodriguez, L.; Grimm, R. A.; Greenberg, N. L.; McCarthy, P. M.; Vandervoort, P. M.; Thomas, J. D.
Lymph nodes play an important part in the body's defense against infection. Swelling might occur even if the infection is trivial or not apparent. Swelling of lymph nodes generally results from localized or systemic infection, abscess ...
Teaching the effects of gravity and intravascular and alveolar pressures on the distribution of pulmonary blood flow using a classic paper by West et al.
"Distribution of blood flow in isolated lung; relation to vascular and alveolar pressures" by J. B. West, C. T. Dollery, and A. Naimark (J Appl Physiol 19: 713-724, 1964) is a classic paper, although it has not yet been included in the Essays on the American Physiological Society Classic Papers Project (http://www.the-aps.org/publications/classics/). This is the paper that originally described the "zones of the lung." The final figure in the paper, which synthesizes the results and discussion, is now seen in most textbooks of physiology or respiratory physiology. The paper is also a model of clear, concise writing. The paper and its final figure can be used to teach or review a number of physiological concepts. These include the effects of gravity on pulmonary blood flow and pulmonary vascular resistance; recruitment and distention of pulmonary vessels; the importance of the transmural pressure on the diameter of collapsible distensible vessels; the Starling resistor; the interplay of the pulmonary artery, pulmonary vein, and alveolar pressures; and the vascular waterfall. In addition, the figure can be used to generate discovery learning and discussion of several physiological or pathophysiological effects on pulmonary vascular resistance and the distribution of pulmonary blood flow. PMID:16481601
Levitzky, Michael G
Evaluation of Diagnos TB AG, a flow-through immunoassay for rapid detection of pulmonary tuberculosis.
We evaluated the diagnostic performance of the Diagnos TB AG immunoassay in 171 Tanzanians with suspected pulmonary tuberculosis (TB). The sensitivity and specificity, and positive and negative predictive values of the rapid test for the detection of pulmonary TB in this population were respectively 60.0%, 33.3%, 40.3% and 52.6%. In its current configuration, this test will not help overcome difficulties in the rapid diagnosis of TB. PMID:20074417
Reither, K; Saathoff, E; Jung, J; Minja, L T; Machibya, H; Maboko, L; Perkins, M D; Hoelscher, M; Boehme, C C
Development of pulmonary blood flow evaluation method with a dynamic flat-panel detector: quantitative correlation analysis with findings on perfusion scan.
Pulmonary blood flow is reflected in dynamic chest radiographs as changes in X-ray translucency, i.e., pixel values. Thus, decreased blood flow should be observed as a reduction of the variation of X-ray translucency. We performed the present study to investigate the feasibility of pulmonary blood flow evaluation with a dynamic flat-panel detector (FPD). Sequential chest radiographs of 14 subjects were obtained with a dynamic FPD system. The changes in pixel value in each local area were measured and mapped on the original image by use of a gray scale in which small and large changes were shown in white and black, respectively. The resulting images were compared to the findings in perfusion scans. The cross-correlation coefficients of the changes in pixel value and radioactivity counts in each local area were also computed. In all patients, pulmonary blood flow disorder was indicated as a reduction of changes in pixel values on the mapping image, and a correlation was observed between the distribution of changes in pixel value and those in radioactivity counts (0.7
Tanaka, Rie; Sanada, Shigeru; Fujimura, Masaki; Yasui, Masahide; Hayashi, Norio; Tsuji, Shiro; Okamoto, Hiroyuki; Nanbu, Yuko; Matsui, Osamu
Stress-induced changes in lymph microcirculation
NASA Astrophysics Data System (ADS)
In the present study some characteristics of lymph microcirculation in mesentery of intact and stressed rats were investigated. The stress was modelled by simultaneous action of rigid immobilization and interrupting sound during 2 h. The direct observation of lymph circulation in microvessels was based on the light intravital videomicroscopy technique. The diameters of microvessels as well as parameters of phasic contractions and valve function of lymphatics were registered. After stress the mean diameter of lymphatic vessels was increased by 13%. The number of microvessels with phasic contractions raised by 20%. The amplitude and frequency of phasic contractions decreased by 31 and 39%, respectively. The percentage of microvessels with lymph flow comprised 86% in control and 93% in stressed animals. The mean velocity of lymph flow increased by 61 micrometers /s whereas the rate of valve work was not modified after stress.
Solov'eva, Anastasiya V.; Brill, Gregory E.; Galanzha, Ekateryna I.; Stepanova, Tatyana V.
Flow Cytometry-Based Cell Type-Specific Assessment of Target Regulation by Pulmonary siRNA Delivery
Pulmonary siRNA delivery has attracted strong interest and has been reported to successfully mediate target gene knockdown in a number of disease models. However, the nature of the epithelial cells that eventually take up siRNA and the question if other lung cell types may also be transfected have so far been neglected. Therefore, we describe here a flow cytometry-based method using transgenic enhanced green fluorescence protein-expressing mice (EGFP mice) for the differentiation of transfected lung cell populations based on their antigen expression.
Merkel, Olivia M.; Marsh, Leigh M.; Garn, Holger; Kissel, Thomas
[A case of pulmonary tumor thrombotic microangiopathy induced by early gastric cancer].
A 56-year-old man with chief complaints of dry cough and dyspnea was admitted. He had severe hypoxemia, and his chest radiographs showed enhancement of pulmonary artery opacities with multiple defects on pulmonary blood flow scintigraphy. Enhanced computed tomography (CT) revealed swelling of the mediastinum and hilar lymph nodes, but no apparent thrombi in the pulmonary arteries was seen. A biopsy specimen of a left neck lymph node showed poorly differentiated adenocarcinoma, including signet-ring cell carcinoma components, but the origin was unclear. Despite receiving chemotherapy, his respiratory condition worsened, and he died 3 days after admission. Routine autopsy failed to clarify the tumor origin, but a detailed dissection of specimens confirmed early gastric cancer. Additionally, pathology of the pulmonary arteries was compatible with pulmonary tumor thrombotic microangiopathy (PTTM). PTTM is a rare condition characterized by the presence of diffuse thrombotic microthrombi and fibrocellular intimal proliferation in the pulmonary vasculature. Accompanied with early gastric cancer, this is an extremely rare but important case of PTTM. PMID:21400909
Yasui, Hideki; Akamatsu, Taisuke; Nakamura, Yutarou; Inui, Naoki; Suda, Takafumi; Chida, Kingo; Meguro, Shiori; Baba, Satoshi
Generation of lymph node-fat pad chimeras for the study of lymph node stromal cell origin.
The stroma is a key component of the lymph node structure and function. However, little is known about its origin, exact cellular composition and the mechanisms governing its formation. Lymph nodes are always encapsulated in adipose tissue and we recently demonstrated the importance of this relation for the formation of lymph node stroma. Adipocyte precursor cells migrate into the lymph node during its development and upon engagement of the Lymphotoxin-b receptor switch off adipogenesis and differentiate into lymphoid stromal cells (Bénézech et al.). Based on the lymphoid stroma potential of adipose tissue, we present a method using a lymph node/fat pad chimera that allows the lineage tracing of lymph node stromal cell precursors. We show how to isolate newborn lymph nodes and EYFP(+) embryonic adipose tissue and make a LN/ EYFP(+) fat pad chimera. After transfer under the kidney capsule of a host mouse, the lymph node incorporates local adipose tissue precursor cells and finishes its formation. Progeny analysis of EYFP(+) fat pad cells in the resulting lymph nodes can be performed by flow-cytometric analysis of enzymatically digested lymph nodes or by immunofluorescence analysis of lymph nodes cryosections. By using fat pads from different knockout mouse models, this method will provide an efficient way of analyzing the origin of the different lymph node stromal cell populations. PMID:24378826
Benezech, Cecile; Caamano, Jorge H
Assessment of left heart and pulmonary circulation flow dynamics by a new pulsed mock circulatory system
We developed a new mock circulatory system that is able to accurately simulate the human blood circulation from the pulmonary\\u000a valve to the peripheral systemic capillaries. Two independent hydraulic activations are used to activate an anatomical-shaped\\u000a left atrial and a left ventricular silicon molds. Using a lumped model, we deduced the optimal voltage signals to control\\u000a the pumps. We used
David Tanné; Eric Bertrand; Lyes Kadem; Philippe Pibarot; Régis Rieu
Estimation of left ventricular diastolic pressures from precordial pulsed-Doppler analysis of pulmonary venous and mitral flow.
Because analysis of pulmonary venous flow (PVF) will be extensively used in comprehensive Doppler assessment of left ventricular diastolic function, this study was designed to (1) evaluate the feasibility of PVF measurement in 116 consecutive patients with various cardiac abnormalities by using precordial pulsed Doppler echocardiography; (2) Estimate mean pulmonary capillary pressure (MPCP) and left ventricular end-diastolic pressure (LVEDP) from Doppler variables of PVF and mitral inflow; and (3) evaluate the influence of clinical and hemodynamic variables on PVF Doppler patterns. We adequately recorded anterograde PVF in 96 (82.7%) patients and retrograde PVF in 45 (38.7%) patients. The strongest correlation between MPCP and Doppler variables of PVF was found with systolic fraction (the systolic velocity time integral expressed as a fraction of total anterograde PVF) (r = -0.88; p < 0.001). Age influenced this relation, with progressive increase of the systolic fraction in older patients. A good correlation (r = 0.72; p < 0.001) was found between LVEDP and the difference in duration of the reversal PVF and the mitral a wave. In conclusion, (1) PVF can be recorded adequately in most patients with precordial Doppler echocardiography; (2) left ventricular diastolic pressures can be estimated reliably by precordial Doppler echocardiography; and (3) the clinical meaning of Doppler-derived indexes of left ventricular diastolic performance is age-related. PMID:8037096
Brunazzi, M C; Chirillo, F; Pasqualini, M; Gemelli, M; Franceschini-Grisolia, E; Longhini, C; Giommi, L; Barbaresi, F; Stritoni, P
Phase-Contrast MRI and CFD Modeling of Apparent 3He Gas Flow in Rat Pulmonary Airways
Phase-contrast (PC) magnetic resonance imaging (MRI) with hyperpolarized 3He is potentially useful for developing and testing patient-specific models of pulmonary airflow. One challenge, however, is that PC-MRI provides apparent values of local 3He velocity that not only depend on actual airflow but also on gas diffusion. This not only blurs laminar flow patterns in narrow airways but also introduces anomalous airflow structure that reflects gas-wall interactions. Here, both effects are predicted in a live rat using computational fluid dynamics (CFD), and for the first time, simulated patterns of apparent 3He gas velocity are compared with in-vivo PC-MRI. Results show 1) that correlations (R2) between measured and simulated airflow patterns increase from 0.23 to 0.79 simply by accounting for apparent 3He transport, and 2) that remaining differences are mainly due to uncertain airway segmentation and partial volume effects stemming from relatively coarse MRI resolution. Higher-fidelity testing of pulmonary airflow predictions should therefore be possible with future imaging improvements.
Minard, Kevin R.; Kuprat, Andrew P.; Kabilan, Senthil; Jacob, Richard E.; Einstein, Daniel R.; Carson, James P.; Corley, Richard A.
Phase-Contrast MRI and CFD Modeling of Apparent 3He Gas Flow in Rat Pulmonary Airways
Phase-contrast (PC) magnetic resonance imaging (MRI) with hyperpolarized 3He is potentially useful for developing and testing patient-specific models of pulmonary airflow. One challenge, however, is that PC-MRI provides apparent values of local 3He velocity that not only depend on actual airflow but also on gas diffusion. This not only blurs laminar flow patterns in narrow airways but also introduces anomalous airflow structure that reflects gas-wall interactions. Here, both effects are predicted in a live rat using computational fluid dynamics (CFD), and for the first time, simulated patterns of apparent 3He gas velocity are compared with in-vivo PC-MRI. Results show (1) that correlations (R2) between measured and simulated airflow patterns increase from 0.23 to 0.79 simply by accounting for apparent 3He transport, and that (2) remaining differences are mainly due to uncertain airway segmentation and partial volume effects stemming from relatively coarse MRI resolution. Higher-fidelity testing of pulmonary airflow predictions should therefore be possible with future imaging improvements.
Minard, Kevin R.; Kuprat, Andrew P.; Kabilan, Senthil; Jacob, Rick E.; Einstein, Daniel R.; Carson, James P.; Corley, Richard A.
Mediastinal lymph node size in lung cancer
Using a size criterion of 1 cm or greater as evidence for abnormality, the size of mediastinal lymph nodes identified by computed tomography (CT) was a poor predictor of mediastinal lymph node metastases in a series of 86 patients who had surgery for bronchogenic carcinoma. The surgery included full nodal sampling in all patients. Of the 86 patients, 36 had nodes greater than or equal to 1 cm identified by CT. Of the 21 patients with mediastinal metastases proven at surgery, 14 had nodes greater than or equal to 1 cm (sensitivity = 67%). Of the 65 patients without mediastinal metastases, 22 had nodes greater than or equal to 1 cm. Obstructive pneumonia and/or pulmonary collapse distal to the cancer was present in 39 patients (45%). Obstructive pneumonia and/or pulmonary collapse is a common occurrence in bronchogenic carcinoma, but mediastinal nodes greater than or equal to 1 cm in this circumstance cannot be presumed to represent metastatic disease. Metastatic mediastinal lymph node involvement was related to nodal size also in patients with evidence of prior granulomatous disease and in patients with no putative benign cause for nodes greater than or equal to 1 cm.
Libshitz, H.I.; McKenna, R.J. Jr.
Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness
BACKGROUNDIt has been suggested that cough effectiveness can be improved by assisted techniques. The effects of manually assisted cough and mechanical insufflation on cough flow physiology are reported in this study.METHODSThe physiological actions and patient self-assessment of manually assisted cough and mechanical insufflation were investigated in 29 subjects (nine normal subjects, eight patients with chronic obstructive pulmonary disease (COPD), four
P Sivasothy; L Brown; I E Smith; J M Shneerson
Reversal of flow in the pulmonary artery: high-pitch spiral as a new method for dose reduction in functional imaging.
Advancements in CT technology lave led to substantial dose reductions for anatomic imaging of the heart. Here we illustrate an example where rapid repeat imaging with a high pitch spiral technique can image physiologic function. By optimal timing, and repeat sub second scanning, we illustrate an unusual case where direction of blood flow in the right pulmonary artery is reversed. PMID:22682263
Boswell, Gilbert E; Cathey, Michael; Campin, Richard; Nayak, Keshav
Respiratory flow phenomena and gravitational deposition in a three-dimensional space-filling model of the pulmonary acinar tree.
The inhalation of micron-sized aerosols into the lung's acinar region may be recognized as a possible health risk or a therapeutic tool. In an effort to develop a deeper understanding of the mechanisms responsible for acinar deposition, we have numerically simulated the transport of nondiffusing fine inhaled particles (1 mum and 3 microm in diameter) in two acinar models of varying complexity: (i) a simple alveolated duct and (ii) a space-filling asymmetrical acinar branching tree following the description of lung structure by Fung (1988, "A Model of the Lung Structure and Its Validation," J. Appl. Physiol., 64, pp. 2132-2141). Detailed particle trajectories and deposition efficiencies, as well as acinar flow structures, were investigated under different orientations of gravity, for tidal breathing motion in an average human adult. Trajectories and deposition efficiencies inside the alveolated duct are strongly related to gravity orientation. While the motion of larger particles (3 microm) is relatively insensitive to convective flows compared with the role of gravitational sedimentation, finer 1 microm aerosols may exhibit, in contrast, complex kinematics influenced by the coupling between (i) flow reversal due to oscillatory breathing, (ii) local alveolar flow structure, and (iii) streamline crossing due to gravity. These combined mechanisms may lead to twisting and undulating trajectories in the alveolus over multiple breathing cycles. The extension of our study to a space-filling acinar tree was well suited to investigate the influence of bulk kinematic interaction on aerosol transport between ductal and alveolar flows. We found the existence of intricate trajectories of fine 1 microm aerosols spanning over the entire acinar airway network, which cannot be captured by simple alveolar models. In contrast, heavier 3 microm aerosols yield trajectories characteristic of gravitational sedimentation, analogous to those observed in the simple alveolated duct. For both particle sizes, however, particle inhalation yields highly nonuniform deposition. While larger particles deposit within a single inhalation phase, finer 1 microm particles exhibit much longer residence times spanning multiple breathing cycles. With the ongoing development of more realistic models of the pulmonary acinus, we aim to capture some of the complex mechanisms leading to deposition of inhaled aerosols. Such models may lead to a better understanding toward the optimization of pulmonary drug delivery to target specific regions of the lung. PMID:19154069
Sznitman, Josué; Heimsch, Thomas; Wildhaber, Johannes H; Tsuda, Akira; Rösgen, Thomas
Ovine model for studying pulmonary immune responses
Anatomical features of the sheep lung make it an excellent model for studying pulmonary immunity. Four specific lung segments were identified which drain exclusively to three separate lymph nodes. One of these segments, the dorsal basal segment of the right lung, is drained by the caudal mediastinal lymph node (CMLN). Cannulation of the efferent lymph duct of the CMLN along with highly localized intrabronchial instillation of antigen provides a functional unit with which to study factors involved in development of pulmonary immune responses. Following intrabronchial immunization there was an increased output of lymphoblasts and specific antibody-forming cells in efferent CMLN lymph. Continuous divergence of efferent lymph eliminated the serum antibody response but did not totally eliminate the appearance of specific antibody in fluid obtained by bronchoalveolar lavage. In these studies localized immunization of the right cranial lobe served as a control. Efferent lymphoblasts produced in response to intrabronchial antigen were labeled with /sup 125/I-iododeoxyuridine and their migrational patterns and tissue distribution compared to lymphoblasts obtained from the thoracic duct. The results indicated that pulmonary immunoblasts tend to relocate in lung tissue and reappear with a higher specific activity in pulmonary lymph than in thoracic duct lymph. The reverse was observed with labeled intestinal lymphoblasts. 35 references, 2 figures, 3 tables.
Joel, D.D.; Chanana, A.D.
Progressive dysfunction of nitric oxide synthase in a lamb model of chronically increased pulmonary blood flow: a role for oxidative stress
Cardiac defects associated with increased pulmonary blood flow result in pulmonary vascular dysfunction that may relate to a decrease in bioavailable nitric oxide (NO). An 8-mm graft (shunt) was placed between the aorta and pulmonary artery in 30 late gestation fetal lambs; 27 fetal lambs underwent a sham procedure. Hemodynamic responses to ACh (1 ?g/kg) and inhaled NO (40 ppm) were assessed at 2, 4, and 8 wk of age. Lung tissue nitric oxide synthase (NOS) activity, endothelial NOS (eNOS), neuronal NOS (nNOS), inducible NOS (iNOS), and heat shock protein 90 (HSP90), lung tissue and plasma nitrate and nitrite (NOx), and lung tissue superoxide anion and nitrated eNOS levels were determined. In shunted lambs, ACh decreased pulmonary artery pressure at 2 wk (P < 0.05) but not at 4 and 8 wk. Inhaled NO decreased pulmonary artery pressure at each age (P < 0.05). In control lambs, ACh and inhaled NO decreased pulmonary artery pressure at each age (P < 0.05). Total NOS activity did not change from 2 to 8 wk in control lambs but increased in shunted lambs (ANOVA, P < 0.05). Conversely, NOx levels relative to NOS activity were lower in shunted lambs than controls at 4 and 8 wk (P < 0.05). eNOS protein levels were greater in shunted lambs than controls at 4 wk of age (P < 0.05). Superoxide levels increased from 2 to 8 wk in control and shunted lambs (ANOVA, P < 0.05) and were greater in shunted lambs than controls at all ages (P < 0.05). Nitrated eNOS levels were greater in shunted lambs than controls at each age (P < 0.05). We conclude that increased pulmonary blood flow results in progressive impairment of basal and agonist-induced NOS function, in part secondary to oxidative stress that decreases bioavailable NO.
Oishi, Peter E.; Wiseman, Dean A.; Sharma, Shruti; Kumar, Sanjiv; Hou, Yali; Datar, Sanjeev A.; Azakie, Anthony; Johengen, Michael J.; Harmon, Cynthia; Fratz, Sohrab; Fineman, Jeffrey R.; Black, Stephen M.
Hemodynamic, plasma volume, and prenodal skin lymph responses to varied resuscitation regimens.
The theoretical efficacy of hypertonic saline (HS) resuscitation for hemorrhagic shock purportedly stems from the osmolar extraction of intracellular fluid into the plasma. This hypothesis presumes a concomitant expansion of the interstitial fluid space. Colloid resuscitation, in theory, expands the plasma volume by extracting interstitial fluid. These hypotheses were tested in a canine-modified Wigger's model of hemorrhagic shock. Forty, male, splenectomized dogs were anesthetized and instrumented. Animals underwent a baseline equilibration period followed by shock for 120 minutes. Each animal was randomized to one of four groups and received equal amounts of Na+ either as lactated Ringer's (LR) solution, 10% dextran 40 (Dex) in normal saline, 7.5% saline (HS), or 7.5% saline plus Dex (HSD). Parameters measured at baseline, shock, and at postresuscitation 30 minutes, 60 minutes, 90 minutes, and 120 minutes, included: mean pressure (MAP), output, pulmonary capillary wedge pressure, prenodal skin lymph flow, serum and lymph albumin, wet-to-dry skin ratios, and plasma volume. MAP, cardiac output, and plasma volume were most quickly restored with LR and Dex resuscitation (MAP = 106 and 118 mm Hg) compared to HS and HSD (MAP = 98 and 92 mm Hg). Lymph flow and lymph albumin flux were best restored with LR and HSD (mean = 85 and 48 microL/min) compared to Dex and HS (mean = 36 and 37 microL/min). Wet/dry skin ratios were greatest at 60 minutes in the LR group but similar at 120 minutes in all four groups. These data suggest that interstitial fluid space remains contracted during the first hour after HS, HSD, and Dex resuscitation compared with LR resuscitation, even though the restoration of plasma volume, MAP, and cardiac output is greatest with the Dex regimen. Further studies with total body water and intracellular water are needed in this model. PMID:8760538
Saxe, J M; Dombi, G W; Lucas, W F; Ledgerwood, A M; Lucas, C E
Increased oxidative stress and severe arterial remodeling induced by permanent high-flow challenge in experimental pulmonary hypertension
Background Involvement of inflammation in pulmonary hypertension (PH) has previously been demonstrated and recently, immune-modulating dendritic cells (DCs) infiltrating arterial lesions in patients suffering from idiopathic pulmonary arterial hypertension (IPAH) and in experimental monocrotaline-induced PH have been reported. Occurrence of perivascular inflammatory cells could be linked to local increase of oxidative stress (OS), as it has been shown for systemic atherosclerosis. The impact of OS on vascular remodeling in PH is still to be determined. We hypothesized, that augmented blood-flow could increase OS and might thereby contribute to DC/inflammatory cell-recruitment and smooth-muscle-cell-proliferation. Methods We applied a monocrotaline-induced PH-model and combined it with permanent flow-challenge. Thirty Sprague-Dawley rats were assigned to following groups: control, monocrotaline-exposure (MCT), monocrotaline-exposure/pneumonectomy (MCT/PE). Results Hemodynamic exploration demonstrated most severe effects in MCT/PE, corresponding in histology to exuberant medial and adventitial remodeling of pulmonary muscular arteries, and intimal remodeling of smaller arterioles; lung-tissue PCR evidenced increased expression of DCs-specific fascin, CD68, proinflammatory cytokines (IL-6, RANTES, fractalkine) in MCT/PE and to a lesser extent in MCT. Major OS enzyme NOX-4 was maximal in MCT/PE. Antioxidative stress enzymes Mn-SOD and glutathion-peroxidase-1 were significantly elevated, while HO-1 showed maximal expression in MCT with significant decrease in MCT/PE. Catalase was decreased in MCT and MCT/PE. Expression of NOX-4, but also of MN-SOD in MCT/PE was mainly attributed to a highly increased number of interstitial and perivascular CXCR4/SDF1 pathway-recruited mast-cells. Stress markers malonedialdehyde and nitrotyrosine were produced in endothelial cells, medial smooth muscle and perivascular leucocytes of hypertensive vasculature. Immunolabeling for OX62, CD68 and actin revealed adventitial and medial DC- and monocyte-infiltration; in MCT/PE, medial smooth muscle cells were admixed with CD68+/vimentin+ cells. Conclusion Our experimental findings support a new concept of immunologic responses to increased OS in MCT/PE-induced PAH, possibly linking recruitment of dendritic cells and OS-producing mast-cells to characteristic vasculopathy.
Physiological effects of flow and pressure triggering during non- invasive mechanical ventilation in patients with chronic obstructive pulmonary disease
BACKGROUND: The effect of the type of trigger system on inspiratory effort has been studied in intubated patients, but no data are available in non-invasive mechanical ventilation where the "trigger variable" may be even more important since assisted modes of ventilation are often employed from the beginning of mechanical ventilation. METHODS: The effect of flow triggering (1 and 5 1/min) and pressure triggering (-1 cm H2O) on inspiratory effort during pressure support ventilation (PSV) and assisted controlled mode (A/C) delivered non-invasively with a full face mask were compared in patients with chronic obstructive pulmonary disease (COPD) recovering from an acute exacerbation. The patients were studied during randomised 15 minute runs at zero positive end expiratory pressure (ZEEP). The oesophageal pressure time product (PTPoes), dynamic intrinsic PEEP (PEEPi,dyn), fall in maximal airway pressure (delta Paw) during inspiration, and ventilatory variables were measured. RESULTS: Minute ventilation, respiratory pattern, dynamic lung compliance and resistances, and changes in end expiratory lung volume (delta EELV) were the same with the two triggering systems. The total PTPoes and its pre-triggering phase (PTP due to PEEPi and PTP due to valve opening) were significantly higher during both PSV and A/C with pressure triggering than with flow triggering at both levels of sensitivity. delta Paw was larger during pressure triggering, and PEEPi,dyn was significantly reduced during flow triggering in the A/C mode only. CONCLUSIONS: In patients with COPD flow triggering reduces the inspiratory effort during both PSV and A/C modes compared with pressure triggering. These findings are likely to be due to a reduction in PEEPi,dyn and in the time of valve opening with a flow trigger. ???
Nava, S.; Ambrosino, N.; Bruschi, C.; Confalonieri, M.; Rampulla, C.
The value of assessing pulmonary venous flow velocity for predicting severity of mitral regurgitation: A quantitative assessment integrating left ventricular function
NASA Technical Reports Server (NTRS)
Although alteration in pulmonary venous flow has been reported to relate to mitral regurgitant severity, it is also known to vary with left ventricular (LV) systolic and diastolic dysfunction. There are few data relating pulmonary venous flow to quantitative indexes of mitral regurgitation (MR). The object of this study was to assess quantitatively the accuracy of pulmonary venous flow for predicting MR severity by using transesophageal echocardiographic measurement in patients with variable LV dysfunction. This study consisted of 73 patients undergoing heart surgery with mild to severe MR. Regurgitant orifice area (ROA), regurgitant stroke volume (RSV), and regurgitant fraction (RF) were obtained by quantitative transesophageal echocardiography and proximal isovelocity surface area. Both left and right upper pulmonary venous flow velocities were recorded and their patterns classified by the ratio of systolic to diastolic velocity: normal (>/=1), blunted (<1), and systolic reversal (<0). Twenty-three percent of patients had discordant patterns between the left and right veins. When the most abnormal patterns either in the left or right vein were used for analysis, the ratio of peak systolic to diastolic flow velocity was negatively correlated with ROA (r = -0.74, P <.001), RSV (r = -0.70, P <.001), and RF (r = -0.66, P <.001) calculated by the Doppler thermodilution method; values were r = -0.70, r = -0.67, and r = -0.57, respectively (all P <.001), for indexes calculated by the proximal isovelocity surface area method. The sensitivity, specificity, and predictive values of the reversed pulmonary venous flow pattern for detecting a large ROA (>0.3 cm(2)) were 69%, 98%, and 97%, respectively. The sensitivity, specificity, and predictive values of the normal pulmonary venous flow pattern for detecting a small ROA (<0.3 cm(2)) were 60%, 96%, and 94%, respectively. However, the blunted pattern had low sensitivity (22%), specificity (61%), and predictive values (30%) for detecting ROA of greater than 0.3 cm(2) with significant overlap with the reversed and normal patterns. Among patients with the blunted pattern, the correlation between the systolic to diastolic velocity ratio was worse in those with LV dysfunction (ejection fraction <50%, r = 0.23, P >.05) than in those with normal LV function (r = -0.57, P <.05). Stepwise linear regression analysis showed that the peak systolic to diastolic velocity ratio was independently correlated with RF (P <.001) and effective stroke volume (P <.01), with a multiple correlation coefficient of 0.71 (P <.001). In conclusion, reversed pulmonary venous flow in systole is a highly specific and reliable marker of moderately severe or severe MR with an ROA greater than 0.3 cm(2), whereas the normal pattern accurately predicts mild to moderate MR. Blunted pulmonary venous flow can be seen in all grades of MR with low predictive value for severity of MR, especially in the presence of LV dysfunction. The blunted pulmonary venous flow pattern must therefore be interpreted cautiously in clinical practice as a marker for severity of MR.
Pu, M.; Griffin, B. P.; Vandervoort, P. M.; Stewart, W. J.; Fan, X.; Cosgrove, D. M.; Thomas, J. D.
Glandular fever and pulmonary artery thrombosis in a paraplegic patient, who had undergone splenectomy for splenic trauma sustained along with spinal cord injury: misdiagnosed initially as urine infection and later as lymphoma when CT scan revealed enlarged lymph nodes: a case report
Background A 36-year-old male sustained fracture of first lumbar vertebra, splenic tear and paraplegia in a motorcycle accident in 2001; splenectomy was performed. Case presentation In 2008, he presented with temperature and feeling rough. With a diagnosis of urine infection, he was prescribed ciprofloxacin, followed by trimethoprim, amoxicillin, and gentamicin, as temperature did not subside. White cell count was 21.2 × 109/L; lymphocytes were 13.05 × 109/L (1.00 – 4.00). Therefore, computerised tomography (CT) of chest and abdomen was performed. Thrombus was present in pulmonary arteries bilaterally involving the lobar and segmental branches. Enlarged lymph nodes were seen in axillae, chest, abdomen and inguinal regions. Radiological diagnosis was lymphoma. Cell marker showed an excess of large granular lymphocytes and activated lymphocytes. The Glandular Fever Slide Test was positive. Subsequently, Paul Bunnell test was also positive. Epstein Barr virus serology was consistent with recent Epstein Barr virus infection. Antibiotic was omitted; enoxaparin was prescribed for pulmonary artery thrombosis. Conclusion Learning points from this case: (1) Although routine administration of antibiotic to a spinal cord injury patient with pyrexia may be acceptable in outpatient setting, other possibilities such as infection by multi-drug resistant organism, viral infection, venous or, arterial thrombosis should be considered if a patient does not respond promptly to antibacterial therapy. (2) When full blood count showed lymphocytosis (comprising > 50% of white blood cells) with atypical morphology, lymphocyte surface markers, Paul Bunnell test, and Epstein Barr virus serology should be performed. These tests would have led to a diagnosis of infectious mononucleosis, and abdominal imaging studies could have been avoided. (3) Lymphoid hyperplasia is the hallmark of infectious mononucleosis; therefore, we should have suspected glandular fever rather than lymphoma when CT scan revealed enlarged lymph nodes in abdomen, mediastinum, axillae and inguinal regions in this patient, who had lymphocytosis with atypical morphology. (4) A soft tissue mass, situated inferior to left hemidiaphragm in this asplenic patient, was misinterpreted as lymph nodes; review of CT led to the correct diagnosis of splenunculus. (5) Acute infection with Epstein Barr virus may lead to transient induction of anti-phospholipid antibodies, which can cause vascular thrombosis. (6) This case illustrates the value of reviewing test results and discussion with senior doctors, as these measures help to recognize medical errors and improve patient care.
[A Study of the Usefulness of Flow-adjustable Bilateral Pulmonary Artery Banding (FABPAB) for Hypoplastic Left Heart Syndrome( HLHS) or HLHS Variant].
Backgrounds:Bilateral pulmonary artery banding( BPAB), a relatively minimally invasive procedure, has begun to be undertaken as the initial operation for the treatment of hypoplastic left heart syndrome (HLHS) or HLHS variant. In the opinion of the present authors, it is practicable to avoid stepwise operations with cardiopulmonary bypass (CPB) in newborn patients by conducting an initial operation consisting of flow-adjustable bilateral pulmonary artery banding (FABPAB) combined with transcatheter pulmonary artery balloon dilatation( PABD), followed in a subsequent treatment course by transcatheter PABD, which would allow for more minimally invasive adjustment of the pulmonary artery bloodflow. This study was conducted as a retrospective evaluation of the usefulness of this therapeutic strategy. Methods:Fourteen patients who underwent BPAB as the initial operation for HLHS/HLHS variant between April 2008 and October 2013 were included in this study. Stepwise surgical repair including BPAB was performed via a median sternotomy as the initial operation, without the use of CPB. And 7patients underwent transcatheter PABD successfully. Results:In this series, 7 patients developed a significant pulmonary artery index (PAI) after PABD (pre PABD:148.3±63.9 vs. post PABD:232.5±73.2, p<0.05). No need of the pulmonary artery reconstruction at the 2nd operation. One patient failed to survive the operation, in which difficulty in adjustment of atrioventricular valvular regurgitation was encountered after the Norwood procedure. There were 3 patients who underwent the Norwood combined BDG at the mean age of 4.6 months and themean body weight of 5.5 kg. Fontan procedure was accomplished in 3 of the 6 patients of the survivor, while 3 patients were on standby for the Fontan procedure. Conclusion:We performed BPAB as the initial operation combined with PABD in the treatment of HLHS/HLHS variant, which enabled avoidance of the initial operation with cardiopulmonary bypass at the neonatal stage and developed a significant pulmonary artery index after PABD. PMID:24917154
Miyamoto, Takashi
Pulmonary embolism, pulmonary hemorrhage and pulmonary infarction
We compared 41 patients with angiographic proof of pulmonary embolism and clinical signs of pulmonary infarction (as evidenced by an infiltrate on x-ray study and pleuritic pain in the area of the embolus) with 24 patients with pulmonary embolism but without infarction. Only 18 of the 41 patients with pulmonary infarction had associated heart disease. Pulmonary infarction was uncommon when
James E. Dalen; Charles I. Haffajee; Joseph S. Alpert; John P. Howe; Ira S. Ockene; John A. Paraskos
Contrasting roles of macrophages and dendritic cells in controlling initial pulmonary Brucella infection.
Control of pulmonary pathogens constitutes a challenging task as successful immune responses need to be mounted without damaging the lung parenchyma. Using immunofluorescence microscopy and flow cytometry, we analyzed in the mouse the initial innate immune response that follows intranasal inoculation of Brucella abortus. Bacteria were absent from parenchymal dendritic cells (DC) but present in alveolar macrophages in which they replicated. When the number of alveolar macrophages was reduced prior to Brucella infection, small numbers of pulmonary DC were infected and a massive recruitment of TNF-?- and iNOS-producing DC ensued. Coincidentally, Brucella disseminated to the lung-draining mediastinal lymph nodes (LN) where they replicated in both migratory DC and migratory alveolar macrophages. Together, these results demonstrate that alveolar macrophages are critical regulators of the initial innate immune response against Brucella within the lungs and show that pulmonary DC and alveolar macrophages play rather distinct roles in the control of microbial burden. PMID:21108467
Archambaud, Cristel; Salcedo, Suzana P; Lelouard, Hugues; Devilard, Elisabeth; de Bovis, Beatrice; Van Rooijen, Nico; Gorvel, Jean-Pierre; Malissen, Bernard
[Pulmonary Blood Flow Measurement using Magnetic Resonance Imaging (MRI) without Contrast Medium;Comparison of Phase Contrast MRI and Perfusion-ventilation Scintigraphy].
To define the accuracy of pulmonary arterial blood flow (PA-flow) measured by phase contrast magnetic resonance imaging (PC-MRI), we compared the PA-flow data of PC-MRI with the data of perfusion-ventilation lung scintigraphy. Eighteen patients who preoperatively underwent PA-flow measurement using PC-MRI and perfusion-ventilation lung scintigraphy were evaluated. The PA-flow (cm3/sec) of MRI was calculated by multiplying maximum velocity (cm/sec) by region of interest (ROI) area (cm2) of measured main pulmonary artery using phase contrast method. The left to right ratio (R/L ratio) of PA-flow measured by PC-MRI was compared with the R/L ratios of the date of perfusion-ventilation lung scintigraphy. The R/L ratios of PC-MRI and perfusion lung scintigraphy were 1.43 ± 1.07 and 1.35 ± 0.82, respectively. Both ratios showed excellent correlation( y=-0.50+1.30x, r=0.99,p<0.001). The R/L ratios of PC-MRI also approximated to those of perfusion lung scintigraphy in the patients with a past history of lung resection, even if their R/L ratios of perfusion lung scintigraphy differed from those of ventilation lung scintigraphy. These results revealed that the PA-flow could be accurately measured by PC-MRI without contrast medium and nuclear medicine instruments. PMID:24743476
Yatsuyanagi, Eiji; Sato, Kazuhiro; Kikuchi, Keisuke; Saito, Hirotsugu
Quantitative analysis of the central-chest lymph nodes based on 3D MDCT image data
NASA Astrophysics Data System (ADS)
Lung cancer is the leading cause of cancer death in the United States. In lung-cancer staging, central-chest lymph nodes and associated nodal stations, as observed in three-dimensional (3D) multidetector CT (MDCT) scans, play a vital role. However, little work has been done in relation to lymph nodes, based on MDCT data, due to the complicated phenomena that give rise to them. Using our custom computer-based system for 3D MDCT-based pulmonary lymph-node analysis, we conduct a detailed study of lymph nodes as depicted in 3D MDCT scans. In this work, the Mountain lymph-node stations are automatically defined by the system. These defined stations, in conjunction with our system's image processing and visualization tools, facilitate lymph-node detection, classification, and segmentation. An expert pulmonologist, chest radiologist, and trained technician verified the accuracy of the automatically defined stations and indicated observable lymph nodes. Next, using semi-automatic tools in our system, we defined all indicated nodes. Finally, we performed a global quantitative analysis of the characteristics of the observed nodes and stations. This study drew upon a database of 32 human MDCT chest scans. 320 Mountain-based stations (10 per scan) and 852 pulmonary lymph nodes were defined overall from this database. Based on the numerical results, over 90% of the automatically defined stations were deemed accurate. This paper also presents a detailed summary of central-chest lymph-node characteristics for the first time.
Lu, Kongkuo; Bascom, Rebecca; Mahraj, Rickhesvar P. M.; Higgins, William E.
The effects of epinephrine\\/norepinephrine on end-tidal carbon dioxide concentration, coronary perfusion pressure and pulmonary arterial blood flow during cardiopulmonary resuscitation
End-tidal CO2 concentration correlates with pulmonary blood flow during cardiopulmonary resuscitation and has been claimed to be a useful tool to judge the effectiveness of chest compression. A high concentration of end-tidal CO2 has been related to a better outcome. However, most authors have noticed a decrease in end-tidal CO2 concentration after administration of epinephrine, concomitant with an increase in
Lars Lindberg; Quiming Liao; Stig Steen
The effects of epinephrine:norepinephrine on end-tidal carbon dioxide concentration, coronary perfusion pressure and pulmonary arterial blood flow during cardiopulmonary resuscitation
End-tidal CO2 concentration correlates with pulmonary blood flow during cardiopulmonary resuscitation and has been claimed to be a useful tool to judge the effectiveness of chest compression. A high concentration of end-tidal CO2 has been related to a better outcome. However, most authors have noticed a decrease in end-tidal CO2 concentration after administration of epinephrine, concomitant with an increase in
Lars Lindberg; Quiming Liao; Stig Steen
Oxygen therapy at low flow causes oxidative stress in chronic obstructive pulmonary disease: Prevention by N-acetyl cysteine.
Exposure to high oxygen concentration produces toxicity by free radical release. We aimed to study: whether stable chronic obstructive pulmonary disease (COPD) patients present an unbalance in the blood redox status; the effect of oxygen administration on blood redox balance; the efficacy of N-acetyl-cysteine (NAC) treatment against the oxidative stress-induced by oxygen administration and whether it is dose-related. To this, 45 stable state III COPD patients were recruited and reduced glutathione (GSH) and oxidised glutathione (GSSG) in erythrocytes and thiol proteins (P-SH) and carbonyl proteins (PC) in both erythrocytes and plasma were evaluated. All COPD patients underwent 2 l/m oxygen for 18 h and NAC at 1200 or 1800 mg/day or placebo for 48 h starting with oxygen administration. Blood samples were collected at basal conditions, after 8 and 18 h of oxygen administration and 24 h after oxygen withdrawal. Results: COPD patients present an unstable redox equilibrium mainly due to plasma sulphydryl protein depletion. Oxygen administration oxidize erythrocyte GSH, decrease P-SH and increase PC levels in both plasma and erythrocytes. NAC administration counteract the oxidative stress and at the highest dose completely prevent protein oxidation. In conclusion, stable state III COPD patients present an unstable redox balance; long term low flow oxygen administration induces systemic oxidative stress, which is prevented by NAC treatment. PMID:16298736
Foschino Barbaro, Maria Pia; Serviddio, Gaetano; Resta, Onofrio; Rollo, Tiziana; Tamborra, Rosanna; Elisiana Carpagnano, Giovanna; Vendemiale, Gianluigi; Altomare, Emanuele
Pulmonary Artery Catheter (PAC) Accuracy and Efficacy Compared with Flow Probe and Transcutaneous Doppler (USCOM): An Ovine Cardiac Output Validation
Background. The pulmonary artery catheter (PAC) is an accepted clinical method of measuring cardiac output (CO) despite no prior validation. The ultrasonic cardiac output monitor (USCOM) is a noninvasive alternative to PAC using Doppler ultrasound (CW). We compared PAC and USCOM CO measurements against a gold standard, the aortic flow probe (FP), in sheep at varying outputs. Methods. Ten conscious sheep, with implanted FPs, had measurements of CO by FP, USCOM, and PAC, at rest and during intervention with inotropes and vasopressors. Results. CO measurements by FP, PAC, and USCOM were 4.0 ± 1.2?L/min, 4.8 ± 1.5?L/min, and 4.0 ± 1.4?L/min, respectively, (n = 280, range 1.9?L/min to 11.7?L/min). Percentage bias and precision between FP and PAC, and FP and USCOM was ?17 and 47%, and 1 and 36%, respectively. PAC under-measured Dobutamine-induced CO changes by 20% (relative 66%) compared with FP, while USCOM measures varied from FP by 3% (relative 10%). PAC reliably detected ?30% but not +40% CO changes, as measured by receiver operating characteristic area under the curve (AUC), while USCOM reliably detected ±5% changes in CO (AUC > 0.70). Conclusions. PAC demonstrated poor accuracy and sensitivity as a measure of CO. USCOM provided equivalent measurements to FP across a sixfold range of outputs, reliably detecting ±5% changes.
Phillips, Robert A.; Hood, Sally G.; Jacobson, Beverley M.; West, Malcolm J.; Wan, Li; May, Clive N.
Morton LM, Turner JJ, Cerhan JR, Linet MS, Treseler PA, Clarke CA, Jack A, Cozen W, Maynadié M, Spinelli JJ, Seniori Costantini A, Rüdiger T, Scarpa A, Zheng T, Weisenburger DD. Proposed classification of lymphoid neoplasms for epidemiologic research from the International Lymphoma Epidemiology Consortium (InterLymph). Blood.
The effect of supine exercise on the distribution of regional pulmonary blood flow measured using proton MRI.
The Zone model of pulmonary perfusion predicts that exercise reduces perfusion heterogeneity because increased vascular pressure redistributes flow to gravitationally nondependent lung, and causes dilation and recruitment of blood vessels. However, during exercise in animals, perfusion heterogeneity as measured by the relative dispersion (RD, SD/mean) is not significantly decreased. We evaluated the effect of exercise on pulmonary perfusion in six healthy supine humans using magnetic resonance imaging (MRI). Data were acquired at rest, while exercising (?27% of maximal oxygen consumption) using a MRI-compatible ergometer, and in recovery. Images were acquired in most of the right lung in the sagittal plane at functional residual capacity, using a 1.5-T MR scanner equipped with a torso coil. Perfusion was measured using arterial spin labeling (ASL-FAIRER) and regional proton density using a fast multiecho gradient-echo sequence. Perfusion images were corrected for coil-based signal heterogeneity, large conduit vessels removed and quantified (in ml·min(-1)·ml(-1)) (perfusion), and also normalized for density and quantified (in ml·min(-1)·g(-1)) (density-normalized perfusion, DNP) accounting for tissue redistribution. DNP increased during exercise (11.1 ± 3.5 rest, 18.8 ± 2.3 exercise, 13.2 ± 2.2 recovery, ml·min(-1)·g(-1), P < 0.0001), and the increase was largest in nondependent lung (110 ± 61% increase in nondependent, 63 ± 35% in mid, 70 ± 33% in dependent, P < 0.005). The RD of perfusion decreased with exercise (0.93 ± 0.21 rest, 0.73 ± 0.13 exercise, 0.94 ± 0.18 recovery, P < 0.005). The RD of DNP showed a similar trend (0.82 ± 0.14 rest, 0.75 ± 0.09 exercise, 0.81 ± 0.10 recovery, P = 0.13). In conclusion, in contrast to animal studies, in supine humans, mild exercise decreased perfusion heterogeneity, consistent with Zone model predictions. PMID:24356515
Hall, E T; Sá, R C; Holverda, S; Arai, T J; Dubowitz, D J; Theilmann, R J; Prisk, G K; Hopkins, S R
Quantitative evaluation of the pattern of shunt flow in the right ventricle and pulmonary artery of dogs with experimental ventricular septal defect.
Cineangiographic studies in patients with ventricular septal defect (VSD) have occasionally demonstrated that part of the blood across the defect is ejected immediately into the pulmonary artery (PA) passing through the outflow tract of the right ventricle (RV), but without being trapped in it. We attempted to make a quantitative evaluation of the flow of a partial shunt pathway (a direct VSD-PA pathway) that drains that part of the blood from the defect. Our method depended on a thermal dilution technique to obtain the ejection fraction of the RV and to observe a simultaneous pair of dilution curves at the roots of the aorta and PA after introduction of tracer into the left atrium. An analytical process was specially designed by incorporating a stable one-pass deconvolution technique. The method was applied to eight anesthetized dogs with acutely produced experimental VSD on the entrance of the outflow tract of the RV. The flow through the direct VSD-PA pathway was, in most cases, greater than 50 and up to 85% (mean of the eight, 57 +/- 5% SE) of the total left-to-right shunt flow. This would imply that less than 50%, and down to as little as 15%, of the total amount of shunt flow contributed to extra work of the RV in these cases. In addition, the impact on the pulmonary vasculature due to such a large amount of pulsatile flow through the direct VSD-PA pathway may accelerate the development of hypertrophy of the pulmonary vessel wall. Images FIGURE 1
Nakai, M; Tomino, T; Goto, Y; Yamamoto, J; Matsui, Y; Togawa, T; Ogino, K
Pulmonary O2 uptake and leg blood flow kinetics during moderate exercise are slowed by hyperventilation-induced hypocapnic alkalosis.
The effect of hyperventilation-induced hypocapnic alkalosis (Hypo) on the adjustment of pulmonary O2 uptake (VO2p) and leg femoral conduit artery ("bulk") blood flow (LBF) during moderate-intensity exercise (Mod) was examined in eight young male adults. Subjects completed four to six repetitions of alternate-leg knee-extension exercise during normal breathing [Con; end-tidal partial pressure of CO2 (PetCO2) approximately 40 mmHg] and sustained hyperventilation (Hypo; PetCO2 approximately 20 mmHg). Increases in work rate were made instantaneously from baseline (3 W) to Mod (80% estimated lactate threshold). VO2p was measured breath by breath by mass spectrometry and volume turbine, and LBF (calculated from mean femoral artery blood velocity and femoral artery diameter) was measured simultaneously by Doppler ultrasound. Concentration changes of deoxy (Delta[HHb])-, oxy (Delta[O2Hb])-, and total hemoglobin-myoglobin (Delta[HbTot]) of the vastus lateralis muscle were measured continuously by near-infrared spectroscopy (NIRS). The kinetics of VO2p, LBF, and Delta[HHb] were modeled using a monoexponential equation by nonlinear regression. The time constants for the phase 2 VO2p (Hypo, 49+/-26 s; Con, 28+/-8 s) and LBF (Hypo, 46+/-16 s; Con, 23+/-6 s) were greater (P<0.05) in Hypo compared with Con. However, the mean response time for the overall Delta[HHb] response was not different between conditions (Hypo, 23+/-5 s; Con, 24+/-3 s), whereas the Delta[HHb] amplitude was greater (P<0.05) in Hypo (8.05+/-7.47 a.u.) compared with Con (6.69+/-6.31 a.u.). Combined, these results suggest that hyperventilation-induced hypocapnic alkalosis is associated with slower convective (i.e., slowed femoral artery and microvascular blood flow) and diffusive (i.e., greater fractional O2 extraction for a given DeltaVO2p) O2 delivery, which may contribute to the hyperventilation-induced slowing of VO2p (and muscle O2 utilization) kinetics. PMID:20339012
Chin, Lisa M K; Heigenhauser, George J F; Paterson, Donald H; Kowalchuk, John M
Pulmonary O2 uptake and leg blood flow kinetics during moderate exercise are slowed by hyperventilation-induced hypocapnic alkalosis
The effect of hyperventilation-induced hypocapnic alkalosis (Hypo) on the adjustment of pulmonary O2 uptake (V?o2p) and leg femoral conduit artery ("bulk") blood flow (LBF) during moderate-intensity exercise (Mod) was examined in eight young male adults. Subjects completed four to six repetitions of alternate-leg knee-extension exercise during normal breathing [Con; end-tidal partial pressure of CO2 (PetCO2) ?40 mmHg] and sustained hyperventilation (Hypo; PetCO2 ?20 mmHg). Increases in work rate were made instantaneously from baseline (3 W) to Mod (80% estimated lactate threshold). V?o2p was measured breath by breath by mass spectrometry and volume turbine, and LBF (calculated from mean femoral artery blood velocity and femoral artery diameter) was measured simultaneously by Doppler ultrasound. Concentration changes of deoxy (?[HHb])-, oxy (?[O2Hb])-, and total hemoglobin-myoglobin (?[HbTot]) of the vastus lateralis muscle were measured continuously by near-infrared spectroscopy (NIRS). The kinetics of V?o2p, LBF, and ?[HHb] were modeled using a monoexponential equation by nonlinear regression. The time constants for the phase 2 V?o2p (Hypo, 49 ± 26 s; Con, 28 ± 8 s) and LBF (Hypo, 46 ± 16 s; Con, 23 ± 6 s) were greater (P < 0.05) in Hypo compared with Con. However, the mean response time for the overall ?[HHb] response was not different between conditions (Hypo, 23 ± 5 s; Con, 24 ± 3 s), whereas the ?[HHb] amplitude was greater (P < 0.05) in Hypo (8.05 ± 7.47 a.u.) compared with Con (6.69 ± 6.31 a.u.). Combined, these results suggest that hyperventilation-induced hypocapnic alkalosis is associated with slower convective (i.e., slowed femoral artery and microvascular blood flow) and diffusive (i.e., greater fractional O2 extraction for a given ?V?o2p) O2 delivery, which may contribute to the hyperventilation-induced slowing of V?o2p (and muscle O2 utilization) kinetics.
Chin, Lisa M. K.; Heigenhauser, George J. F.; Paterson, Donald H.
Disproportionate pulmonary hypertension in a patient with early-onset pulmonary emphysema treated with specific drugs for pulmonary arterial hypertension.
Severe pulmonary hypertension in chronic obstructive pulmonary disease (COPD) is referred to as 'disproportionate' because the elevated pulmonary artery pressure does not match the degree of air flow limitation. We report a 41-year-old man presenting with early-onset pulmonary emphysema and pulmonary hypertension with a mean pressure of 74 mmHg. Continuous intravenous epoprostenol led to marked hemodynamic improvement, and epoprostenol was successfully replaced with bosentan. The patient has been followed for 3 years without exacerbation. This is the first report demonstrating the long-term efficacy of specific drugs for pulmonary arterial hypertension in disproportionate pulmonary hypertension in COPD. PMID:22001462
Shimizu, Masatoshi; Imanishi, Junichi; Takano, Takatsugu; Miwa, Yoichi
... valve pulmonary stenosis; Pulmonary stenosis; Stenosis - pulmonary valve; Balloon valvuloplasty - pulmonary ... water pills) Treat abnormal heartbeats and rhythms Percutaneous balloon pulmonary dilation (valvuloplasty) may be performed when no ...
Expiratory flow limitation and the response to breathing a helium-oxygen gas mixture in a canine model of pulmonary emphysema.
The pathophysiology of reduced maximum expiratory flow in a canine model of pulmonary emphysema was studied, and the results interpreted in terms of the wave-speed theory of flow limitation. According to this theory, maximum expiratory flow is related both to the cross-sectional area and compliance at an airway site where a critical gas velocity is first reached ("choke-point") and to gas density. Pulmonary emphysema was produced by the repeated instillations of the enzyme papain into the airways of six dogs. In five control dogs, a saline solution was instilled. During forced vital capacity deflation, in an open-chest preparation, maximum expiratory flow, choke-point locations, and the response to breathing an 80:20 helium/oxygen gas mixture were determined at multiple lung volumes. To locate choke-points, a pressure measuring device was positioned in the airway to measure lateral and end-on intrabronchial pressures, from which the relevant wave-speed parameters were obtained. In general, the reduced maximum expiratory flow in emphysema can be explained by diminished lung elastic recoil pressure and by altered bronchial pressure-area behavior, which results in a more peripheral location of choke-points that have smaller cross-sectional areas than controls. With respect to the density dependence of maximum expiratory flow, this response did not differ from control values in four dogs with emphysema in which frictional pressure losses upstream from choke-points did not differ on the two gas mixtures. In two dogs with emphysema, however, upstream frictional pressure losses were greater on helium/oxygen than on air, which resulted in a smaller cross-sectional area on helium/oxygen; hence density dependence decreased.
Mink, S N
[Determination of sentinel lymph node by Tc(99m) in small-cell lung cancer].
Introduction: In the prospective study was aimed to be the actual node staging identified sentinel and mediastinel lymph nodes and mapping in patient with operable non-small cell lung carcinomas. Materials and Methods: Twelve patients underwent pulmonary resections due to non-small cell bronchial carcinoma in the study were included . Intraoperatively, by injecting Tc99m to peritumoral tissues, average 96 minutes later, radioactivity levels of the tumoral tissue and lymph nodes were measured. All patients were evaluated by bronchoscopy for endobronchial lesions. The patients were scanned for the metastasis of solid organs in order to pre-operative staging. Results: The interlobar lymph node stations as a sentinel lymph nodes were detected in 45% of the patient. Lobes of specific, lymph node stations and skip metastasis detected lymph nodes were identified. Sentinel lymph node was in 77% of patients at the level N1 and in 66%of patients at the level N2. It were at two different stations in 66% of patients and at single-station in 33% of patient . In 1 (11%) of 9 patients identified sentinel lymph node, the metastasis has been reported by the routine histopathological examination. Conclusion: To detection sentinel lymph node, micrometastasis also allows for a more detailed pathological examination. It provides making true node staging in patients and postoperative therapy helps to organize appropriate support with non-small cell lung cancer. PMID:24814077
Zeybek, Arife; Sarper, Alpay; Erdo?an, Abdullah; Dertsiz, Levent; Demircan, Abid
A stable approach for coupling multidimensional cardiovascular and pulmonary networks based on a novel pressure-flow rate or pressure-only Neumann boundary condition formulation.
In many biomedical flow problems, reversed flows along with standard treatment of Neumann boundary conditions can cause instabilities. We have developed a method that resolves these instabilities in a consistent way while maintaining correct pressure and flow rate values. We also are able to remove the necessary prescription of both pressure and velocities/flow rates to problems where only pressure is known. In addition, the method is extended to coupled 3D/reduced-D fluid and fluid-structure interaction models. Numerical examples mainly focus on using Neumann boundary condition in cardiovascular and pulmonary systems, particularly, coupled with 3D-1D and 3D-0D models. Inflow pressure, traction, and impedance boundary conditions are first tested on idealized tubes for various Womersley numbers. Both pressure and flow rate are shown to match the analytical solutions for these examples. Our method is then tested on a coupled 1D-3D-1D artery example, demonstrating the power and simplicity of extending this method toward fluid-structure interaction. Finally, the proposed method is investigated for a coupled 3D-0D patient-specific full lung model during spontaneous breathing. All coupled 3D/reduced-D results show a perfect matching of pressure and flow rate between 3D and corresponding reduced-D boundaries. The methods are straight-forward to implement in contrast to using Lagrange multipliers as previously proposed in other studies. PMID:24243701
Ismail, M; Gravemeier, V; Comerford, A; Wall, W A
Surgery for Pulmonary Metastases From Colorectal Carcinoma
Background. This study aims to clarify which patients would benefit by surgery for pulmonary metastases from colorectal carcinoma. Methods. A retrospective study was undertaken in 25 patients who had undergone complete resection. In all cases, prethoracotomy carcinoembryonic antigen (CEA) level was measured and mediastinal or hilar lymph nodes were histologically examined. Results. Overall 5-year survival was 39.2%. The 5-year survival
Masayoshi Inoue; Yahiro Kotake; Katsuhiro Nakagawa; Kiyohiro Fujiwara; Kenjiro Fukuhara; Tsutomu Yasumitsu
Label free in vivo laser speckle imaging of blood and lymph vessels
NASA Astrophysics Data System (ADS)
The peripheral lymphatic vascular system is a part of the immune body system comprising a complex network of lymph vessels and nodes that are flowing lymph toward the heart. Traditionally the imaging of lymphatic vessels is based on the conventional imaging modalities utilizing contrast fluorescence materials. Given the important role of the lymphatic system there is a critical need for the development of noninvasive imaging technologies for functional quantitative diagnosis of the lymph vessels and lymph flow without using foreign chemicals. We report a label free methodology for noninvasive in vivo imaging of blood and lymph vessels, using long-exposure laser speckle imaging approach. This approach entails great promise in the noninvasive studies of tissues blood and lymph vessels distribution in vivo.
Kalchenko, Vyacheslav; Kuznetsov, Yuri; Meglinski, Igor; Harmelin, Alon
Venous thromboembolism; Lung blood clot; Blood clot - lung; Embolus; Tumor embolus; Embolism - pulmonary ... pulmonary embolus is most often caused by a blood clot in a vein. The most common blood ...
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 ...
Dynamic spiral MRI of pulmonary gas flow using hyperpolarized3He: Preliminary studies in healthy and diseased lungs
An optimized interleaved-spiral pulse sequence, providing high spatial and temporal resolution, was developed for dynamic imaging of pulmonary ventilation with hyperpolarized 3He, and tested in healthy volunteers and patients with lung disease. Off-resonance artifacts were minimized by using a short data- sampling period per interleaf, and gradient-fidelity errors were compensated for by using measured k-space trajectories for image reconstruction. A
Michael Salerno; Talissa A. Altes; James R. Brookeman; Eduard E. de Lange; John P. Mugler
Pulmonary sarcoidosis and antiphospholipid syndrome.
Various autoimmune diseases have been reported to occur in patients with sarcoidosis. However, coexistence of sarcoidosis and antiphospholipid syndrome (APS) is extremely rare. We describe a 59-year-old female patient with pulmonary sarcoidosis who had preceding APS. Her previous medical history consisted of a miscarriage and ischemic colitis. She was diagnosed as APS during the onset of a brainstem infarction with positive reaction to beta2-glycoprotein I-dependent anticardiolipin antibody. Two years later, chest CT revealed enlargement of the hilar and mediastinal lymph nodes and small nodules in the lung fields. Transbronchial lung biopsy demonstrated non-caseating epithelioid cell granuloma leading to the diagnosis of definite pulmonary sarcoidosis. This is the first APS case where pulmonary involvement with sarcoidosis has been confirmed through lung biopsy. Our case report suggests that APS should be recognized as an accompanying disorder of sarcoidosis. PMID:16771926
Takahashi, Fumiyuki; Toba, Michie; Takahashi, Kazuhisa; Tominaga, Shigeru; Sato, Koichi; Morio, Yoshiteru; Nakao, Yuta; Tajima, Ken; Miura, Kayo; Uekusa, Toshimasa; Fukuchi, Yoshinosuke
We have previously shown that acute increases in pulmonary blood flow (PBF) are limited by a compensatory increase in pulmonary vascular resistance (PVR) via an endothelin-1 (ET-1) dependent decrease in nitric oxide synthase (NOS) activity. The mechanisms underlying the reduction in NO signaling are unresolved. Thus, the purpose of this study was to elucidate mechanisms of this ET-1-NO interaction. Pulmonary arterial endothelial cells (PAEC) were acutely exposed to shear stress in the presence or absence of tezosentan, a combined ETA/ETB receptor antagonist. Shear increased NOx, eNOS phospho-Ser1177, and H2O2 and decreased catalase activity; tezosentan enhanced, while ET-1 attenuated all of these changes. In addition, ET-1 increased eNOS phospho-Thr495 levels. In lambs, 4h of increased PBF decreased H2O2, eNOS phospho-Ser1177, and NOX levels, and increased eNOS phospho-Thr495, phospho-catalase and catalase activity. These changes were reversed by tezosentan. PEG-catalase reversed the positive effects of tezosentan on NO signaling. In all groups, opening the shunt resulted in a rapid increase in PBF by 30min. In vehicle- and tezosentan/PEG-catalase lambs, PBF did not change further over the 4h study period. PVR fell by 30min in vehicle- and tezosentan-treated lambs, and by 60min in tezosentan/PEG-catalase-treated lambs. In vehicle- and tezosentan/PEG-catalase lambs, PVR did not change further over the 4h study period. In tezosentan-treated lambs, PBF continued to increase and LPVR to decrease over the 4h study period. We conclude that acute increases in PBF are limited by an ET-1 dependent decrease in NO production via alterations in catalase activity, H2O2 levels, and eNOS phosphorylation.
Rafikov, Ruslan; Aggarwal, Saurabh; Hou, Yali; Datar, Sanjeev A.; Sharma, Shruti; Azakie, Anthony; Fineman, Jeffrey R.; Black, Stephen M.
Flow cytometric assessment of circulating platelet and erythrocytes microparticles in young thalassemia major patients: relation to pulmonary hypertension and aortic wall stiffness.
Heart disease is the leading cause of mortality and morbidity in ?-thalassemia major (?-TM). Aggregability of abnormal red cells and membrane-derived microparticles (MPs) stemming from activated platelets and erythrocytes are responsible for thrombotic risk. We measured platelet and erythrocyte MPs (PMPs and ErMPs) in 60 young ?-TM patients compared with 40 age- and sex-matched healthy controls and assessed their relation to clinicopathological characteristics and aortic elastic properties. Patients were studied stressing on transfusion history, splenectomy, thrombotic events, chelation therapy, hematological and coagulation profiles, flow cytometric measurement of PMPs (CD41b(+) ) and ErMPs (glycophorin A(+) ) as well as echocardiographic assessment of aortic elastic properties. Aortic stiffness index and pulmonary artery pressure were significantly higher, whereas aortic strain and distensibility were lower in TM patients than controls (P < 0.001). Both PMPs and ErMPs were significantly elevated in TM patients compared with controls, particularly patients with risk of pulmonary hypertension, history of thrombosis, splenectomy or serum ferritin >2500 ?g/L (P < 0.001). Compliant patients on chelation therapy had lower MPs levels than non-compliant patients (P < 0.001). PMPs and ErMPs were positively correlated to markers of hemolysis, serum ferritin, D-dimer, vWF Ag, and aortic stiffness, whereas negatively correlated to hemoglobin level and aortic distensibility (P < 0.05). We suggest that increased MPs may be implicated in vascular dysfunction, pulmonary hypertension risk, and aortic wall stiffness observed in thalassemia patients. Their quantification could provide utility for early detection of cardiovascular abnormalities and monitoring the biological efficacy of chelation therapy. PMID:23506251
Tantawy, Azza A G; Adly, Amira A M; Ismail, Eman A R; Habeeb, Nevin M
Adsorption of lymphocytes on the sorbents in correction of inflammatory lesions has significant clinical perspectives as the cells and active biological substances they secrete function actively in inflamed tissues acting in the site of its application: every cell adsorbs and inactivates foreign substances, every cytokin affects certain target cells. The products of these cells functioning and dissociation as well as the products of immune system reaction to them remain on the sorbent and are eliminated together with granules during bandaging or by the end of the treatment thus do not entering the organism. Lymphocytic monolayer on the sorbent does not prevent its specific action in pathologic nidus. In this case sorbent does not only drain the tissue duplicating certain primitive non specific functions of regional lymph node (barrier, filtrating, transport, draining and protective functions) but also performs certain highly specialized functions of immunocompetent organs--selective adsorption and inactivation of antigenic substances. It is reasonable to use sorbents for adsorbing lymphocytes in kapron containers which exclude the preparation leak into wounds and cavities and act as a filter preventing fast inactivation of the preparation by large fragments of tissue detritus. PMID:10709197
Borodin, Iu I; Liubarski?, M S; Ma?borodin, I V; Pekarev, O G; Smagin, A A
Murine Superficial Lymph Node Surgery
In the field of immunology, to understand the progression of an immune response against a vaccine, an infection or a tumour, the response is often followed over time. Similarly, the study of lymphocyte homeostasis requires time course experiments. Performing these studies within the same mouse is ideal to reduce the experimental variability as well as the number of mice used. Blood withdrawal allows performance of time course experiments, but it only gives information about circulating lymphocytes and provides a limited number of cells1-4. Since lymphocytes circulating through the body and residing in the lymph nodes have different properties, it is important to examine both locations. The sequential removal of lymph nodes by surgery provides a unique opportunity to follow an immune response or immune cell expansion in the same mouse over time. Furthermore, this technique yields between 1-2x106 cells per lymph node which is sufficient to perform phenotypic characterization and/or functional assays. Sequential lymph node surgery or lymphadenectomy has been successfully used by us and others5-11. Here, we describe how the brachial and inguinal lymph nodes can be removed by making a small incision in the skin of an anesthetised mouse. Since the surgery is superficial and done rapidly, the mouse recovers very quickly, heals well and does not experience excessive pain. Every second day, it is possible to harvest one or two lymph nodes allowing for time course experiments. This technique is thus suitable to study the characteristics of lymph node-residing lymphocytes over time. This approach is suitable to various experimental designs and we believe that many laboratories would benefit from performing sequential lymph node surgeries.
Mathieu, Melissa; Labrecque, Nathalie
[Procedure guideline for sentinel lymph node diagnosis].
The authors present a procedure guideline for scintigraphic detection of sentinel lymph nodes in malignant melanoma and other skin tumours, in breast cancer, in head and neck cancer, and in prostate and penile carcinoma. Important goals of sentinel lymph node scintigraphy comprise reduction of the extent of surgery, lower postoperative morbidity and optimization of histopathological examination focussing on relevant lymph nodes. Sentinel lymph node scintigraphy itself does not diagnose tumorous lymph node involvement and is not indicated when lymph node metastases have been definitely diagnosed before sentinel lymph node scintigraphy. Procedures are compiled with the aim to reliably localise sentinel lymph nodes with a high detection rate typically in early tumour stages. Radiation exposure is low so that pregnancy is not a contraindication for sentinel lymph node scintigraphy. Even with high volumes of scintigraphic sentinel lymph node procedures surgeons, theatre staff and pathologists receive a radiation exposure <1 mSv/year so that they do not require occupational radiation surveillance. PMID:20485862
Vogt, H; Schmidt, M; Bares, R; Brenner, W; Grünwald, F; Kopp, J; Reiners, C; Schober, O; Schümichen, C; Schicha, H; Sciuk, J; Sudbrock, F; Wengenmair, H
Comparison of Doppler flow Tei-indexes with pulmonary artery thermodilution measurement of cardiac output in an experimental porcine model.
The objective of our study was to compare Doppler echocardiography imaging with pulmonary artery thermodilution measurement during mechanical ventilation. Total 78 piglets (6 weeks old, average weight 24 kg, under general anesthesia) were divided into 4 groups under different cardiac loading conditions (at rest, with increased left ventricular afterload, with increased right ventricular preload, and with increased afterload of both heart ventricles). At 60 and 120 min the animals were examined by echocardiography and simultaneously pulmonary artery thermodilution was used to measure cardiac output. Tei-indexes data were compared with invasively monitored hemodynamic data and cardiac output values together with calculated vascular resistance indices. A total of 224 parallel measurements were obtained. Correlation was found between values of right Tei-index of myocardial performance and changes in right ventricular preload (p<0.05) and afterload (p<0.01). Significant correlation was also found between left index values and changes of left ventricular preload (p<0.001), afterload (p<0.001), stroke volume (p<0.01), and cardiac output (p<0.01). In conclusion, echocardiographic examination and determination of the global performance selectively for the right and left ventricle can be recommended as a suitable non-invasive supplement to the whole set of methods used for monitoring of circulation and cardiac performance. PMID:21401299
Kobr, J; T?eška, V; Molá?ek, J; Kuntscher, V; Liška, V; Slavík, Z
Assessment of the Pulmonary Vascular Blood Supply in Patients with Pulmonary Atresia, Ventricular Septal Defect, and Aortopulmonary Collateral Arteries
In pulmonary atresia (PA) with ventricular septal defect (VSD) and aortopulmonary collateral arteries (APCA), the pulmonary vas- cular blood supply may be very complex with great anatomical variations, so that some segments of the pulmonary lobes may be supplied by blood flow from the central pulmonary arteries (PPAA) or APCA, or both 1 . Due to this extreme heterogeneity, several
Ulisses Alexandre Croti; Miguel Lorenzo; Barbero Marcial; Carla Tanamati; Marcelo Biscegli Jatene; Domingo Marcolino Braile; Sergio Almeida de Oliveira
Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness
BACKGROUND—It has been suggested that cough effectiveness can be improved by assisted techniques. The effects of manually assisted cough and mechanical insufflation on cough flow physiology are reported in this study.?METHODS—The physiological actions and patient self-assessment of manually assisted cough and mechanical insufflation were investigated in 29 subjects (nine normal subjects, eight patients with chronic obstructive pulmonary disease (COPD), four subjects with respiratory muscle weakness (RMW) with scoliosis, and eight subjects with RMW without scoliosis).?RESULTS—The peak cough expiratory flow rate and cough expiratory volume were not improved by manually assisted cough and mechanical insufflation alone or in combination in normal subjects. The median increase in peak cough expiratory flow in subjects with RMW without scoliosis with manually assisted cough alone or in combination with mechanical insufflation of 84 l/min (95% confidence interval (CI) 19 to 122) and 144 l/min (95% CI 14 to 195), respectively, reflects improvement in the expulsive phase of coughing by these techniques. Manually assisted cough and mechanical insufflation in combination raised peak expiratory flow rate more than either technique alone in this group. The abnormal chest shape in scoliotic subjects and the fixed inspiratory pressure used made effective manually assisted cough and mechanical insufflation difficult in this group and no improvements were found. In patients with COPD manually assisted cough alone and in combination with mechanical insufflation decreased peak expiratory flow rate by 144 l/min (95% CI 25 to 259) and 135 l/min (95% CI 30 to 312), respectively.?CONCLUSIONS—Manually assisted cough and mechanical insufflation should be considered to assist expectoration of secretions in patients with RMW without scoliosis but not in those with scoliosis.??
Sivasothy, P; Brown, L; Smith, I; Shneerson, J
\\u000a After hematopoietic stem cell transplant (HSCT), up to 60% of patients develop pulmonary complications. In spite of antibacterial,\\u000a antiviral, and antifungal prophylaxis, reduced host defenses render the HSCT patient vulnerable to pulmonary and other infections\\u000a in the early weeks and even months post-transplantation. This chapter will suggest an integrative approach followed by a description\\u000a of the most common pulmonary syndromes
Tarek Eid; Alan F. Barker
Cryptococcosis is a deep mycosis that develops in immunosuppressed individuals. Isolated pulmonary cryptococcosis is a rare disease. The authors describe an autopsy case of pulmonary cryptococcosis in a 69-year-old woman with diabetes mellitus suppressing the immune system. Pulmonary inflammatory changes were characterized by disseminated destructive changes, a weak exudative reaction and the formation of epithelioid cell granulomas with the presence of Pirogov-Langerhans giant multinucleate cells. Round fungal cells weakly stained with hematoxylin and eosin can be mistakenly taken as artifacts. The diagnosis of chronic pulmonary cryptococcosis was established only after histological study using the selective staining. PMID:19938707
Rogov, K A; Ivashneva, I L; Grishina, A V
Keystones in lymph node development
New molecular markers are constantly increasing our knowledge of developmental processes. In this review article we have attempted to summarize the keystones of lymphoid tissue development in embryonic and pathological conditions. During embryonic lymph node development in the mouse, cells from the anterior cardinal vein start to bud and sprout, forming a lymph sac at defined sites. The protrusion of mesenchymal tissue into the lymph sacs forms the environment, where so-called 'lymphoid tissue inducer cells' and 'mesenchymal organizer cells' meet and interact. Defects of molecules involved in the recruitment and signalling cascades of these cells lead to primary immunodeficiency diseases. A comparison of molecules involved in the development of secondary lymphoid organs and tertiary lymphoid organs, e.g. in autoimmune diseases, shows that the same molecules are involved in both processes. This has led to the hypothesis that the development of tertiary lymphoid organs is a recapitulation of embryonic lymphoid tissue development at ectopic sites.
Blum, Katrin S; Pabst, Reinhard
Computer simulation of circulation in patient with total cavo-pulmonary connection: inter-relationship of cardiac and vascular pressure, flow, resistance and capacitance.
The aim is to develop a computer model representative of the circulation in a patient with a uni-ventricular heart surgically palliated by a total cavo-pulmonary connection (TCPC). The effects of known hazardous exposures on this type of circulation are investigated. A model of the cardiovascular system is built using standard components such as transmission lines, restrictors and capacitances. The chamber of the heart consists of a volume connected to checkvalves, and an oscillating source flow connected to the volume represents the pumping of the heart. The following are simulated: exposure to cold, heat, high altitude, accelerating forces, blood loss, reduction in ventricular function, atrioventricular-valve regurgitation and treatment with afterload-reducing agents. During simulations, all the parameters can be changed, independently of each other, and the resulting changes in flow, resistance and pressure are recorded. Exposure to cold, reduced ventricular function and atriventricular-valve regurgitation result in a decrease in cardiac output (14, 58 and 45%, respectively). At high altitude, an increase of 18% is noted in the central venous pressure. Afterload-reducing agents increase the cardiac output by 8% and reduce central aortic pressure by 23%. Blood loss results in a marked reduction in perfusion pressure. It is concluded that the computer model is a useful instrument for simulation of a TCPC or Fontan circulation. The original criteria for this surgical procedure are those showing the most marked haemodynamic responses to different stimulus. PMID:9538552
Rydberg, A; Teien, D E; Krus, P
Recent developments in morphology of lymphatic vessels and lymph nodes.
This paper reviews the morphology of lymphatics and lymphangiogenesis in vivo, microenvironments that promote lymphangiogenesis, and the structure and function of lymph nodes. Lymphatic capillaries consist of a single layer of lymphatic endothelial cells (LECs) and have valves, while collecting lymphatics are endowed with smooth muscle cells (SMCs) and valves besides a single layer of LECs. In the embryonic rat diaphragm, LECs first migrate presumably according to interstitial fluid flow and later join to form lymphatic vessels. SMCs of the collecting lymphatics are apparently differentiated from mesenchymal cells. LECs cultured on Cell Culture Inserts under a low oxygen condition proliferate very well and form a lymphatic network. LECs cultured on a collagen fiber network with a natural three-dimensional (3D) architecture under low oxygen rapidly form a 3D lymphatic network. The lymph node initiates an immune response as a critical crossroads for the encounter between antigen-presenting cells, antigens from lymph, and lymphocytes recruited into nodes from the blood. The node consists of spaces lined with LECs and parenchyma. High endothelial venules in the node strongly express Aquaporin-1, suggesting their involvement in the net absorption of water from lymph coming through afferent lymphatics. SMCs in node capsules seem to be involved in squeezing out lymphocytes and lymph. (English Translation of J Jpn Col Angiol 2008; 48: 107-112.). PMID:23555502
Ohtani, Osamu; Ohtani, Yuko
[Cavitating mesenteric lymph node syndrome].
Cavitating mesenteric lymph node syndrome (CMLNS) is a complication of celiac disease (chronic enteropathy characterized by intolerance to gluten ingestion) that is documented but poorly understood. Patients with CMLNS often present with weight loss that is refractory to treatment, fatigue, and diarrhea associated to clinical signs and laboratory findings of hyposplenism. Computed tomography shows multiple cystic mesenteric masses with a central low attenuation area caused by the presence of fluid and/or adipose material in the central cavity of the mesenteric lymph node. PMID:17058652
Méndez-Uriburu, L; Ahualli, J; Fajre, L; Ortiz Mayor, M
Lymph node dissection - understanding the immunological function of lymph nodes
Lymph nodes (LN) are one of the important sites in the body where immune responses to pathogenic antigens are initiated. This immunological function induced by cells within the LN is an extensive area of research. To clarify the general function of LN, to identify cell populations within the lymphatic system and to describe the regeneration of the lymph vessels, the experimental surgical technique of LN dissection has been established in various animal models. In this review different research areas in which LN dissection is used as an experimental tool will be highlighted. These include regeneration studies, immunological analysis and studies with clinical questions. LN were dissected in order to analyse the different cell subsets of the incoming lymph in detail. Furthermore, LN were identified as the place where the induction of an antigen-specific response occurs and, more significantly, where this immune response is regulated. During bacterial infection LN, as a filter of the lymph system, play a life-saving role. In addition, LN are essential for the induction of tolerance against harmless antigens, because tolerance could not be induced in LN-resected animals. Thus, the technique of LN dissection is an excellent and simple method to identify the important role of LN in immune responses, tolerance and infection.
Buettner, M; Bode, U
Congenital pulmonary lymphangiectasia (PL) is a rare developmental disorder involving the lung and characterized by pulmonary subpleural, interlobar, perivascular, and peribronchial lymphatic dilatation. Both frequency and etiology are unknown. PL presents at birth with severe respiratory distress, tachypnea, and cyanosis, with a very high mortality rate at or within a few hours of birth. At birth, mechanical ventilation and pleural
Carlo BELLINI; Francesco BOCCARDO; Corradino CAMPISI
Objective: Retrospective analysis was performed to determine the suitability of pulmonary homograft as an aortic valve substitute. Methods: From January 1994 through June 1999, 147 patients (mean age, 32.2 ± 17.3 years) underwent aortic valve replacement with either an aortic homograft (group 1: n = 103, 25 fresh antibiotic preserved and 78 cryopreserved) or a pulmonary homograft (group 2: n
Shiv Kumar Choudhary; Anita Saxena; Bharat Dubey; A. Sampath Kumar
Objective Recent observations suggest that surgeon volume is associated with lymph node counts during retroperitoneal lymph node dissection (RPLND). We report our contemporary single-surgeon experience with lymph node counts during primary RPLND for nonseminomatous germ cell tumors (NSGCT). Methods Using the Memorial Sloan-Kettering Testis Cancer Database, we identified 124 consecutive patients treated with primary RPLND by a single experienced surgeon for NSGCT between 2004 and 2008. Predictors of positive nodes and number of positive nodes were evaluated with logistic and linear regression models adjusting for year of surgery and clinical stage. Results Positive lymph nodes were observed in 37 (30%) while 87 (70%) patients were pN0. Mean total node count was 51 (SD= 23) during the 5 year study period. Mean node counts for the paracaval, interaortocaval, and paraaortic regions were 8 (SD= 6), 17 (SD= 9), and 26 (SD= 15), respectively. In a multivariate analysis, higher total node count was significantly associated with finding positive nodes (odds ratio 1.02 for each additional node counted; p=0.037) and finding multiple positive nodes (coefficient 0.04 for each additional node counted; p=0.004). Year of surgery (p<0.001) was associated with higher total node counts, while clinical stage and pathologist were not (p>0.5 for each). Conclusion The average total node count for a primary RPLND by an experienced surgeon is approximately 50 nodes with nearly half of the nodes originating in the paraaortic region. These results will be useful when assessing the adequacy of lymph node dissections for testis, renal, and upper tract urothelial malignancies.
Thompson, R. Houston; Carver, Brett S.; Bosl, George J.; Bajorin, Dean; Motzer, Robert; Feldman, Darren; Reuter, Victor E.; Sheinfeld, Joel
Catheter rehabilitation of occluded aberrant pulmonary artery
A 10-year old girl underwent a CT angiogram to investigate right lung hypoplasia. This showed a normal bronchial tree, lung parenchyma and pulmonary venous drainage, but an absent right pulmonary artery. Cardiac catheterization with pulmonary vein wedge injections identified a disconnected hypoplastic right pulmonary artery system supplied by an occluded right-sided ductus arteriosus. Transcatheter recanalization of the ductus re-established right pulmonary artery flow and growth. Ultimately, this allowed for complete surgical repair and restoration of normal perfusion of the right lung, leading to complete functional rehabilitation.
Noonan, Patrick M.E.; Ramchandani, Bharat; Barron, David J.; Stumper, Oliver
[Physiology and physiopathology of postnatal pulmonary adaptation. 1: Physiology].
The aim of the review consists of the help to understand the complex physiological mechanisms of the onset of breathing and the regulation of the respiration during the early newborn period. The lungs of the newborn contain nearly no alveoli. Postnatal formation of alveoli enlarges the gas exchange surface until the 20th year of life, the lung volume increases by a factor of 27. Immediately postnatal the aeration of the lungs is performed by several deep inspirations with breath hold and following crying. The fetal lung liquid is resorbed via both, lymph and blood vessels. Stability of the functional residual capacity is reached very rapidly. The inflation augmenting reflex and sighing support effectively this process. The significant importance of the surfactant for the successful begin of air breathing is described. Onset of respiration is combined with the decrease of the pulmonary arterial resistance and the remarkable increase of the pulmonary blood flow. The hypoxic response in the newborn is biphasic. An initial short hyperventilation is regularly followed by ventilatory depression. Neurophysiological causes are evident. Hyperventilation by inhalation of gas mixtures with higher CO2 concentrations is low, at least in preterm infants. The causes are believed to ly in the limitation of the efficiency of the respiratory muscles. Peripheral chemoreceptors in the glomus caroticum and in the bronchial mucosa, stretch receptors in the bronchial muscles, and muscle spindles in the intercostal muscles are functioning in newborns as well as in preterm infants. PMID:1945451
Schwartze, H
Swollen lymph nodes in the groin (image)
Lymph nodes play an important part in the body's defense against infection. Swelling might occur even if the infection is trivial or not apparent. Swelling of lymph nodes generally results from localized or systemic infection, abscess ...
Relative rates of albumin equilibration in the skin interstitium and lymph during increased permeability
The initial equilibration of /sup 125/I-labelled albumin between the vascular and extravascular compartments was studied in hindpaw heel skin of anesthetized rabbits. Bradykinin (0.3 ..mu..g/min) was infused into a small branch of the femoral artery. A second group of rabbits served as control. Following bradykinin, prenodal popliteal lymph flow was 4 times control flow. The lymph-to-plasma concentration ratios for total protein and albumin were, respectively, 60% and 50% larger than control. Tissue albumin concentration was twice control. After reaching a steady, elevated lymph flow, tracer albumin was infused to maintain plasma activity constant for 3 hrs. The plasma volume in tissue samples was measured using /sup 131/I-labeled albumin injected 10 min before ending the experiment. Endogenous albumin was measured in plasma, lymph, and tissue samples using rocket electroimmunoassay. After 3 hrs of tracer infusion, lymph specific activity was 3 times greater than control. In the control group, plasma albumin equilibrated more rapidly with lymph than with tissue (p < 0.05). Following bradykinin, extravascular specific activity was 4 times control, resulting in lymph and tissue equilibrating with plasma at similar rates. Thus, increasing capillary permeability causes the extravascular albumin mass to behave as if distributed in a single compartment.
Powers, M.R.; Wallace, J.R.; Bell, D.R.
Surgery for pulmonary metastases from colorectal carcinoma
Background. This study aims to clarify which patients would benefit by surgery for pulmonary metastases from colorectal carcinoma.Methods. A retrospective study was undertaken in 25 patients who had undergone complete resection. In all cases, prethoracotomy carcinoembryonic antigen (CEA) level was measured and mediastinal or hilar lymph nodes were histologically examined.Results. Overall 5-year survival was 39.2%. The 5-year survival rate for
Masayoshi Inoue; Yahiro Kotake; Katsuhiro Nakagawa; Kiyohiro Fujiwara; Kenjiro Fukuhara; Tsutomu Yasumitsu
Convective diffusion of nanoparticles from the epithelial barrier toward regional lymph nodes.
Drug delivery using nanoparticles as drug carriers has recently attracted the attention of many investigators. Targeted delivery of nanoparticles to the lymph nodes is especially important to prevent cancer metastasis or infection, and to diagnose disease stage. However, systemic injection of nanoparticles often results in organ toxicity because they reach and accumulate in all the lymph nodes in the body. An attractive strategy would be to deliver the drug-loaded nanoparticles to a subset of draining lymph nodes corresponding to a specific site or organ to minimize systemic toxicity. In this respect, mucosal delivery of nanoparticles to regional draining lymph nodes of a selected site creates a new opportunity to accomplish this task with minimal toxicity. One example is the delivery of nanoparticles from the vaginal lumen to draining lymph nodes to prevent the transmission of HIV in women. Other known examples include mucosal delivery of vaccines to induce immunity. In all cases, molecular and particle transport by means of diffusion and convective diffusion play a major role. The corresponding transport processes have common inherent regularities and are addressed in this review. Here we use nanoparticle delivery from the vaginal lumen to the lymph nodes as an example to address the many aspects of associated transport processes. In this case, nanoparticles penetrate the epithelial barrier and move through the interstitium (tissue) to the initial lymphatics until they finally reach the lymph nodes. Since the movement of interstitial liquid near the epithelial barrier is retarded, nanoparticle transport was found to take place through special foci present in the epithelium. Immediately after nanoparticles emerge from the foci, they move through the interstitium due to diffusion affected by convection (convective diffusion). Specifically, the convective transport of nanoparticles occurs due to their convection together with interstitial fluid through the interstitium toward the initial lymph capillaries. Afterwards, nanoparticles move together with the lymph flow along the initial lymph capillaries and then enter the afferent lymphatics and ultimately reach the lymph node. As the liquid moves through the interstitium toward the initial lymph capillaries due to the axial movement of lymph along the lymphatics, the theory for coupling between lymph flow and concomitant flow through the interstitium is developed to describe this general case. The developed theory is applied to interpret the large uptake of Qdots by lymph nodes during inflammation, which is induced by pre-treating mouse vagina with the surfactant Nonoxynol-9 prior to instilling the Qdots. Inflammation is viewed here to cause broadening of the pores within the interstitium with the concomitant formation of transport channels which function as conduits to transport the nanoparticles to the initial lymph capillaries. We introduced the term "effective channels" to denote those channels which interconnect with foci present in the epithelial barrier and which function to transport nanoparticles to initial lymph capillaries. The time of transport toward the lymph node, predicated by the theory, increases rapidly with increasing the distance y0 between the epithelial barrier and the initial lymph capillaries. Transport time is only a few hours, when y0 is small, about some R (where R is the initial lymph capillary radius), due to the predomination of a rather rapid convection in this case. This transport time to the lymph nodes may be tens of hours (or longer) when y0 is essentially larger and the slow diffusion controls the transport rate in a zone not far from the epithelial barrier, where convection is weak at large y0. Accounting for transport by diffusion only, which is mainly considered in many relevant publications, is not sufficient to explain our nanoparticle uptake kinetics because the possibility of fast transport due to convection is overlooked. Our systematic investigations have revealed that the information about the main transport condition
Dukhin, Stanislav S; Labib, Mohamed E
Pulmonary fibrotic response to inhalation of ZnO nanoparticles and toluene co-exposure through directed flow nose only exposure chamber.
The increasing use of Zinc Oxide nanoparticles (ZnONPs) in paint industry is not supplemented with adequate toxicology data. This report focuses on the fibrogenic toxicity caused due to co-exposure of ZnONPs and toluene in male Wistar rats, exposed for 28 days, through directed flow nose only exposure chamber. The rats were grouped as air control, toluene control (200 ppm), zinc oxide control (10 mg/m(3)), low dose co-exposed (5 mg/m(3) ZnO and 200 ppm of toluene) and high dose co-exposed (10 mg/m(3) of ZnO and 200 ppm of toluene). Our study demonstrates that co-exposure of ZnONPs and toluene (as in paint industry), even at their respective permissible exposure level (5 mg/m(3) for ZnO and 200 ppm for toluene) have the potential to produce a progressive inflammatory and fibrotic response in the alveolar tissues of the lungs. We observed a significant increase in inflammatory markers in BAL fluid and elevated malondialdehyde (MDA) levels with lower levels of intracellular reduced glutathione (GSH) in lungs of rats of co-exposed group. Significant increase in the levels of pro-inflammatory mediators (IL-6, Ik??, Cox-II, p-NF-?B) in lung tissues also indicated pulmonary damage. To best of our knowledge this is the first study which highlights the toxicity of co-exposed ZnO NPs and toluene. PMID:24255948
Jain, Sonam; Rachamalla, Mahesh; Kulkarni, Apoorva; Kaur, Jasmine; Tikoo, Kulbhushan
... What will I learn in Pulmonary Rehabilitation? The education part of the program happens both in a classroom, one-on-one with the professional staff, and during each exercise session. During group meetings, you will learn new ways ...
... another type of congenital heart defect called a patent ductus arteriosus (PDA). Persons with pulmonary atresia may ... artery and aorta. The vessel is called a patent ductus arteriosus (PDA). Other treatments include: A thin, ...
... Pulmonary Rehabilitation Reviewed on 9/09 By Nicole Smith, OTR Nicole Smith, OTR Occupational Therapist View full profile COPD: Treatment ... William J. Janssen Donald R. Rollins Daniel R. Smith Elaine M K Schwartz Michelle A. Beutz James ...
A case of rapidly growing solitary tumour of the right upper lobe of the lung in a 72-year-old man is presented. It shows the typical histological appearance of a pulmonary blastoma. Only 13 cases were published previously, none from Canada. It is a matter of opinion whether pulmonary blastoma should be classified as a separate entity or as a distinct form of carcinosarcoma. ImagesFIG. 1FIG. 2FIG. 3FIG. 4
Danziger, H.
Pulmonary and caval blood flow patterns in patients with intracardiac and extracardiac Fontan: a magnetic resonance study
Summary\\u000a \\u000a Aims\\u000a We compared in vivo blood flow and pulsatility after different types of Fontan operation using magnetic resonance imaging.\\u000a \\u000a \\u000a \\u000a \\u000a Material and methods\\u000a A total of 37 consecutive patients (mean age 19±7.9 years, 7.3±3.2 years after Fontan operation), 7 with atriopulmonary anastomosis\\u000a (APC), 18 with intra-atrial lateral tunnel (LTFO) and 12 with extracardiac Fontan (ECFO) were studied using magnetic resonance
Katrin Klimes; Hashim Abdul-Khaliq; Stanislav Ovroutski; Wei Hui; Vladimir Alexi-Meskishvili; Birgit Spors; Roland Hetzer; Roland Felix; Peter E. Lange; Felix Berger; Matthias Gutberlet
Pulmonary bactericidal activity, macrophage phagocytic activity, alveolar macrophage (AM) enzyme activity and T- and B-cell mitogenesis of lymphocytes from lung associated (LALN) or mesenteric lymph nodes (MESLN) were assessed in rats and/or mice exposed 4 hr/d, 4 days/wk for 1, ...
Mycobacterial Lineages Causing Pulmonary and Extrapulmonary Tuberculosis, Ethiopia
Molecular typing of 964 specimens from patients in Ethiopia with lymph node or pulmonary tuberculosis showed a similar distribution of Mycobacterium tuberculosis strains between the 2 disease manifestations and a minimal role for M. bovis. We report a novel phylogenetic lineage of M. tuberculosis strongly associated with the Horn of Africa.
Firdessa, Rebuma; Berg, Stefan; Hailu, Elena; Schelling, Esther; Gumi, Balako; Erenso, Girume; Gadisa, Endalamaw; Kiros, Teklu; Habtamu, Meseret; Hussein, Jemal; Zinsstag, Jakob; Robertson, Brian D.; Ameni, Gobena; Lohan, Amanda J.; Loftus, Brendan; Comas, Inaki; Gagneux, Sebastien; Tschopp, Rea; Yamuah, Lawrence; Hewinson, Glyn; Gordon, Stephen V.; Young, Douglas B.
Pulmonary lymphangioleiomyomatosis followed by a localized retroperitoneal lymphangioleiomyoma.
Lymphangioleiomyomatosis is a rare disease that affects females of reproductive age. Microscopically, it is characterized by abnormal proliferation of immature smooth muscle-like cells that grow diffusely in the lung. Extrapulmonary manifestations in the mediastinum, peritoneum and pelvic lymph nodes are uncommon. We here describe a patient who initially presented with pulmonary lymphangioleiomyomatosis and subsequently developed a localized retroperitoneal mass. Pathologic examination showed that the mass was a lymphangioleiomyoma. The result of the immunohistochemical study was the same as that for the pulmonary lesion. It is therefore suggested that metastatic lymphangioleiomyoma should be included in the differential diagnosis in the patient with pulmonary lymphangioleiomyomatosis presenting with an extrapulmonary lesion. PMID:17078865
Tai, Hui-Chun; Lin, Jui-Wei; Wang, Yi-Hsi; Eng, Hock-Liew; Lu, Hung-I; Liu, Yueh-Wei; Huang, Chao-Cheng
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
Relative rates of albumin equilibration in the skin interstitium and lymph during vasodilation
The initial equilibration of /sup 125/I-labeled albumin between the vascular and extravascular compartments was studied in hindpaw skin of 6 anesthetized rabbits. Papavarine (200 ug/min) was infused into a small branch of the femoral artery of one limb with the contralateral limb as a control. There was a 1.2-fold increase in lymph flow (p < 0.01) with no significant change in the lymph-to-plasma total protein concentration ratio from prepopliteal lymphatics following papavarine. After reaching a constant, elevated lymph flow, tracer labeled albumin was infused to maintain the plasma activity constant for 3 hrs. The plasma volume in tissue samples was measured using /sup 131/I-labeled albumin injected 10 min before ending the experiment. Endogenous albumin was measured in plasma, lymph, and tissue samples using rocket electroimmunoassay. After 3 hrs of tracer infusion, lymph specific activity relative to plasma was significantly greater in the vasodilated hindlimb (0.30 +/- 0.07 vs 0.13 +/- 0.05; mean +/- SE; p < 0.01). Extravascular specific activity relative to plasma was greater in the vasodilated limb (0.13 +/- 0.02 vs 0.09 +/- 0.02; p < 0.05). Thus, vasodilation increased the rates at which lymph and tissue equilibrate with plasma. Also, the difference between lymph and tissue equilibration was greater in the vasodilated hindlimb.
Powers, M.R.; Wallace, J.R.; Bell, D.R.
Histopathology of the Lymph Nodes
Lymph nodes function as filters of tissues and tissue fluids and are sites of origin and production of lymphocytes for normal physiological functions. As part of this normal function, they react to both endogenous and exogenous substances with a variety of specific morphological and functional responses. Lesions can be both proliferative and nonproliferative, and can be treatment-related or not. The histological evaluation of lymph nodes is necessary in order to understand the immunotoxic effects of chemicals with the resulting data providing an important component of human risk assessment. It is the challenge of the toxicologic pathologist to interpret the pathology data within the complete clinical evaluation of the entire animal. Daily insults, ageing and toxins can alter the normal histology and primary function of lymph nodes. Therefore it is important to distinguish and differentiate lesions that occur naturally during normal development and ageing from those that are induced by xenobiotics. To achieve this goal, comparison with strain- age- and sex-matched controls is crucial.
Elmore, Susan A.
IVC filter limb penetration of the caval wall during retroperitoneal surgery/lymph node dissection.
Optional inferior vena cava (IVC) filters are being increasingly used for protection against pulmonary embolism in patients with deep vein thrombosis where anticoagulation is contraindicated. We describe two cases during retroperitoneal surgery where the IVC filters were found to have perforated the cava wall and were subsequently removed intra-operatively. Cava wall penetration by filter limbs poses a significant danger during retroperitoneal lymph node dissection and filters should be removed preoperatively. PMID:23210584
Goh, Gerard S; Slattery, Michael M; Given, Mark F; Little, David; Lee, Michael J
Proteomic Analysis of Human Mesenteric Lymph
Extensive animal work has established mesenteric lymph as the mechanistic link between gut ischemia/reperfusion (I/R) and distant organ injury. Our trauma and transplant services provide a unique opportunity to assess the relevance of our animal data to human mesenteric lymph under conditions that simulate those used in the laboratory. Mesenteric lymph was collected from eleven patients; with lymphatic injuries, during semi-elective spine reconstruction, or immediately before organ donation. The lymph was tested for its ability to activate human neutrophils in vitro, and was analyzed by label-free proteomic analysis. Human mesenteric lymph primed human PMNs in a pattern similar to that observed in previous rodent, swine, and primate studies. A total of 477 proteins were identified from the 11 subject's lymph samples with greater than 99% confidence. In addition to classical serum proteins, markers of hemolysis, extracellular matrix components, and general tissue damage were identified. Both tissue injury and shock correlate strongly with production of bioactive lymph. Products of red blood cell hemolysis correlate strongly with human lymph bioactivity and immunoglobulins have a negative correlation with the pro-inflammatory lymph. These human data corroborate the current body of research implicating post shock mesenteric lymph in the development of systemic inflammation and multiple organ failure. Further studies will be required to determine if the proteins identified participate in the pathogenesis of multiple organ failure and if they can be used as diagnostic markers.
Dzieciatkowska, Monika; Wohlauer, Max V.; Moore, Ernest E.; Damle, Sagar; Peltz, Erik; Campsen, Jeffrey; Kelher, Marguerite; Silliman, Christopher; Banerjee, Anirban; Hansen, Kirk C.
Pulmonary compliance and lung volume are related to terrestriality in anuran amphibians.
Abstract Dehydration tolerance of anuran amphibians is directly related to their ability to mobilize lymphatic reserves, with more terrestrial species having more effective lymph mobilization dependent on specialized skeletal muscles acting directly on the lymph sacs and via pulmonary ventilation. Consequently, we tested the hypothesis that pulmonary compliance, lung volume, and femoral lymphatic sac volume were related to terrestriality-and, hence, lymph mobilization-for 18 species of aquatic, semiaquatic, or terrestrial anuran amphibians. Lung compliance and volume were significantly related to body mass, but there was no significant phylogenetic pattern. There were significant habitat-related patterns for mass-corrected and phylogenetically corrected residuals for these pulmonary variables. Femoral lymph volume was significantly related to body mass, with no significant phylogenetic pattern, and there was only a weak correlation for habitat with mass-corrected and phylogenetically corrected residuals. These results suggest that pulmonary volume and compliance are strongly related to terrestriality in anuran amphibians and are under significant selection pressure to enhance lymph mobilization, but lymph sac volume does not appear to have a major role in adaptation to terrestriality. PMID:24769702
Withers, Philip C; Hedrick, Michael S; Drewes, Robert C; Hillman, Stanley S
Trauma Hemorrhagic Shock-Induced Lung Injury Involves a Gut-Lymph-Induced TLR4 Pathway in Mice
Background Injurious non-microbial factors released from the stressed gut during shocked states contribute to the development of acute lung injury (ALI) and multiple organ dysfunction syndrome (MODS). Since Toll-like receptors (TLR) act as sensors of tissue injury as well as microbial invasion and TLR4 signaling occurs in both sepsis and noninfectious models of ischemia/reperfusion (I/R) injury, we hypothesized that factors in the intestinal mesenteric lymph after trauma hemorrhagic shock (T/HS) mediate gut-induced lung injury via TLR4 activation. Methods/Principal Findings The concept that factors in T/HS lymph exiting the gut recreates ALI is evidenced by our findings that the infusion of porcine lymph, collected from animals subjected to global T/HS injury, into naďve wildtype (WT) mice induced lung injury. Using C3H/HeJ mice that harbor a TLR4 mutation, we found that TLR4 activation was necessary for the development of T/HS porcine lymph-induced lung injury as determined by Evan's blue dye (EBD) lung permeability and myeloperoxidase (MPO) levels as well as the induction of the injurious pulmonary iNOS response. TRIF and Myd88 deficiency fully and partially attenuated T/HS lymph-induced increases in lung permeability respectively. Additional studies in TLR2 deficient mice showed that TLR2 activation was not involved in the pathology of T/HS lymph-induced lung injury. Lastly, the lymph samples were devoid of bacteria, endotoxin and bacterial DNA and passage of lymph through an endotoxin removal column did not abrogate the ability of T/HS lymph to cause lung injury in naďve mice. Conclusions/Significance Our findings suggest that non-microbial factors in the intestinal mesenteric lymph after T/HS are capable of recreating T/HS-induced lung injury via TLR4 activation.
Palange, David; Doucet, Danielle; Bonitz, Robert P.; Lu, Qi; Colorado, Iriana; Sheth, Sharvil U.; Chandler, Benjamin; Kannan, Kolenkode B.; Ramanathan, Madhuri; Xu, Da Zhong; Deitch, Edwin A.; Feinman, Rena
Interlaboratory and Interstudy Reproducibility of a Novel Lateral-Flow Device and Influence of Antifungal Therapy on Detection of Invasive Pulmonary Aspergillosis
Interest in lateral-flow devices (LFDs) as potential point-of-care assays for the diagnosis of infectious diseases has increased. Our objective was to evaluate the interlaboratory and interstudy reproducibility and the effects of antifungal therapy on an LFD developed for invasive pulmonary aspergillosis (IPA) detection. An established neutropenic guinea pig model of IPA caused by Aspergillus fumigatus was used. At predetermined time points (1 h and 3, 5, and 7 days postinoculation), blood and bronchoalveolar lavage (BAL) fluid were collected from infected and uninfected animals. In a separate experiment, guinea pigs were treated with posaconazole (10 mg/kg of body weight orally [p.o.] twice a day [BID]), voriconazole (10 mg/kg p.o. BID), liposomal amphotericin B (10 mg/kg intraperitoneally [i.p.] once a day [QD]), or caspofungin (2 mg/kg i.p. QD), and samples were collected on days 7 and 11. Each laboratory independently evaluated the IgG monoclonal antibody-based LFD. Galactomannan and (1?3)-?-d-glucan were also measured using commercially available kits. Good interlaboratory agreement was observed with the LFD, as the results for 97% (32/33) of the serum and 78.8% (26/33) of the BAL fluid samples from infected animals were in agreement. Good interstudy agreement was also observed. The serum sensitivity of each surrogate-marker assay was reduced in animals treated with antifungals. In contrast, these markers remained elevated within the BAL fluids of treated animals, which was consistent with the fungal burden and histopathology results. These results demonstrate that the LFD assay is reproducible between different laboratories and studies. However, the sensitivity of this assay and other markers of IPA may be reduced with serum in the presence of antifungal therapy.
Najvar, Laura K.; Bocanegra, Rosie; Kirkpatrick, William R.; Patterson, Thomas F.; Thornton, Christopher R.
Performance of Galactomannan, Beta-d-Glucan, Aspergillus Lateral-Flow Device, Conventional Culture, and PCR Tests with Bronchoalveolar Lavage Fluid for Diagnosis of Invasive Pulmonary Aspergillosis.
Galactomannan detection in bronchoalveolar lavage (BAL) fluid samples (GM test) is currently considered the gold standard test for diagnosing invasive pulmonary aspergillosis (IPA). The limitations, however, are the various turnaround times and availability of testing. We compared the performance of GM testing with that of conventional culture, an Aspergillus lateral-flow-device (LFD) test, a beta-d-glucan (BDG) test, and an Aspergillus PCR assay by using BAL fluid samples from immunocompromised patients. A total of 78 BAL fluid samples from 78 patients at risk for IPA (74 samples from Graz and 4 from Mannheim) collected between December 2012 and May 2013 at two university hospitals in Austria and Germany were included. Three patients had proven IPA, 14 probable IPA, and 17 possible IPA, and 44 patients had no IPA. The diagnostic accuracies of the different methods for probable/proven IPA were evaluated. The diagnostic odds ratios were the highest for the GM, PCR, and LFD tests. The sensitivities for the four methods (except culture) were between 70 and 88%. The combination of the GM (cutoff optical density index [ODI], >1.0) and LFD tests increased the sensitivity to 94%, while the combination of the GM test (>1.0) and PCR resulted in 100% sensitivity (specificity for probable/proven IPA, 95 to 98%). The performance of conventional culture was limited by low sensitivity, while that of the BDG test was limited by low specificity. We evaluated established and novel diagnostic methods for IPA and found that the Aspergillus PCR, LFD, and GM tests were the most useful methods for diagnosing the disease by using BAL fluid samples. In particular, the combination of the GM test and PCR or, if PCR is not available, the LFD test, allows for sensitive and specific diagnosis of IPA. PMID:24671798
Hoenigl, M; Prattes, J; Spiess, B; Wagner, J; Prueller, F; Raggam, R B; Posch, V; Duettmann, W; Hoenigl, K; Wölfler, A; Koidl, C; Buzina, W; Reinwald, M; Thornton, C R; Krause, R; Buchheidt, D
Transient changes in the pulmonary function of welders: a cross sectional study of Monday peak expiratory flow.
OBJECTIVES--The aim was to compare the peak expiratory flow (PEF) of welders and non-welders over a 12 hour period from the start of work on Monday. METHODS--The two study groups consisted of 20 welders and 20 non-welders, all men who had essentially never smoked, with no significant difference in age, height, ethnicity, or baseline spirometry between the groups. The PEF was measured for each welder before the start of work and 15 minutes, 30 minutes, and 1, 2, 4, 7, and 12 hours after the start of welding. The same method was applied to the non-welders, for whom a proxy time for the start of welding was used. RESULTS--The percentage change in baseline PEF was calculated for each subject at each of the recording times. The welder and non-welder group means for these results were significantly different at 15 minutes (p = 0.028). Also, the group mean for maximum fall in PEF (at any of the recording times during the 12 hour period) was significantly greater for the welders (p = 0.011). 50% of the welders (10/20), but only 5% of the non-welders (1/20), experienced a fall in PEF in excess of 5% (p = 0.0046). 25% of the welders (5/20) experienced drops of greater than 5% within the first 15 minutes. CONCLUSION--The results are suggestive of an immediate type reaction in welders, similar to that seen in some cases of occupational asthma, although not so severe. Studies to determine if these reactions reflect non-specific bronchial hyper-responsiveness would be useful. It is recommended that future studies also undertake breathing zone measurements to relate the response to particular constituents of the welding plume, especially the gases ozone and nitrogen dioxide.
Donoghue, A M; Glass, W I; Herbison, G P
Pulmonary embolus: detection and follow-up using magnetic resonance
Magnetic resonance imaging (MRI) of an angiographically confirmed pulmonary embolus was performed. The thrombus appeared as an intense intraluminal signal within the left descending pulmonary artery; this signal was absent on repeat examination after clot lysis. Because MR will not image flowing blood, it provides a potential method of non-invasive identification of stationary emboli within the pulmonary vascular tree.
Moore, E.H.; Gamsu, G.; Webb, W.R.; Stulbarg, M.S.
Pulmonary artery banding; adequacy and long-term outcome
Objective: Pulmonary artery banding remains a palliative option for patients with congenital heart disease and excessive pulmonary blood flow, if there is unfavourable anatomy or frail condition. In contrast to more developed countries, our patients at Red Cross Children's Hospital, Cape Town, often present to medical services late and in poor nutritional condition. We retrospectively reviewed patients undergoing pulmonary artery
Paulo Pinho; Ulrich O Von Oppell; Johan Brink; John Hewitson
Pulmonary tumor embolism syndrome from occult colonic adenocarcinoma
Pulmonary tumor embolism syndrome is a rare phenomenon that can occur in patients who have an occult neoplasm that metastasizes. We describe a case of an elderly woman with an undiagnosed colon cancer who suffered from respiratory distress and compromised pulmonary blood flow from micrometastasis in the pulmonary arteries.
Hitchcock, Michael A.; Guileyardo, Joseph M.
Exercise-induced Pulmonary Hypertension
Exercise stresses the pulmonary circulation through increases in cardiac output (Q.) and left atrial pressure. Invasive as well as noninvasive studies in healthy volunteers show that the slope of mean pulmonary artery pressure (mPAP)–flow relationships ranges from 0.5 to 3 mm Hg?min?L?1. The upper limit of normal mPAP at exercise thus approximates 30 mm Hg at a Q. of less than 10 L?min?1 or a total pulmonary vascular resistance at exercise of less than 3 Wood units. Left atrial pressure increases at exercise with an average upstream transmission to PAP in a close to one-for-one mm Hg fashion. Multipoint PAP–flow relationships are usually described by a linear approximation, but present with a slight curvilinearity, which is explained by resistive vessel distensibility. When mPAP is expressed as a function of oxygen uptake or workload, plateau patterns may be observed in patients with systolic heart failure who cannot further increase Q. at the highest levels of exercise. Exercise has to be dynamic to avoid the increase in systemic vascular resistance and abrupt changes in intrathoracic pressure that occur with resistive exercise and can lead to unpredictable effects on the pulmonary circulation. Postexercise measurements are unreliable because of the rapid return of pulmonary vascular pressures and flows to the baseline resting state. Recent studies suggest that exercise-induced increase in PAP to a mean higher than 30 mm Hg may be associated with dyspnea-fatigue symptomatology.
Vanderpool, Rebecca; Dhakal, Bishnu P.; Saggar, Rajeev; Saggar, Rajan; Vachiery, Jean-Luc; Lewis, Gregory D.
Local Chemical and Nervous Control of Consecutive Vascular Sections in the Mesenteric Lymph Nodes of the Cat.
National Technical Information Service (NTIS)
A method which made it possible to follow continuously and simultaneously the reactions within the consecxive vascular sections has been used to study blood flow through the lymph nodes around the mesenteric root of the cat. The acutely sympathectomized r...
O. Lundgren I. Wallentin
... pressure." Pulmonary hypertension is an increase in blood pressure in the blood vessels that carry blood to the lungs. It is ... the narrowed arteries. This results in high blood pressure in the right side of your heart and in the blood vessels that carry blood to the lungs. Symptoms What ...
Nano-imaging of the lymph network structure with quantum dots
NASA Astrophysics Data System (ADS)
Sentinel lymph node diagnosis contributes to operative strategy in cancer surgery. During lymph node metastasis, cancer cells first reach the sentinel lymph node (SLN) via lymph flow. To perform SLN biopsy effectively, it is important that cancer cells are detected with high sensitivity in SLN connected to the tumor site. Here we present a method to visualize a high-risk area in the SLN for lymph node metastasis with a high degree of accuracy. Quantum dots (QDs), bright fluorescent nanoparticles, were endoscopically injected into the gastrointestinal wall of pigs, and their signal was specifically detected in the SLN with a laparoscopic device. Single-particle imaging under a confocal microscope showed that the QDs were distributed heterogeneously in the SLN and that their distribution marked the inflow locus of afferent lymphatic vessels where lymph node metastasis begins. Moreover, we developed a method using cellular marker conjugated QDs that visualizes specific cells in SLNs, suggesting that this method can be applied for the detection of cancer cells in sentinel lymph nodes using tumor-specific-molecular conjugated QDs. These results show that our method might significantly increase the detection rate of cancer metastasis in SLNs.
Hikage, Makoto; Gonda, Kohsuke; Takeda, Motohiro; Kamei, Takashi; Kobayashi, Masaki; Kumasaka, Masutaka; Watanabe, Mika; Satomi, Susumu; Ohuchi, Noriaki
In vivo quantification of lymph viscosity and pressure in lymphatic vessels and draining lymph nodes of arthritic joints in mice.
Rheumatoid arthritis (RA) is a chronic inflammatory joint disease with episodic flares. In TNF-Tg mice, a model of inflammatory-erosive arthritis, the popliteal lymph node (PLN) enlarges during the pre-arthritic 'expanding' phase, and then 'collapses' with adjacent knee flare associated with the loss of the intrinsic lymphatic pulse. As the mechanisms responsible are unknown, we developed in vivo methods to quantify lymph viscosity and pressure in mice with wild-type (WT), expanding and collapsed PLN. While no differences in viscosity were detected via multiphoton fluorescence recovery after photobleaching (MP-FRAP) of injected FITC-BSA, a 32.6% decrease in lymph speed was observed in vessels afferent to collapsed PLN (P < 0.05). Direct measurement of intra-lymph node pressure (LNP) demonstrated a decrease in expanding PLN versus WT pressure (3.41 ± 0.43 vs. 6.86 ± 0.56 cmH2O; P < 0.01), which dramatically increased to 9.92 ± 1.79 cmH2O in collapsed PLN. Lymphatic pumping pressure (LPP), measured indirectly by slowly releasing a pressurized cuff occluding indocyanine green (ICG), demonstrated an increase in vessels afferent to expanding PLN versus WT (18.76 ± 2.34 vs. 11.04 ± 1.47 cmH2O; P < 0.01), which dropped to 2.61 ± 0.72 cmH2O (P < 0.001) after PLN collapse. Herein, we document the first in vivo measurements of murine lymph viscosity and lymphatic pressure, and provide evidence to support the hypothesis that lymphangiogenesis and lymphatic transport are compensatory mechanisms to prevent synovitis via increased drainage of inflamed joints. Furthermore, the decrease in lymphatic flow and loss of LPP during PLN collapse are consistent with decreased drainage from the joint during arthritic flare, and validate these biomarkers of RA progression and possibly other chronic inflammatory conditions. PMID:24421350
Bouta, Echoe M; Wood, Ronald W; Brown, Edward B; Rahimi, Homaira; Ritchlin, Christopher T; Schwarz, Edward M
Pulmonary thromboendarterectomy for thromboembolic pulmonary hypertension
•PULMONARY ARTERY thromboendarterectomy (PTE) is a surgical procedure that offers the only cure for chronic thromboembolic pulmonary hypertension (TPH), a progressive form of secondary pulmonary hypertension.•CURRENT ESTIMATES INDICATE that 1% to 5% of patients who survive a pulmonary embolus will develop chronic TPH with progressively worsening pulmonary hypertension and right-sided heart failure.•THIS BILATERAL PROCEDURE is performed through a sternotomy incision
Susan Barrow; Cecile Cherry; Carol Hickey; Karen Sue Kelly
Thoracoscopic mediastinal lymph node dissection for lung cancer.
In lung cancer, mediastinum lymphatic spread occurs. We review our technique and experience of thoracoscopic mediastinal lymphnode dissection (MLND). Between 1997 and 2011, 992 patients with primary lung cancer underwent thoracoscopic major pulmonary resection with MLND. Initially we used a combination of electrocautery and clips to divide blood vessels and lymphatic channels; our current technique relies on a vessel sealing system (VSS) which is expeditious and leads to less lymphorrhea. Furthermore, dissection of station 7 nodes is performed after each main bronchus or right intermediate bronchus is taped with a 0 silk suture, which is then brought out of the thorax through the access incision for antero-lateral retraction of the tracheal carina. We dissect between 3 and 4 N2 lymph node stations and a total of approximately 20 N2 lymph nodes. Postoperative complications related to MLND occurred in 35 of 992 patients (3.5%), 15 (1.5%) for recurrent laryngeal nerve injury, 3 (0.3%) for bilateral vagal injury, 14 (1.4%) for chylothorax and 3 (0.3%) for airway injury. However, none were lethal. Thoracoscopic mediastinal dissection is safe and feasible in treating lung cancer. We believe our technique and VSS are very useful for thoracoscopic MLND. PMID:22643666
Watanabe, Atsushi; Nakazawa, Jyunnji; Miyajima, Masahiro; Harada, Ryo; Nakashima, Shinji; Mawatari, Tohru; Higami, Tetsuya
[Pulmonary thromboembolism with pulmonary tuberculosis].
Out of 77 patients who were admitted to our hospital because of pulmonary tuberculosis from January 2007 to October 2009, 3 patients (3.9%) suffered from pulmonary thrombotic embolism (PTE) and/or deep venous thrombosis (DVT). Case 1: An 80-year-old male with elevated D-dimer was diagnosed with PTE on the basis of an enhanced chest CT showing filling defects in the bilateral pulmonary arteries. Case 2: A 39-year-old male presented with prolonged high-grade fever even after administration of anti-tuberculosis drugs and complained of weakness. His D-dimer was high on admission and became still higher; then, edema was found on his left lower limb, and he was diagnosed with DVT on the basis of lower limb ultrasonography showing isoechoic thrombosis from the IVC to the left popliteal vein. An IVC filter was needed to treat his lesion. Case 3: A 69-year-old female with elevated D-dimer and edema on the right lower limb was diagnosed with PTE and DVT on the basis of chest CT findings. Since anti-coagulation therapy could not be continued due to intestinal bleeding, an IVC filter was placed. All 3 cases presented with no dyspnea and two of the three cases showed no hypoxemia. Even in cases of pulmonary tuberculosis without dyspnea, D-dimer seems to be useful for the early diagnosis of thromboembolism. PMID:21922781
Komazaki, Yoshitoshi; Sakakibara, Yumi; Sakashita, Hiroyuki; Miyazaki, Yasunari; Inase, Naohiko
Lymphatic function is impaired following irradiation of a single lymph node.
Abstract Introduction: Lymph nodes are often the target of radiotherapy procedures. Unfortunately, the impact of nodal irradiation on lymphatic function is uncertain. In this study, our aim was to quantify the impact of lymph node irradiation on lymph flow. Methods and Results: The popliteal node or the nodal excision site of rabbits was treated with four daily 8?Gy doses of radiation. A FITC-dextran tracer was infused into a prenodal popliteal lymphatic. The area under the tracer blood recovery curve (AUC) indicated lymphatic functionality and the inflow pressure versus flow rate relationship inferred resistance through the system. Fluoroscopic and histological examination provided supporting data. Radiation of intact nodes decreased lymph transport significantly at 1 week, 1 month, and 6 months post-treatment (AUCs of 207.9±79.87, 191.6±62.95, and 250.44±46.45) in comparison to controls (667.32±104.18). Surprisingly, this functional decline was similar to that detected with a combination of node removal and irradiation of the excision site. The pressure-flow relationships in all treatment groups were significantly different from controls. This may be due in part to fibrosis and the thickening of the nodal capsules and trabeculae observed at 1 and 6 months. Fluoroscopy and Evans blue dye studies revealed vigorous new lymphatic vessel growth and occasionally, vessels anastomosed with local veins. Conclusions: Irradiation of the popliteal lymph node impaired lymph transport and increased the pressure required to maintain flow through the system. New vessel formation and the growth of lymph-venous anastomoses indicated the development of alternative drainage pathways as a compensatory response. PMID:24838016
Baker, Amy; Semple, John L; Moore, Sara; Johnston, Miles
Use of High Frequency Ultrasound to Monitor Cervical Lymph Node Alterations in Mice
Cervical lymph node evaluation by clinical ultrasound is a non-invasive procedure used in diagnosing nodal status, and when combined with fine-needle aspiration cytology (FNAC), provides an effective method to assess nodal pathologies. Development of high-frequency ultrasound (HF US) allows real-time monitoring of lymph node alterations in animal models. While HF US is frequently used in animal models of tumor biology, use of HF US for studying cervical lymph nodes alterations associated with murine models of head and neck cancer, or any other model of lymphadenopathy, is lacking. Here we utilize HF US to monitor cervical lymph nodes changes in mice following exposure to the oral cancer-inducing carcinogen 4-nitroquinoline-1-oxide (4-NQO) and in mice with systemic autoimmunity. 4-NQO induces tumors within the mouse oral cavity as early as 19 wks that recapitulate HNSCC. Monitoring of cervical (mandibular) lymph nodes by gray scale and power Doppler sonography revealed changes in lymph node size eight weeks after 4-NQO treatment, prior to tumor formation. 4-NQO causes changes in cervical node blood flow resulting from oral tumor progression. Histological evaluation indicated that the early 4-NQO induced changes in lymph node volume were due to specific hyperproliferation of T-cell enriched zones in the paracortex. We also show that HF US can be used to perform image-guided fine needle aspirate (FNA) biopsies on mice with enlarged mandibular lymph nodes due to genetic mutation of Fas ligand (Fasl). Collectively these studies indicate that HF US is an effective technique for the non-invasive study of cervical lymph node alterations in live mouse models of oral cancer and other mouse models containing cervical lymphadenopathy.
Walk, Elyse L.; McLaughlin, Sarah; Coad, James; Weed, Scott A.
Detrimental effects of hydralazine in patients with chronic air-flow obstruction and pulmonary hypertension. A combined hemodynamic and radionuclide study
The acute effects of intravenously administered hydralazine on pulmonary hemodynamics and ejection radionuclide angiography were evaluated in 9 patients with chronic airflow obstruction (forced expiratory volume in one second, 1.2 +/- 0.8 L, mean +/- SD), pulmonary hypertension (mean pulmonary artery pressure (PAP), 29 +/- 13 mmHg), and sleep hypoxemia (maximal sleep desaturation, 20 +/- 16%). The effect of hydralazine was measured during both normoxia and hypoxia and compared with the effect of hyperoxia. Hydralazine increased cardiac index from 3.7 +/- 0.2 to 4.5 +/- 0.8 L/min/m2 (mean +/- SE, p less than 0.05, n . 9), but there were no significant changes in PAP (29 +/- 4 to 32 +/- 4 mmHg), mean pulmonary vascular resistance index (PVRI) (390 +/- 80 to 360 +/- 80 dyn.s.cm.-5.m2), mean right ventricular stroke work index (12.7 +/- 2.7 to 15.0 +/- 2.2 g.m/m2), and mean pulmonary capillary wedge pressure (12 +/- 1 to 12 +/- 2 mmHg). Mean right ventricular ejection fraction and mean right ventricular end diastolic volume also were not changed after treatment with hydralazine. Hyperoxia was used to assess the reversibility of pulmonary hypertension and to compare this with hydralazine. Hyperoxia increased arterial oxygen saturation (SaO2) from 91 +/- 1 to 96 +/- 1% and decreased the cardiac index from 3.8 +/- 0.1 to 3.1 +/- 0.2 L/min/m2 (p less than 0.02, n . 6) but, as with hydralazine, there was no significant change in PAP (28 +/- 6 to 25 +/- 6 mmHg) and PVRI (350 +/- 120 to 360 +/- 80 dyn.s.cm-5).m2).
Tuxen, D.V.; Powles, A.C.; Mathur, P.N.; Pugsley, S.O.; Campbell, E.J.
The clinical and pathological features are described of a case of pulmonary calcinosis complicating cystic disease of the renal medulla. A histopathological study of the lung revealed calcification in the alveolar walls and in the blood vessels, predominantly in the pulmonary veins and venules. The calcified deposits were also studied by electron microscopy, and appearances suggestive of active growth of the deposits were recognised. Chemical analysis of the lung revealed a calcium content some 55 times greater than that of a normal lung. There was a five-fold increase in magnesium content. Reference is made to the literature demonstrating that the chemical composition of metastic calcification differs according to whether it is visceral or non-visceral in type. Images
Heath, D; Robertson, A J
Paragonimiasis is a food-borne zoonosis caused by a trematode of the genus Paragonimus(1,2). Infestation is rare in Spain, but the influx of people from endemic areas should make us keep this condition in the differential diagnosis of our patients(2,5). We report the case a patient from Ecuador and resident in Spain for 7 years with active pulmonary tuberculosis on arrival in Spain and later diagnosed with of pulmonary paragonimiasis due to persistent haemoptysis. The diagnosis was established by surgical lung specimen showing granulomas containing parasite eggs and the macroscopic view of the fluke within a lung cavity. Initial tuberculosis treatment and current treatment with praziquantel controlled both conditions. PMID:21420222
Gómez-Seco, Julio; Rodríguez-Guzmán, Marcel José; Rodríguez-Nieto, María Jesús; Gómez-Escolar, Pablo Fernández; Presa-Abos, Teresa; Fortes-Alen, José
\\u000a Rehabilitation has been practised for several decades, but its application in respiratory disease is relatively recent. Although\\u000a by definition chronic obstructive pulmonary disease (COPD) is a disease state characterised by the presence of a progressive\\u000a and irreversible airflow obstruction, the primary treatment traditionally consists of pharmacological modulation of the airflow\\u000a limitation by bronchodilating and anti-inflammatory agents. Despite symptomatic relief after
Annemie M. W. J. Schols; Emiel F. M. Wouters
Understanding Pulmonary Vascular Disease
... may be prevented by surgery or irradiation therapy. Pulmonary Edema Pulmonary edema occurs when fluid builds up in the air ... the lungs and causes a shortness of breath. Pulmonary edema may be caused by exercise at very high ...
Pulmonary Arterial Hypertension
... American Thoracic Society Pulmonary Arterial Hypertension Normal blood vessel (blood ows freely) Pulmonary Hypertension (blood ow is slow) Main pulmonary artery Left atrium Blood Vessel Left ventricle Right ventricle Right atrium Online Version ...
Perspectives in nuclear medicine: pulmonary studies
Since the introduction of I-131 labeled macroaggregates in 1964, noninvasive techniques involving injection of radiolabeled agents and remote detection of emitted radiation have become well established in detecting pulmonary disorders in routine clinical medicine. In the past, pulmonary nuclear medicine has been dominated by studies that depict the distribution of pulmonary perfusion and/or ventilation-perfusion balance (e.g., for the detection of pulmonary embolism, obstructive airway disease, lung carcinoma). With the recent development of emission tomography and the potential for new, function-oriented radiopharmaceuticals, however, pulmonary nuclear medicine is entering a new era. The status of contemporary pulmonary nuclear medicine is briefly reviewed in several areas of major interest and applications and focus on areas where new developments are needed and seem feasible in the near future. Several important regional physiological processes measurable by these techniques include: (a) the presence or absence of pulmonary embolism, (b) relative pulmonary blood flow, (c) permeability to specific molecules, (d) lung tissue metabolism, (e) ventilation distribution and (f) the relationship between ventilation and blood flow (perfusion). (JMT)
Budinger, T.F. (Univ. of California, Berkeley); McNeil, B.J.; Alderson, P.O.
Structural Aspects of the Lymphocyte Traffic in Rat Submandibular Lymph Node
NASA Astrophysics Data System (ADS)
Modulation of lymphocyte flow in the lymphatic compartment of the lymph node may serve, in part, to promote lymphocyte sensitization during an antigenic challenge. This study was undertaken to show where this might occur by examining the structural relationships of the intranodal lymphatic pathways, blood vessels, and connective tissue support with respect to lymphocyte and lymph flow. Differently stained plastic resins were injected into the blood vessels and lymphatics of the submandibular lymph node and visualized with a confocal laser scanning microscope. The specimens were corroded to study the three-dimensional cast structures by scanning electron microscopy. Alkali digestion was also used to prepare the reticular fiber network in the lymph node for scanning electron microscopic examination. At the hilus of the node, two to three arteries gave off arterioles running in medullary cords towards the cortex. The medullary cords, the periphery of the deep cortex, and the perifollicular zones had dense capillary networks. In contrast, the center of the follicle and the center of the deep cortex were less highly vascularized. High-endothelial venules were restricted to the perifollicular zone and the periphery of the deep cortex. At the cortico-medullary boundary, they abruptly transformed into medullary venules with a normal endothelium. The marginal sinus of the lymph node was crossed by thick reticular fibers that arose from the inner sheets of the capsule. The lymph pathway went through the marginal sinus, into the trabecular sinus, to the cortical perifollicular sinus, the dense lymphatic sinus around the deep cortex, and finally into the medullary sinus. At present, the exact functional significance of the complex lymph node lymphatic architecture is not clear. However, the highly organized structural organization may play a significant role in regulating and directing lymphocyte flow to facilitate antigen presentation.
Okada, Shigenori; Albrecht, Ralph M.; Aharinejad, Seyedhossein; Schraufnagel, Dean E.
Pulmonary embolism and tuberculosis.
Tuberculosis has a high prevalence in Tunisia, but pulmonary embolism is rarely reported in Mycobacterium tuberculosis infection. We describe 3 cases of pulmonary embolism associated with severe pulmonary tuberculosis. Pulmonary embolism occurred within 2 to 13 days of pulmonary tuberculosis diagnosis. Clinical, bacteriological, and radiological evolutions were noted within 6 months for pulmonary tuberculosis, but controlling the international normalized ratio was difficult in 2 cases, and low-molecular-weight heparin was prescribed for 6 months in one case. The association between tuberculosis and pulmonary embolism is rare, but it should be systematically investigated, particularly in those with severe pulmonary or disseminated tuberculosis. PMID:24771743
Kwas, Hamida; Habibech, Sonia; Zendah, Ines; Elmjendel, Imen; Ghedira, Habib
Pulmonary embolism (PE) remains one of the most challenging medical diseases in the emergency department. PE is a potentially life threatening diagnosis that is seen in patients with chest pain and/or dyspnea but can span the clinical spectrum of medical presentations. In addition, it does not have any particular clinical feature, laboratory test, or diagnostic modality that can independently and confidently exclude its possibility. This article offers a review of PE in the emergency department. It emphasizes the appropriate determination of pretest probability, the approach to diagnosis and management, and special considerations related to pregnancy and radiation exposure. PMID:22487110
Ouellette, David W; Patocka, Catherine
Alpha-chain Disease with Pulmonary Manifestations
A case of alpha-chain disease of the pulmonary type is described in a man presenting with dyspnoea, mottling on chest x-ray picture, and a CO-transfer factor of 36%, suggestive of fibrosing alveolitis. The serum IgA consisted entirely of abnormal alpha chains devoid of light chains. This protein had the unusual property of reacting by immunofluorescence with rat mitochondria but not with human issues or with those of other species. Postmortem examination showed enlarged mediastinal lymph nodes with no evidence of malignancy or fibrosing alveolitis. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5
Florin-Christensen, A; Doniach, D.; Newcomb, P. B.
Pulmonary thromboembolism in AIDS patient with chronic venous insufficiency, pulmonary tuberculosis and breast cancer: a case report and pathophysiology review.
Recent literature reports thrombotic episodes occurring in patients with HIV infection associated with other abnormalities including neoplasms and infections predisposing to a hypercoagulable state. We report a 47-year-old woman who developed pulmonary thromboembolism in association with HIV infection, pulmonary tuberculosis and breast cancer. She was treated with rifampin, isoniazid, pyrazinamide; heparin, phenprocoumon, zidovudine, lamivudine and efavirenz. Acid fast bacilli were visualized in a sputum smear and three months after, Mycobacterium tuberculosis was isolated from lymph node biopsy during a episode of immune reconstitution. The isolated mycobacteria showed sensitivity to all first-line drugs. HIV infection, breast cancer and pulmonary tuberculosis have several mechanisms that induce hypercoagulable state and can lead to thromboembolic complications. Pulmonary thromboembolism in this patient was a diagnostic challenge because of all the other severe diseases that she experienced at the same time. PMID:16699634
Cortez-Escalante, Juan José; Castro, Cleudson; Romero, Gustavo Adolfo Sierra; Matos, Luiza; Saif, Muhammad Wasif
Familial Blood and Lymph Node Cancers Study
A study of a group of familial blood and lymph node cancers (also called "lymphoproliferative disorders"), including: chronic lymphocytic leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, Waldenström's macroglobulinemia, and multiple myeloma
Spontaneous Pneumothorax in a Case of Pulmonary Langerhans Cell Histiocytosis
ABSTRACT Langerhans Cell Histiocytosis (LCH) is a rare disease involving clonal proliferation of Langerhans cells, abnormal cells deriving from bone marrow and capable of migrating from skin to lymph nodes. Clinically, its manifestations range from isolated bone lesions to multisystem disease. The authors present the case of 37 years old male, first diagnosed with Pulmonary LCH (PLCH) 9 years before current admission in thoracic surgery department, with left recurrent pneumothorax. The appropriate surgical resolution for this patient is thoracoscopic surgery with pleuro-pulmonary symphysis, resulting complete lung expansion. This procedure results in a significantly lower occurrence of subsequent same side pneumothorax, thus being the best choice for these patients.
CIUCHE, Adrian; NISTOR, Claudiu; PANTILE, Daniel; MARIN, Dragos; TUDOSE, Augustin
Robotic-assisted inguinal lymph node dissection: A preliminary report
Penile cancer with inguinal lymph node metastasis is a common cancer in India. Open inguinal lymphadenectomy is the gold standard treatment of metastatic inguinal lymph nodes. We report our experience and technique of robotic assisted inguinal lymph node dissection in two patients presented with palpable inguinal lymph nodes, which to our knowledge is the first reported case series from India.
Dogra, P. N.; Saini, Ashish Kumar; Singh, Prabhjot
Laparoscopic Retroperitoneal Lymph Node Dissection: Extraperitoneal Approach
We review our early experience with laparoscopic retroperitoneal lymph node dissection (RPLND) via extraperitoneal approach\\u000a to assess the precise pathological status of retroperitoneal lymph nodes in early-stage testicular cancer. A total of 32 patients\\u000a (23 with stage I, 4 with stage IIa, and 5 with stage IIb) with testicular cancer underwent extraperitoneal laparoscopic RPLND\\u000a in the supine position. After developing
Makoto Satoh; Akihiro Ito; Yoichi Arai
[Pulmonary neuroendocrine neoplasms].
The pulmonary neuroendocrine neoplasms originate from the enterochromaffin cells which are diffusely distributed in the body. The incidence of these tumors has increased significantly in recent decades due to the available diagnostics. They make up about 1?-?2?% of all lung tumors and 20?-?30?% of all neuroendocrine neoplasms. The current WHO classification from 2004 divides them into typical carcinoids (TC), atypical carcinoids (AC), large cell neuroendocrine carcinomas (LCNEC) and small cell carcinomas (SCLC). The major neuroendocrine biomarkers are chromogranin A, synaptophysin and CD56. TC have a low mitotic rate of 2 mitoses/2?mm(2) (10 HPF), whereas the mitotic rate of the AC is 2?-?10 mitoses/2?mm(2) (10 HPF). The Ki-67 staining is helpful to distinguish typical and atypical carcinoids from the highly malignant LCNEC and SCLC. Clinically, the patient presents usually with cough, hemoptysis or bronchial obstruction. The occurrence of a carcinoid or Cushing's syndrome and a tumor-associated acromegaly are rare. Surgical resection with radical lymph node dissection is the treatment of choice for achieving long-term survival. Endoscopic resection of the endobronchial tumor growth is a good alternative for inoperable endobronchially localized tumors. Peptide receptor radionuclide therapy (PRRT) is a promising treatment option for patients with metastatic or unresectable pulmonary neuroendocrine tumors. New targeted therapies using angiogenesis inhibitors, mTOR inhibitors, and tyrosine kinase inhibitors are being tested for their effectiveness in many previous studies. Typical carcinoid tumors metastasize less frequently than AC, the 5-year survival rate of patients with TC being over 90?%. Patients with AC have a 5-year survival rate between 35?% and 87?%. The highly malignant LCNEC and SCLC, on the other hand, have a 5-year survival rate between 15?% and 57?%, and 5?% respectively.The increasing number of therapeutic options and diagnostic procedures requires a multidisciplinary approach and decision-making in multidisciplinary tumor conferences to ensure a personalized treatment approach. Therefore patients with a neuroendocrine neoplasm of the lung should be treated in specialized centers. PMID:25006841
Sayeg, Y; Sayeg, M; Baum, R P; Kulkarni, H R; Presselt, N; Mäder, I; Kunze, A; Sänger, J; Hörsch, D; Bonnet, R
This review article discusses three topics related to pulmonary vascular disease: 1) pulmonary vascular changes associated with portal hypertension, 2) ANCA-associated pulmonary vasculitis, and 3) Takayasu's arteritis. Hepatopulmonary syndrome and pulmonary hypertension have recently been reported as pulmonary vascular changes accompanied with portal hypertension. Endogenous vasoactive agents that reach the pulmonary circulation through porto-systemic shunt vessels are thought to contribute to these vascular changes. In ANCA-associated vasculitis, hemorrhage, interstitial pneumonitis, and nodular lesions are common manifestations in the lung. In Takayasu's arteritis, CT occasionally demonstrates mosaic attenuation owing to pulmonary arteritis and peripheral reticulolinear changes probably due to thromboembolism. PMID:11321813
Takahashi, K
Haemodynamic response to intravenous hydralazine in patients with pulmonary hypertension.
The acute pulmonary and systemic haemodynamic response to low (0.15 mg/kg) and high (0.30 mg/kg) doses of intravenous hydralazine was evaluated in 26 consecutive patients with severe pulmonary hypertension due to cor pulmonale (nine patients), primary pulmonary hypertension (11 patients), or pulmonary embolism (six patients). Hydralazine did not cause a significant change in pulmonary arterial resistance or pressure in any group but produced a significant reduction in systemic resistance, which correlated with plasma concentration, and a significant increase in pulmonary blood flow index in all groups. Ten patients who experienced a reduction in pulmonary arterial resistance of at least 5 U X m2 after administration of hydralazine had higher initial values for pulmonary arterial resistance and systemic resistance and a lower pulmonary blood flow index than those who did not respond. Maintenance oral hydralazine treatment during nine to 36 months of follow up did not seem to affect symptoms or mortality. These results indicate that hydralazine has limited value in acutely reducing pulmonary arterial pressure or affecting clinical outcome in patients with pulmonary hypertension.
McGoon, M D; Seward, J B; Vlietstra, R E; Choo, M H; Moyer, T P; Reeder, G S
Idiopathic Pulmonary Arterial Hypertension
\\u000a Idiopathic pulmonary arterial hypertension (IPAH), formerly referred to as primary pulmonary hypertension, is a disease in\\u000a which there is a persistent elevation of pulmonary artery pressure without demonstrable cause. There is expert agreement that\\u000a the definition of pulmonary hypertension, as was required for entry into the Primary Pulmonary Hypertension Registry of the\\u000a US National Institutes of Health (NIH), and for
Jane E. Lewis; Richard N. Channick
Color doppler ultrasound of pulmonary consolidation
Color Doppler ultrasound (US) is a very powerful imaging tool that can simultaneously display blood flow information and Doppler spectral analysis. This imaging modality, for the first time, provides an opporturnity to assess pulmonary blood flow and perfusion noninvasively. Color Doppler US has many potential applications in diseases of the chest. Color Doppler imaging is useful in assisting the diagnosis
Pan-Chyr Yang
Strongyloides stercoralis is a unique parasite. It can complete its life cycle entirely within the human host. As a result, an autoinfection cycle is set up. As long as there is an intact immune system, the host can control the parasitic burden, and the organism may persist for years after the initial inoculum. Most infected individuals experience mild gastrointestinal or pulmonary symptoms that may fluctuate for years. When cell-mediated immunity becomes impaired (ie, corticosteroid use, malignancy, acquired immunodeficiency syndrome), the parasite burden will grow, disseminate, and cause hyperinfection. Strongyloidiasis is endemic in the tropical and subtropical areas of the world; additionally, it is also endemic in the southeastern United States. Strongyloidiasis is associated with asthma, preexisting lung disease, and immunosuppression, including acquired immunodeficiency syndrome. Eosinophilia is not a prerequisite; therefore, the diagnosis of strongyloidiasis requires a high index of suspicion.
Mokhlesi, Babak; Shulzhenko, Oksana; Garimella, Prasad S.; Kuma, Leslie; Monti, Catherine
Sarcoidosis is an inflammatory granulomatous disease that is characterized by diverse organ system manifestations, a variable clinical course, and a predilection for affecting relatively young adults worldwide. Abnormalities on chest radiographs are detected in 85% to 95% of patients who have sarcoidosis. Approximately 20% to 50% of patients who have sarcoidosis present with respiratory symptoms, including dyspnea, cough, chest pain, and tightness of the chest. The clinical course and manifestations of pulmonary sarcoidosis are protean: spontaneous remission occurs in approximately two thirds of patients; up to 30% of patients have chronic course of the lung disease, resulting in progressive, (sometimes life-threatening) loss of lung function. Morbidity that correlates to sarcoidosis occurs in 1% to 4% of patients. PMID:18539238
Mihailovic-Vucinic, Violeta; Jovanovic, Dragana
[Pulmonary coccidioidomycosis].
Coccidioidomycosis is an acute, generally mild, respiratory disease that rarely becomes chronic or disseminated and fatal. The aetiologic agent is Coccidioides immitis, a dimorphic fungus growing in soil. The fungus is endemic in hot semi-arid areas in the USA and South America. Human beings and animals become infected by inhaling dust with arthroconidia. The fungus gives rise to either a purulent or a granulomatous inflammation or both. Clinically and radiologically, it can be confused with neoplasms and tuberculosis. The disease may be fatal in immuno-deprived persons who are also at risk of reactivation of a latent infection. Coccidioidomycosis can be detected serologically. The standard treatment of severe illness is Amphotericin B. The authors present the first histologically and serologically verified case of pulmonary coccidioidomycosis in Denmark. An increased number of coccidioidomycosis can be expected with increased travelling and an increased number of immuno-deprived persons. PMID:8317018
Wiebe, B M; Stenderup, J; Grode, G W; Jacobsen, G K
Molecular pathogenesis of pulmonary arterial hypertension
Recent investigations have suggested that it might be possible to reverse the pathology of pulmonary arterial hypertension (PAH), a disorder that can be rapidly progressive and fatal despite current treatments including i.v. prostacyclin. This review will address the cellular and molecular processes implicated in clinical, genetic, and experimental studies as underlying the pulmonary vascular abnormalities associated with PAH. Emerging treatments are aimed at inducing apoptosis of abnormal vascular cells that obstruct blood flow and at promoting regeneration of "lost" distal vasculature.
Rabinovitch, Marlene
Neutrophil elastase activity in pulmonary venous blood during lung resection
OBJECTIVES Neutrophil elastase has been reported to play an important role in acute lung injury, which is a major cause of postoperative mortality after pulmonary resection. Neutrophil elastase released in the lungs reaches the peripheral circulation via the pulmonary veins. This study was performed to compare neutrophil elastase activity in pulmonary venous blood (collected during lobectomy) with that in the peripheral blood, and to determine the perioperative changes of neutrophil elastase activity. METHODS In 34 patients undergoing lobectomy with mediastinal lymph node dissection, the leucocyte count, neutrophil count, neutrophil elastase activity and levels of tumour necrosis factor-?, interleukin-6 and interleukin-8 were measured in the pulmonary venous blood and peripheral arterial blood before and after surgery. Then, these parameters were compared between before and after surgery with peripheral and pulmonary blood. RESULTS Neutrophil elastase activity was found to be significantly higher in pulmonary venous blood at the completion of surgery than at the start (during thoracotomy), while the neutrophil elastase activity of peripheral arterial blood showed no significant change between the start and completion of surgery. CONCLUSIONS In conclusion, measurement of neutrophil elastase activity in pulmonary venous blood revealed changes associated with lobectomy.
Nagamatsu, Yoshinori; Iwasaki, Yasunori; Omura, Harutaka; Hayashida, Ryozo; Kashihara, Masaki; Nishi, Tatsuya; Yoshiyama, Koichi; Shirouzu, Kazuo
Elevated pulmonary artery pressure among Amhara highlanders in Ethiopia
OBJECTIVE Pulmonary arterioles respond to hypoxia with constriction that raises vascular resistance and pulmonary artery blood pressure. The response is sustained indefinitely by the chronic hypoxia of high-altitude residence among highlanders of European and Andean descent, but not Tibetans. The objective of this study was to identify the consequences of lifelong hypoxia exposure for the pulmonary vasculature among Amhara high-altitude natives from Ethiopia. METHODS A three-way static group comparison tested for the effect of Amhara ancestry and high residence altitude on pulmonary hemodynamics measured using echocardiography in samples of 76 healthy adult Amhara lifelong residents at 3700m, 54 Amhara lifelong residents at 1200m, and 46 U.S. low-altitude residents at 282m. RESULTS Amhara at 3700m had average Doppler-estimated pulmonary artery systolic pressure (tricuspid regurgitant gradient) of 27.9 ± 8.4 (SD) mmHg as compared with 21.9 ± 4.0 among Amhara at low altitude and 16.5 ± 3.6 in the U.S. low-altitude reference sample. However, there was no residence altitude effect on pulmonary blood flow or vascular resistance. Amhara ancestry was associated with greater pulmonary artery systolic pressure and pulmonary blood flow, yet lower pulmonary vascular resistance. CONCLUSIONS The Amhara at 3700m had elevated pulmonary artery pressure, but without the elevated pulmonary vascular resistance characteristic of the classic model of the response to long-term hypoxia by the pulmonary vasculature. The elevated pressure among Amhara may be a consequence of high pulmonary blood flow regardless of altitude and represent a newly identified pattern of response.
Hoit, Brian D.; Dalton, Nancy D.; Gebremedhin, Amha; Janocha, Allison; Zimmerman, Peter A.; Zimmerman, Allison M.; Strohl, Kingman P.; Erzurum, Serpil C.; Beall, Cynthia M
Exogenous normal lymph alleviates microcirculation disturbances and abnormal hemorheological properties in rats with disseminated intravascular coagulation
Disturbances of the microcirculation and abnormal hemorheological properties are important factors that play an important role in disseminated intravascular coagulation (DIC) and result in organ dysfunction or failure. In the present study, we established an animal model of DIC using intravenous Dextran 500 in rats, and used exogenous normal lymph corresponding to 1/15 of whole blood volume for injection through the left jugular vein. We found that normal lymph could improve the blood pressure and survival time of rats with DIC. The results regarding the mesenteric microcirculation showed that the abnormality of the diameter of mesenteric microvessels and micro-blood flow speed in the DIC+lymph group was significantly less than in the DIC+saline group. Whole blood viscosity, relative viscosity, plasma viscosity, hematocrit (Hct), erythrocyte sedimentation rate (ESR), and electrophoresis time of erythrocytes were significantly increased in the DIC+saline group compared to the control group. The electrophoretic length and migration of erythrocytes from the DIC+saline and DIC+lymph groups were significantly slower than the control group. Blood relative viscosity, Hct, ESR, and electrophoretic time of erythrocytes were significantly increased in the DIC+lymph group compared to the control group. Whole blood viscosity, relative viscosity and reduced viscosity were significantly lower in the DIC+lymph group than in the DIC+saline group, and erythrocyte deformability index was also significantly higher than in the DIC+saline and control groups. These results suggest that exogenous normal lymph could markedly improve the acute microcirculation disturbance and the abnormal hemorheological properties in rats with DIC induced by Dextran 500.
Niu, Chun-Yu; Zhao, Zi-Gang; Zhang, Yu-Ping; Hou, Ya-Li; Li, Jun-Jie; Jiang, Hua; Zhang, Jing
Giant infantile pulmonary hemangioma.
We present a very unusual case of giant infantile pulmonary hemangioma presenting as a large solitary pulmonary mass. This was successfully managed with surgical resection. Histological examination revealed that the mass was positive for GLUT-1 receptor, a marker for infantile hemangioma. To our knowledge only a few cases of pulmonary hemangioma have been described previously in the literature. Pulmonary hemangiomas are very rare lesions, most of them presenting as a pulmonary mass. This case emphasizes the fact that this rare lesion should be considered in the differential of an enhancing pulmonary mass in an infant. PMID:20461368
Pandya, Rajul; Tummala, Venkat
Impairment of Lymph Drainage in Subfascial Compartment of Forearm in Breast Cancer-Related Lymphedema
Background: In arm lymphedema secondary to axillary surgery and radiotherapy (breast cancer-related lymphedema), the swelling is largely epifascial and lymph flow per unit epifascial volume is impaired. The subfascial muscle compartment is not measurably swollen despite the iatrogenic damage to its axillary drainage pathway, but this could be due to its low compliance. Our aim was to test the hypothesis that subfascial lymph drainage too is impaired. Methods and Results: Quantitative lymphoscintigraphy was used to measure the removal rate constant (local lymph flow per unit distribution volume) for technetium-99m-human immunoglobulin G injected intramuscularly in the forearms of nine women with unilateral lymphedema. The removal rate constant was on average 31% lower in the ipsilateral swollen forearm than in the contralateral forearm (swollen arm: ?0.096 ± 0.041% min?1, contralateralarm: ?0.138 ± 0.037% min?1; mean ± SD, p = 0.037). The decrease in subfascial rate constant correlated strongly with increase in arm volume (r 0.88, p = 0.002), even though the swelling is mainly epifascial. There was no convincing evidence of dermal backflow. Conclusions: Lymph flow in the subfascial muscle compartment is decreased in breast cancer-related lymphedema. The correlation between impairment of subfascial drainage and epifascial arm swelling could be because both depend on the severity of axillary damage, or because loss of function in subfascial lymphatics impairs drainage from the epifascial to the subfascial system.
The Posterior Cervical Lymph Node in Toxoplasmosis
Posterior cervical node enlargement is characteristic of clinical toxoplasmosis in adults. Lymph node biopsies from 37 patients, who were tested for toxoplasmosis by serologic and isolation studies, were examined. A characteristic pattern of sinus histiocytosis was seen in 17 of 18 posterior cervical nodes and in only 1 of 4 lymph nodes from other sites from patients with toxoplasmosis. The characteristic pattern was not seen in posterior cervical nodes or in lymph nodes from other sites from patients with other diseases. Lymphoma obscured the characteristic changes of toxoplasmosis in the posterior cervical nodes and other nodes of 5 patients with these coexisting diseases. Organisms were seen in tissue sections in only 2 instances. T gondii was isolated from mice in 14 of 17 attempts using nodes from patients with toxoplasmosis, but from none of 8 attempts using nodes from patients with other diseases. ImagesFig 3Fig 4Fig 1Fig 2
Gray, George F.; Kimball, Anne C.; Kean, B. H.
Lymph Node Mapping in the Mouse
Accurate identification of lymph nodes in the mouse is critical for studies of tumor metastasis, and of regional immune responses following immunization. However, these small lymphatic organs are often difficult to identify in mice using standard dissection techniques, so that larger rats have been used to characterize rodent lymphatic drainage. We developed techniques injecting dye into the mouse footpad or tail, to label the lymphatic drainage of the hind leg and flank, pelvic viscera, prostate and mammary glands. While lymphatic drainage patterns were similar in mice and rats, the inguinal lymph nodes showed distinct differences in afferent and efferent drainage. These techniques allow accurate and rapid identification of lymph nodes and lymphatic drainage in normal as well as diseased mice.
Harrell, Maria. I.; Iritani, Brian M.; Ruddell, Alanna
New ultrasound techniques for lymph node evaluation.
Conventional ultrasound (US) is the recommended imaging method for lymph node (LN) diseases with the advantages of high resolution, real time evaluation and relative low costs. Current indications of transcutaneous ultrasound and endoscopic ultrasound include the detection and characterization of lymph nodes and the guidance for LN biopsy. Recent advances in US technology, such as contrast enhanced ultrasound (CEUS), contrast enhanced endoscopic ultrasound (CE-EUS), and real time elastography show potential to improve the accuracy of US for the differential diagnosis of benign and malignant lymph nodes. In addition, CEUS and CE-EUS have been also used for the guidance of fine needle aspiration and assessment of treatment response. Complementary to size criteria, CEUS could also be used to evaluate response of tumor angiogenesis to anti-angiogenic therapies. In this paper we review current literature regarding evaluation of lymphadenopathy by new and innovative US techniques. PMID:23946589
Cui, Xin-Wu; Jenssen, Christian; Saftoiu, Adrian; Ignee, Andre; Dietrich, Christoph F
Effects of prometryne on apoptosis and necrosis in thymus, lymph node and spleen in mice.
Prometryne is a methylthio-s-triazine herbicide. Significant traces are documented in environment, mainly waters, soil and plants used for nutrition. The aim of this study was to estimate prometryne immunotoxic properties through induction of apoptotic and/or necrotic changes in thymocytes, splenocytes and lymph node cells after repeated subchronical exposure. Three different doses of prometryne (185, 375, 555mgkg(-1)) were applied per os every 48h, over 28 days. Flow cytometry assay (annexinV-FITC and PI) was conducted to record apoptotic and necrotic damage. In the spleen significant changes in the percentage of apoptotic cells were not detected between treated and control groups respectively. In thymus and lymph node, within the lowest dose group (185mgkg(-)1), an increase in percentage of early apoptosis without any significant increase in necrosis was detected. Medium (375mgkg(-1)) as well as high dose triggered increase in late apoptosis in lymph node while in thymus; late apoptosis was increased only in animals exposed to the highest dose (555mgkg(-1)). The highest applied dose, in thymus and lymph node respectively, caused a general decrease in percentage of vital cells in favour of marked increase of percentages of all types of dying cells (apoptotic, late apoptotic/early necrotic and necrotic). Prometryne caused disbalance in major organs of immune system, markedly lymph nodes and thymus, by induction of early apoptotic changes in dose/time specific manner. PMID:21783937
Diki?, Domagoj; Zidovec-Lepej, Snježana; Remenar, Anica; Bendelja, Krešo; Benkovi?, Vesna; Horvat-Kneževi?, Anica; Brozovi?, Gordana; Oršoli?, Nada
Unilateral Pulmonary Hilar Tumor Mass: Is It Always Lung Cancer?
ABSTRACT Sarcoidosis is a multisystem inflammatory disease of unknown etiology, characterized by noncaseating epithelioid cell granulomas. In sarcoidosis, the most common radiological findings are mediastinal and bilateral hilar lymph node enlargement. We present a case of sarcoidosis with a rare radiological aspect of pulmonary hilar tumor mass. A 54-year-old female patient, active smoker (40 packs/year), with a history of cutaneous lupus, was admitted in our institute for progressive dyspnea and dry cough. At admission physical examination and laboratory tests were normal. Pulmonary function tests diagnosed an obstructive syndrome. Chest X-ray showed a tumor mass of the right pulmonary hilum. Transbronchial biopsy was nondiagnostic. HRCT-scan showed a tumor mass in the right hilum, which raised the suspicion of a lung cancer. PET-CT scan revealed a high metabolic activity of the tumor mass and of a paratracheal right lymphadenopathy. Lymph node biopsy by mediastinoscopy showed noncaseating epithelioid-cell granulomas, sustaining the diagnosis of sarcoidosis. The outcome was favorable, with spontaneous remission without treatment, but with a relapse that responded after systemic corticotherapy. In conclusion, even if a tumor mass in the pulmonary hilum is highly suggestive of lung cancer, a positive diagnosis should be made only after histological examination, because other benign conditions, like sarcoidosis, could have such an aspect.
TOMA, Claudia Lucia; DUMITRACHE-RUJINSKI, Stefan; BELACONI, Ionela Nicoleta; PARASCHIV, Bianca; ALEXE, Mihai; SERBESCU, Aneta; LEONTE, Diana; BOGDAN, Miron Alexandru
Unilateral pulmonary hilar tumor mass: is it always lung cancer?
Sarcoidosis is a multisystem inflammatory disease of unknown etiology, characterized by noncaseating epithelioid cell granulomas. In sarcoidosis, the most common radiological findings are mediastinal and bilateral hilar lymph node enlargement. We present a case of sarcoidosis with a rare radiological aspect of pulmonary hilar tumor mass.A 54-year-old female patient, active smoker (40 packs/year), with a history of cutaneous lupus, was admitted in our institute for progressive dyspnea and dry cough. At admission physical examination and laboratory tests were normal. Pulmonary function tests diagnosed an obstructive syndrome. Chest X-ray showed a tumor mass of the right pulmonary hilum. Transbronchial biopsy was nondiagnostic. HRCT-scan showed a tumor mass in the right hilum, which raised the suspicion of a lung cancer. PET-CT scan revealed a high metabolic activity of the tumor mass and of a paratracheal right lymphadenopathy. Lymph node biopsy by mediastinoscopy showed noncaseating epithelioid-cell granulomas, sustaining the diagnosis of sarcoidosis. The outcome was favorable, with spontaneous remission without treatment, but with a relapse that responded after systemic corticotherapy.In conclusion, even if a tumor mass in the pulmonary hilum is highly suggestive of lung cancer, a positive diagnosis should be made only after histological examination, because other benign conditions, like sarcoidosis, could have such an aspect. PMID:24023595
Toma, Claudia Lucia; Dumitrache-Rujinski, Stefan; Belaconi, Ionela Nicoleta; Paraschiv, Bianca; Alexe, Mihai; Serbescu, Aneta; Leonte, Diana; Bogdan, Miron Alexandru
Mucoepidermoid carcinoma of the bronchus presenting with a negative chest X-ray and normal pulmonary function in two teenagers: two case reports and review of the literature.
Two adolescents presented with a history of dyspnea upon exertion and cough. In both cases, the chest X-ray and pulmonary function testing, including flow-volume loop, were normal. A bronchial tumor was diagnosed by CT scan, which was ordered after each patient had an episode of hemoptysis. The sedimentation rate was the only abnormal laboratory test in both cases. Mucoepidermoid carcinoma of the bronchus, a rare tumor in childhood, was found at pathology in both cases. There was no evidence of metastases to local lymph nodes or distal sites. There were 47 previously reported cases in children. Recurrent pneumonia and persistent cough were the most common presenting findings. These tumors are of low-grade malignant potential but they can become locally invasive, extending into cartilage and surrounding soft tissue. Prognosis is good with complete resection. PMID:14679495
Giusti, Robert J; Flores, Raja M
Nodular pulmonary amyloidosis in a patient with rheumatoid arthritis.
We describe a 67-year-old white woman with a long-standing active rheumatoid arthritis who refused treatment. Chest roentgenograms performed in 2000 revealed a pulmonary nodule in the mid-left lung. Progression of the nodule was followed annually by computerized tomography (CT). In the last CT in 2002, we observed multiple nodules in both lungs in the absence of lymph gland involvement. The patient was operated by video-thoracoscopy to resect one of the pulmonary nodules. Pathological examination of the excised tissue revealed amyloid A-type (AA) amyloidosis. Although pulmonary amyloidosis is rare in patients with systemic AA amyloidosis, we recommend that this possibility be considered when confronted with a patient with these characteristics. PMID:17332981
Calatayud, J; Candelas, G; Gómez, A; Morado, C; Trancho, F Hernando
Diagnosis of peripheral pulmonary carcinoid tumor using endobronchial ultrasound
A 51-year-old woman with severe asthma underwent bronchoscopy and endobronchial ultrasound (EBUS) for investigation of a 15-mm peripheral lung nodule. Histology demonstrated a typical carcinoid tumor. Pulmonary location is the second commonest site for carcinoid tumors. Diagnosis of peripheral carcinoid tumor of the lung is difficult due to its small size, poor accuracy of cytologic diagnosis, and low sensitivity of positron emission tomography in detecting it. EBUS has a high diagnostic yield and a low complication rate in the evaluation of small solitary pulmonary nodules. The ultrasound appearance of carcinoid tumors is identical to that of lung carcinomas. Prompt diagnosis of carcinoid tumor is desirable as regional lymph node metastasis is seen in 10% of patients and is associated with a reduced 5-year survival. We feel that, where possible, all patients presenting with solitary pulmonary nodules should be investigated initially using EBUS due to its high diagnostic rate and the very low incidence of adverse events.
Steinfort, Daniel P.; Finlay, Moira; Irving, Louis B.
Diagnosis of peripheral pulmonary carcinoid tumor using endobronchial ultrasound.
A 51-year-old woman with severe asthma underwent bronchoscopy and endobronchial ultrasound (EBUS) for investigation of a 15-mm peripheral lung nodule. Histology demonstrated a typical carcinoid tumor. Pulmonary location is the second commonest site for carcinoid tumors. Diagnosis of peripheral carcinoid tumor of the lung is difficult due to its small size, poor accuracy of cytologic diagnosis, and low sensitivity of positron emission tomography in detecting it. EBUS has a high diagnostic yield and a low complication rate in the evaluation of small solitary pulmonary nodules. The ultrasound appearance of carcinoid tumors is identical to that of lung carcinomas. Prompt diagnosis of carcinoid tumor is desirable as regional lymph node metastasis is seen in 10% of patients and is associated with a reduced 5-year survival. We feel that, where possible, all patients presenting with solitary pulmonary nodules should be investigated initially using EBUS due to its high diagnostic rate and the very low incidence of adverse events. PMID:19561897
Steinfort, Daniel P; Finlay, Moira; Irving, Louis B
Pulmonary arterial remodeling in chronic obstructive pulmonary disease is lobe dependent
Abstract Pulmonary arterial remodeling has been demonstrated in patients with severe chronic obstructive pulmonary disease (COPD), but it is not known whether lobar heterogeneity of remodeling occurs. Furthermore, the relationship between pulmonary hypertension (PH) and pulmonary arterial remodeling in COPD has not been established. Muscular pulmonary arterial remodeling in arteries 0.10–0.25 mm in diameter was assessed in COPD-explanted lungs and autopsy controls. Remodeling was quantified as the percentage wall thickness to vessel diameter (%WT) using digital image analysis. Repeat measures mixed-effects remodeling for %WT was performed according to lobar origin (upper and lower), muscular pulmonary arterial size (small, medium, and large), and echocardiography-based pulmonary arterial pressure (no PH, mild PH, and moderate-to-severe PH). Lobar perfusion and emphysema indices were determined from ventilation-perfusion and computed tomography scans, respectively. Overall, %WT was greater in 42 subjects with COPD than in 5 control subjects (). Within the COPD group, %WT was greater in the upper lobes () and in the small muscular pulmonary arteries (). Lobar differences were most pronounced in medium and large arteries. Lobar emphysema index was not associated with arterial remodeling. However, there was a significant positive relationship between the lobar perfusion index and pulmonary arterial remodeling (). The presence of PH on echocardiography showed only a trend to a small effect on lower lobe remodeling. The pattern of pulmonary arterial remodeling in COPD is complicated and lobe dependent. Differences in regional blood flow partially account for the lobar heterogeneity of pulmonary arterial remodeling in COPD.
Wrobel, Jeremy P.; McLean, Catriona A.; Thompson, Bruce R.; Snell, Gregory I.
Main pulmonary artery aneurysm.
Alterations of main pulmonary artery have been described in literature. Main pulmonary artery aneurysm is very rare with few available published data. We present a case of echocardiographic finding of a main pulmonary artery aneurysm in a 78-year-old Italian woman. PMID:19631397
Patanč, Salvatore; Marte, Filippo; Dattilo, Giuseppe; Sturiale, Mauro
Sentinel lymph node navigation surgery for early stage gastric cancer
We attempted to evaluate the history of sentinel node navigation surgery (SNNS), technical aspects, tracers, and clinical applications of SNNS using Infrared Ray Electronic Endoscopes (IREE) combined with Indocyanine Green (ICG). The sentinel lymph node (SLN) is defined as a first lymph node (LN) which receives cancer cells from a primary tumor. Reports on clinical application of SNNS for gastric cancers started to appear since early 2000s. Two prospective multicenter trials of SNNS for gastric cancer have also been accomplished in Japan. Kitagawa et al reported that the endoscopic dual (dye and radioisotope) tracer method for SN biopsy was confirmed acceptable and effective when applied to the early-stage gastric cancer (EGC). We have previously reported the usefulness of SNNS in gastrointestinal cancer using ICG as a tracer, combined with IREE (Olympus Optical, Tokyo, Japan) to detect SLN. LN metastasis rate of EGC is low. Hence, clinical application of SNNS for EGC might lead us to avoid unnecessary LN dissection, which could preserve the patient's quality of life after operation. The most ideal method of SNNS should allow secure and accurate detection of SLN, and real time observation of lymphatic flow during operation.
Mitsumori, Norio; Nimura, Hiroshi; Takahashi, Naoto; Kawamura, Masahiko; Aoki, Hiroaki; Shida, Atsuo; Omura, Nobuo; Yanaga, Katsuhiko
Natural-State X-Ray Survey of Pulmonary Stenosis with Intact Ventricular Septum in Children.
National Technical Information Service (NTIS)
The investigation has shown that the following symptoms established by X-ray: prominence of the pulmonary arc, reduced pulmonary flow, heart dilatation, hypertrophy of the right ventricle and dilatation of the pulmonary trunck in right lateral X-ray, as i...
I. B. Askevold
Neonatal hyperreninemia and hypertensive heart failure relieved with resection of an intralobar pulmonary sequestration
Intralobar pulmonary sequestrations are congenital lung malformations sometimes known to cause symptoms of heart failure in the neonate because of shunting of blood flow from an anomalous systemic feeding artery into the pulmonary venous system. These are cured by pulmonary lobectomy. We report the case of a 37-weeks' gestational age infant who presented with bilateral pleural effusions perinatally, followed by
Maridelle B. Millendez; Erick Ridout; Ginger Pole; Mary Edwards
Off-label use of an adjustable gastric banding system for pulmonary artery banding
Background: Pulmonary artery banding is proposed as a first palliation in infants with complex congenital heart disease and high pulmonary blood flow. In addition, it may be used to retrain the left ventricle. Optimal tightening may be difficult to obtain, leading to reoperation. An implantable device for pulmonary artery banding with telemetric control was recently developed allowing for repeated adjustments,
Younes Boudjemline; Emmanuelle Pineau; Caroline Bonnet; Alix Mollet; Sylvia Abadir; Damien Bonnet; Daniel Sidi; Gabriella Agnoletti
Evaluation of pulmonary perfusion in lung regions showing isolated xenon-133 ventilation washout defects
Xenon-133 washout phase imaging is often used to help determine whether the etiology of a perfusion defect is embolic or due to pulmonary parenchymal pathology, such as chronic obstructive pulmonary disease. This study was designed to evaluate the pulmonary blood flow patterns associated with isolated defects on xenon washout images. Scintigraphic lung studies were reviewed until 100 cases with abnormal
Lymph Node Metastases and Prognosis in Penile Cancer
Lymph node status is a key prognostic factor in penile squamous cell carcinoma. Recently, growing evidence indicates a multimodality approach consisting of neoadjuvant chemotherapy followed by consolidation surgery improves the outcome of locally advanced penile cancer. Thus, accurate estimation of survival probability in node-positive penile cancer is critical for treatment decision making, counseling of patients and follow-up scheduling. This article reviewed evolving developments in assessing the risk for cancer progression based on lymph node related variables, such as the number of metastatic lymph nodes, bilateral lymph node metastases, the ratio of positive lymph nodes, extracapsular extension of metastatic lymph nodes, pelvic lymph node metastases, metastatic deposit in sentinel lymph nodes and N stage in TNM classification. Controversial issues surrounding the prognostic value of these nodal related predictors were also discussed.
Zhu, Yao; Ye, Ding-wei
Lymph node metastases and prognosis in penile cancer.
Lymph node status is a key prognostic factor in penile squamous cell carcinoma. Recently, growing evidence indicates a multimodality approach consisting of neoadjuvant chemotherapy followed by consolidation surgery improves the outcome of locally advanced penile cancer. Thus, accurate estimation of survival probability in node-positive penile cancer is critical for treatment decision making, counseling of patients and follow-up scheduling. This article reviewed evolving developments in assessing the risk for cancer progression based on lymph node related variables, such as the number of metastatic lymph nodes, bilateral lymph node metastases, the ratio of positive lymph nodes, extracapsular extension of metastatic lymph nodes, pelvic lymph node metastases, metastatic deposit in sentinel lymph nodes and N stage in TNM classification. Controversial issues surrounding the prognostic value of these nodal related predictors were also discussed. PMID:23359765
Zhu, Yao; Ye, Ding-Wei
Intraoperative Imaging for Sentinel Lymph Nodes.
National Technical Information Service (NTIS)
The main objective of this investigation is to determine the feasibility and value of the use of a small field of view camera gamma camera intraoperatively for sentinel lymph node (SLN) localization in breast cancer patients. A camera with a 5 in. x 5 in....
C. M. Greene J. N. Aarsvold N. Hertel
Homing and cellular traffic in lymph nodes
Lymph nodes (LNs) are the organs where innate immune responses lead to acquired immunity, where some of our most devastating pathogens evade immunity, and where autoreactive lymphocytes first encounter tissue-specific self-antigens and are either tolerized or activated. The many roles of LNs depend on the coordinated migration of its cellular constituents. This article covers new insights into the organization and
Thorsten R. Mempel; Ulrich H. von Andrian
GLP-1 released to the mesenteric lymph duct in mice: Effects of glucose and fat
Using a newly developed in vivo model measuring glucagon-like peptide-1 (GLP-1) in gut lymphatics in mice, we quantified GLP-1 secretion in vivo after glucose versus fat ingestion with and without concomitant DPP-4 inhibition. The mesenteric lymphatic duct was cannulated in anesthetized C57BL6/J mice and lymph was collected in 30 min intervals. Glucose or fat emulsion (IntralipidR) (0.03, 0.1 or 0.3 kcal) with or without DPP-4-inhibition (NVP DPP728; 10 ?mol/kg) was administered by gastric gavage. Basal intact GLP-1 levels were 0.37 ± 0.04 pmol/l (n = 61) in lymph compared to 0.07 ± 0.03 in plasma (n = 6; P = 0.04) and basal DPP-4 activity was 4.7 ± 0.3 pmol/min/?l in lymph (n = 23) compared to 22.3 ± 0.9 pmol/min/?l in plasma (n = 8; P < 0.001). Lymph flow increased from 1.2 ± 0.1 ?l/min to 2.3 ± 02 ?l/min at 30 min after glucose and fat administration, with no difference between type of challenge or dose (n = 81). Lymph GLP-1 levels increased calorie-dependently after both glucose and fat but with different time courses in that glucose induced a transient increase which had returned to baseline after 90 min whereas the lipid induced a sustained increase which was still elevated above baseline after 210 min. Lymph GLP-1 appearance during 210 min was two to three-fold higher after glucose (7.4 ± 2.3 fmol at 0.3 kcal) than after isocaloric fat (2.9 ± 0.8 fmol at 0.3 kcal; P < 0.001). The slope between caloric load and lymph GLP-1 appearance was, however, identical after glucose and fat. We conclude that lymph GLP-1 is higher than plasma GLP-1 whereas lymph DPP-4 activity is lower than plasma DPP-4 activity and that both glucose and fat clearly stimulate GLP-1 secretion calorie-dependently in vivo but with different time courses.
Ohlsson, Lena; Kohan, Alison B.; Tso, Patrick; Ahren, Bo
Sentinel Lymph Node Biopsy for Breast Cancer: Our Technique and Future Directions in Lymph Node Staging
Breast cancer remains a major cause of cancer death for women in the United States. Accurate cancer staging, especially of the axillary lymph nodes, is essential for predicting the prognosis of patients and for determining the appropriate multimodality treatment strategy. Historically, the traditional approach for staging the lymphatic metastasis in breast cancer has been Axillary lymph node dissection (ALND). However, as the understanding of the lymphatic drainage of the breast has improved, the Sentinel lymph node (SLN) biopsy has replaced ALND as the gold standard for lymph node staging in breast cancer. Multiple studies have demonstrated the benefits of SLN biopsy compared to ALND in terms of morbidity, while maintaining the clinical ability to appropriately stage patients, but without any loss in therapeutic impact. In this review, we discuss the historical development of SLN biopsy, describe our technique in detail, and discuss the possible future directions of the lymphatic staging of breast cancer.
Rashid, Omar M.; Takabe, Kazuaki
Penile cancer--the sentinel lymph node controversy.
The management of lymph nodes in penile cancer has always been a problem. Sentinel lymph node biopsy was supposed to solve this problem but has not been universally accepted due to conflicting results. We herein present a case of penile cancer with bilateral pathologically positive inguinal lymph nodes associated with concurrent negative sentinel lymph node biopsies. We discuss the possible reasons for this situation and suggest guidelines to study this issue. PMID:1792706
Srinivas, V; Joshi, A; Agarwal, B; Mundhada, U; Shah, A; Phadke, A G
Smear positive extra pulmonary tuberculosis disease at University of Gondar Hospital, Northwest Ethiopia
Background While pulmonary tuberculosis is the most common presentation, extra pulmonary tuberculosis is also an important clinical problem. However, no adequate information had been made available on the prevalence of smear positive extra pulmonary tuberculosis in Gondar. The aim of this study was to assess the prevalence and possible risk factors of smear positive extra pulmonary tuberculosis among suspected patients at University of Gondar Hospital. Methods A cross-sectional study on extra pulmonary tuberculosis suspected patients was conducted at University of Gondar Hospital from January 2012 to April, 2012. Specimens of patients suspected of extra pulmonary tuberculosis were obtained from fine needle aspiration and body fluid samples collected by pathologist. Demographic characteristics and other variables were collected using a pretested semi-structured questionnaire. Smears were prepared from each sample and stained by Ziehel Neelson and Wright stain. The result of the study was analyzed with bivariate and multivariate logistic regression. Result A total of 344 extra pulmonary tuberculosis suspected clients were included in the study and specimens were taken from lymph node aspirates and body fluids. The overall prevalence of smear positive extra pulmonary tuberculosis was 34 (9.9%). Of these cases of extra pulmonary tuberculosis, lymph node tuberculosis constituted the largest proportion (82.4%). Among the 34 extra pulmonary tuberculosis patients, over half of them (52.9%) were positive for human immunodeficiency virus. The largest proportion of tuberculosis and human immunodeficiency virus cases occurred among persons with in the age group of 31–40 years. Previous history of tuberculosis (OR?=?4.77, 95% CI 1.86-12.24), contact to a known tuberculosis cases (OR?=?6.67 95% CI 2.78-16.90), history of underlying diseases (OR?=?2.79 95% CI 1.15-6.78) and income (OR?=?12.9 95% CI 2.25-68.02) were significantly associated with extra pulmonary tuberculosis infection. Conclusion The prevalence of smear positive extra pulmonary tuberculosis infection in Gondar is high. Screening of lymph node and other body fluid specimens for extra pulmonary tuberculosis could help for treatment, control and prevention of the disease.
Recanalization of the lymph vessels after a division of the intestinal lymph trunk in the rat
Massive lymphorrhea, containing transudative ascites due to a peritonectomy after undergoing surgery for gastrointestinal\\u000a cancer, accompanied by an extended lymphadenectomy, has occasionally been observed but has usually improved spontaneously\\u000a within a short period of time. The regeneration of the lymph vessels following lymphadenectomy for gastrointestinal cancer\\u000a has been postulated. We investigated the regeneration of the lymph vessels in an animal
Kazuhide Kumagai; Kennichi Yamagata; Takayuki Tanaka
Lymphedema After Sentinel Lymph Node Biopsy for Cutaneous Melanoma
Background: Sentinel lymph node (SLN) biopsy has rap- idly become the procedure of choice for assessing the lymph node status of patients with 1992 American Joint Committee on Cancer stages I and II melanoma. The pro- cedure was designed to be less invasive and, therefore, less likely to cause complications than a complete lymph node dissection. To our knowledge, this
David A. Wrone; Kenneth K. Tanabe; A. Benedict Cosimi; Michele A. Gadd; Wiley W. Souba; Arthur J. Sober
Lymphotrophic nanoparticle enhanced MR imaging (LNMRI) for lymph node imaging
The accurate staging of lymph nodes in various primary tumors continues to pose a major diagnostic challenge. Following the detection of lymph nodes, the next arduous task is the characterization of nodes into benign and malignant categories. Cross-sectional modalities like CT and MRI rely on nodal size as the primary yardstick for differentiating benign from malignant lymph nodes. Other parameters
Anuradha Saokar; Marta Braschi; Mukesh G. Harisinghani
In the rat the greatest accumulation, in any anatomical structure, of titanium dioxide following its intravenous injection was found in two small clusters of lymph nodes in upper abdomen behind the peritoneum. These are the lymph nodes of the liver. This extraordinary quantitative characteristic of the abdominal clusters is attributed to their topography which results in progressive filtration of particulate matter from hepatic lymph.
Huggins, Charles B.; Froehlich, Jeffrey P.
Lymph node shape in computed tomography imaging as a predictor for axillary lymph node metastasis in patients with breast cancer
The aim of the present study was to evaluate whether preoperative computed tomography (CT) is a useful modality for the diagnosis of axillary lymph node metastasis. The axillary lymph node status was examined in patients with primary breast cancer who had undergone surgery. In total, 75 patients were analyzed with preoperative contrast CT images, following which the patients underwent an intraoperative sentinel lymph node biopsy to determine possible predictors of axillary lymph node metastasis. The lymph node shape was classified into three groups, which included fat-, clear-and obscure-types. Multivariate analysis revealed that clear-type lymph nodes in preoperative contrast CT imaging may be an independent predictor of lymph node metastasis (odds ratio, 15; P=0.003). Therefore, the results indicated that preoperative CT examination is useful to predict axillary lymph node metastasis.
[Long-term survival of a patient with advanced colon cancer and para-aortic lymph node metastases treated with re-administration of high-dose molecular targeted agent bevacizumab].
A 49-year-old woman was admitted to our hospital because of epigastralgia and abdominal distension. She was diagnosed as advanced colon cancer with para-aortic and common iliac lymph node metastases, without liver and lung metastasis. Extended right hemicolectomy was performed to remove symptoms of stenosis. Bevacizumab (BV) (5 mg/kg) + mFOLFOX6 was performed as the initial postoperative chemotherapy. The tumor marker CEA, CA19-9 decreased, and reduction in the size of distant lymph node metastasis was confirmed, which obtained PR. In July 2009, computed tomography revealed the right pulmonary hilar lymph node metastases and progressive disease was confirmed; therefore, cetuximab and FOLFIRI combination therapy was initiated. However, in October 2009, bilateral inguinal lymph node metastases was seen; therefore we changed chemotherapy to BV (10 mg/kg) and FOLFIRI. Although the abdominal lymph node was decreased slightly after 2 months, chemotherapy was changed to BV (10 mg/kg) and mFOLFOX6 since the inguinal lymph node had enlarged. Skin metastases appeared, and there was no change in the inguinal lymph node and abdominal lymph node. She was deceased due to peritonitis carcinomatosis; however, her survival time exceeded 30 months. There was a possibility that long-term survival could be obtained by increasing the quantity of BV and re-administering it in second-line chemotherapy after PD in BV + FOLFOX first-line chemotherapy. PMID:24196080
Ebisawa, Yoshiaki; Chisato, Naoyuki; Okayama, Taishi; Tani, Chikayoshi; Kono, Toru; Taniguchi, Masahiko; Furukawa, Hiroyuki
Pulmonary hemodynamics modify the rat pulmonary artery response to injury. A neointimal model of pulmonary hypertension.
Hemodynamic factors have profound influences on blood vessels. To test the hypothesis that hemodynamic conditions modify the pattern of remodeling in response to injury, monocrotaline (MCT) injury in Sprague-Dawley rats was followed 1 week later by left pneumonectomy to increase blood flow to the right lung. Right pulmonary artery remodeling in these MCT plus pneumonectomy animals was compared with animals receiving MCT or pneumonectomy alone. Neointimal changes developed in more than 90% of all right lung intra-acinar vessels 5 weeks after MCT injury (4 weeks after pneumonectomy). Neointimal lesions did not develop in untreated animals or in animals receiving MCT or pneumonectomy only. Animals with a neointimal pattern of remodeling developed severe right ventricular hypertrophy (RVH) whereas animals with a medial hypertrophy pattern of remodeling (MCT only) developed moderate RVH compared with control animals. Neointimal lesions and RVH were similar whether injury preceded pneumonectomy or vice versa. To exclude the possibility that neointimal lesions resulted from injury plus post-pneumonectomy compensatory lung growth, rather than injury plus increased flow, a left subclavian-pulmonary artery anastomosis was substituted for pneumonectomy. Neointimal lesions and severe RVH developed in these animals but were not seen in animals receiving either MCT or anastomosis only. These studies demonstrate an important role for hemodynamics in determining the pattern of pulmonary vascular remodeling after injury. Images Figure 1 Figure 4
Okada, K.; Tanaka, Y.; Bernstein, M.; Zhang, W.; Patterson, G. A.; Botney, M. D.
Pulmonary hemodynamics modify the rat pulmonary artery response to injury. A neointimal model of pulmonary hypertension.
Hemodynamic factors have profound influences on blood vessels. To test the hypothesis that hemodynamic conditions modify the pattern of remodeling in response to injury, monocrotaline (MCT) injury in Sprague-Dawley rats was followed 1 week later by left pneumonectomy to increase blood flow to the right lung. Right pulmonary artery remodeling in these MCT plus pneumonectomy animals was compared with animals receiving MCT or pneumonectomy alone. Neointimal changes developed in more than 90% of all right lung intra-acinar vessels 5 weeks after MCT injury (4 weeks after pneumonectomy). Neointimal lesions did not develop in untreated animals or in animals receiving MCT or pneumonectomy only. Animals with a neointimal pattern of remodeling developed severe right ventricular hypertrophy (RVH) whereas animals with a medial hypertrophy pattern of remodeling (MCT only) developed moderate RVH compared with control animals. Neointimal lesions and RVH were similar whether injury preceded pneumonectomy or vice versa. To exclude the possibility that neointimal lesions resulted from injury plus post-pneumonectomy compensatory lung growth, rather than injury plus increased flow, a left subclavian-pulmonary artery anastomosis was substituted for pneumonectomy. Neointimal lesions and severe RVH developed in these animals but were not seen in animals receiving either MCT or anastomosis only. These studies demonstrate an important role for hemodynamics in determining the pattern of pulmonary vascular remodeling after injury. PMID:9327735
Okada, K; Tanaka, Y; Bernstein, M; Zhang, W; Patterson, G A; Botney, M D
Chronic thromboembolic pulmonary hypertension.
Chronic thromboembolic pulmonary hypertension is one of the few forms of pulmonary hypertension that is surgically curable. It is likely underdiagnosed and must be considered in every patient presenting with pulmonary hypertension to avoid missing the opportunity to cure these patients. This article discusses the epidemiology, risk factors, natural history, diagnosis, and preoperative evaluation of patients with this disorder. Also covered are putative mechanisms for the conversion of acute emboli into fibrosed thrombembolic residua. Mechanical obstruction of the central pulmonary vasculature is rarely the sole cause of the pulmonary hypertension, and a discussion of the small vessel arteriopathy present in these patients is offered. Technical aspects of pulmonary endartectomy and the data supporting its role are discussed, as are the limited data on pulmonary arterial hypertension specific medical therapies for patients deemed noncandidates for the operation. PMID:21047580
Auger, William R; Kim, Nick H; Trow, Terence K
Anomalous pulmonary venous connections.
Developmental lung anomalies are classified into 3 main categories: bronchopulmonary (lung bud) anomalies, vascular anomalies, and combined lung and vascular anomalies. These anomalies are uncommon, and patients are at times asymptomatic; hence, identifying a developmental lung anomaly in the adult can be a challenge. Pulmonary vascular anomalies include interruption or absence of the main pulmonary artery, anomalous origin of the left pulmonary artery from the right pulmonary artery, anomalous pulmonary venous drainage (partial or complete), and pulmonary arteriovenous malformations. Systemic vascular anomalies comprise persistent left superior vena cava, anomalies of azygos and hemiazygos systems, and anomalies of the thoracic aorta and its major branches. In this article, we present embryology, classification, epidemiology, clinical presentation, and imaging features of anomalous pulmonary venous connections, with special emphasis on multidetector computed tomography and magnetic resonance imaging. These state-of-art imaging techniques have facilitated accurate and prompt diagnosis of these anomalies. PMID:23168060
Katre, Rashmi; Burns, Stephanie K; Murillo, Horacio; Lane, Michael J; Restrepo, Carlos S
Effects of alpha adrenergic blockade and tissue catecholamine depletion on pulmonary vascular response to hypoxia
The highly reactive pulmonary vascular bed of the neonatal calf was utilized to determine whether the hypoxic pulmonary pressor response is modified by ?-adrenergic blockade with phenoxybenzamine (Group A) or by tissue catecholamine depletion with reserpine (Group B). In addition, in Group A, the effects of hypoxia on the pulmonary circulation were compared and contrasted with those of l-norepinephrine (?-receptor stimulator) and isoproterenol (?-receptor stimulator). In Group A, changes in pulmonary vascular resistance were calculated from measurements of appropriate pressures and of pulmonary blood flow (electromagnetic flowmeter). The increase in pulmonary vascular resistance produced by hypoxia was not diminished by ?-adrenergic blockade. However, blockade abolished the pulmonary vasoconstrictor effect of norepinephrine. During hypoxic pulmonary vasoconstriction, the administration of either norepinephrine or isoproterenol lowered the pulmonary vascular resistance both before and after ?-blockade. While this may be a true vasodepressor effect of these drugs it may also reflect passive changes in the pulmonary vessels secondary to an increased pulmonary blood flow. The pulmonary vascular response to hypoxia in the reserpinized calves (Group B) was tested under three circumstances: (1) in the awake animal, (2) in the anesthetized animal prepared in the same way as those in Group A, and (3) during constant flow perfusion of the left lower lobe pulmonary artery. From these studies it was concluded that tissue catecholamine depletion did not diminish the pulmonary vascular response to hypoxia. Thus, neither ?-adrenergic blockade nor tissue catecholamine depletion prevents the hypoxic pulmonary pressor response. Furthermore, ?-blockade prevents the pulmonary vasoconstrictor response to norepinephrine but not to hypoxia. Therefore it is concluded that hypoxic pulmonary vasoconstriction is not mediated through adrenergic receptor stimulation or release of endogenous catecholamines.
Silove, Eric D.; Grover, Robert F.
Diagnosis and management of pulmonary arterial hypertension using MR imaging.
Pulmonary arterial hypertension (PAH) is a syndrome that results from restricted blood flow through the pulmonary arterial circulation, which leads to a pathological increase in pulmonary vascular resistance (PVR) and ultimately to right heart failure. The prognosis of patients with PAH has improved with the recent development of new medications. The need for new noninvasive diagnostic tools is increasing. Magnetic resonance (MR) imaging is the gold standard for assessing the right ventricle (RV). Its high degree of reproducibility makes it ideal for monitoring changes in RV parameters in response to therapy. MR imaging can also provide both anatomical and functional information about pulmonary hemodynamics. This article reviews the current status of MR imaging of the right side of the heart and pulmonary circulation in patients with PAH and other associated pulmonary diseases. PMID:23474963
Iwasawa, Tae
Preservation of micro-architecture and angiogenic potential in a pulmonary acellular matrix obtained using intermittent intra-tracheal flow of detergent enzymatic treatment.
Tissue engineering of autologous lung tissue aims to become a therapeutic alternative to transplantation. Efforts published so far in creating scaffolds have used harsh decellularization techniques that damage the extracellular matrix (ECM), deplete its components and take up to 5 weeks to perform. The aim of this study was to create a lung natural acellular scaffold using a method that will reduce the time of production and better preserve scaffold architecture and ECM components. Decellularization of rat lungs via the intratracheal route removed most of the nuclear material when compared to the other entry points. An intermittent inflation approach that mimics lung respiration yielded an acellular scaffold in a shorter time with an improved preservation of pulmonary micro-architecture. Electron microscopy demonstrated the maintenance of an intact alveolar network, with no evidence of collapse or tearing. Pulsatile dye injection via the vasculature indicated an intact capillary network in the scaffold. Morphometry analysis demonstrated a significant increase in alveolar fractional volume, with alveolar size analysis confirming that alveolar dimensions were maintained. Biomechanical testing of the scaffolds indicated an increase in resistance and elastance when compared to fresh lungs. Staining and quantification for ECM components showed a presence of collagen, elastin, GAG and laminin. The intratracheal intermittent decellularization methodology could be translated to sheep lungs, demonstrating a preservation of ECM components, alveolar and vascular architecture. Decellularization treatment and methodology preserves lung architecture and ECM whilst reducing the production time to 3 h. Cell seeding and in vivo experiments are necessary to proceed towards clinical translation. PMID:23727263
Maghsoudlou, Panagiotis; Georgiades, Fanourios; Tyraskis, Athanasios; Totonelli, Giorgia; Loukogeorgakis, Stavros P; Orlando, Giuseppe; Shangaris, Panicos; Lange, Peggy; Delalande, Jean-Marie; Burns, Alan J; Cenedese, Angelo; Sebire, Neil J; Turmaine, Mark; Guest, Brogan N; Alcorn, John F; Atala, Anthony; Birchall, Martin A; Elliott, Martin J; Eaton, Simon; Pierro, Agostino; Gilbert, Thomas W; De Coppi, Paolo
Plasma hemoglobin (Hb) scavenges endothelium-derived nitric oxide (NO), producing systemic and pulmonary vasoconstriction in many species. We hypothesized that i.v. administration of murine cell-free Hb would produce pulmonary vasoconstriction and enhance hypoxic pulmonary vasoconstriction (HPV) in mice. To assess the impact of plasma Hb on basal pulmonary vascular tone in anesthetized mice we measured left lung pulmonary vascular resistance (LPVRI) before and after infusion of Hb at thoracotomy. To confirm the findings obtained at thoracotomy, measurements of right ventricular systolic pressure (RVSP) and systemic arterial pressure (SAP) were obtained in closed-chest wild-type mice. To elucidate whether pretreatment with Hb augments HPV we assessed the increase in LPVRI before and during regional lung hypoxia produced by left mainstem bronchial occlusion (LMBO) in wild-type mice pretreated with Hb. Infusion of Hb increased SAP but did not change pulmonary arterial pressure (PAP), left lung pulmonary arterial flow (QLPA) or LPVRI in either wild-type or diabetic mice with endothelial dysfunction. Scavenging of NO by plasma Hb did not alter HPV in wild-type mice. Inhibition of NO synthase with L-NAME did not change the basal LPVRI, but augmented HPV during LMBO. Our data suggest that scavenging of NO by plasma Hb does not alter pulmonary vascular tone in mice. Therefore, generation of NO in the pulmonary circulation is unlikely to be responsible for the low basal pulmonary vascular tone of mice.
Beloiartsev, Arkadi; Baron, David M.; Yu, Binglan; Bloch, Kenneth D.; Zapol, Warren M.
Pulmonary Nontuberculous Mycobacterial Disease
Rationale: Pulmonary nontuberculous mycobacterial (PNTM) disease is increasing, but predisposing features have been elusive. Objectives: To prospectively determine the morphotype, immunophenotype, and cystic fibrosis transmembrane conductance regulator genotype in a large cohort with PNTM. Methods: We prospectively enrolled 63 patients with PNTM infection, each of whom had computerized tomography, echocardiogram, pulmonary function, and flow cytometry of peripheral blood. In vitro cytokine production in response to mitogen, LPS, and cytokines was performed. Anthropometric measurements were compared with National Health and Nutrition Examination Survey (NHANES) age- and ethnicity-matched female control subjects extracted from the NHANES 2001–2002 dataset. Measurements and Main Results: Patients were 59.9 (±9.8 yr [SD]) old, and 5.4 (±7.9 yr) from diagnosis to enrollment. Patients were 95% female, 91% white, and 68% lifetime nonsmokers. A total of 46 were infected with Mycobacterium avium complex, M. xenopi, or M. kansasii; 17 were infected with rapidly growing mycobacteria. Female patients were significantly taller (164.7 vs. 161.0 cm; P < 0.001) and thinner (body mass index, 21.1 vs. 28.2; P < 0.001) than matched NHANES control subjects, and thinner (body mass index, 21.1 vs. 26.8; P = 0.002) than patients with disseminated nontuberculous mycobacterial infection. A total of 51% of patients had scoliosis, 11% pectus excavatum, and 9% mitral valve prolapse, all significantly more than reference populations. Stimulated cytokine production was similar to that of healthy control subjects, including the IFN-?/IL-12 pathway. CD4+, CD8+, B, and natural killer cell numbers were normal. A total of 36% of patients had mutations in the cystic fibrosis transmembrane conductance regulator gene. Conclusions: Patients with PNTM infection are taller and leaner than control subjects, with high rates of scoliosis, pectus excavatum, mitral valve prolapse, and cystic fibrosis transmembrane conductance regulator mutations, but without recognized immune defects.
Kim, Richard D.; Greenberg, David E.; Ehrmantraut, Mary E.; Guide, Shireen V.; Ding, Li; Shea, Yvonne; Brown, Margaret R.; Chernick, Milica; Steagall, Wendy K.; Glasgow, Connie G.; Lin, JingPing; Jolley, Clara; Sorbara, Lynn; Raffeld, Mark; Hill, Suvimol; Avila, Nilo; Sachdev, Vandana; Barnhart, Lisa A.; Anderson, Victoria L.; Claypool, Reginald; Hilligoss, Dianne M.; Garofalo, Mary; Fitzgerald, Alan; Anaya-O'Brien, Sandra; Darnell, Dirk; DeCastro, Rosamma; Menning, Heather M.; Ricklefs, Stacy M.; Porcella, Stephen F.; Olivier, Kenneth N.; Moss, Joel; Holland, Steven M.
Sentinel lymph node biopsy in breast cancer patients with previous breast augmentation surgery.
The number of breast augmentation surgeries (BAS) has increased. Therefore, the number of breast cancer patients with history of BAS has also increased. In this paper, we present two cases of sentinel lymph node biopsy (SLNB) in patients with previous BAS who were diagnosed with breast cancer. The patients were augmented using different approach; the first case was augmented through transaxillary incision, whereas the second case was augmented through periareolar incision. Lymphoscintigraphy (LPG) was performed on the patients 1 day prior to operation, enabling confirmation of lymphatic flow and SLN in both patients. SLNB was successfully performed in both cases. In one patient, SLNB was performed using indocyanine green (ICG) fluorescence and the Photodynamic Eye (PDE) system. Regardless of history of BAS, ICG and PDE system showed lymphatic flow and SLN in real time. LPG and ICG fluorescence were useful methods for SLN detection in patients with previous BAS, being able to confirm lymph flow before operation. Biopsy methods using LPG and PDE system were considered useful for difficult confirmation of lymph flow after breast augmentation. This is the first report of SLNB using ICG and PDE system for patients with previous BAS. PMID:21671037
Nagao, Tomoya; Hojo, Takashi; Kurihara, Hiroaki; Tsuda, Hitoshi; Tanaka-Akashi, Sadako; Kinoshita, Takayuki
Central pulmonary artery anatomy in right ventricular outflow tract obstructions.
We reviewed the cine-angiograms of 190 patients with right ventricular outflow tract (RVOT) obstructions for size and anatomy of pulmonary arteries, patent ductus arteriosus (PDA) and major aorto pulmonary collateral arteries (MAPCAs). Patients were grouped into three, Tetralogy of Fallot (TOF) with pulmonary atresia (group 1, N=86), TOF with pulmonary stenosis (group 2, N=97) and 7 cases of pulmonary atresia with intact interventricular septum (group 3). Out of 86 patients in group 1, 49 had PDA alone, 30 had MAPCAs alone, six had both and one had none. In group 2, 31 patients had persistent PDA and one patient had MAPCAS and PDA. A discrete stenosis (DS) of pulmonary artery was seen significantly more in patients with RVOT obstructions associated with PDA compared to patients without PDA (67/84 vs. 5/96). Out of the 84 cases with ducti, 53 had stenosis of the pulmonary artery at the site of ductus insertion. Thus presence of PDA was an important factor in the development of DS. The likely cause of pulmonary artery stenosis in TOF with PDA may be the opposing flows through RVOT and PDA producing a watershed effect at the ductus-pulmonary artery junction. Diffuse hypoplasia of pulmonary arteries (DH) was seen more significantly in RVOT obstructions associated with MAPCAs, compared to other patient groups (19/36 vs. 14/87). These small pulmonary arteries had no discrete stenosis and this diffuse hypoplasia might be the result of inadequate blood flow during intrauterine life [Harikrishnan S, Tharakan J, Titus T, Bhat A, Sivasankaran S, Bimal F, Syam Sunder KR, James, KJ. Central pulmonary artery anatomy in right ventricular outflow tract obstructions. Indian Heart Journal 1997;49:624 (Abstract)[18
Harikrishnan, S; Tharakan, J; Titus, T; Bhat, A; Sivasankaran, S; Bimal, F; Shyam Sunder, K R
Analysis of Pulmonary Dendritic Cell Maturation and Migration during Allergic Airway Inflammation
Dendritic cells (DCs) are the key players involved in initiation of adaptive immune response by activating antigen-specific T cells. DCs are present in peripheral tissues in steady state; however in response to antigen stimulation, DCs take up the antigen and rapidly migrate to the draining lymph nodes where they initiate T cell response against the antigen1,2. Additionally, DCs also play a key role in initiating autoimmune as well as allergic immune response3. DCs play an essential role in both initiation of immune response and induction of tolerance in the setting of lung environment4. Lung environment is largely tolerogenic, owing to the exposure to vast array of environmental antigens5. However, in some individuals there is a break in tolerance, which leads to induction of allergy and asthma. In this study, we describe a strategy, which can be used to monitor airway DC maturation and migration in response to the antigen used for sensitization. The measurement of airway DC maturation and migration allows for assessment of the kinetics of immune response during airway allergic inflammation and also assists in understanding the magnitude of the subsequent immune response along with the underlying mechanisms. Our strategy is based on the use of ovalbumin as a sensitizing agent. Ovalbumin-induced allergic asthma is a widely used model to reproduce the airway eosinophilia, pulmonary inflammation and elevated IgE levels found during asthma6,7. After sensitization, mice are challenged by intranasal delivery of FITC labeled ovalbumin, which allows for specific labeling of airway DCs which uptake ovalbumin. Next, using several DC specific markers, we can assess the maturation of these DCs and can also assess their migration to the draining lymph nodes by employing flow cytometry.
Kushwah, Rahul; Hu, Jim
Prognostic role of lymph node metastasis in early gastric cancer
Objective To clarify the relationship between clinicopathological features and lymph node metastasis and to propose the potential indications of lymph node metastasis for prognosis in early gastric cancer (EGC) patients. Methods We retrospectively observed 226 EGC patients with lymph node resection, and analyzed the associations between lymph node metastasis and clinicopathological parameters using the chi-square test in univariate analysis and logistic regression analysis in multivariate analysis. Overall survival analysis was determined using the Kaplan-Meier and log-rank test. We conducted multivariate prognosis analysis using the Cox proportional hazards model. Results Of all the EGC patients, 7.5% (17/226) were histologically shown to have lymph node metastasis. The differentiation, lymphovascular invasion and depth of invasion were independent risk factors for lymph node metastasis in EGC. The 5- and 10-year survival rates were significantly lower in patients with lymph node metastasis than in those without and the patients also had shorter progress-free survival time. Lymph node metastasis and tumor size were independent prognostic factors for EGC. The status of the lymph nodes was a significant factor in predicting recurrence or metastasis after surgery. Conclusions The undifferentiated carcinoma and lymphovascular and/or submucosal invasion were associated with a higher incidence of lymph node metastasis in EGC patients, whom need to perform subsequent D2 lymphadenectomy or laparoscopic lymph node dissection and more rigorous follow-up or additional chemotherapy/radiation after D2 gastrectomy for poor prognosis and high recurrence/metastasis rate.
Zheng, Zhixue; Liu, Yiqiang; Bu, Zhaode; Zhang, Lianhai; Li, Ziyu; Du, Hong
Hsp70 vaccination-induced primary immune responses in efferent lymph of the draining lymph node.
Bovine paratuberculosis is a highly prevalent chronic infection of the small intestine in cattle, caused by Mycobacterium avium subspecies paratuberculosis (MAP). In earlier studies we showed the protective effect of Hsp70/DDA subunit vaccination against paratuberculosis. In the current study we set out to measure primary immune responses generated at the site of Hsp70 vaccination. Lymph vessel cannulation was performed to obtain efferent lymph from the prescapular lymph node draining the neck area where the vaccine was applied. Hsp70 vaccination induced a significant increase of CD21(+) B cells in efferent lymph, accounting for up to 40% of efferent cells post-vaccination. Proliferation (Ki67(+)) within the CD21(+) B cell and CD4(+) T cell populations peaked between day 3 and day 5 post-vaccination. From day 7, Hsp70-specific antibody secreting cells (ASCs) could be detected in efferent lymph. Hsp70-specific antibodies, mainly of the IgG1 isotype, were also detected from this time point onwards. However, post-vaccination IFN-? production in efferent lymph was non-sustained. In conclusion, Hsp70-vaccination induces only limited Th1 type immune responsiveness as reflected in efferent lymph draining the vaccination site. This is in line with our previous observations in peripheral blood. The main primary immunological outcome of the Hsp70/DDA subunit vaccination is B cell activation and abundant Hsp70-specific IgG1 production. This warrants the question whether Hsp70-specific antibodies contribute to the observed protective effect of Hsp70 vaccination in calves. PMID:23973322
Vrieling, Manouk; Santema, Wiebren; Vordermeier, Martin; Rutten, Victor; Koets, Ad
Surgical treatment of chronic thromboembolic pulmonary hypertension.
It is likely that chronic thromboembolic pulmonary hypertension (CTEPH) is more prevalent than currently recognised. Imaging studies are fundamental to decision making with respect to operability. All patients with suspected CTEPH should be referred to an experienced surgical centre. Currently, there is no risk scoring stratification system to guide operability assessment and it is predominantly based on surgical experience. The aim of pulmonary endarterectomy (PEA) is the removal of obstructive material to immediately reduce pulmonary vascular resistance. PEA affords the best chance of cure, but is difficult to perfect. Recognition and clearance of distal segmental and subsegmental disease is the main problem. The basic surgical techniques include: median sternotomy incision, cardiopulmonary bypass, arteriotomy incisions within pericardium, and a true endarterectomy with meticulous full distal dissection. Deep hypothermic circulatory arrest is recommended as the best means of reducing blood flow in the pulmonary artery to allow a clear field for dissection. In the recent PEACOG (PEA and COGnition) trial there was no evidence of cognitive impairment post-PEA. Reperfusion pulmonary oedema and residual pulmonary hypertension are unique post-operative complications post-PEA and are associated with increased mortality. However, in-hospital mortality is now <5% in experienced centres. PMID:23143539
Jenkins, David P; Madani, Michael; Mayer, Eckhard; Kerr, Kim; Kim, Nic; Klepetko, Walter; Morsolini, Marco; Dartevelle, Philippe
The Lymph Self-Antigen Repertoire
The lymphatic fluid originates from the interstitial fluid which bathes every parenchymal organ and reflects the "omic" composition of the tissue from which it originates in its physiological or pathological signature. Several recent proteomic analyses have mapped the proteome-degradome and peptidome of this immunologically relevant fluid pointing to the lymph as an important source of tissue-derived self-antigens. A vast array of lymph-circulating peptides have been mapped deriving from a variety of processing pathways including caspases, cathepsins, MMPs, ADAMs, kallikreins, calpains, and granzymes, among others. These self peptides can be directly loaded on circulatory dendritic cells and expand the self-antigenic repertoire available for central and peripheral tolerance.
Clement, Cristina C.; Santambrogio, Laura
Sentinel Lymph Node Biopsy in Colon Cancer
Introduction: The clinical impact of sentinel lymph node biopsy (SLNB) in colon cancer is still controversial. The purpose of this prospective multicenter trial was to evaluate its clinical value to predict the nodal status and identify factors that influence these results. Methods: Colon cancer patients without prior colorectal surgery or irradiation were eligible. The sentinel lymph node (SLN) was identified intraoperatively by subserosal blue dye injection around the tumor. The SLN underwent step sections and immunohistochemistry (IHC), if classified free of metastases after routine hematoxylin and eosin examination. Results: At least one SLN (median, n = 2) was identified in 268 of 315 enrolled patients (detection rate, 85%). Center experience, lymphovascular invasion, body mass index (BMI), and learning curve were positively associated with the detection rate. The false-negative rate to identify pN+ patients by SLNB was 46% (38 of 82). BMI showed a significant association to the false-negative rate (P < 0.0001), the number of tumor-involved lymph nodes was inversely associated. If only slim patients (BMI ?24) were investigated in experienced centers (>22 patients enrolled), the sensitivity increased to 88% (14 of 16). Moreover, 21% (30 of 141) of the patients, classified as pN0 by routine histopathology, revealed micrometastases or isolated tumor cells (MM/ITC) in the SLN. Conclusions: The contribution of SLNB to conventional nodal staging of colon cancer patients is still unspecified. Technical problems have to be resolved before a definite conclusion can be drawn in this regard. However, SLNB identifies about one fourth of stage II patients to reveal MM/ITC in lymph nodes. Further studies must clarify the clinical impact of these findings in terms of prognosis and the indication of adjuvant therapy.
Bembenek, Andreas E.; Rosenberg, Robert; Wagler, Elke; Gretschel, Stephan; Sendler, Andreas; Siewert, Joerg-Ruediger; Nahrig, Jorg; Witzigmann, Helmut; Hauss, Johann; Knorr, Christian; Dimmler, Arno; Grone, Jorn; Buhr, Heinz-Johannes; Haier, Jorg; Herbst, Hermann; Tepel, Juergen; Siphos, Bence; Kleespies, Axel; Koenigsrainer, Alfred; Stoecklein, Nikolas H.; Horstmann, Olaf; Grutzmann, Robert; Imdahl, Andreas; Svoboda, Daniel; Wittekind, Christian; Schneider, Wolfgang; Wernecke, Klaus-Dieter; Schlag, Peter M.
Sentinel lymph node mapping in breast cancer
Sentinel lymph node (SLN) biopsy is a rapidly emerging treatment option for the patient with early stage invasive breast cancer\\u000a and a clinically negative axilla. In the era of mammographic detection, SLN biopsy has the potential to eliminate axillary\\u000a dissection for the enlarging cohort of breast cancer patients who are node-negative. With experience, using radioisotope,\\u000a blue dye, or both, SLN
Hiram S. Cody
Pulmonary toxicity of Mount St. Helens volcanic ash
The effects of Mount St. Helens volcanic ash, a sandy loam soil, and quartz particles on the lung and mediastinal lymph nodes of Fischer rats were studied at time intervals of up to 109 days after in tratracheal instillation of 40 mg ash, soil, or quartz in a single dose or after multiple doses of ash instilled in seven consecutive weekly doses for a total deposition of 77 mg. Quartz caused early granuloma formation, later fibrosis was also seen in lymph nodes. Volcanic ash caused an ill-defined inflammatory reaction with a few rats showing granuloma formulation, a very limited linear fibrosis, and a moderate lipoproteinosis, and lymph nodes were enlarged with numerous microgranulomas but without reticulin and collagen formation. Pulmonary reactions to soil particles were less intense but similar to those in ash- exposed animals; lymph nodes were not enlarged. No significant clearance of ash was found at 3 months after instillation. Volcanic ash produced a simple pneumoconiosis similar to what has been described for animals and humans living for prolonged periods of time in dusty desert areas of the United States.
Sanders, C.L.; Conklin, A.W.; Gelman, R.A.; Adee, R.R.; Rhoads, K.
Anomalous unilateral single pulmonary vein mimicking pulmonary arteriovenous malformation.
Anomalies involving the pulmonary vein are so rare that most of them have been reported as a case or a series of several cases. Some of them often simulate pulmonary arteriovenous malformation (AVM), and patients undergo pulmonary angiography for embolization. Herein we report a case of anomalous unilateral single pulmonary vein that was confirmed on pulmonary angiography after initial diagnosis of pulmonary AVM on contrast medium-enhanced chest computed tomography. PMID:23989502
Hyun, Dongho; Do, Young Soo; Lim, Seong Joo; Park, Hong Suk; Park, Kwang Bo
Specific Migratory Dendritic Cells Rapidly Transport Antigen from the Airways to the Thoracic Lymph Nodes
Antigen transport from the airway mucosa to the thoracic lymph nodes (TLNs) was studied in vivo by intratracheal instillation of fluorescein isothiocyanate (FITC)-conjugated macromole- cules. After instillation, FITC 1 cells with stellate morphology were found deep in the TLN T cell area. Using flow cytometry, an FITC signal was exclusively detected in CD11c med-hi \\/major histocompatibility complex class II (MHCII)
Karim Y. Vermaelen; Ines Carro-Muino; Bart N. Lambrecht; Romain A. Pauwels
Prediction of therapeutic response in steroid-treated pulmonary sarcoidosis. Evaluation of clinical parameters, bronchoalveolar lavage, gallium-67 lung scanning, and serum angiotensin-converting enzyme levels
To find a pretreatment predictor of steroid responsiveness in pulmonary sarcoidosis the authors studied 21 patients before and after steroid treatment by clinical evaluation, pulmonary function tests, bronchoalveolar lavage (BAL), gallium-67 lung scan, and serum angiotensin-converting enzyme (SACE) level. Although clinical score, forced vital capacity (FVC), BAL percent lymphocytes (% lymphs), quantitated gallium-67 lung uptake, and SACE levels all improved with therapy, only the pretreatment BAL % lymphs correlated with the improvement in FVC (r = 0.47, p less than 0.05). Pretreatment BAL % lymphs of greater than or equal to 35% predicted improvement in FVC of 10/11 patients, whereas among 10 patients with BAL % lymphs less than 35%, 5 patients improved and 5 deteriorated. Clinical score, pulmonary function parameters, quantitated gallium-67 lung uptake, and SACE level used alone, in combination with BAL % lymphs or in combination with each other, did not improve this predictive value. The authors conclude that steroid therapy improves a number of clinical and laboratory parameters in sarcoidosis, but only the pretreatment BAL % lymphs are useful in predicting therapeutic responsiveness.
Hollinger, W.M.; Staton, G.W. Jr.; Fajman, W.A.; Gilman, M.J.; Pine, J.R.; Check, I.J.
Effects of exogenous vasoactive intestinal peptide on mesenteric lymph pathway during early intestinal ischemia-reperfusion injury in rats.
Mesenteric lymph pathway serves as the primary route by which gut injury leads to systemic inflammation and distant organ injury. The inflammation of the intestinal tract is partially mediated by vasoactive intestinal peptide (VIP). Therefore, the aim of this study was to test whether exogenous VIP affects mesenteric lymph pathway during early intestinal ischemia-reperfusion (IIR) injury. Rats were randomized into control, control+VIP, IIR and IIR+VIP groups. The observation of mesenteric lymph flow was carried out by cannulation of mesenteric lymphatics. The distribution of in vivo lymphocyte trafficking was performed by (51)Cr labeled lymphocytes and was measured by ?-counter. Endotoxin concentration was assayed using the limulus test kit and TNF-? level was detected by ELISA. When IIR injury treated with VIP, the volumes of lymph flow increased by 80%, which caused the number of lymphocytes exiting in mesenteric lymphatic increased by 50% while the proportion of (51)Cr-lymphocytes in Peyer's patches, intestinal effector tissues, mesenteric nodes, large intestine, stomach decreased by 58%, 51%, 58%, 63%, 64% respectively at the 6th h after reperfusion following intestinal ischemia. Meanwhile, endotoxin and TNF-? levels in intestinal lymph decreased by 51% and 83%. These results suggest that exogenous VIP ameliorates IIR induced splanchnic organ damage via inhibition of toxic mediators reaching systemic circulation and reinforcement of the effective immune responses in gut-associated lymphoid tissues (GALT). PMID:23872373
Yang, Hui; Jin, Yu; Wang, Chun H; Tang, Cheng W
Transcatheter Occlusion of a Large Pulmonary Arteriovenous Malformation Using the Amplatzer Vascular Plug
Pulmonary arteriovenous malformation (AVM) is a rare entity with well-described signs, symptoms, and complications. Pulmonary\\u000a AVMs can be congenital or acquired. They have been described in the setting of severe liver disease and after palliation with\\u000a a Glenn shunt in which the hepatic venous blood flow has been excluded from the pulmonary blood flow. A variety of surgical\\u000a and transcatheter
H. Farra; D. T. Balzer
Chronic thromboembolic pulmonary hypertension.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially life-threatening condition characterized by obstruction of pulmonary arterial vasculature by acute or recurrent thromboemboli with subsequent organization, leading to progressive pulmonary hypertension and right heart failure. Until relatively recently, CTEPH was a diagnosis made primarily at autopsy, but advances made in diagnostic modalities and surgical pulmonary endarterectomy techniques have made this disease treatable and even potentially curable. Although published guidelines are available, in the absence of randomized controlled trials regarding CTEPH there is a lack of standardization, and treatment options have to be individualized. PMID:22748907
Moraca, Robert J; Kanwar, Manreet
[A case of sarcoidosis presenting as a solitary pulmonary nodule].
A 73-year-old woman presented at a private clinic because of non productive cough. She was treated with several drugs, but no relief was obtained. She was therefore referred to our hospital for further investigations. Chest CT films revealed a solitary nodule in the right lower lung field and mediastinal and bilateral hilar lymphadenopathy. The FDG-PET CT showed a high FDG uptake in the pulmonary nodule and bilateral hilar and mediastinal lymph nodes. Her serum angiotensin-converting enzyme level was normal and a PPD skin test was negative. Because the transbronchial biopsy specimens were not diagnostic, video-assisted thoracoscopic surgery was performed. The pathologic diagnosis of the resected lung and lymph node was sarcoidosis. There was no sign of other organ involvement. The symptoms remitted without steroid therapy and one year after surgery she continues to do well and has no evidence of recurrence. PMID:19195199
Itoh, Tomoyoshi; Kobayashi, Daiki; Rensha, Kayoko; Minami, Kennichi
Clinical characteristics of pulmonary arterial hypertension associated with Down syndrome.
The genetic abnormalities associated with Down syndrome (DS) are still being identified. Few studies have examined the roles of CRELD1 and GATA4 in cardiac abnormalities or their association with pulmonary artery histopathology. Children with DS have an elevated risk of pulmonary arterial hypertension (PAH). This increased risk is likely mainly due to genetic background, the structural characteristics of the pulmonary vascular wall, and certain heart diseases and partly due to pulmonary hypoplasia, upper and lower airway obstructive diseases, chronic infection, and neuromuscular underdevelopment. Exposure to increased left-to-right shunt flow increases sheer stress on endothelium and may induce endothelial dysfunction followed by irreversible remodeling of pulmonary arteries. Pathologic changes include endothelial cell proliferation and thickening of the pulmonary arterial wall due to mechanical responses to the thinner medial smooth muscle cell layer, which includes underdevelopment of alveoli. Production of prostacyclin and nitric oxide is diminished in DS, but endothelin-1 and thromboxane are elevated. Perioperatively, patients with DS may experience pulmonary hypertensive crisis after intracardiac repair and prolonged PAH, and have a poorer response to nitric oxide inhalation. To better manage DS, it is crucial to systematically evaluate the systemic complications of DS. Cardiac catheterization data, particularly those regarding pulmonary arterial resistance, are essential in assessing severity and response to vasodilating agents, preventing postoperative crisis, and evaluating the possibility of intracardiac repair. Advanced therapy with pulmonary vasodilating agents appears effective. Operative risk is similar for individuals with and without DS, except among patients with a complete atrioventricular canal defect. PMID:24689825
Saji, Tsutomu
Mesenchymal Stromal Cell Dependent Regression of Pulmonary Metastasis from Ewing's
Introduction: Ewing's sarcoma (ES) is the second most common bone tumor in children. Survival has not improved over the last decade and once pulmonary metastatic disease is present, survival is dismal. Mesenchymal stromal cell (MSC) therapy has shown potential benefit for Kaposi's sarcoma; however, the role of progenitor cell therapies for cancer remains controversial. MSC treatment of ES or pulmonary metastatic disease has not been demonstrated. We have developed an orthotopic xenograft model of ES in which animals develop spontaneous pulmonary metastases. Within this model, we demonstrate the use of MSCs to target ES lung metastasis. Materials and Methods: Human ES cells were transfected with luciferase and injected into the rib of nude mice. Development of pulmonary metastases was confirmed by imaging. After flow cytometry based characterization, MSCs were injected into the tail vein of nude mice with established local ES tumor or pulmonary metastasis. Mice were treated with intravenous MSCs weekly followed by bioluminescent imaging. Results: The intravenous injection of MSCs in an ES model decreases the volume of pulmonary metastatic lesions; however, no effect on primary chest wall tumor size is observed. Thus verifying the MSC preferential homing to the lung. MSCs are found to "home to" the pulmonary parenchyma and remain engrafted up to 5?days after delivery. Discussion: MSC treatment of ES slows growth of pulmonary metastasis. MSCs have more affinity for pulmonary metastasis and can effect a greater decrease in tumor growth in the lungs compared to the primary tumor site.
Hayes-Jordan, Andrea; Wang, Yong Xin; Walker, Peter; Cox, Charles S.
What Causes Idiopathic Pulmonary Fibrosis?
... from the NHLBI on Twitter. What Causes Idiopathic Pulmonary Fibrosis? Sometimes doctors can find out what is causing pulmonary fibrosis (lung scarring). For example, exposure to environmental pollutants ...
[Stereotactic radiotherapy following chemo-radiotherapy for lymph node metastasis of stage III non-small-cell lung cancer].
It has been expected that stereotactic radiotherapy (SRT) is one of the useful treatments for non-resectable early lung cancer. In the case radiotherapy was thought to be difficult due to the wideness of irradiation area, it is probable to undergo chemo-radiotherapy safely using SRT for a primary lesion. We report two cases of Stage III non-small-cell lung cancer, which underwent SRT for primary tumors following chemo-radiotherapy for the lymph node metastasis. In both two cases, a reduction of V?? (the normal pulmonary volume to receive radiation exposure: more than 20 Gy) was a possibility, and symptomatic radiation pneumonitis was not observed. PMID:22202326
Futamura, Yohei; Sawa, Toshiyuki; Hasegawa, Takaaki; Horiba, Akane; Ishiguro, Takashi; Yoshida, Tsutomu; Iida, Takayoshi; Marui, Tsutomu; Murakami, Eiji; Azuma, Ken-Ichiro; Murakawa, Shinji
Pulmonary Vascular Pressure Profiles in Broilers Selected for Susceptibility to Pulmonary Hypertension Syndrome: Age and Gender Comparisons
Broilers that are susceptible to pulmonary hypertension syndrome (PHS, ascites) have an elevated pulmonary arterial pressure (PAP) when compared with PHS-resistant broilers. Two distinctly different syndromes, pulmonary arterial hypertension (PAH) and pulmonary venous hypertension (PVH), both are associated with increases in PAP. Pulmonary arterial hypertension occurs when the right ventricle must elevate the PAP to overcome increased resistance to flow through restrictive pulmonary arterioles upstream from the pulmonary capillaries. In contrast, PVH is commonly caused by increased downstream (post-capillary) resistance. The sites of resistance to pulmonary blood flow are deduced by making contemporaneous measurements of the PAP and the wedge pressure (WP), and calculating the trans-pulmonary pressure gradient (TPG = PAP-WP). We obtained PAP and WP values from 8, 12, 16, 20 and 24 wk old anesthetized male and female broilers from a PHS-susceptible line. Pressures were recorded as a catheter was advanced through a wing vein to the pulmonary artery and onward until the WP was obtained. In addition to gender and age comparisons of vascular pressure gradients, the data also were pooled to obtain three cohorts for broilers having the lowest PAP values (n = 52; range: 12 to 22.9 mmHg), intermediate PAP values (n = 63; range: 23 to 32.9 mmHg), and highest PAP values (n = 62; range: 33 to 62 mmHg) independent of age or gender. Within each of the age, gender and PAP cohort comparisons, broilers with elevated PAP consistently exhibited the hemodynamic characteristics of PAH (elevated PAP and TPG combined with a normal WP) and not PVH (elevated PAP and WP combined with a normal or reduced TPG). Susceptibility to PHS can be attributed primarily to pulmonary arterial hypertension associated with increased pre-capillary (arteriole) resistance.
Wideman, R. F.; Eanes, M. L.; Hamal, K. R.; Anthony, N. B.
Diffuse pulmonary lymphangiomatosis
Diffuse pulmonary lymphangiomatosis (DPL) is a rare disease characterized by infiltration of the lung, pleura and mediastinum with thin-walled lymphangiomas. DPL can result in mass effect from infiltrative disease, restrictive and obstructive pulmonary physiology, chylous effusions and respiratory failure. The present article discusses clinical, radiographic and pathological features, and treatment options for DPL.
Kadakia, Kunal C; Patel, Sandeep M; Yi, Eunhee S; Limper, Andrew H
Pulmonary hypertension in CKD.
Pulmonary arterial hypertension is a rare disease often associated with positive antinuclear antibody and high mortality. Pulmonary hypertension, which rarely is severe, occurs frequently in patients with chronic kidney disease (CKD). The prevalence of pulmonary hypertension ranges from 9%-39% in individuals with stage 5 CKD, 18.8%-68.8% in hemodialysis patients, and 0%-42% in patients on peritoneal dialysis therapy. No epidemiologic data are available yet for earlier stages of CKD. Pulmonary hypertension in patients with CKD may be induced and/or aggravated by left ventricular disorders and risk factors typical of CKD, including volume overload, an arteriovenous fistula, sleep-disordered breathing, exposure to dialysis membranes, endothelial dysfunction, vascular calcification and stiffening, and severe anemia. No specific intervention trial aimed at reducing pulmonary hypertension in patients with CKD has been performed to date. Correcting volume overload and treating left ventricular disorders are factors of paramount importance for relieving pulmonary hypertension in patients with CKD. Preventing pulmonary hypertension in this population is crucial because even kidney transplantation may not reverse the high mortality associated with established pulmonary hypertension. PMID:23164943
Bolignano, Davide; Rastelli, Stefania; Agarwal, Rajiv; Fliser, Danilo; Massy, Ziad; Ortiz, Alberto; Wiecek, Andrzej; Martinez-Castelao, Alberto; Covic, Adrian; Goldsmith, David; Suleymanlar, Gultekin; Lindholm, Bengt; Parati, Gianfranco; Sicari, Rosa; Gargani, Luna; Mallamaci, Francesca; London, Gerard; Zoccali, Carmine
Congenital pulmonary lymphangiectasia
Congenital pulmonary lymphangiectasia (PL) is a rare developmental disorder involving the lung, and characterized by pulmonary subpleural, interlobar, perivascular and peribronchial lymphatic dilatation. The prevalence is unknown. PL presents at birth with severe respiratory distress, tachypnea and cyanosis, with a very high mortality rate at or within a few hours of birth. Most reported cases are sporadic and the etiology
Carlo Bellini; Francesco Boccardo; Corradino Campisi; Eugenio Bonioli
Primary Pulmonary Hypertension
... narrowing worsens over time and causes high blood pressure in these blood vessels. It is sometimes call unexplained pulmonary hypertension because it describes pulmonary hypertension when there is no underlying heart or lung ... the high blood pressure. Symptoms of PPH can develop so slowly that ...
Pulmonary function tests are valuable investigations in the management of patients with suspected or previously diagnosed respiratory disease. They aid diagnosis, help monitor response to treatment and can guide decisions regarding further treatment and intervention. The interpretation of pulmonary functions tests requires knowledge of respiratory physiology. In this review we describe investigations routinely used and discuss their clinical implications.
Ranu, Harpreet; Wilde, Michael; Madden, Brendan
Operative balloon pulmonary valvuloplasty.
Closed operative pulmonary valvulotomy for relief of critical pulmonary valve stenosis can be performed effectively by intraoperative use of a balloon catheter without inflow occlusion or hemodynamic instability and with minimal blood loss. Follow-up evaluation indicates adequate growth of the valve. PMID:2952841
Walls, J T; Lababidi, Z; Curtis, J J
[Chronic thromboembolic pulmonary hypertension].
Chronic thromboembolic pulmonary hypertension is due to unresolved or recurrent pulmonary embolism. In the United States the estimated prevalence is 0.1-0.5% among survived patients with pulmonary embolism. The survival rate at 5 years was 30% among patients with a mean pulmonary artery pressure > 40 mmHg at the time of diagnosis and only 10% among those with a value > 50 mmHg. The interval between the onset of disturbances and the diagnosis may be as long as 3 years. Doppler echocardiography permits to establish the diagnosis of pulmonary hypertension. Radionuclide scanning determines whether pulmonary hypertension has a thromboembolic basis. Right heart catheterization and pulmonary angiography are performed in order to establish the extension and the accessibility to surgery of thrombi and to rule out other causes. The surgical treatment is thromboendarterectomy. A dramatic reduction in the pulmonary vascular resistance can be achieved; corresponding improvements in the NYHA class--from class III or IV before surgery to class I-II after surgery--are usually observed. Patients who are not considered candidates for thromboendarterectomy may be considered candidates for lung transplantation. PMID:14664293
Zonzin, Pietro; Vizza, Carmine Dario; Favretto, Giuseppe
Comparative proteomic analysis of rodent plasma and mesenteric lymph.
The lymph has long been considered as the plasma filtrate and the proteomes of the lymph have received scanty attention. Currently, mesenteric lymph is reported to play an important role in the pathogenesis of multiple organ dysfunction syndrome in some critical illnesses. A better understanding of the composition and proteomes of mesenteric lymph becomes imperative to disclose the mechanistic role of mesenteric lymph. Seven male Sprague-Dawley rats were fasted overnight, and anesthetized to collect plasma and mesenteric lymph. The specimens were subjected to proteomic analysis using two-dimensional gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). An average of 434 and 412 protein spots were found in the gels of the plasma and mesenteric lymph respectively. Peptide mass fingerprint analysis identified 77 proteins for 212 protein spots. The 2-DE proteomic pattern of mesenteric lymph was largely similar to that of the plasma. As in the plasma, large protein spots of albumin dominated the protein pattern in mesenteric lymph. Other major proteins identified in 2-DE gels included immunoglobulin heavy and light chains, fibrinogen alpha-, beta- and gamma-chains, serotransferrin, protease inhibitors, kininogens, macroglobulins, haptoglobin, and apolipoproteins. Meanwhile, mesenteric lymph contained an array of proteins that differentiated it from the plasma. The most differentially expressed proteins in mesenteric lymph were gamma-fibrinogen, protease inhibitors, and proteins related to lipid transport/metabolism. The study presents a detailed description of mesenteric lymph proteomes of a common experimental animal in physiological status using a common proteomic approach. These results provide the basis for future research. PMID:23656218
Yuan, Kuo-Ching; Fang, Jen-Feng; Hsieh, Sen-Yung; Shih, Hsin-Nung
Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of non-lymph node thoracic lesions
AIMS: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has shown excellent diagnostic capabilities for mediastinal and hilar lymphadenopathy. However, its value in thoracic non-lymph node lesions is less clear. This study was designed to assess the value of EBUS-TBNA in distinguishing malignant from benign thoracic non-lymph node lesions. METHODS: From October 2009 to August 2011, 552 patients underwent EBUS-TBNA under local anesthesia and with conscious sedation. We retrospectively reviewed 81 of these patients who had tracheobronchial wall-adjacent intrapulmonary or isolated mediastinal non-lymph node lesions. On-site cytological evaluation was not used. Immunohistochemistry (IHC) was performed to distinguish the origin or type of malignancy when necessary. RESULTS: EBUS-TBNA was performed in 68 tracheobronchial wall-adjacent intrapulmonary and 13 isolated mediastinal non-lymph node lesions. Of the 81 patients, 77 (95.1%, 60 malignancies and 17 benignancies) were diagnosed through EBUS-TBNA, including 57 primary lung cancers, 2 mediastinal tumors, 1 pulmonary metastatic adenocarcinoma, 7 inflammation, 5 tuberculosis, 3 mediastinal cysts, 1 esophageal schwannoma, and 1 focal fibrosis. There were four false-negative cases (4.9%). Of the 60 malignancies, there were 9 (15.0%) which originally had no definite histologic origin or type. Thus, IHC was performed, with 7 (77.8%) being subsequently confirmed. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EBUS-TBNA in distinguishing malignant from benign lesions were 93.4% (60/64), 100% (17/17), 100% (60/60), 81.0% (17/21), and 95.1% (77/81), respectively. CONCLUSION: EBUS-TBNA is a safe procedure with a high sensitivity for distinguishing malignant from benign thoracic non-lymph node lesions within the reach of EBUS-TBNA, with IHC usually providing a more definitive diagnosis.
Yang, Huizhen; Zhao, Heng; Garfield, David H.; Teng, Jiajun; Han, Baohui; Sun, Jiayuan
Angiofollicular lymph node hyperplasia with amyloidosis.
Two cases of angiofollicular lymph node hyperplasia are described, one of the solitary plasma cell type the other of the multicentric hyaline vascular type. Both cases illustrate the wide ranging clinical and pathological findings associated with this condition but both also have unusual features. The solitary plasma cell lesion had an exceptional 32 year clinical history and was associated with systemic amyloidosis of AL type. The multicentric hyaline vascular case was associated with coexistent multiple myeloma and amyloid deposition also of AL type. These cases are presented with a review of the relevant literature. Images Figure 1 Figure 2
West, K. P.; Morgan, D. R.; Lauder, I.
Contemporary inguinal lymph node dissection: minimizing complications
Objectives This review describes the morbidity of inguinal lymph node dissection (ILND) performed as part of the management of penile\\u000a cancer as well as recent modifications that may reduce the incidence of complications.\\u000a \\u000a \\u000a \\u000a Methods A review of the literature was conducted using Pubmed© for studies reporting complication outcomes of ILND for penile cancer. Furthermore, our contemporary results and patient\\u000a related morbidity associated
Philippe E. Spiess; Mike S. Hernandez; Curtis A. Pettaway
The local lymph node assay in 2014.
Toxicology endeavors to predict the potential of materials to cause adverse health (and environmental) effects and to assess the risk(s) associated with exposure. For skin sensitizers, the local lymph node assay was the first method to be fully and independently validated, as well as the first to offer an objective end point with a quantitative measure of sensitizing potency (in addition to hazard identification). Fifteen years later, it serves as the primary standard for the development of in vitro/in chemico/in silico alternatives. PMID:24603516
Basketter, David A; Gerberick, G Frank; Kimber, Ian
Lymphatic Mapping and Sentinel Lymph Node Biopsy.
The status of the regional nodal basin remains the most important prognostic indicator of survival. The current standard of care for the management of invasive breast cancer is the complete removal of the tumor, with documentation of negative margins by either mastectomy or lumpectomy, followed by complete axillary lymph node dissection. Data suggest that complete lymph node dissection (CLND) provides better local control of the disease and may actually offer a survival advantage. Lymphatic mapping and sentinel lymph node (SLN) biopsy are clearly changing this long-held paradigm and have the potential to change the standard of surgical care of the breast cancer patient. The purpose of this report is to describe the lymphatic mapping experience at the H. Lee Moffitt Cancer Center and Research Institute. From April 1994 to January 1999, 1,147 consecutive breast cancer patients were enrolled in an institutional review board-approved lymphatic mapping protocol. Lymphatic mapping was performed using Tc99m-labeled sulfur colloid and isosulfan blue dye. An SLN was defined as any blue node and/or any hot node with ex vivo radioactivity counts >/=10 times an excised non-SLN or in situ radioactivity counts >/=3 times the background counts. Lymphatic mapping was successful in identifying the SLN in 1,098 of 1,147 (95.7%) cases. In the first 186 patients, all of whom underwent CLND following SLN biopsy, one false-negative biopsy was encountered for a false-negative rate of 0.83%. The method of diagnosis (excisional versus minimally invasive) does not appear to impact on lymphatic mapping. Tumor size, however, is directly related to the probability of axillary lymph node involvement. Advances in technology and the development of minimally invasive surgical techniques have heralded a new era in surgery. Lymphatic mapping and SLN biopsy may actually prove to be a more accurate method of identifying metastases to the axilla by allowing a more focused pathologic examination of the axillary node(s) at highest risk for metastasis. With adequate training, this technique can be readily implemented as a valuable tool in the surgical treatment of breast cancer. PMID:11348304
Bass, Siddharth S.; Lyman, Gary H.; McCann, Christa R.; Ku, Ni Ni; Berman, Claudia; Durand, Kara; Bolano, Monica; Cox, Sarah; Salud, Christopher; Reintgen, Douglas S.; Cox, Charles E.
The pulmonary extracellular lining.
The extracellular lining of the lungs is reviewed. The pulmonary extracellular lining is a complex mixture of phospholipids, proteins and carbohydrates which is absolutely essential for the maintenance of normal pulmonary functions such as gas exchange. Without the lining the lungs would collapse. Alterations in the pulmonary extracellular lining may underlie some disease conditions induced by toxic agents, especially those which interfere with the formation of pulmonary surfactant. The extracellular lining could be used to detect and monitor damage and disease caused by agents toxic to the lungs. The lining contains many hydrolytic enzymes which may act to detoxify certain toxic agents such as those which contain ester groups. The pulmonary extracellular lining could play a significant role mediating the toxic action of inhaled agents as well as the removal of those agents from the lungs. Images FIGURE 1.
George, G; Hook, G E
[Lymphatic vascular system, development and lymph formation. Review].
The lymphatic vascular system is widely developed among vertebrates. Lymphatic vessels provide the interstitial fluid (20% of the body weight) drainage through interstitial prelymphatic channels, capillaries, precollectors and collectors flowing into the venous blood. Endothelial cells of capillaries are overlapped and fixed to interstitial collagen and elastic fibres by anchoring filaments facilitating the fluid transfer. Precollectors and collectors have valves controlling the lymph flux direction. In addition to external mechanisms, the lymphangions of collectors have contracting muscle cells driving the flow. Lymphatic endothelial cells are routinely identified by the expression of podoplanin, LYVE-1 and VEGFR3. In the embryo, prelymphatic endothelial cells emerge from the cardinal veins and migrate into the mesenchyma forming embryonic lymphatic sacs. Prox1, Sox18 and COUP-TFII play a major role in the endothelial speciation, VEGFC as VEGFD combined to VEGFR3 in cell migration and proliferation and FoxC2 in valves development. In cancer or inflammation, various factors secreted by cancer cells and/or inflammatory cells induce a neolymphangiogenesis. Recently it has been shown that cells from the bone marrow could be potential precursors for lymphatic endothelial cells. PMID:23474100
Bernaudin, J-F; Kambouchner, M; Lacave, R
Clinical significance of lymph node metastasis in gastric cancer
Gastric cancer, one of the most common malignancies in the world, frequently reveals lymph node, peritoneum, and liver metastases. Most of gastric cancer patients present with lymph node metastasis when they were initially diagnosed or underwent surgical resection, which results in poor prognosis. Both the depth of tumor invasion and lymph node involvement are considered as the most important prognostic predictors of gastric cancer. Although extended lymphadenectomy was not considered a survival benefit procedure and was reported to be associated with high mortality and morbidity in two randomized controlled European trials, it showed significant superiority in terms of lower locoregional recurrence and disease related deaths compared to limited lymphadenectomy in a 15-year follow-up study. Almost all clinical investigators have reached a consensus that the predictive efficiency of the number of metastatic lymph nodes is far better than the extent of lymph node metastasis for the prognosis of gastric cancer worldwide, but other nodal metastatic classifications of gastric cancer have been proposed as alternatives to the number of metastatic lymph nodes for improving the predictive efficiency for patient prognosis. It is still controversial over whether the ratio between metastatic and examined lymph nodes is superior to the number of metastatic lymph nodes in prognostic evaluation of gastric cancer. Besides, the negative lymph node count has been increasingly recognized to be an important factor significantly associated with prognosis of gastric cancer.
Deng, Jing-Yu; Liang, Han
[The historical perspective of the sentinel lymph node concept].
The sentinel lymph node procedure is currently standard care in the treatment of breast cancer. The introduction of this procedure in 1992 would not have been possible without the pioneering discoveries regarding lymph nodes and cancer. The Italian surgeon Gaspar Asellius (1581-1626) visualized the lymphatic vessels of a dog after it had been fed and shortly before dissection. At the end of the 17th century, the French anatomists Lauth and Sappey visualized the lymphatics by injecting deceased criminals with mercury. In 1858, the German pathologist Virchow (1821-1902) launched the theory that lymph nodes act as defensive barriers. He also made the first microscopical illustration ofa sentinel lymph node. Gould et al. and Cabaăs independently launched the precursors of the current modern sentinel lymph node concept in 1959 and 1977 respectively. Gould et al. were the first people to use the term "sentinel node'. Cabańas used lymphangiography for the visualisation of the sentinel lymph node. Controversies about the barrier function of the lymph nodes, the fear of skip metastasis and the difficulties of performing the Cabańas procedure, prevented a breakthrough of this concept. In 1992 Morton et al. rediscovered the valuable sentinel node biopsy concept and introduced blue dye for the investigation of patients with melanoma. The combination of lymphoscintigraphy, intra-operative gamma probe guidance and patent blue further increased the reliability of the sentinel lymph node biopsy procedure. Unnecessary lymph gland dissection procedures with considerable morbidity can be prevented by this procedure. PMID:18240761
Bekker, J; Meijer, S
Lymph node metastasis in gastric cardiac adenocarcinoma in male patients
AIM: To reveal the clinicopathological features and risk factors for lymph node metastases in gastric cardiac adenocarcinoma of male patients. METHODS: We retrospective reviewed a total of 146 male and female patients with gastric cardiac adenocarcinoma who had undergone curative gastrectomy with lymphadenectomy in the Department of Surgery, Xin Hua Hospital and Rui Jin Hospital of Shanghai Jiaotong University Medical School between November 2001 and May 2012. Both the surgical procedure and extent of lymph node dissection were based on the recommendations of Japanese gastric cancer treatment guidelines. Univariate and multivariate analyses of lymph node metastases and the clinicopathological features were undertaken. RESULTS: The rate of lymph node metastases in male patients with gastric cardiac adenocarcinoma was 72.1%. Univariate analysis showed an obvious correlation between lymph node metastases and tumor size, gross appearance, differentiation, pathological tumor depth, and lymphatic invasion in male patients. Multivariate logistic regression analysis revealed that tumor differentiation and pathological tumor depth were the independent risk factors for lymph node metastases in male patients. There was an obvious relationship between lymph node metastases and tumor size, gross appearance, differentiation, pathological tumor depth, lymphatic invasion at pN1 and pN2, and nerve invasion at pN3 in male patients. There were no significant differences in clinicopathological features or lymph node metastases between female and male patients. CONCLUSION: Tumor differentiation and tumor depth were risk factors for lymph node metastases in male patients with gastric cardiac adenocarcinoma and should be considered when choosing surgery.
Ren, Gang; Chen, Ying-Wei; Cai, Rong; Zhang, Wen-Jie; Wu, Xiang-Ru; Jin, Ye-Ning
Inhaled treprostinil and pulmonary arterial hypertension
Multiple conditions result in development of pulmonary hypertension. Pulmonary arterial hypertension (PAH) is the subclassification of pulmonary hypertension, in which known or unknown underlying conditions lead to similar intrinsic alterations in the pulmonary vasculature. PAH is a progressive condition characterized by restricted blood flow through the pulmonary circulation leading to poor survival in the absence of effective therapy. Over the last two decades, new therapeutic agents have substantially improved the course and prognosis for PAH patients. Three available classes of drugs, ie, prostacyclins, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors provide multiple options for treatment of PAH. Endothelin receptor antagonists and phosphodiesterase-5 inhibitors are administered orally, whereas prostacyclin therapies are delivered by continuous intravenous or subcutaneous infusion, or as aerosols by nebulization. Because of the risks and inconveniences associated with administration, prostacyclins are typically reserved for patients with more advanced disease or progression despite oral therapy. Inhaled administration may be a safer and easier route for prostacyclin administration. Treprostinil is a prostacyclin analog that has been demonstrated to be effective when administered by continuous subcutaneous or intravenous infusion, and more recently by nebulization.
Nadler, Samuel T; Edelman, Jeffrey D
Pulmonary neutral fat embolism in dogs.
Twenty-two adult dogs were each given a single, 30-minute injection of 1.5 ml/kg body weight of pure triolein, and their pulmonary, hepatic, renal, and cerebral morphology was observed for 1, 2, 3, 4, 5, 6, 15, 24, and 48 hours; 3,4, and 5 days; 1 and 2 weeks; and 1 month after the injection. A picture of massive capillary occlusion by lipid droplets was followed by rapidly resolvable inflammatory pneumopathy of granulomatous type, leaving a normal lung at the end of the experiment. The cleaning of the capillaries may be attributed to the mechanical action of the blood flow and to the inflammatory reaction with evacuation of necrotic cells via the bronchial route. Transient pulmonary edema is attributed to increased pulmonary arterial pressure. There was no intravacular coagulation. The few pulmonary lesions observed after the triolein injection suggest that the chemical theory of neutral fat hydrolysis by pulmonary lipase and the toxicity of free fatty acids that are released should be reconsidered. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7
Jacobovitz-Derks, D.; Derks, C. M.
Leaving antegrade pulmonary blood flow results in reversal of flow in the azygous vein and decompression of the cavopulmonary circulation: mechanism of cyanosis defined with cardiac magnetic resonance imaging.
We report the case of a 2.5-year-old patient with single-ventricle physiology who underwent cardiac magnetic resonance study for cyanosis after Kawashima operation. Magnetic resonance imaging study showed a veno-venous collateral redirecting systemic venous flow, responsible for cyanosis. PMID:24345722
Anwar, Shafkat; Whitehead, Kevin K; Harris, Matthew A
Familial Congenital Nonimmune Hydrops, Chylothorax and Pulmonary Lymphangiectasia
Pulmonary lymphangiectasia is an uncommon congenital anomaly, and familial occurrence has rarely been reported. We report on two sibs with bilateral pleural effusion/chylothorax and hydrops who died neonatally. One sib required prenatal intrauterine hemithoracic drainage. Autopsy confirmed congenital pulmonary lymphangiectiasia (CPL) histologically in the first case. Hydrops, characterized as subcutaneous edema and effusions in two or more body cavities, may be due to a variety of factors, but the co-occurrence of CPL in one of these sibs, although rare, supports the notion that chylothorax and hydrops may be caused by structural lesions of lymph channels. Although most cases of CPL are sporadic, the reported sibs support autosomal recessive inheritance, with intrafamilial variability of a lymphatic disorder on a genetic basis. Mutations in VEGFR3 in families with Milroy disease, mutations of FOXC2 in the lymphedema-distichiasis syndrome, and fatal chylothorax in ?9-deficient mice are potential candidate genes.
Stevenson, David A.; Pysher, Theodore J.; Ward, Robert M.; Carey, John C.
Familial congenital non-immune hydrops, chylothorax, and pulmonary lymphangiectasia.
Pulmonary lymphangiectasia is an uncommon congenital anomaly, and familial occurrence has rarely been reported. We report on two sibs with bilateral pleural effusion/chylothorax and hydrops who died neonatally. One sib required prenatal intrauterine hemithoracic drainage. Autopsy confirmed congenital pulmonary lymphangiectasia (CPL) histologically in the first case. Hydrops, characterized as subcutaneous edema and effusions in two or more body cavities, may be due to a variety of factors, but the co-occurrence of CPL in one of these sibs, although rare, supports the notion that chylothorax and hydrops may be caused by structural lesions of lymph channels. Although most cases of CPL are sporadic, the reported sibs support autosomal recessive inheritance, with intrafamilial variability of a lymphatic disorder on a genetic basis. Mutations in vascular endothelial growth factor receptor-3 (VEGFR3) in families with Milroy disease, mutations of FOXC2 in the lymphedema-distichiasis syndrome, and fatal chylothorax in alpha9-deficient mice are potential candidate genes. PMID:16419129
Stevenson, David A; Pysher, Theodore J; Ward, Robert M; Carey, John C
Hypoxic pulmonary vasoconstriction as a contributor to response in acute pulmonary embolism.
Hypoxic pulmonary vasoconstriction (HPV) is an adaptive response unique to the lung whereby blood flow is diverted away from areas of low alveolar oxygen to improve ventilation-perfusion matching and resultant gas exchange. Some previous experimental studies have suggested that the HPV response to hypoxia is blunted in acute pulmonary embolism (APE), while others have concluded that HPV contributes to elevated pulmonary blood pressures in APE. To understand these contradictory observations, we have used a structure-based computational model of integrated lung function in 10 subjects to study the impact of HPV on pulmonary hemodynamics and gas exchange in the presence of regional arterial occlusion. The integrated model includes an experimentally-derived model for HPV. Its function is validated against measurements of pulmonary vascular resistance in normal subjects at four levels of inspired oxygen. Our results show that the apparently disparate observations of previous studies can be explained within a single model: the model predicts that HPV increases mean pulmonary artery pressure in APE (by 8.2 ± 7.0% in these subjects), and concurrently shows a reduction in response to hypoxia in the subjects who have high levels of occlusion and therefore maximal HPV in normoxia. PMID:24770844
Burrowes, K S; Clark, A R; Wilsher, M L; Milne, D G; Tawhai, M H
Proximal pulmonary arterial and intrapulmonary radiologic features of Eisenmenger syndrome and primary pulmonary hypertension.
Extrapulmonary and intrapulmonary radiologic features of Eisenmenger syndrome and primary pulmonary hypertension (PPH) and the clinical expressions that coincide with the radiologic features of these 2 forms of pulmonary hypertension have not previously been characterized. Computed tomography (CT) and pulmonary CT angiography (CTA) utilized GE High Speed Advantage or Siemens Evolution electron beam tomographic (EBT) scanners in 31 patients with cyanotic pulmonary vascular disease (PVD) (group A: 12 men and 19 women; mean age 38 +/- 4 years) and in 13 women with PPH-acyanotic PVD (group B: mean age 30 +/- 3 years). Ten group A and 3 group B patients underwent imaging twice, yielding 57 studies. Group A patients' extrapulmonary radiologic features included proximal pulmonary arteries that were consistently enlarged, and were aneurysmal in 13%, causing bronchial compression and atelectasis. Thromboses were uniformly present and mild in 71% and moderate to massive in 29% of patients. Massive proximal thromboses caused asphyxic death and augmented right-to-left shunts by increasing flow resistance. Mild to extensive mural calcific deposits occurred in 26% of patients. Intrapulmonary radiologic features included intrapulmonary embolic infarction, intrapulmonary hemorrhage, bronchial/systemic arterial collaterals, and neovascularity. Group B patients' extrapulmonary radiologic features included proximal pulmonary arteries that were consistently enlarged but not aneurysmal and devoid of thromboses. Mild to extensive mural calcific deposits occurred in 23% of these patients. Intrapulmonary radiologic features were confined to mosaic attenuation and bronchial/systemic collaterals. PMID:12860221
Perloff, Joseph K; Hart, Eric M; Greaves, S Melanie; Miner, Pamela D; Child, John S
Pulmonary epidermoid carcinoma in a patient with acromegaly: a rare entity
A 56-years-old woman was referred to our unit for partially treated acromegaly. She had a high level of insulin growth factor. She did not complain of any pulmonary symptoms and was a non-smoker. Physical examination revealed clinical features of acromegaly. She had a 13 mm pituitary adenoma and was proposed for surgical intervention. Her chest X-ray showed a right paracardiac tumor. Computed tomography scan revealed a large right-sided fowler tumor. Pituitary surgery was cancelled and lobectomy after biopsy with lymph nodes excision was performed through thoracotomy. Histological study of the tumor revealed a medium differentiated epidermoid carcinoma with positive lymph nodes and extension to pleura. She was referred to chemotherapy protocol. Association between carcinoma and acromegaly has previously been reported. Most common tumors are colorectal and thyroid neoplasia. As we see in this case report, we need to consider other carcinomas in acromegalic patients like pulmonary carcinoma, despite their rarity in women.
El Aziz, Siham; Chadli, Asma; Obbiba, Atika; El Ghomari, Hassan; Farouqi, Ahmed
Pulmonary epidermoid carcinoma in a patient with acromegaly: a rare entity.
A 56-years-old woman was referred to our unit for partially treated acromegaly. She had a high level of insulin growth factor. She did not complain of any pulmonary symptoms and was a non-smoker. Physical examination revealed clinical features of acromegaly. She had a 13 mm pituitary adenoma and was proposed for surgical intervention. Her chest X-ray showed a right paracardiac tumor. Computed tomography scan revealed a large right-sided fowler tumor. Pituitary surgery was cancelled and lobectomy after biopsy with lymph nodes excision was performed through thoracotomy. Histological study of the tumor revealed a medium differentiated epidermoid carcinoma with positive lymph nodes and extension to pleura. She was referred to chemotherapy protocol. Association between carcinoma and acromegaly has previously been reported. Most common tumors are colorectal and thyroid neoplasia. As we see in this case report, we need to consider other carcinomas in acromegalic patients like pulmonary carcinoma, despite their rarity in women. PMID:22891085
El Aziz, Siham; Chadli, Asma; Obbiba, Atika; El Ghomari, Hassan; Farouqi, Ahmed
Sensitive, Noninvasive Detection of Lymph Node Metastases
Background Many primary malignancies spread via lymphatic dissemination, and accurate staging therefore still relies on surgical exploration. The purpose of this study was to explore the possibility of semiautomated noninvasive nodal cancer staging using a nanoparticle-enhanced lymphotropic magnetic resonance imaging (LMRI) technique. Methods and Findings We measured magnetic tissue parameters of cancer metastases and normal unmatched lymph nodes by noninvasive LMRI using a learning dataset consisting of 97 histologically proven nodes. We then prospectively tested the accuracy of these parameters against 216 histologically validated lymph nodes from 34 patients with primary cancers, in semiautomated fashion. We found unique magnetic tissue parameters that accurately distinguished metastatic from normal nodes with an overall sensitivity of 98% and specificity of 92%. The parameters could be applied to datasets in a semiautomated fashion and be used for three-dimensional reconstruction of complete nodal anatomy for different primary cancers. Conclusion These results suggest for the first time the feasibility of semiautomated nodal cancer staging by noninvasive imaging.
Social temperament and lymph node innervation
Socially inhibited individuals show increased vulnerability to viral infections, and this has been linked to increased activity of the sympathetic nervous system (SNS). To determine whether structural alterations in SNS innervation of lymphoid tissue might contribute to these effects, we assayed the density of catecholaminergic nerve fibers in 13 lymph nodes from 7 healthy adult rhesus macaques that showed stable individual differences in propensity to socially affiliate (Sociability). Tissues from Low Sociable animals showed a 2.8-fold greater density of catecholaminergic innervation relative to tissues from High Sociable animals, and this was associated with a 2.3-fold greater expression of nerve growth factor (NGF) mRNA, suggesting a molecular mechanism for observed differences. Low Sociable animals also showed alterations in lymph node expression of the immunoregulatory cytokine genes IFNG and IL4, and lower secondary IgG responses to tetanus vaccination. These findings are consistent with the hypothesis that structural differences in lymphoid tissue innervation might potentially contribute to relationships between social temperament and immunobiology.
Sloan, Erica K.; Capitanio, John P.; Tarara, Ross P.; Cole, Steve W.
Primary lymph node plasmacytomas (plasmacytic lymphomas).
To determine whether primary lymph node plasmacytoma (PLNP) is a distinct entity among other types of plasma cell neoplasia, we analyzed a large series of PLNPs from 2 large lymphoma registries to compare histologic, immunophenotypic, and clinical features of PLNPs, nonnodal extramedullary plasmacytomas, and multiple myeloma. Twenty-five PLNPs (clinical data on 15 cases) were compared with 10 non-lymph node plasmacytomas and 51 cases of multiple myeloma; 36 cases of reactive plasmacytoses were used as controls. The histologic features of PLNP and other extramedullary plasmacytomas were similar. The histologic features of PLNPs were more immature than those of reactive plasmacytoses and less immature than in multiple myeloma. The immunophenotype of PLNPs significantly differed from that of reactive plasmacytoses, other extramedullary plasmacytomas, and multiple myeloma. PLNPs did not progress to multiple myeloma, unlike other extramedullary plasmacytomas, even though survival in PLNPs and other extramedullary plasmacytomas was similar. Our findings suggest that PLNPs may be distinct from other plasma cell dyscrasias. PMID:11190797
Menke, D M; Horny, H P; Griesser, H; Tiemann, M; Katzmann, J A; Kaiserling, E; Parwaresch, R; Kyle, R A
Chronic pulmonary artery dissection associated with pulmonary arterial hypertension
Abstract Pulmonary artery dissection is a complication associated with pulmonary arterial hypertension. This complication is described as acute in onset and is frequently fatal without intervention. We describe a patient with idiopathic pulmonary arterial hypertension and chest pain found to have an unsuspected chronic pulmonary artery dissection on postmortem examination. Chronic pulmonary artery dissection should be considered in patients with chest pain and worsening dyspnea, as the frequency this condition may be underestimated.
Retrograde pulmonary embolectomy by flushing of the pulmonary veins.
A glue embolization of a cerebral arteriovenous malformation in a 3-year-old boy was complicated by a massive pulmonary embolus due to glue entering the venous circulation. Attempted pulmonary embolectomy via pulmonary arteriotomy after emergency cardiopulmonary bypass was unsuccessful. However, retrograde flushing of the pulmonary veins with cold saline solution produced large quantities of embolus through the pulmonary arteriotomy. Bypass was discontinued uneventfully with no residual cardiopulmonary problems. PMID:8526638
John, L C; Awad, W I; Anderson, D R
Sleep apnea and pulmonary hypertension
Summary The pulmonary artery pressure values of 65 patients with sleep apnea syndrome were measured at rest and during ergometer exercise up to 100 W. Pulmonary hypertension at rest was found in 13, and during exercise in 31 more patients. Only 8 patients with pathological pressure findings suffered from pulmonary hypertension in combination with a pulmonary or cardiac disease. In
T. Podszus; W. Bauer; J. Mayer; T. Penzel; J. H. Peter; P. von Wichert
Pulmonary effects of acute vanadium pentoxide inhalation in monkeys.
An experimental study was conducted to investigate the hypothesis that changes in pulmonary function induced by vanadium pentoxide (V2O5) inhalation would be accompanied by evidence of pulmonary inflammation. Sixteen adult, male cynomolgus monkeys were acutely exposed by whole-body inhalation of V2O5 dust at aerosol concentrations of 0.5 mg V2O5/m3 and 5.0 mg V2O5/m3, conducted at a 1-wk interval. Comprehensive pulmonary function tests were performed 1 day after each inhalation exposure to detect functional changes in the airways and pulmonary parenchyma. Pulmonary inflammation was assessed by cytologic analysis of respiratory cells recovered from the lower respiratory tract by bronchoalveolar lavage (BAL). Postexposure values for pulmonary function and BAL were compared with the baseline values determined for each monkey prior to V2O5 exposure. Acute V2O5 dust inhalation produced significant air-flow limitation in both central and peripheral airways without producing any detectable changes in parenchymal function. These functional changes were accompanied by a significant increase in the total cell counts recovered from the lungs by BAL. The increase in total cell count occurred through a dramatic increase in absolute number and relative percentage of polymorphonuclear leukocytes (PMN). These findings suggest that pulmonary inflammatory changes involving PMN may play an important role in the occurrence of air-flow limitation after acute inhalation of V2O5 dust. PMID:3907443
Knecht, E A; Moorman, W J; Clark, J C; Lynch, D W; Lewis, T R
Increased pulmonary arterial pressure in children with nephrotic syndrome
Aims: To evaluate the pulmonary arterial pressure in children with nephrotic syndrome (NS). Methods: Doppler echocardiography was performed in 40 children with NS (aged 1.5–13 years) at NS onset (n = 28) or relapse (n = 12), and 40 normal controls. Pulmonary pressure was estimated by: (1) measuring the systolic transtricuspid gradient from tricuspid regurgitation; and (2) measuring the time to peak velocity of pulmonary flow. Results: Thirty five of the 40 patients with NS had measurable tricuspid regurgitation with a pulmonary systolic pressure ranging from 21 to 48 mm Hg. Pulmonary systolic pressure was >40 mm Hg in seven patients. The pulmonary time to peak velocity was shortened and the ratio of time to peak velocity and right ventricular ejection time decreased compared with controls. The patients with increased pulmonary pressure had a longer time since onset of NS. One patient developed thrombus in the inferior vena cava during hospitalisation. Conclusion: Pulmonary arterial pressure was increased in children with NS. Further work is needed to evaluate the aetiology and clinical implications of this abnormality.
Du, Z; Cao, L; Liang, L; Chen, D; Li, Z
Pulmonary hypertension associated with sarcoidosis
Pulmonary involvement is common in sarcoidosis, an immune-mediated inflammatory disorder that is characterized by non-caseating granulomas in tissue. Sarcoid patients with advanced pulmonary disease, especially end-stage pulmonary fibrosis, risk developing pulmonary hypertension (World Health Organization group III pulmonary hypertension secondary to hypoxic lung disease). Increased levels of endothelin (ET)-1 in plasma and bronchoalveolar lavage of some sarcoid patients suggest that
Robert P Baughman
Phenotypic diversity of antigen-presenting cells in ovine-afferent intestinal lymph.
The phenotypic and functional repertoire of antigen-presenting cells (APCs) remains incompletely characterized, particularly during the migratory phase of their life history, when these cells leave peripheral tissues and travel via afferent lymphatic vessels to regional lymph nodes. Lymphatic cannulation procedures were used to collect ovine APCs as they migrated from the mucosa of the small intestine to regional lymph nodes. A panel of 19 new monoclonal antibodies (mAbs) was produced to characterize surface molecules expressed on APCs by means of two-color flow cytometry and microscopy. Two broad patterns of mAb reactivity were evident. Twelve mAbs reacted almost exclusively with cells in the APC-gated region, because all these mAbs stained < 3% of cells in the lymphocyte-gated region. Within this group, some mAbs identified distinct subsets of dendritic cells (DCs). The second group of seven mAbs displayed high-intensity staining on cells in the APC-gated region but also reacted with variable numbers (4-26%) of cells in the lymphocyte-gated region. This indicates that molecules recognized by these mAbs are highly expressed on APCs but also occur on other lineages. When new mAbs were analyzed by two-color flow cytometry of cells in afferent intestinal lymph, a wide range of differences in reactivity were observed, especially on CD11b(+), CD11c(+), CD4(+), MHCII(+), and gammasigmaTCR(+) cells. Although molecular specificities of mAbs reported here remain undefined, marked heterogeneity of staining patterns indicates considerable phenotypic, and probably functional, diversity within APC population in afferent intestinal lymph. MAbs reported here will provide useful tools to explore these features further. PMID:12234531
Pernthaner, Anton; Cole, Sally-Anne; Gatehouse, Tressa; Hein, Wayne R
From atretic to perforated: a closer view of pulmonary atresia.
A 7-day-old male infant with membranous pulmonary atresia and intact ventricular septum (PA/IVS) underwent hybrid pulmonary valvotomy. Access was via median sternotomy guided by intra-operative epicardial ultrasonography. After puncturing the atretic pulmonary valve, a 6 mm Wanda balloon catheter was inflated to dilate the atretic valve. Adequate valve movement with antegrade flow was confirmed using real time epicardial echocardiography. Intra-operative epicardial ultrasonography is an effective tool for guiding PA/IVS during hybrid procedures. Epicardial echo imaging provides clear images with excellent quality, helps guide the hybrid operation, and prevents the need for the ionizing radiation of fluoroscopy. PMID:24117949
Shen, Ching-Hui; Wang, Chung-Chi; Fang, Hsien-Te; Lin, Ming-Chih
Congenital Heart Disease Associated with Pulmonary Arterial Hypertension
Pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) is common among the subtypes of PAH.\\u000a It is quite variable in terms of clinical manifestations, severity of associated PAH, response to therapy, and outcomes, depending\\u000a on the anatomy of the specific lesion, pulmonary circulatory flows and pressures, and other factors. Genetic predisposition\\u000a likely plays a role, but no specific
Michael J. Landzberg
The Histochemistry of Prefascial Lymph Vessels in Recurrent Erysipelas
For histochemical examination, excisions were taken from the prefascial lymph vessels of the dorsum of the foot in the case of 54 patients with recurrent erysipelas immediately before lymphangiography. The results obtained were compared with the data of a simultaneous histological study. In the course of the studies, the lymph vessel adenosine triphosphatase, leucine aminopeptidase, succinic dehydrogenase, nicotinic acid adenine
I. Schneider; G. Thury
Efficacy of sentinel lymph node biopsy in male breast cancer
Background: Sentinel lymph node biopsy (SLNB) is rapidly becoming the standard of care in the treatment of women with early stage breast cancer. Male breast cancer although relatively rare, has typically been treated with mastectomy and axillary lymph node dissection (ALND). Men who develop breast carcinoma have the same risk as their female counterparts of developing the morbidities associated with
Vincent M. Cimmino; Amy C. Degnim; Michael S. Sabel; Kathleen M. Diehl; Lisa A. Newman; Alfred E. Chang
Dendritic-cell trafficking to lymph nodes through lymphatic vessels
Antigen-presenting dendritic cells often acquire foreign antigens in peripheral tissues such as the skin. Optimal encounter with naive T cells for the presentation of these antigens requires that the dendritic cells migrate to draining lymph nodes through lymphatic vessels. In this article, we review important aspects of what is known about dendritic-cell trafficking into and through lymphatic vessels to lymph
Veronique Angeli; Melody A. Swartz; Gwendalyn J. Randolph
Novel method and applications for labeling and identifying lymph nodes
NASA Astrophysics Data System (ADS)
The lymphatic system comprises a series of interconnected lymph nodes that are commonly distributed along branching or linearly oriented anatomic structures. Physicians must evaluate lymph nodes when staging cancer and planning optimal paths for nodal biopsy. This process requires accurately determining the lymph node's position with respect to major anatomical landmarks. In an effort to standardize lung cancer staging, The American Joint Committee on Cancer (AJCC) has classified lymph nodes within the chest into 4 groups and 14 sub groups. We present a method for automatically labeling lymph nodes according to this classification scheme, in order to improve the speed and accuracy of staging and biopsy planning. Lymph nodes within the chest are clustered around the major blood vessels and the airways. Our fully automatic labeling method determines the nodal group and sub-group in chest CT data by use of computed airway and aorta centerlines to produce features relative to a given node location. A classifier then determines the label based upon these features. We evaluate the efficacy of the method on 10 chest CT datasets containing 86 labeled lymph nodes. The results are promising with 100% of the nodes assigned to the correct group and 76% to the correct sub-group. We anticipate that additional features and training data will further improve the results. In addition to labeling, other applications include automated lymph node localization and visualization. Although we focus on chest CT data, the method can be generalized to other regions of the body as well as to different imaging modalities.
Kiraly, Atilla P.; Naidich, David P.; Guendel, Lutz; Zhang, Li; Novak, Carol L.
Staging Laparotomy for Endometrial Carcinoma: Assessment of Retroperitoneal Lymph Nodes
The surgical staging scheme for uterine corpus cancer adopted in 1988 by the International Federation of Gynecology and Obstetrics assigns patients with tumor spread to retroperitoneal lymph nodes to stage IIIC. However, a recommended approach to the detection of lymph node metastasis is not delineated. As part of an ongoing project to assess the value of surgical staging procedures, we
Linus Chuang; Thomas W. Burke; Carmen Tornos; Barbara D. Marino; Michele F. Mitchell; Guillermo Tortolero-Luna; Charles Levenback; Mitchell Morris; David M. Gershenson
Intra-lymph Node Injection of Biodegradable Polymer Particles
Generation of adaptive immune response relies on efficient drainage or trafficking of antigen to lymph nodes for processing and presentation of these foreign molecules to T and B lymphocytes. Lymph nodes have thus become critical targets for new vaccines and immunotherapies. A recent strategy for targeting these tissues is direct lymph node injection of soluble vaccine components, and clinical trials involving this technique have been promising. Several biomaterial strategies have also been investigated to improve lymph node targeting, for example, tuning particle size for optimal drainage of biomaterial vaccine particles. In this paper we present a new method that combines direct lymph node injection with biodegradable polymer particles that can be laden with antigen, adjuvant, or other vaccine components. In this method polymeric microparticles or nanoparticles are synthesized by a modified double emulsion protocol incorporating lipid stabilizers. Particle properties (e.g. size, cargo loading) are confirmed by laser diffraction and fluorescent microscopy, respectively. Mouse lymph nodes are then identified by peripheral injection of a nontoxic tracer dye that allows visualization of the target injection site and subsequent deposition of polymer particles in lymph nodes. This technique allows direct control over the doses and combinations of biomaterials and vaccine components delivered to lymph nodes and could be harnessed in the development of new biomaterial-based vaccines.
Solano, Eduardo; Mukhamedova, Maryam; Jewell, Christopher M.
Benign Nevus Cells in the Capsule of Lymph Nodes.
National Technical Information Service (NTIS)
Six cases are reported in which the capsule of a lymph node contained clusters of benign-appearing nevus cells. The marginal sinus and the parenchyma of the lymph node did not contain similar cells. Four of the six cases had known malignant tumors, but no...
W. T. Johnson E. B. Helwig
Regulation of lymph node vascular growth by dendritic cells
Lymph nodes grow rapidly and robustly at the initiation of an immune response, and this growth is accompanied by growth of the blood vessels. Although the vessels are critical for supplying nutrients and for controlling cell trafficking, the regulation of lymph node vascular growth is not well understood. We show that lymph node endothelial cells begin to proliferate within 2 d of immunization and undergo a corresponding expansion in cell numbers. Endothelial cell proliferation is dependent on CD11c+ dendritic cells (DCs), and the subcutaneous injection of DCs is sufficient to trigger endothelial cell proliferation and growth. Lymph node endothelial cell proliferation is dependent on vascular endothelial growth factor (VEGF), and DCs are associated with increased lymph node VEGF levels. DC-induced endothelial cell proliferation and increased VEGF levels are mediated by DC-induced recruitment of blood-borne cells. Vascular growth in the draining lymph node includes the growth of high endothelial venule endothelial cells and is functionally associated with increased cell entry into the lymph node. Collectively, our results suggest a scenario whereby endothelial cell expansion in the draining lymph node is induced by DCs as part of a program that optimizes the microenvironment for the ensuing immune response.
Webster, Brian; Ekland, Eric H.; Agle, Lucila M.; Chyou, Susan; Ruggieri, Regina; Lu, Theresa T.
Intra-lymph node injection of biodegradable polymer particles.
Generation of adaptive immune response relies on efficient drainage or trafficking of antigen to lymph nodes for processing and presentation of these foreign molecules to T and B lymphocytes. Lymph nodes have thus become critical targets for new vaccines and immunotherapies. A recent strategy for targeting these tissues is direct lymph node injection of soluble vaccine components, and clinical trials involving this technique have been promising. Several biomaterial strategies have also been investigated to improve lymph node targeting, for example, tuning particle size for optimal drainage of biomaterial vaccine particles. In this paper we present a new method that combines direct lymph node injection with biodegradable polymer particles that can be laden with antigen, adjuvant, or other vaccine components. In this method polymeric microparticles or nanoparticles are synthesized by a modified double emulsion protocol incorporating lipid stabilizers. Particle properties (e.g. size, cargo loading) are confirmed by laser diffraction and fluorescent microscopy, respectively. Mouse lymph nodes are then identified by peripheral injection of a nontoxic tracer dye that allows visualization of the target injection site and subsequent deposition of polymer particles in lymph nodes. This technique allows direct control over the doses and combinations of biomaterials and vaccine components delivered to lymph nodes and could be harnessed in the development of new biomaterial-based vaccines. PMID:24430972
Andorko, James I; Tostanoski, Lisa H; Solano, Eduardo; Mukhamedova, Maryam; Jewell, Christopher M
Clinical application of carbon nanoparticle lymph node tracer in the VI region lymph node dissection of differentiated thyroid cancer.
The application and clinical significance of carbon nanoparticle lymph tracer in the VI region (central region) lymph node dissection of differentiated thyroid cancer was investigated. Eighty patients with differentiated thyroid cancer were equally divided into the carbon nanoparticle-marked group (ipsilateral thyroid injection) and the control group (no injection). All patients underwent standard primary tumor treatment and VI lymph node dissection. The number of lymph nodes retrieved in the carbon nanoparticle group (mean = 6.725 pieces, range = 1-13) was significantly higher than those retrieved in the control group (mean = 3.6, range = 1-7; P < 0.05). The black staining lymph node rate was 69.89%. A significantly higher number of lymph nodes less than 2 mm were detected in the carbon nanoparticle group (P = 0.0023). The transfer rates and lymph node metastasis rates did not differ significantly between the two groups. The black-staining lymph node metastasis rate was 20.74% (39/188) and the non-staining lymph node metastasis rate was 22.22% (18/81), which were not significantly different (P = 0.7856). No parathyroid accidental resection was observed in the carbon nanoparticle group, whereas three cases occurred in the control group (P = 0.2405). In conclusion, carbon nanoparticles show good lymphatic tracer effects, easy identification, increased number of lymph nodes retrieved, more accurate reflection of the VI region lymph node status, and increased accuracy of the clinical stage. These results should help develop reasonable surgery programs and follow-up comprehensive treatments, and can help to reduce the risk of accident parathyroid resection. PMID:24841788
Sun, S P; Zhang, Y; Cui, Z Q; Chen, Q; Zhang, W; Zhou, C X; Xie, P P; Liu, B G
Case Report of Pulmonary Sarcoidosis Suspected to be Pulmonary Metastasis in a Patient with Breast Cancer.
Standard endocrine therapy and chemotherapy can induce long-term remission in breast cancer patients; however, breast cancer can recur at any site. Pulmonary nodules with lymphadenopathy in advanced cancer patients are likely to be assumed as metastases. A 44-year-old woman with a history of breast cancer was presented to our institution with abnormal findings on 18-fluorodeoxyglucose positron emission tomography imaging, which suggested lung metastasis. She had previously been diagnosed with breast cancer (T1N2M0, Stage IIIa, intraductal carcinoma, triple negative cancer). Histological analysis of the mediastinal lymph node biopsy demonstrated sarcoidosis, showing a chronic, non-caseating, granulomatous inflammation. Our case highlights the need for non-malignant diagnoses in those with prior malignancies, and the need for histological evaluations in the event of first recurrence following potentially curative therapy. PMID:25038768
Kim, Hye Sook; Lee, Suk-Young; Oh, Sang Cheul; Choi, Chul Won; Kim, Jun Suk; Seo, Jae Hong
CT and PET-CT of a Dog with Multiple Pulmonary Adenocarcinoma
ABSTRACT A 10-year-old, intact female Yorkshire terrier had multiple pulmonary nodules on thoracic radiography and ultrasonography with no lesions elsewhere. Computed tomography (CT) and positron emission tomography and computed tomography (PET-CT) using 18F-fluorodeoxyglucose (FDG) were performed to identify metastasis and undetected primary tumors. On CT examination, pulmonary nodules had a hypoattenuating center with thin peripheral enhancement, suggesting ischemic or necrotizing lesion. In PET-CT at 47 min after intravenous injection of 11.1 MBq/kg of FDG, the maximum standardized uptake value of each pulmonary nodule was about from 3.8 to 6.4. There were no abnormal lesions except for four pulmonary nodules on the CT and PET-CT. Primary lung tumor was tentatively diagnosed, and palliative therapy using 2 mg/kg tramadol and 2.2 mg/kg carprofen twice per day was applied. After the dog's euthanasia due to deteriorated clinical signs and poor prognosis, undifferentiated pulmonary adenocarcinoma was diagnosed through histopathologic and immunochemistry examination. To the best of the authors' knowledge, this is the first study of CT and PET-CT features of canine pulmonary adenocarcinoma. In this case, multiple pulmonary adenocarcinoma could be determined on the basis of FDG PET-CT through screening the obvious distant metastasis and/or lymph node invasions and excluding unknown primary tumors.
KIM, Jisun; KWON, Seong Young; CENA, Rohani; PARK, Seungjo; OH, Juyeon; OUI, Heejin; CHO, Kyoung-Oh; MIN, Jung-Joon; CHOI, Jihye
CT and PET-CT of a Dog with Multiple Pulmonary Adenocarcinoma.
A 10-year-old, intact female Yorkshire terrier had multiple pulmonary nodules on thoracic radiography and ultrasonography with no lesions elsewhere. Computed tomography (CT) and positron emission tomography and computed tomography (PET-CT) using 18F-fluorodeoxyglucose (FDG) were performed to identify metastasis and undetected primary tumors. On CT examination, pulmonary nodules had a hypoattenuating center with thin peripheral enhancement, suggesting ischemic or necrotizing lesion. In PET-CT at 47 min after intravenous injection of 11.1 MBq/kg of FDG, the maximum standardized uptake value of each pulmonary nodule was about from 3.8 to 6.4. There were no abnormal lesions except for four pulmonary nodules on the CT and PET-CT. Primary lung tumor was tentatively diagnosed, and palliative therapy using 2 mg/kg tramadol and 2.2 mg/kg carprofen twice per day was applied. After the dog's euthanasia due to deteriorated clinical signs and poor prognosis, undifferentiated pulmonary adenocarcinoma was diagnosed through histopathologic and immunochemistry examination. To the best of the authors' knowledge, this is the first study of CT and PET-CT features of canine pulmonary adenocarcinoma. In this case, multiple pulmonary adenocarcinoma could be determined on the basis of FDG PET-CT through screening the obvious distant metastasis and/or lymph node invasions and excluding unknown primary tumors. PMID:24389742
Kim, Jisun; Kwon, Seong Young; Cena, Rohani; Park, Seungjo; Oh, Juyeon; Oui, Heejin; Cho, Kyoung-Oh; Min, Jung-Joon; Choi, Jihye
Gas exchange and pulmonary hypertension following acute pulmonary thromboembolism: has the emperor got some new clothes yet?
Abstract Patients present with a wide range of hypoxemia after acute pulmonary thromboembolism (APTE). Recent studies using fluorescent microspheres demonstrated that the scattering of regional blood flows after APTE, created by the embolic obstruction unique in each patient, significantly worsened regional ventilation/perfusion (V/Q) heterogeneity and explained the variability in gas exchange. Furthermore, earlier investigators suggested the roles of released vasoactive mediators in affecting pulmonary hypertension after APTE, but their quantification remained challenging. The latest study reported that mechanical obstruction by clots accounted for most of the increase in pulmonary vascular resistance, but that endothelin-mediated vasoconstriction also persisted at significant level during the early phase.
[Clinical significance of lymph node micrometastases in cervical cancer].
In most cancers of epithelial origin, metastases to the lymph nodes constitute the most important prognostic factor and are predictive of the results of the surgical and adjuvant therapies. Data on the lymph node status allows to design an appropriate treatment plan. Despite advances in gynecologic oncology the importance of lymph node micrometastases in cervical cancer especially in nonsentinel lymph nodes which are detected by ultrastaging, has not been fully elucidated. The purpose of the article is to familiarize the reader with the state of current knowledge on cervical cancer micrometastases. The authors attempt to answer the question about the benefits of lymph node assessment in the search for micrometastases in cervical cancer as well as to address emerging doubts. PMID:24191518
Sniadecki, Marcin; Sawicki, Sambor; Wojtylak, Szymon; Liro, Marcin; Wydra, Dariusz
The lymph as a pool of self antigens
Prenodal lymph is generated from the interstitial fluid that surrounds organs, and thus contains products of organ metabolism and catabolism. New proteomic analyses have identified in lymph proteins and peptides that are derived from capillary extravasation and tissue-specific proteins. Many of these peptides are detected at nanomolar concentrations in the lymph prior to passage through a regional lymph node. Before entering the node and once inside proteins and processed peptides are filtered from the lymph by circulating immature DC or non-activated nodal APC (macrophages, B cells and immature DC). Here, we suggest that this process ensures organ-specific self-antigens are displayed to circulating and nodal antigen-presenting cells, thus contributing to the maintenance of peripheral tolerance.
Clement, Cristina C.; Rotzschke, Olaf; Santambrogio, Laura
Pregnancy and pulmonary hypertension.
Pulmonary hypertension during pregnancy is associated with considerable risks of maternal mortality and morbidity. Our systematic review of the literature on the use of targeted treatments for pulmonary arterial hypertension during pregnancy indicates a considerable decrease of mortality since a previous review in 1998 (16% v 38%), and a further non-significant decrease in mortality since the latest review in 2009 (16% v 25%). In addition to the use of targeted treatments, the timely institution of these treatments, and early planned delivery, may contribute to better outcome. Furthermore, research suggests that women with mild pulmonary hypertension or favourable functional class may have a better prognosis, but there is yet no proof of decreased mortality among these women. Despite an improved prognosis, pregnancy is contra-indicated in women with pulmonary hypertension and, when pregnancy occurs, termination should be considered. When pregnancy continues, management by a multidisciplinary team in a specialist centre is indicated. PMID:24685319
Pieper, Petronella G; Lameijer, Heleen; Hoendermis, Elke S
Percutaneous Pulmonary Valve Implantation
Pulmonary regurgitation (PR) is a frequent sequelae after repair of tetralogy of Fallot, pulmonary atresia, truncus arteriosus, Rastelli and Ross operation. Due to patient growth and conduit degeneration, these conduits have to be changed frequently due to regurgitation or stenosis. However, morbidity is significant in these repeated operations. To prolong conduit longevity, bare-metal stenting in the right ventricular outflow tract (RVOT) obstruction has been performed. Stenting the RVOT can reduce the right ventricular pressure and symptomatic improvement, but it causes PR with detrimental effects on the right ventricle function and risks of arrhythmia. Percutaneous pulmonary valve implantation has been shown to be a safe and effective treatment for patients with pulmonary valve insufficiency, or stenotic RVOTs.
Lee, Hyoung-Doo
... the technician know. Pulmonary function tests (PFT's) are breathing tests to find out how well you move air in and out of your lungs and how well oxygen enters your body. The most common PFT's are ...
Human Pulmonary Dirofilariasis.
National Technical Information Service (NTIS)
Eight cases of human pulmonary dirofilariasis are reported, bringing the total number of reported cases to 27. The lesions and the anatomic features of the worms are described and illustrated. (Author)
R. C. Neafie J. Piggott
Surgery and Sentinel Lymph Node Biopsy
In patients with melanoma, surgery is pivotal not only for the primary tumor but also for regional and often distant metastases. The minimally invasive technique of sentinel node biopsy has become standard for detection of occult regional node metastasis in patients with intermediate-thickness primary melanoma; in these patients it has a central role in determining prognosis and a significant impact on survival when biopsy results are positive. Its role in thin melanoma remains under evaluation. The regional tumor-draining sentinel node is also a useful model for studies of melanoma-induced immunosuppression. Although completion lymphadenectomy remains the standard of care for patients with sentinel node metastasis, results of ongoing phase III trials will indicate whether sentinel node biopsy without further lymph node surgery is adequate therapy for certain patients with minimal regional node disease.
Faries, Mark B.; Morton, Donald L.
T cell responses in lymph nodes.
Activation of T cells by antigen-presenting cells (APCs) in lymph nodes (LNs) is a key initiating event in many immune responses. Our understanding of this process has been both improved and complicated in recent years by evidence from techniques such as intravital microscopy that has revealed new levels of dynamism in the interaction of T cells and APCs. In particular, the complex motility of T cells within LNs, and their serial interactions with many APCs, imply that earlier static models of T cell activation need to be updated. Here we review the first attempts to model T cell interactions with APCs in LNs that incorporate simulations of T cell motility, based on experimental observations. We show that lattice-based modeling approaches are the dominant trend in these models, and then chart a possible course for development of these models toward spatially-resolved models of immune responses within LNs. PMID:20836014
Bogle, Gib; Dunbar, P Rod
Autoimmune Pulmonary Alveolar Proteinosis
\\u000a Pulmonary alveolar proteinosis (PAP) is a rare syndrome characterized by accumulation of surfactant lipids and proteins in\\u000a pulmonary alveoli that can result in progressive impairment in gas exchange and respiratory insufficiency. The serendipitous\\u000a discovery of PAP in GM-CSF-deficient mice and subsequent identification that neutralizing GM-CSF autoantibodies are strongly\\u000a associated with PAP in humans led to our current concepts of the
Bruce C. Trapnell; Koh Nakata; Yoshikazu Inoue
Pharmacotherapy of Pulmonary Hypertension
Pulmonary arterial hypertension is a serious disease with significant morbidity and mortality. While it can occur idiopathically, it is more commonly associated with other cardiac or lung diseases. While most of the available therapies were tested in adult populations, and most therapies in children remain off-label, new reports and randomized trials are emerging that inform the treatment of pediatric populations. This review discusses currently available therapies for pediatric pulmonary hypertension, their biologic rationales, and evidence for their clinical effectiveness.
Steinhorn, Robin H.
Arginase and pulmonary diseases
Recent studies have indicated that arginase, which converts l-arginine into l-ornithine and urea, may play an important role in the pathogenesis of various pulmonary disorders. In asthma, chronic obstructive\\u000a pulmonary disease (COPD) and cystic fibrosis, increased arginase activity in the airways may contribute to obstruction and\\u000a hyperresponsiveness of the airways by inducing a reduction in the production of bronchodilatory nitric
Harm Maarsingh; Tonio Pera; Herman Meurs
Evaluation of Lymph Node Status in Male Breast Cancer Patients: A Role for Sentinel Lymph Node Biopsy
Sentinel lymph node (SLN) biopsy is rapidly emerging as an alternative to axillary lymph node dissection (ALND) for many female breast cancer patients. In contrast, ALND remains the standard of care for male breast cancer patients with similar tumors. We evaluated the results of SLN biopsy in male breast cancer patients with clinically negative axillae. This study included all male
Daniel Albo; Frederick C. Ames; Kelly K. Hunt; Merrick I. Ross; S. Eva Singletary; Henry M. Kuerer
Active Macromolecule Uptake by Lymph Node Antigen-Presenting Cells: A Novel Mechanism in Determining Sentinel Lymph Node Status
Background: Although sentinel lymph node (SLN) biopsy is a powerful staging tool for patients with melanoma and breast cancer, controversy remains regarding specific aspects of technique. We examined particle uptake by antigen-presenting cells (APCs) to determine if this mechanism is responsible for the differential retention of radioactivity in SLNs relative to nonsentinel lymph nodes (NSLNs). Methods: Mapping was conducted in
Mark B. Faries; Isabelle Bedrosian; Carol Reynolds; Hung Q. Nguyen; Abass Alavi; Brian J. Czerniecki
Percutaneous balloon pulmonary valvuloplasty.
Percutaneous balloon pulmonary valvuloplasty (BPV) was performed in 18 consecutive patients with valvular pulmonary stenosis (PS) with no associated cardiac defects. The patients were 11 months to 19 years of age. The balloon was positioned across the pulmonary valve and inflated to pressures of 80, 100, and 120 pounds/square inch (psi). Each inflation lasted approximately 10 seconds. Peak systolic pulmonary valve gradient (delta P) and cardiac output were measured before and 15 minutes after BPV. There was no change in cardiac output, but all patients had an improved delta P. The prevalvuloplasty delta P was 81 +/- 31 mm Hg, decreasing to 23 +/- 11 mm Hg after BPV (p less than 0.01). The right ventricular peak systolic pressure decreased from 106 +/- 31 to 50 +/- 12 mm Hg (p less than 0.01). No pulmonary regurgitation was noted after BPV. The balloons were 12 or 15 mm in diameter, chosen according to the diameter of the pulmonary valve anulus. Pressures of 100 to 120 psi were required to achieve full inflation of the balloons. BPV also was performed in a patient with tetralogy of Fallot. Subsequent total repair provided an opportunity to observe the mechanism of the dilatation. Evidence of a small tear alongside the anterior valve raphe was noted. BPV induced a significant decrease in delta P and may offer an alternative method for treating PS. PMID:6225329
Lababidi, Z; Wu, J R
Inflammatory cytokines in pulmonary hypertension
Pulmonary hypertension is an "umbrella term" used for a spectrum of entities resulting in an elevation of the pulmonary arterial pressure. Clinical symptoms include dyspnea and fatigue which in the absence of adequate therapeutic intervention may lead to progressive right heart failure and death. The pathogenesis of pulmonary hypertension is characterized by three major processes including vasoconstriction, vascular remodeling and microthrombotic events. In addition accumulating evidence point to a cytokine driven inflammatory process as a major contributor to the development of pulmonary hypertension. This review summarizes the latest clinical and experimental developments in inflammation associated with pulmonary hypertension with special focus on Interleukin-6, and its role in vascular remodeling in pulmonary hypertension.
Effects of Acetazolamide on Ventilatory, Cerebrovascular, and Pulmonary Vascular Responses to Hypoxia
Rationale: Acute mountain sickness (AMS) may affect individuals who (rapidly) ascend to altitudes higher than 2,000-3,000 m. A more serious consequence of rapid ascent may be high-altitude pulmonary edema, a hydrostatic edema associated with increased pulmonary capillary pressures. Acetazolamide is effective against AMS, possibly by increasing ventilation and cerebral blood flow (CBF). In animals, it inhibits hypoxic pulmonary vasoconstriction. Objectives:
Luc J. Teppema; George M. Balanos; Craig D. Steinback; Allison D. Brown; Glen E. Foster; Henry J. Duff; Richard Leigh; Marc J. Poulin
Intravital Imaging of the Mouse Popliteal Lymph Node
Lymph nodes (LNs) are secondary lymphoid organs, which are strategically located throughout the body to allow for trapping and presentation of foreign antigens from peripheral tissues to prime the adaptive immune response. Juxtaposed between innate and adaptive immune responses, the LN is an ideal site to study immune cell interactions1,2. Lymphocytes (T cells, B cells and NK cells), dendritic cells (DCs), and macrophages comprise the bulk of bone marrow-derived cellular elements of the LN. These cells are strategically positioned in the LN to allow efficient surveillance of self antigens and potential foreign antigens3-5. The process by which lymphocytes successfully encounter cognate antigens is a subject of intense investigation in recent years, and involves an integration of molecular contacts including antigen receptors, adhesion molecules, chemokines, and stromal structures such as the fibro-reticular network2,6-12. Prior to the development of high-resolution real-time fluorescent in vivo imaging, investigators relied on static imaging, which only offers answers regarding morphology, position, and architecture. While these questions are fundamental in our understanding of immune cell behavior, the limitations intrinsic with this technique does not permit analysis to decipher lymphocyte trafficking and environmental clues that affect dynamic cell behavior. Recently, the development of intravital two-photon laser scanning microscopy (2P-LSM) has allowed investigators to view the dynamic movements and interactions of individual cells within live LNs in situ12-16. In particular, we and others have applied this technique to image cellular behavior and interactions within the popliteal LN, where its compact, dense nature offers the advantage of multiplex data acquisition over a large tissue area with diverse tissue sub-structures11,17-18. It is important to note that this technique offers added benefits over explanted tissue imaging techniques, which require disruption of blood, lymph flow, and ultimately the cellular dynamics of the system. Additionally, explanted tissues have a very limited window of time in which the tissue remains viable for imaging after explant. With proper hydration and monitoring of the animal's environmental conditions, the imaging time can be significantly extended with this intravital technique. Here, we present a detailed method of preparing mouse popliteal LN for the purpose of performing intravital imaging.
Liou, H. L. Rachel; Myers, Jay T.; Barkauskas, Deborah S.; Huang, Alex Y.
CD169 mediates the capture of exosomes in spleen and lymph node
Exosomes are lipid nanovesicles released following fusion of the endosoma limiting membrane with the plasma membrane; however, their fate in lymphoid organs after their release remains controversial. We determined that sialoadhesin (CD169; Siglec-1) is required for the capture of B cell-derived exosomes via their surface-expressed ?2,3-linked sialic acids. Exosome-capturing macrophages were present in the marginal zone of the spleen and in the subcapsular sinus of the lymph node. In vitro assays performed on spleen and lymph node sections confirmed that exosome binding to CD169 was not solely due to preferential fluid flow to these areas. Although the circulation half-life of exosomes in blood of wild-type and CD169?/? mice was similar, exosomes displayed altered distribution in CD169?/? mice, with exosomes freely accessing the outer marginal zone rim of SIGN-R1+ macrophages and F4/80+ red pulp macrophages. In the lymph node, exosomes were not retained in the subcapsular sinus of CD169?/? mice but penetrated deeper into the paracortex. Interestingly, CD169?/? mice demonstrated an enhanced response to antigen-pulsed exosomes. This is the first report of a role for CD169 in the capture of exosomes and its potential to mediate the immune response to exosomal antigen.
Dunn, Amy C.; Crocker, Paul R.
Pattern of lymph node pathology in Western saudi arabia.
Background: This study aimed to characterize the histopathological pattern of lymph node pathology among Saudi patients and to highlight the age and gender variations of these lesions as base line data. Materials and Methods: We retrospectively analyzed the data from lymph node biopsy specimens received at the Department of Pathology, King Fahad Hospital, Madinah, Saudi Arabia from January 2006 to December 2013. Results: Of the 289 lymph node biopsy specimens received, 154 (53.3%) were from males and 135 (46.7%) from females giving a male: female ratio of 1.14:1. Age of the patients ranged from 2.5 to 96 years with a mean age 33.9 years. The commonest lymph node group affected was the cervical (30.4%) followed by axillary (9.7%) and inguinal (8.7%). Malignant lymphoma [71 Hodgkin's disease (HD), 57 non Hodgkin's lymphoma (NHL)] 128 (44.3%), reactive hyperplasia 68 (23.5%), and tuberculosis 41 (14.2%) were the common causes of lymph node enlargement. While HD, reactive hyperplasia and tuberculosis were commonest in young adult patients (10-29 years old) and rare above the age of 50 years; NHL was the predominant cause of lymph node enlargement above 50 years. Conclusions: Lymph node biopsy plays an important role in establishing the cause of lymphadenopathy. Among the biopsied nodes, lymphomas were the most common (44.3%) followed by non-specific reactive hyperplasia (23.5%) and tuberculous lymphadenitis (14.2%). PMID:24969903
Albasri, Abdulkader Mohammed; El-Siddig, Abeer Abdalla; Hussainy, Akbar Shah; Alhujaily, Ahmed Safar
Prospective study of sentinel lymph node biopsy for conjunctival melanoma
Background To report our experience with sentinel lymph node biopsy for staging patients with conjunctival melanoma. Methods A prospective review of patients with conjunctival melanoma who underwent sentinel lymph node biopsy at St Bartholomew's Hospital from May 2008 to May 2012. The selection criterion for sentinel node biopsy depended on the tumour thickness (?2?mm) and location of the conjunctival melanoma. The main outcome measures were the incidence of sentinel lymph node positivity and the procedure-related complications. Results In 4?years, 26 out of 70 patients met the selection criteria for sentinel lymph node biopsy. 4 patients declined and 22 patients consented for the procedure. Technetium-99m failed to identify a sentinel lymph node in four of the 22 patients (18%). Of the remaining 18 patients, two were found to have subclinical micrometastasis in regional lymph nodes. Median follow-up was 20?months (range 6–36?months). No false-negative events were observed. Complications of the procedure included transient blue staining of the epibulbar surface in five patients and transient facial nerve palsy in one patient. Conclusions Sentinel lymph node biopsy is a safe procedure with minimal complications. It should be considered for the staging of conjunctival melanomas, especially melanomas in non-limbal location or conjunctival melanomas ?2?mm thick.
Cohen, Victoria M L; Tsimpida, Maria; Hungerford, John L; Jan, Hikmat; Cerio, Rino; Moir, Graeme
Pulmonary artery endothelium resident endothelial colony-forming cells in pulmonary arterial hypertension
Proliferative pulmonary vascular remodeling is the pathologic hallmark of pulmonary arterial hypertension (PAH) that ultimately leads to right heart failure and death. Highly proliferative endothelial cells known as endothelial colony-forming cells (ECFC) participate in vascular homeostasis in health as well as in pathological angiogenic remodeling in disease. ECFC are distinguished by the capacity to clonally proliferate from a single cell. The presence of ECFC in the human pulmonary arteries and their role in PAH pathogenesis is largely unknown. In this study, we established a simple technique for isolating and growing ECFC from cultured pulmonary artery endothelial cells (PAEC) to test the hypothesis that ECFC reside in human pulmonary arteries and that the proliferative vasculopathy of PAH is related to greater numbers and/or more proliferative ECFC in the pulmonary vascular wall. Flow cytometric forward and side scatter properties and aggregate correction were utilized to sort unmanipulated, single PAEC to enumerate ECFC in primary PAEC cultures derived from PAH and healthy lungs. After 2 weeks, wells were assessed for ECFC formation. ECFC derived from PAH PAEC were more proliferative than control. A greater proportion of PAH ECFC formed colonies following subculturing, demonstrating the presence of more ECFC with high proliferative potential among PAH PAEC. Human androgen receptor assay showed clonality of progeny, confirming that proliferative colonies were single cell-derived. ECFC expressed CD31, von Willebrand factor, endothelial nitric oxide synthase, caveolin-1 and CD34, consistent with an endothelial cell phenotype. We established a simple flow cytometry method that allows ECFC quantification using unmanipulated cells. We conclude that ECFC reside among PAEC and that PAH PAEC contain ECFC that are more proliferative than ECFC in control cultures, which likely contributes to the proliferative angiopathic process in PAH.
Duong, Heng T.; Comhair, Suzy A.; Aldred, Micheala A.; Mavrakis, Lori; Savasky, Benjamin M.; Erzurum, Serpil C.; Asosingh, Kewal
Pulmonary Hypertension in Hemolytic Disorders
The inherited hemoglobin disorders sickle cell disease and thalassemia are the most common monogenetic disorders worldwide. Pulmonary hypertension is one of the leading causes of morbidity and mortality in adult patients with sickle cell disease and thalassemia, and hemolytic disorders are potentially among the most common causes of pulmonary hypertension. The pathogenesis of pulmonary hypertension in hemolytic disorders is likely multifactorial, including hemolysis, impaired nitric oxide (NO) bioavailability, chronic hypoxemia, chronic thromboembolic disease, chronic liver disease, and asplenia. In contrast to patients with traditional forms of pulmonary arterial hypertension, patients with hemolytic disorders have a mild-to-moderate degree of elevation in mean pulmonary pressures, with mild elevations in pulmonary vascular resistance. The hemodynamic etiology of pulmonary hypertension in these patients is multifactorial and includes pulmonary arterial hypertension, pulmonary venous hypertension, and pulmonary hypertension secondary to a hyperdynamic state. Currently, there are limited data on the effects of any specific treatment modality for pulmonary hypertension in patients with hemolytic disorders. It is likely that maximization of treatment of the primary hemoglobinopathy in all patients and treatment with selective pulmonary vasodilators and antiproliferative agents in patients with pulmonary arterial hypertension would be beneficial. However, there is still a major need for large multinational trials of novel therapies for this patient population.
Gladwin, Mark T.
Radiofrequency Ablation of Pulmonary Neoplasm Complicated by Pulmonary Hemorrhage
Pulmonary hemorrhage is a potentially serious complication of radiofrequency ablation of pulmonary neoplasms that may occur with or without hemoptysis. Several factors influence the development of parenchymal hemorrhage, including tumor size, tumor location, and procedural technique. As radiofrequency ablation has become more common, the prompt diagnosis and appropriate treatment of hemorrhage is vital. The authors report a case of radiofrequency ablation of a solitary pulmonary metastasis complicated by pulmonary hemorrhage and hemoptysis.
Dillon, P.; Sato, Kent T.
Uncommon applications of sentinel lymph node mapping: urogenital cancers.
Beside the classical applications of sentinel lymph node mapping, some new procedures are emerging and showing feasibility and clinical utility. In this chapter, we will report on sentinel lymph node mapping in 1) malignancies of the female reproductive system (cervical cancer, endometrial cancer, vulvar cancer and ovarian cancer); 2) malignancies of the male reproductive system (prostate cancer, penile cancer and testicular cancer); 3) malignancies in kidney and bladder. This paper presents the uncommon applications of sentinel lymph node mapping in urogenital neoplasms. PMID:24835291
Giammarile, F; Vidal-Sicart, S; Valdés Olmos, R A
Idiopathic giant abdominal lymph cyst: a case report
Introduction Giant lymph cysts are a relatively frequent complication after surgical procedures in the abdomen, often after kidney transplantation, but there are also cases after pelvic surgery such as lymphadenectomy and others. In the recent literature, there have been no reported cases of idiopathic giant lymphocyst. Case presentation We present the case of a 76-year-old Caucasian man who had a lymph cyst he had known of for more than 15 years. Laparoscopic treatment was necessary because of hydronephrosis of the left kidney. Conclusion This case shows that laparoscopic drainage and partial resection of the lymph cyst is a safe and effective treatment.
Pulmonary Hypertension in Idiopathic Pulmonary Fibrosis: A Review
Idiopathic pulmonary fibrosis (IPF) is a progressive diffuse parenchymal disease with a poor prognosis. Pulmonary hypertension (PH) often complicates the course of IPF and may even be found in patients with preserved lung function. Possible pathogenetic mechanisms of PH in IPF include vascular destruction, pulmonary hypoxic vasoconstriction and vascular remodeling due to overexpression of cytokines and growth factors. PH in
Georgia Pitsiou; Despina Papakosta; Demosthenes Bouros
Pulmonary thromboembolism in children.
Pulmonary thromboembolism (PTE) is uncommonly diagnosed in the pediatric patient, and indeed often only discovered on autopsy. The incidence of pediatric PTE depends upon the associated underlying disease, diagnostic tests used, and index of suspicion. Multiple risk factors can be found including: peripartum asphyxia, dyspnea, haemoptysis, chest pain, dehydration, septicemia, central venous lines (CVLs), trauma, surgery, ongoing hemolysis, vascular lesions, malignancy, renal disease, foreign bodies or, uncommonly, intracranial venous sinus thrombosis, burns, or nonbacterial thrombotic endocarditis. Other types of embolism can occur uncommonly in childhood and need to be recognized, as the required treatment will vary. These include pulmonary cytolytic thrombi, foreign bodies, tumor and septic emboli, and post-traumatic fat emboli. No single noninvasive test for pulmonary embolism is both sensitive and specific. A combination of diagnostic procedures must be used to identify suspect or confirmed cases of PTE. This article reviews the risk factors, clinical presentation and treatment of pulmonary embolism in children. It also highlights the current diagnostic tools and protocols used to evaluate pulmonary embolism in pediatric patients. PMID:15635472
Babyn, Paul S; Gahunia, Harpal K; Massicotte, Patricia
Use of a PEG-conjugated bright near-infrared dye for functional imaging of rerouting of tumor lymphatic drainage after sentinel lymph node metastasis
Tumor lymphangiogenesis promotes metastatic cancer spread to lymph nodes and beyond. However, the potential remodeling and functionality of tumor-draining lymphatic vessels has remained unclear. Thus, we aimed to develop non-invasive imaging methods for repeated quantitative imaging of lymphatic drainage and of contractile collecting lymphatic vessel function in mice, with colloidal near-infrared (NIR) tracers and a custom fluorescence stereomicroscope specially adapted for NIR sensitive imaging. Using these tools, we quantitatively determined pulse rates and valvular function of collecting lymphatic vessels with high resolution. Unexpectedly, we found that tumor-draining lymphatic vessels in a melanoma footpad model initially were dilated but remained functional, despite lower pulse rates. In two independent tumor models, impaired lymphatic function was detected once metastases were present in draining lymph nodes. Importantly, we found that lymphatic dysfunction, induced by metastatic tumor spread to sentinel lymph nodes, can lead to a rerouting of lymphatic flow away from the metastatic lymph node, via collateral lymphatic vessels, to alternate lymph nodes. These findings might have important clinical implications for the procedure of sentinel lymph node mapping that represents the standard of care for determining prognosis and treatment of melanoma and breast cancer patients.
Proulx, Steven T.; Luciani, Paola; Christiansen, Ailsa; Karaman, Sinem; Blum, Katrin S.; Rinderknecht, Matthias; Leroux, Jean-Christophe; Detmar, Michael
Unusual cause of pulmonary emboli.
Pulmonary emboli resulted due to intravasation of iophendylate during myelography the previous day. Findings consistent with pulmonary emboli in nonambulatory patients after myelography should not always be diagnosed as thromboembolic disease from blood clots. PMID:6478908
Vitums, V C
Pulmonary effects of intravenous atropine induce ventilation perfusion mismatch.
Atropine is used for a number of medical conditions, predominantly for its cardiovascular effects. Cholinergic nerves that innervate pulmonary smooth muscle, glands, and vasculature may be affected by anticholinergic medications. We hypothesized that atropine causes alterations in pulmonary gas exchange. We conducted a prospective interventional study with detailed physiologic recordings in anesthetized, spontaneously breathing rats (n = 8). Animals breathing a normoxic gas mixture titrated to a partial arterial pressure of oxygen of 110-120 were exposed to an escalating dose of intravenous atropine (0.001, 0.01, 0.1, 5.0, and 20.0 mg/kg body mass). Arterial blood gas measurements were recorded every 2 min (×5) at baseline, and following each of the 5 doses of atropine. In addition, the animals regional pulmonary blood flow was measured using neutron-activated microspheres. Oxygenation decreased immediately following intravenous administration of atropine, despite a small increase in the volume of inspired air with no change in respiratory rate. Arterial blood gas analysis showed an increase in pulmonary dysfunction, characterized by a widening of the alveolar-arteriole gradient (p < 0.003 all groups except for the lowest dose of atropine). The microsphere data demonstrates an abrupt and marked heterogeneity of pulmonary blood flow following atropine treatment. In conclusion, atropine was found to decrease pulmonary gas exchange in a dose-dependent fashion in this rat model. PMID:24773405
Gaspari, Romolo J; Paydarfar, David
Sildenafil And Hypoxic Pulmonary Hypertension
We have previously demonstrated that sildenafil inhibits hypoxia-induced pulmonary vasoconstriction in healthy subjects. The\\u000a aim of this study was to investigate the effects of the PDE5 inhibitor sildenafil on pulmonary hemodynamics in patients with\\u000a high altitude pulmonary hypertension (HAPH). Twenty-two patients with HAPH were randomized by age and level of mean pulmonary\\u000a arterial pressure (PAP) in 3 groups: a first
BAKTYBEK K. KOJONAZAROV; Mirsaid Mirrakhimov; Nicholas Morrell; Martin Wilkins; Almaz Aldashev
Prenatal diagnosis of pulmonary atresia: impact on clinical presentation and early outcome
Aim: The impact of prenatal diagnosis on morbidity and mortality for certain types of congenital heart disease (obstructive left heart lesions and transposition of the great arteries) is well established. No data are available for lesions with duct dependent pulmonary flow. We aimed to assess the impact of prenatal diagnosis of pulmonary atresia on clinical presentation and neonatal outcome.Method: Fifty-eight
Aphrodite Tzifa; Claire Barker; Shane M Tibby; John M Simpson
Normalization of high pulmonary vascular resistance with LVAD support in heart transplantation candidates
Objective: Pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) lead to poor outcome after heart transplantation due to postoperative failure of the non-conditioned right ventricle. The role of continuous flow left ventricular assist device (LVAD) support in the reduction of elevated PVR was evaluated in a series of clinical implants. Methods: Among 17 patients with terminal heart failure receiving
Sacha P. Salzberg; Mario L. Lachat; Kai von Harbou; Gregor Zünd; Marko I. Turina
Partial removal of the pulmonary artery in video-assisted thoracic surgery for non-small cell lung cancer
Lobectomy with partial removal of the pulmonary artery in video-assisted thoracic surgery (VATS) currently remains a challenge for thoracic surgeons. We were interested in introducing pulmonary vessel blocking techniques in open thoracic surgery into video-assisted thoracic surgery (VATS) procedures. In this study, we reported a surgical technique simultaneously blocking the pulmonary artery and the pulmonary vein for partial removal of the pulmonary artery under VATS. Seven patients with non-small-cell lung cancer (NSCLC) received lobectomy with partial removal of the pulmonary artery using the technique between December 2007 and March 2012. Briefly, rather than using a small clamp on the distal pulmonary artery to the area of invading cancer, we replaced a vascular clamp with a ribbon and Hem-o-lock clip to block the preserved pulmonary veins so as to prevent back bleeding and yield a better view for surgeons. The mean occlusion time of the pulmonary artery and pulmonary veins were 44.0±10.0 and 41.3±9.7 minutes, respectively. The mean repair time of the pulmonary artery was 25.3±13.7 minutes. No complications occurred. No patients showed abnormal blood flow through the reconstructed vessel. There were no local recurrences on the pulmonary artery. In conclusion, the technique for blocking the pulmonary artery and veins is feasible and safe in VATS and reduces the risk of abrupt intraoperative bleeding and the chance of converting to open thoracotomy, and extends the indications of VATS lobectomy.
Xu, Keping; Zhang, Zhi; Zhao, Jianqiang; Huang, Jianfeng; Yin, Rong; Xu, Lin
Lymphocyte migration into syngeneic implanted lymph nodes
To judge the functional activity of lymphocytes of an implanted lymph node (LN), the proliferative response of lymphocytes of the implanted organ in the blast-transformation reaction in vitro and their ability to induce a local graft versus host reaction (GVHR) were determined. The lymphocyte suspension for labeling with /sup 51/Cr was obtained from peripheral LN in different situations from syngeneic mice. The resulting lymphocyte suspension was labeled with a solution of sodium chromate-/sup 51/Cr in a concentration of 20-40 microCi/100.10/sup 6/ cells in 1 ml for 40 min at 37/sup 0/C. The proliferative activity of a suspension of lymphocytes was estimated as incorporation of /sup 3/H-thymidine into DNA during incubation of the cell suspension for 3 days. Data on migration of /sup 51/Cr-labeled cells and the results of the morphological observations revealed marked ability of lymphocytes of the peripheral pool to colonize the regenerating stroma.
Gordeeva, M.S.
Intermediate lymph (efferent from the prefemoral lymph node) was collected for 600 hr from both flanks of each of four sheep that had an autograft of skin on the left flank and a homograft of skin on the right flank. 8 days after the grafts had been applied considerable numbers of large basophilic cells, apparently identical with those that appear during immune responses to conventional antigens, appeared in the lymph draining from the homografts. No such cells appeared in the lymph draining from the autografts. At this time the homografts were already showing signs of rejection and were apparently dead well before the cellular response in the lymph reached a peak, about 350 hr (14–15 days) after the homografts had been applied. During the peak of the response up to 40% of the cells in the lymph were basophilic cells and in one experiment such cells were leaving the lymph node at a rate of 200 million per hr. Peripheral lymph (afferent to the popliteal lymph node) draining from the sites of homografts of skin was collected from five sheep. This lymph contained few white cells (<1000 per mm3) and showed only an insignificant lymphoid cell reaction. Although the percentage of macrophage-like cells was increased significantly there were few signs of a lymphoid cell reaction; the lymph also contained much amorphous debris. Experiments in which the basophilic cells from the efferent lymph were labeled in vitro with thymidine-3H and returned to the sheep by intravenous injections were carried out in six sheep. The presence of the labeled cells in the grafts, blood, and other tissue was detected by liquid scintillation counting of nucleic acid extracts of biopsy and postmortem material and by radioautography. 2–3 labeled cells out of every 1000 injected entered the homografts but hardly any entered the autografts. However, labeled basophilic cells that had originated in response to bacterial antigens entered the homografts with equal facility. It is thus hard to believe that the immunological specificity of a lymphoid cell endows it with a specific "homing" capability. Furthermore, in all the experiments the specific radioactivities of the nucleic acids extracted from the blood mononuclear cells were approximately of the same order as those of the nucleic acids extracted from the homografts. It was concluded that most of the mononuclear cells that infiltrate homografts represent a random selection from the mononuclear cell population of the blood.
Hall, J. G.
Venous thromboembolism is the third leading cause of cardiovascular death in the United States and is the second leading cause of death among hospitalized cancer patients. Continued controversy exists regarding the role of thrombolytic therapy among patients with acute pulmonary embolism. Limited research exists on thrombolytic therapy in this setting, most of which has focused on symptoms, including right ventricular function, hemodynamic status, and electrocardiographic changes. However, these studies have excluded patients with a known malignancy. Presented is an interesting case of a patient, in remission from breast cancer, who presented to the emergency department with symptomatic pulmonary emboli. The presentation, medical management, and consequences of the treatment have been discussed. Also, a brief review of the literature is presented regarding the treatment of acute pulmonary embolism. PMID:22407373
McLenon, Melissa
[Pulmonary nodules and arachnophobia].
Pulmonary nodules are a common reason for consultation and their investigation must always exclude a possible neoplastic cause. This means that, in addition to a thorough history, investigations may be necessary which are sometimes invasive and therefore potentially a cause of iatrogenic harm. The toxic aetiologies for pulmonary nodules are rare. We report a case of a patient with pulmonary nodules occurring predominantly in the right lung, about 1cm in diameter, non-cavitating without calcification, and sometimes surrounded by a peripheral halo. The nodules were a chance finding during preoperative evaluation. After a comprehensive review, a reaction to an inhaled irritant was the preferred hypothesis, specifically overuse of a compound insecticide containing, in addition to the propellant gas and solvent type hydrocarbon - a mixture of piperonyl butoxide, of esbiothrine and permethrin. Removal of this led to the complete disappearance of nodules. Pathological examination identified bronchiolitis obliterans with organising pneumonia accompanied by non-necrotizing granulomas and lipid vacuoles. PMID:24461445
Colinet, B; Dargent, J-L; Fremault, A
Predictors of sentinel lymph node status and onset of regional lymph nodes metastases in melanoma.
(Full text is available at http://www.manu.edu.mk/prilozi). Introduction: Several clinico-pathological characteristics such as age, sex, tumour localization, Breslow thickness, ulceration, mitotic count, vessel invasion and the presence of tumour-infiltrating lymphocytes have been identified as independent prognostic factors for relapse and overall survival of patients with skin melanoma. The aim of this study was to identify characteristics of primary melanoma which predict sentinel lymph node (SLN) positivity and the onset of regional lymph nodes metastases. Material and methods: A total of 60 patients who underwent surgery for mali-gnant skin melanoma, divided into examined and control group, were analyzed. In the patients from the examined group SLN were marked with 1% solution of methylene blue, removed and histologically examined. The radical lymphadenectomy was performed as a separate procedure in the patients with SLN positive for metastasis. We analysed the differences in age, sex, tumour location, tumour area, primary tumour thickness, Clark levels of invasion, lymphocytic infiltration and presence of ulcerations in patients in the examined group and the control group and the correlation of the examined variables with the onset of metastases in the SLN. Results: The results showed that the differences between the groups were statistically significant only for the primary melanoma thickness and the Clark level of invasion. There was a significant difference in the intensity of the lymphocytic infiltration between the SLN negative patients and the patients from the control group. A statistically significant correlation with SLN positive status was found only with the Clark level of invasion. Key words: melanoma, sentinel lymph node, tumour thickness. PMID:23425876
Noveski, L; Dzokic, Gj; Dzonov, B; Zafirova-Ivanovska, B; Zhivadinovik, J
Lymph Node Ratio for Postoperative Staging of Laryngeal Squamous Cell Carcinoma with Lymph Node Metastasis
Background Lymph node metastasis has a significant impact on laryngeal cancer prognosis. The role of lymph node ratio (LNR, ratio of metastatic to examined nodes) in the staging of laryngeal cancer was not reported. Patients and Methods Records of laryngeal cancer patients with lymph node involvement from Surveillance, Epidemiology, and End Results database (SEER, training set, N?=?1963) and Fudan University Shanghai Cancer Center (FDSCC, validating set, N?=?27) were analyzed for the prognostic value of LNR. Kaplan–Meier survival estimates, the Log-rank ?2 test and Cox proportional hazards model were used for univariate and multivariate analysis. Optimal LNR cutoff points were identified by X-tile. Results Optimal LNR cutoff points classified patients into three risk groups R1 (?0.09), R2 (0.09–0.20) and R3 (>0.20), corresponding to 5-year cause-specific survival and overall survival in SEER patients of 55.1%, 40.2%, 28.8% and 43.1%, 31.5%, 21.8%, 2-year disease free survival and disease specific survival in FDSCC patients of 74.1%, 62.5%, 50.0%, and 67.7%, 43.2%, 25.0%, respectively. R3 stratified more high risk patients than N3 with the same survival rate, and R classification clearly separated N2 patients to 3 risk groups and N1 patients to 2 risk groups (R1–2 and R3). Conclusions R classification is a significant prognostic factor of laryngeal cancer and should be used as a complementary staging system of N classification.
Wang, Yu-Long; Li, Duan-Shu; Wang, Yu; Wang, Zhuo-Ying; Ji, Qing-Hai
Unusual Case of Pulmonary Hypertension
Truly reversible pulmonary hypertension is rare. Acquired systemic arteriovenous (A-V) fistulas following spinal surgery (laminectomy) are a less recognized ca