These are representative sample records from related to your search topic.
For comprehensive and current results, perform a real-time search at

Value of Systematic Mediastinal Lymph Node Dissection During Pulmonary Metastasectomy  

Microsoft Academic Search

Background. Systematic mediastinal lymph node dis- section is the accepted standard when curative resection of bronchial carcinoma is performed. However, medias- tinal lymph node dissection is not routinely performed with pulmonary metastasectomy, in which only enlarged or suspicious lymph nodes are removed. The incidence of malignant infiltration of mediastinal lymph nodes in patients with pulmonary metastases is not known. Methods.

Florian Loehe; Sonja Kobinger; Rudolf A. Hatz; Thomas Helmberger; Udo Loehrs; Heinrich Fuerst



Value of systematic mediastinal lymph node dissection during pulmonary metastasectomy  

Microsoft Academic Search

Background. Systematic mediastinal lymph node dissection is the accepted standard when curative resection of bronchial carcinoma is performed. However, mediastinal lymph node dissection is not routinely performed with pulmonary metastasectomy, in which only enlarged or suspicious lymph nodes are removed. The incidence of malignant infiltration of mediastinal lymph nodes in patients with pulmonary metastases is not known.Methods. Sixty-three patients who

Florian Loehe; Sonja Kobinger; Rudolf A Hatz; Thomas Helmberger; Udo Loehrs; Heinrich Fuerst



Thoracoscopic left upper lobectomy with systematic lymph nodes dissection under left pulmonary artery clamping  

PubMed Central

Video-assisted thoracoscopic surgery (VATS) has become a routine procedure for stage I and II lung cancers. However, in the presence of multiple metastasized lymph nodes invading the pulmonary artery or its major branches, the pulmonary artery have to be resected partially or sleeve resected, which could be extremely risky under thoracoscopic conditions. In order to reduce the risk of bleeding, an experienced thoracic surgeon would occlude the inflow and outflow of the pulmonary artery before anatomically dissecting the area of the pulmonary artery with tumor invasion. Different centers may use different clamping techniques and devices. Here, we report our technique of totally thoracoscopic left upper lobectomy with systematic lymph nodes dissection under pulmonary artery clamping for a 49-year-old woman with left upper lobe carcinoma. The video demonstrates our thinking and surgical process. PMID:25589991

Dong, Yi-Nan; Sun, Nan; Ren, Yi; Zhang, Liang; Li, Ji-Jia



Flow Cytometric Immunophenotype of Canine Lymph Node Aspirates  

Microsoft Academic Search

Increasing availability of reagents able to distinguish subtypes of lymphocytes and other leukocytes has enabled greater under- standing of lymphocyte biology and pathology in the dog. Lymphocytes in circulation most commonly are subjected to immuno- phenotypic assessment by flow cytometry, but needle aspirates of lymph nodes can be similarly suitable for immunophenotypic examination. In this investigation, the feasibility of immunophenotyping

D. Gibson; I. Aubert; J. P. Woods; A. Abrams-Ogg; S. Kruth; R. D. Wood; D. Bienzle



Pulmonary compliance and lung volume varies with ecomorphology in anuran amphibians: implications for ventilatory-assisted lymph flux.  


Vertical movement of lymph from ventral regions to the dorsally located lymph hearts in anurans is accomplished by specialized skeletal muscles working in concert with lung ventilation. We hypothesize that more terrestrial species with greater lymph mobilization capacities and higher lymph flux rates will have larger lung volumes and higher pulmonary compliance than more semi-aquatic or aquatic species. We measured in situ mean and maximal compliance (?volume/?pressure), distensibility (%?volume/?pressure) and lung volume over a range of physiological pressures (1.0 to 4.0 cmH(2)O) for nine species of anurans representing three families (Bufonide, Ranidae and Pipidae) that span a range of body masses and habitats from terrestrial to aquatic. We further examined the relationship between these pulmonary variables and lymph flux for a semi-terrestrial bufonid (Rhinella marina), a semi-aquatic ranid (Lithobates catesbeianus) and an aquatic pipid (Xenopus laevis). Allometric scaling of pulmonary compliance and lung volume with body mass showed significant differences at the family level, with scaling exponents ranging from ?0.75 in Bufonidae to ?1.3 in Pipidae. Consistent with our hypothesis, the terrestrial Bufonidae species had significantly greater pulmonary compliance and greater lung volumes compared with semi-aquatic Ranidae and aquatic Pipidae species. Pulmonary distensibility ranged from ?20 to 35% cmH(2)O(-1) for the three families but did not correlate with ecomorphology. For the three species for which lymph flux data are available, R. marina had a significantly higher (P<0.001) maximal compliance (84.9±2.7 ml cmH(2)O(-1) kg(-1)) and lung volume (242.1±5.5 ml kg(-1)) compared with L. catesbeianus (54.5±0.12 ml cmH(2)O(-1) kg(-1) and 139.3±0.5 ml kg(-1)) and X. laevis (30.8±0.7 ml cmH(2)O(-1) kg(-1) and 61.3±2.5 ml kg(-1)). Lymph flux rates were also highest for R. marina, lowest for X. laevis and intermediate in L. catesbeianus. Thus, there is a strong correlation between pulmonary compliance, lung volume and lymph flux rates, which suggests that lymph mobilization capacity may explain some of the variation in pulmonary compliance and lung volume in anurans. PMID:21900475

Hedrick, Michael S; Hillman, Stanley S; Drewes, Robert C; Withers, Philip C



Lymph flow transients following elevation of venous pressure in the dog hindpaw.  


Lymph flow transients were studied in a dog paw preparation when venous pressure was elevated by 15 and 25 mmHg. The lymph flow transients showed a very rapid initial increase which then declined to a steady-state value that was one-half the peak lymph flow response for both pressure changes. Lymph flow increased in the initial 5.3 minutes following venous pressure elevation to 10.4 +/- 2.0 and 18.1 +/- 4.5 times the normal lymph flow (mean +/- standard deviation) for the 15 and 25 mmHg increases in venous pressure, respectively. However, approximately 9 minutes after attaining the maximal flow rate, the lymph flow declined to only 5.5 +/- 0.7 and 9.8 +/- 1.8 times the control values. These data demonstrate another condition in which lymph flow is not maintained at the maximal capability. Possible mechanisms causing the observed biphasic lymph flow response to capillary pressure elevation are: 1) changes in Starling forces oppose an increase in capillary pressure; 2) the rate of change in tissue fluid pressure affects lymph flow to a greater extent than does the absolute change in tissue fluid pressure; or, 3) the lymphatics empty upon elevation and refill as the capillaries filter. PMID:1791726

Chen, H I; Granger, H J; Taylor, A E



Measurement of regional pulmonary blood volume in patients with increased pulmonary blood flow or pulmonary arterial hypertension  

SciTech Connect

The effects of chronic increase in pulmonary blood flow and chronic pulmonary hypertension on regional pulmonary blood volume was measured in two groups of patients. One group of patients had intracardiac, left-to-right shunts without appreciable pulmonary hypertension, and the other consisted of patients with Eisenmenger's syndrome or primary pulmonary hypertension, i.e. patients with normal or reduced blood flow and severe pulmonary hypertension. A technique based on positron tomography was used to measure lung density (by transmission scanning) and regional pulmonary blood volume (after inhalation of /sup 11/CO). The distribution of pulmonary blood volume was more uniform in patients with chronic increase in pulmonary blood flow than in normal subjects. There were also indications of an absolute increase in intrapulmonary blood volume by about 15%. In patients with chronic pulmonary arterial hypertension, the distribution of pulmonary blood volume was also abnormally uniform. There was, however, no indication that overall intrapulmonary blood volume was substantially different from normal subjects. The abnormally uniform distribution of pulmonary blood volume can be explained by recruitment and/or dilatation of vascular beds. Intrapulmonary blood volume appears to be increased in patients with intracardiac, left-to-right shunts. With the development of pulmonary hypertension, intrapulmonary blood volume falls, which may be explained by reactive changes in the vasculature and/or obliteration of capillaries.

Wollmer, P.; Rozcovek, A.; Rhodes, C.G.; Allan, R.M.; Maseri, A.



Altered reactivity and nitric oxide signaling in the isolated thoracic duct from an ovine model of congenital heart disease with increased pulmonary blood flow.  


We have previously shown decreased pulmonary lymph flow in our lamb model of chronically increased pulmonary blood flow, created by the in utero placement of an 8-mm aortopulmonary shunt. The purpose of this study was to test the hypothesis that abnormal lymphatic function in shunt lambs is due to impaired lymphatic endothelial nitric oxide (NO)-cGMP signaling resulting in increased lymphatic vascular constriction and/or impaired relaxation. Thoracic duct rings were isolated from 4-wk-old shunt (n = 7) and normal (n = 7) lambs to determine length-tension properties, vascular reactivity, and endothelial NO synthase protein. At baseline, shunt thoracic duct rings had 2.6-fold higher peak to peak tension and a 2-fold increase in the strength of contractions compared with normal rings (P < 0.05). In response to norepinephrine, shunt thoracic duct rings had a 2.4-fold increase in vascular tone compared with normal rings (P < 0.05) and impaired relaxation in response to the endothelium-dependent dilator acetylcholine (63% vs. 13%, P < 0.05). In vivo, inhaled NO (40 ppm) increased pulmonary lymph flow (normalized for resistance) ?1.5-fold in both normal and shunt lambs (P < 0.05). Inhaled NO exposure increased bioavailable NO [nitrite/nitrate (NOx); ?2.5-fold in normal lambs and ?3.4-fold in shunt lambs] and cGMP (?2.5-fold in both) in the pulmonary lymph effluent (P < 0.05). Chronic exposure to increased pulmonary blood flow is associated with pulmonary lymphatic endothelial injury that disrupts NO-cGMP signaling, leading to increased resting vasoconstriction, increased maximal strength of contraction, and impaired endothelium-dependent relaxation. Inhaled NO increases pulmonary lymph NOx and cGMP levels and pulmonary lymph flow in normal and shunt lambs. Therapies that augment NO-cGMP signaling within the lymphatic system may provide benefits, warranting further study. PMID:24531811

Datar, Sanjeev A; Oishi, Peter E; Gong, Wenhui; Bennett, Stephen H; Sun, Christine E; Johengen, Michael; Maki, Jun; Johnson, Rebecca C; Raff, Gary W; Fineman, Jeffrey R



Altered reactivity and nitric oxide signaling in the isolated thoracic duct from an ovine model of congenital heart disease with increased pulmonary blood flow  

PubMed Central

We have previously shown decreased pulmonary lymph flow in our lamb model of chronically increased pulmonary blood flow, created by the in utero placement of an 8-mm aortopulmonary shunt. The purpose of this study was to test the hypothesis that abnormal lymphatic function in shunt lambs is due to impaired lymphatic endothelial nitric oxide (NO)-cGMP signaling resulting in increased lymphatic vascular constriction and/or impaired relaxation. Thoracic duct rings were isolated from 4-wk-old shunt (n = 7) and normal (n = 7) lambs to determine length-tension properties, vascular reactivity, and endothelial NO synthase protein. At baseline, shunt thoracic duct rings had 2.6-fold higher peak to peak tension and a 2-fold increase in the strength of contractions compared with normal rings (P < 0.05). In response to norepinephrine, shunt thoracic duct rings had a 2.4-fold increase in vascular tone compared with normal rings (P < 0.05) and impaired relaxation in response to the endothelium-dependent dilator acetylcholine (63% vs. 13%, P < 0.05). In vivo, inhaled NO (40 ppm) increased pulmonary lymph flow (normalized for resistance) ?1.5-fold in both normal and shunt lambs (P < 0.05). Inhaled NO exposure increased bioavailable NO [nitrite/nitrate (NOx); ?2.5-fold in normal lambs and ?3.4-fold in shunt lambs] and cGMP (?2.5-fold in both) in the pulmonary lymph effluent (P < 0.05). Chronic exposure to increased pulmonary blood flow is associated with pulmonary lymphatic endothelial injury that disrupts NO-cGMP signaling, leading to increased resting vasoconstriction, increased maximal strength of contraction, and impaired endothelium-dependent relaxation. Inhaled NO increases pulmonary lymph NOx and cGMP levels and pulmonary lymph flow in normal and shunt lambs. Therapies that augment NO-cGMP signaling within the lymphatic system may provide benefits, warranting further study. PMID:24531811

Datar, Sanjeev A.; Oishi, Peter E.; Gong, Wenhui; Bennett, Stephen H.; Sun, Christine E.; Johengen, Michael; Maki, Jun; Johnson, Rebecca C.; Raff, Gary W.



Altered lymphatics in an ovine model of congenital heart disease with increased pulmonary blood flow  

PubMed Central

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. PMID:22207591

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.



Modeling of hyaluronan clearance with application to estimation of lymph flow.  


One of the important factors in blood pressure regulation is the maintenance of the level of blood volume, which depends on several factors including the rate of lymph flow. Lymph flow can be measured directly using cannulation of lymphatic vessels, which is not clinically feasible, or indirectly by the tracer appearance rate, which is the rate at which macromolecules appear into the blood from the peritoneal cavity. However, indirect lymph flow measurements do not always provide consistent results. Through its contribution to osmotic pressure and resistance to flow, the macromolecule hyaluronan takes part in the regulation of tissue hydration and the maintenance of water and protein homeostasis. It arrives in blood plasma through lymph flow. Lymphatic hyaluronic acid (HA, hyaluronan) concentration is several times higher than that in plasma, suggesting that the lymphatic route may account for the majority of HA found in plasma. Furthermore, circulating levels of HA reflect the dynamic state between delivery to-and removal from-the bloodstream. To develop an accurate estimation of the fluid volume distribution and dynamics, the rate of lymph flow needs to be taken into account and hyaluronan could be used as a marker in estimating this flow. To examine the HA distribution and system fluid dynamics, a six-compartment model, which could reflect both the steady-state relationships and qualitative characteristics of the dynamics, was developed. This was then applied to estimate fluid shifts from the interstitial space via the lymphatic system to the plasma during different physiological stresses (orthostatic stress and the stress of ultrafiltration during dialysis). Sensitivity analysis shows that during ultrafiltration, lymph flow is a key parameter influencing the total HA level, thus suggesting that the model may find applications in addressing the problem of estimating lymph flow. Since the fluid balance between interstitium and plasma is maintained by lymph flow and microvasculature filtration, our novel method of flow estimation may provide an important tool for understanding fluid dynamics during perturbations of the cardiovascular system. Since the fluid balance between interstitium and plasma is maintained by lymph flow and microvasculature filtration, our novel method of flow estimation may provide an important tool for understanding fluid dynamics during perturbations of the cardiovascular system. PMID:21743125

Rössler, Andreas; Fink, Martin; Goswami, Nandu; Batzel, Jerry J



Comparison of lymph and blood flow in microvessels: coherent optical measurements  

NASA Astrophysics Data System (ADS)

In the present study the characteristics of blood and lymph microcirculation are investigated. The microcirculation was studied on small intestine mesentery in norm and during NG-nitro-L-arginine (L- NNA) application. The direct measurement of lymph flow velocity (parameter V) in individual microvessels was based on the technique of light intravital videomicroscopy. The first spectral moments of Doppler signal characterizing the mean velocities of lymph and blood flow in microvessels (parameters M1L and M1B) were measured by speckle- interferometrical method. Simultaneously, diameters of blood and lymph microvessels as well as parameters of phasic contractions and valve function of lymphatics were registered. The mean diamters of investigated lymphatics and venules were 170+/-20 ?m and 8+/-0.5 ?m, correspondingly. In 24% of lymph microvessels phasic contractions were observed. The mean flow velocity in blood microvessels was 10 times more than the one in lymphatics. L-NNA application led to variable effects on diameter of lymphatics, increased the number of microvessels with phasic contractions and modified parameters of these contractions. The mean velocity of lymph flow (V) was increased. The mean value of M1L was not changed; the M1L maximum in 75% of the lymphatics was increased. In 88% of venules M1B was decreased on 25+/-7%.

Galanzha, Ekateryna I.; Ulyanov, Sergey S.; Tuchin, Valery V.; Brill, Gregory E.; Solov'eva, Anastasiya V.; Sedykh, Alexey V.



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)



Lagrangian transport properties of pulmonary interfacial flows  

PubMed Central

Disease states characterized by airway fluid occlusion and pulmonary surfactant insufficiency, such as respiratory distress syndrome, have a high mortality rate. Understanding the mechanics of airway reopening, particularly involving surfactant transport, may provide an avenue to increase patient survival via optimized mechanical ventilation waveforms. We model the occluded airway as a liquid-filled rigid tube with the fluid phase displaced by a finger of air that propagates with both mean and sinusoidal velocity components. Finite-time Lyapunov exponent (FTLE) fields are employed to analyse the convective transport characteristics, taking note of Lagrangian coherent structures (LCSs) and their effects on transport. The Lagrangian perspective of these techniques reveals flow characteristics that are not readily apparent by observing Eulerian measures. These analysis techniques are applied to surfactant-free velocity fields determined computationally, with the boundary element method, and measured experimentally with micro particle image velocimetry (?-PIV). We find that the LCS divides the fluid into two regimes, one advected upstream (into the thin residual film) and the other downstream ahead of the advancing bubble. At higher oscillatory frequencies particles originating immediately inside the LCS experience long residence times at the air–liquid interface, which may be conducive to surfactant transport. At high frequencies a well-mixed attractor region is identified; this volume of fluid cyclically travels along the interface and into the bulk fluid. The Lagrangian analysis is applied to velocity data measured with 0.01 mg ml?1 of the clinical pulmonary surfactant Infasurf in the bulk fluid, demonstrating flow field modifications with respect to the surfactant-free system that were not visible in the Eulerian frame. PMID:23049141

Smith, Bradford J.; Lukens, Sarah; Yamaguchi, Eiichiro; Gaver, Donald P.



Independent value of fascin immunoreactivity for predicting lymph node metastases in typical and atypical pulmonary carcinoids  

Microsoft Academic Search

Immunoreactivity for fascin, an actin-bundling protein related to cell motility, has been reported in breast, ovary, pancreas, skin, and non-small cell carcinomas, and associated with more advanced disease stage and poorer prognosis. Data on pulmonary neuroendocrine (NE) tumors, however, are lacking. We evaluated the expression of fascin by immunohistochemistry—using two different monoclonal antibodies—in surgical specimens of pulmonary NE tumors of

Giuseppe Pelosi; Felice Pasini; Filippo Fraggetta; Ugo Pastorino; Antonio Iannucci; Patrick Maisonneuve; Gianluigi Arrigoni; Giovanni De Manzoni; Enrica Bresaola; Giuseppe Viale



In Vivo Multispectral Photoacoustic Lymph Flow Cytometry with Natural Cell Focusing and Multicolor Nanoparticle Probes  

PubMed Central

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. PMID:18677768

Galanzha, Ekaterina I.; Shashkov, Evgeny V.; Tuchin, Valery V.; Zharov, Vladimir P.



Pulmonary vascular response to platelet-activating factor in awake sheep and the role of cyclooxygenase metabolites.  


We examined the effects of platelet activating factor (PAF) (1.0 microgram/kg infusion for 15 min) on pulmonary hemodynamics and lung fluid balance and the role of cyclooxygenase metabolites in mediating these responses in unanesthetized sheep prepared with lung lymph fistulas. Platelet activating factor infusion resulted in immediate and transient increases in pulmonary artery pressure, pulmonary vascular resistance, and pulmonary lymph flow. The lymph-to-plasma protein concentration ratio did not change significantly from baseline. Circulating platelet and leukocyte counts decreased immediately after PAF infusion; the leukopenia was the result of a rapid decrease in both the neutrophil and mononuclear leukocyte counts. Arterial thromboxane B2 (TxB2) concentration increased after the PAF infusion, but the 6-keto prostaglandin F1 alpha (a prostacyclin degradation product) concentration did not change from baseline. A chemically similar substance, Lyso-PAF, had no effect on the pulmonary hemodynamic, lymph, and hematologic parameters or the TxB2 generation. Administration of cyclooxygenase inhibitors, meclofenamate or indomethacin, prior to PAF infusion prevented thromboxane B2 generation and attenuated the pulmonary hemodynamic response. The initial pulmonary lymph flow and transvascular protein clearance (lymph flow times lymph-to-plasma protein concentration) responses to PAF were attenuated after cyclooxygenase inhibition. However, there were time-dependent increases in pulmonary lymph flow and transvascular protein clearance in the cyclooxygenase-inhibited groups. These results indicate that PAF induces pulmonary vasoconstriction mediated by cyclooxygenase metabolites.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3752711

Burhop, K E; van der Zee, H; Bizios, R; Kaplan, J E; Malik, A B



Effects of f-Met-Leu-Phe-induced inflammation on intestinal lymph flow and lymphatic pump behavior.  


Previous studies in the literature indicate that intraenteric placement of the chemotactic peptide N-formyl-methionyl-leucyl-phenylalanine (f-Met-Leu-Phe) evokes an intestinal inflammatory response characterized by an accumulation of interstitial fluid and increased lymph flow. Furthermore, it is known that movement of lymph away from the intestine is dependent on the rhythmic pumping of lymph by collecting lymphatics in the mesentery. The purpose of the present study was to determine whether the f-Met-Leu-Phe-induced increase in lymph formation is countered by an increase in lymphatic pump efficiency. Male Sprague-Dawley rats were anesthetized, and a segment of ileum with adjacent mesentery was exteriorized. The mesentery was positioned over an optical window, and a 100-microns collecting lymphatic was selected for study. The preparation was transferred to a video microscope, and the activity of the lymphatic pump was monitored under control conditions and during intraluminal infusion of 1 microM f-Met-Leu-Phe. Lymph propulsion by the lymphatic pump was calculated from the product of stroke volume and contraction frequency. In one group of animals, total lymph flow was determined by cannulating the lymphatic draining the ileal segment. Total lymph flow increased following f-Met-Leu-Phe placement in the intestine. The increased lymph flow was paralleled by a rise in lymphatic pumping. The rise in lymph propulsion by the lymphatic pump resulted exclusively from an increased stroke volume, inasmuch as contraction frequency did not change. The results of the present study suggest that activation of the lymphatic pump during acute inflammation may be important in preventing interstitial edema. PMID:1539654

Benoit, J N; Zawieja, D C



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.



Alterations in lung arginine metabolism in lambs with pulmonary hypertension associated with increased pulmonary blood flow  

PubMed Central

Previous studies demonstrate impaired nitric oxide (NO) signaling in children and animal models with congenital heart defects and increased pulmonary blood flow. However, the molecular mechanisms underlying these alterations remain incompletely understood. The purpose of this study was to determine if early changes in arginine metabolic pathways could play a role in the reduced NO signaling demonstrated in our lamb model of congenital heart disease with increased pulmonary blood flow (Shunt lambs). The activities of the arginine recycling enzymes, argininosuccinate synthetase (ASS) and argininosuccinate lyase (ASL) were both decreased in lung tissues of Shunt lambs while arginase activity was increased. Associated with these alterations, lung L-arginine levels were decreased. These changes correlated with an increase in NO synthase-derived reactive oxygen species (ROS) generation. This study provides further insights into the molecular mechanisms leading to decreased NO signaling in Shunt lambs and suggests that altered arginine metabolism may play a role in the development of the endothelial dysfunction associated with pulmonary hypertension secondary to increased pulmonary blood flow. PMID:19818875

Sharma, Shruti; Kumar, Sanjiv; Sud, Neetu; Wiseman, Dean A.; Tian, Jing; Rehmani, Imran; Datar, Sanjeev; Oishi, Peter; Fratz, Sohrab; Venema, Richard C.; Fineman, Jeffrey R.; Black, Stephen M.



Optical monitoring of complex dynamics of blood sedimentation and lymph flow in vessels  

NASA Astrophysics Data System (ADS)

In this paper a few examples of the complex behavior of biological systems detected by optical techniques are described. All examples are related to cell suspensions behavior in in vitro and in vivo studies. In vitro studies performing investigation of a fine structure of blood sedimentation process and establishing nonlinear features of blood sedimentation as disease prognostic parameters are overviewed. Three optical techniques: OCT, CW laser beam transverse synchronized transillumination method and spatially-modulated laser beam transillumination method were considered. In blood sedimentation studied by OCT the regular or irregular oscillations of the RBC/plasma boundary were observed. The functional properties of erythrocytes in patients with coronary heart disease by mean of spatially-modulated laser beam transillumination method to reveal the stages of the acute coronary syndrome formation are discussed. The laser speckle and intravital TV-microscopic techniques applied to in vivo studies of lymph flow in microvessels are overviewed. The hypothesis on the alternating-translation (shuttle-stream) character of lymph flow is discussed.

Tuchin, Valery V.



Contribution of calcium-activated chloride channel to elevated pulmonary artery pressure in pulmonary arterial hypertension induced by high pulmonary blood flow  

PubMed Central

The correlation between calcium-activated chloride channel (CaCC) and pulmonary arterial hypertension (PAH) induced by high pulmonary blood flow remains uncertain. In this study, we investigated the possible role and effects of CaCC in this disease. Sixty rats were randomly assigned to normal, sham, and shunt groups. Rats in the shunt group underwent abdominal aorta and inferior vena cava shunt surgery. The pulmonary artery pressure was measured by catheterization. Pathological changes, right ventricle hypertrophy index (RVHI), arterial wall area/vessel area (W/V), and arterial wall thickness/vessel external diameter (T/D) were analyzed by optical microscopy. Electrophysiological characteristics of pulmonary arterial smooth muscle cells (PASMCs) were investigated using patch clamp technology. After 11 weeks of shunting, PAH and pulmonary vascular structural remodeling (PVSR) developed, accompanied by increased pulmonary pressure and pathological interstitial pulmonary changes. Compared with normal and sham groups, pulmonary artery pressure, RVHI, W/V, and T/D of the shunt group rats increased significantly. Electrophysiological results showed primary CaCC characteristics. Compared with normal and sham groups, membrane capacitance and current density of PASMCs in the shunt group increased significantly, which were subsequently attenuated following chloride channel blocker niflumic acid (NFA) treatment. To conclude, CaCC contributed to PAH induced by high pulmonary blood flow and may represent a potential target for treatment of PAH. PMID:25755701

Wang, Kai; Chen, Chuansi; Ma, Jianfa; Lao, Jinquan; Pang, Yusheng



A comparative study of frozen-section immunoperoxidase and flow cytometry for immunophenotypic analysis of lymph node biopsies.  

PubMed Central

Immunophenotyping by flow cytometry and frozen-section immunoperoxidase was compared on 21 consecutive lymph node biopsy specimens, of which a diagnosis of lymphoma was made for 11 specimens. Samples for flow cytometry were obtained by a fine-needle aspiration technique. Concordance between frozen-section immunoperoxidase and flow cytometry for all routine markers on all specimens ranged from 76 to 100%. In general, B-cell markers showed poorer concordance than T-cell markers, with kappa and lambda light chains having the poorest concordance, at 76% each. Flow cytometry was significantly more sensitive (90 versus 30%; P < 0.006) and had a significantly higher negative predictive value (100 versus 63%; P < 0.006) than frozen-section immunoperoxidase for demonstrating light-chain restriction. There was no significant difference in the specificities (100 versus 91%) or positive predictive values (100% each) between the two methods. Both methods demonstrated characteristic immunophenotypes for intermediate cell lymphomas, small lymphocytic lymphomas, and T-cell lymphoblastic lymphomas. Frozen-section immunoperoxidase and flow cytometry appear to be significantly concordant methods for immunophenotypic analysis of lymph node biopsies. Light-chain restriction is more readily demonstrated by flow cytometry than frozen-section immunoperoxidase. We believe that ex vivo fine-needle aspiration is a simple and reliable method of obtaining cell suspensions of lymph nodes for flow cytometry. PMID:7496966

Biesemier, K W; Dent, G A; Pryzwansky, K B; Folds, J D



A Case of Secondary Syphilis Involving Tonsil, Pulmonary, and Multiple Lymph Nodes: 18F-FDG PET/CT Findings.  


A 50-year-old man with general fatigue and weight loss underwent FDG PET/CT scan to detect possible occult malignancy. The images revealed abnormal FDG activity in the tonsils, right lung, and in the cervical, axillary, and inguinal lymph nodes. Lymphoma was initially suspected. However, pathologic examination after cervical lymph node biopsy revealed only reactive hyperplasia. Further examinations including serologic tests led to a diagnosis of secondary syphilis. A follow-up PET/CT scan after a 6-month benzylpenicillin therapy showed significant interval improvement. PMID:25546195

Fu, Zhanli; Zhang, Jin; Li, Qian; Liu, Meng; Kang, Lei



Factors affecting regional pulmonary blood flow in chronic ischemic heart disease  

SciTech Connect

To assess the effect of left heart disease on pulmonary blood flow distribution, we measured mean pulmonary arterial and wedge pressures, cardiac output, pulmonary vascular resistance, pulmonary blood volume, and arterial oxygen tension before and after treatment in 13 patients with longstanding ischemic heart failure and pulmonary edema. Pulmonary edema was evaluated by a radiographic score, and regional lung perfusion was quantified on a lung scan by the upper to lower third ratio (U:L ratio) of pulmonary blood flow per unit of lung volume. In all cases, redistribution of lung perfusion toward the apical regions was observed; this pattern was not affected by treatment. After treatment, pulmonary vascular pressures, resistance, and edema were reduced, while pulmonary blood volume did not change. At this time, pulmonary vascular resistance showed a positive correlation with the U:L ratio (r = 0.78; P less than 0.01), whereas no correlation was observed between U:L ratio and wedge pressure, pulmonary edema, or arterial oxygen tension. Hence, redistribution of pulmonary blood flow, in these patients, reflects chronic structural vascular changes prevailing in the dependent lung regions.

Pistolesi, M.; Miniati, M.; Bonsignore, M.; Andreotti, F.; Di Ricco, G.; Marini, C.; Rindi, M.; Biagini, A.; Milne, E.N.; Giuntini, C.



Prediction of the axillary lymph node status in mammary cancer on the basis of clinicopathological data and flow cytometry.  


Axillary lymph node status is a major prognostic factor in mammary carcinoma. It is clinically desirable to predict the axillary lymph node status from data from the mammary cancer specimen. In the study, the axillary lymph node status, routine histological parameters and flow-cytometric data were retrospectively obtained from 1139 specimens of invasive mammary cancer. The ten variables: age, tumour type, tumour grade, tumour size, skin infiltration, lymphangiosis carcinomatosa, pT4 category, percentage of tumour cells in G2/M- and S-phases of the cell cycle, and ploidy index were considered as predictor variables, and the single variable lymph node metastasis pN (0 for pN0, or 1 for pN1 or pN2) was used as an output variable. A stepwise logistic regression analysis, with the axillary lymph node as a dependent variable, was used for feature selection. Only lymphangiosis carcinomatosa and tumour size proved to be significant as independent predictor variables; the other variables were non-contributory. Three paradigms with supervised learning rules (multilayer perceptron, learning vector quantisation and support vector machines) were used for the purpose of prediction. If any of these paradigms was used with the information from all ten input variables, 73% of cases could be correctly predicted, with specificity ranging from 82 to 84% and sensitivity ranging from 60 to 63%. If only the two significant input variables were used, lymphangiosis carcinomatosa and tumour diameter, the prediction accuracy was no worse. Nearly identical results were obtained by two different techniques of cross-validation (leave-one-out against ten-fold cross validation). It was concluded that: artificial neural networks can be used for risk stratification on the basis of routine data in individual cases of mammary cancer; and lymphangiosis carcinomatosa and tumour size are independent predictors of axillary lymph node metastasis in mammary cancer. PMID:15587463

Mattfeldt, T; Kestler, H A; Sinn, H P



Pulmonary fluid flow challenges for experimental and mathematical modeling.  


Modeling the flow of fluid in the lungs, even under baseline healthy conditions, presents many challenges. The complex rheology of the fluids, interaction between fluids and structures, and complicated multi-scale geometry all add to the complexity of the problem. We provide a brief overview of approaches used to model three aspects of pulmonary fluid and flow: the surfactant layer in the deep branches of the lung, the mucus layer in the upper airway branches, and closure/reopening of the airway. We discuss models of each aspect, the potential to capture biological and therapeutic information, and open questions worthy of further investigation. We hope to promote multi-disciplinary collaboration by providing insights into mathematical descriptions of fluid-mechanics in the lung and the kinds of predictions these models can make. PMID:25096289

Levy, Rachel; Hill, David B; Forest, M Gregory; Grotberg, James B



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



Lymph nodes  

MedlinePLUS Videos and Cool Tools

... and conveying lymph and by producing various blood cells. Lymph nodes play an important part in the ... the microorganisms being trapped inside collections of lymph cells or nodes. Eventually, these organisms are destroyed and ...


SPECT imaging of pulmonary blood flow in a rat  

NASA Astrophysics Data System (ADS)

Small animal imaging is experiencing rapid development due to its importance in providing high-throughput phenotypic data for functional genomics studies. We have developed a single photon emission computed tomography (SPECT) system to image the pulmonary perfusion distribution in the rat. A standard gamma camera, equipped with a pinhole collimator, was used to acquire SPECT projection images at 40 sec/view of the rat thorax following injection of Tc99m labeled albumin that accumulated in the rat's lungs. A voxel-driven, ordered-subset expectation maximization reconstruction was implemented. Following SPECT imaging, the rat was imaged using micro-CT with Feldkamp conebeam reconstruction. The two reconstructed image volumes were fused to provide a structure/function image of the rat thorax. Reconstruction accuracy and performance were evaluated using numerical simulations and actual imaging of an experimental phantom consisting of Tc99m filled chambers with known diameters and count rates. Full-width half-maximum diameter measurement errors decreased with increasing chamber diameter, ranging from < 6% down to 0.1%. Errors in the ratio of count rate estimates between tubes were also diameter dependent but still relatively small. This preliminary study suggests that SPECT will be useful for imaging and quantifying the pulmonary blood flow distribution and the distribution of Tc99m labeled ligands in the lungs of small laboratory animals.

Wietholt, Christian; Molthen, Robert C.; Johnson, Roger H.; Dawson, Christopher A.; Clough, Anne V.



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



Severe ASIA syndrome associated with lymph node, thoracic, and pulmonary silicone infiltration following breast implant rupture: experience with four cases.  


Silicone has been considered biologically inert; thus it has been employed in many medical devices and nowadays is commonly used in plastic surgery for mammary prosthesis. It is well tolerated in most cases. However, autoimmune disorders and siliconomas with granulomatous reactions after silicone implant rupture have been described. We report cases of four women who developed systemic disorders following rupture of silicone breast implants resulting in lymph node and thoracic silicone infiltration. The symptoms in these cases, including arthralgia, myalgia, generalized weakness, severe fatigue, sleeping disturbances, cognitive impairment, memory loss, irritable bowel syndrome, and weight loss, clearly match the criteria of the recently defined autoimmune/inflammatory syndrome induced by adjuvants (ASIA). PMID:25801889

Nesher, G; Soriano, A; Shlomai, G; Iadgarov, Y; Shulimzon, T R; Borella, E; Dicker, D; Shoenfeld, Y



High-Flow Nasal Cannula Therapy in a Patient with Reperfusion Pulmonary Edema following Percutaneous Transluminal Pulmonary Angioplasty  

PubMed Central

A 62-year-old woman with Wolff-Parkinson-White syndrome was with recent worsening of dyspnea to New York Heart Association functional status Class III. The patient was diagnosed as having central type chronic thromboembolic pulmonary hypertension. By cardiac catheterization, her mean pulmonary artery pressure was 53 mmHg with total pulmonary resistance 2238 dynes·sec·cm?5. After medical therapies with tadalafil, furosemide, ambrisentan, beraprost, and warfarin were initiated, percutaneous transluminal pulmonary angioplasty (PTPA) was performed. Following PTPA, life-threating hypoxemia resulting from postoperative reperfusion pulmonary edema developed. High-flow nasal cannula therapy (HFNC) was applied, and 100% oxygen at 50?L/min of flow was required to keep oxygenation. HFNC was continued for 3 days, and the patient was discharged on 8th postoperative day with SpO2 of 97% on 3?L/min of oxygen inhalation. Because of the simplicity of the technique, the lower cost of equipment, and remarkable patient tolerance to the treatment, we speculate that HFNC can take over the post of noninvasive ventilation as first-line therapy for patients with acute respiratory failure. PMID:25126437

Moriyama, Kiyoshi; Satoh, Toru; Motoyasu, Akira; Kohyama, Tomoki; Kotani, Mariko; Kanai, Riichiro; Ando, Tadao



Afferent pathways of lymph flow within the popliteal node in sheep.  


Lymph enters the popliteal node in sheep either at the subcapsular sinus, or through terminal afferent lymphatics which pass within trabeculae to medullary sinuses. Lymph from the subcapsular sinus traverses trabecular sinuses and/or a network of tubular sinuses in the cortex before entering the medullary sinuses, which are very extensive. Carbon particles, injected either into an afferent lymphatic or subcutaneously into the leg, were initially found mainly in a circumscribed area of the subcapsular sinus. Within a few hours they were present within macrophages in and around medullary sinuses in a band which extended around virtually the whole medulla. It was concluded that the pathways taken by lymph constituents in the sheep node may differ from those described for mice, rats and rabbits. PMID:3693111

Heath, T J; Kerlin, R L; Spalding, H J



Pulmonary blood flow redistribution by increased gravitational force  

NASA Technical Reports Server (NTRS)

This study was undertaken to assess the influence of gravity on the distribution of pulmonary blood flow (PBF) using increased inertial force as a perturbation. PBF was studied in unanesthetized swine exposed to -Gx (dorsal-to-ventral direction, prone position), where G is the magnitude of the force of gravity at the surface of the Earth, on the Armstrong Laboratory Centrifuge at Brooks Air Force Base. PBF was measured using 15-micron fluorescent microspheres, a method with markedly enhanced spatial resolution. Each animal was exposed randomly to -1, -2, and -3 Gx. Pulmonary vascular pressures, cardiac output, heart rate, arterial blood gases, and PBF distribution were measured at each G level. Heterogeneity of PBF distribution as measured by the coefficient of variation of PBF distribution increased from 0.38 +/- 0.05 to 0.55 +/- 0.11 to 0.72 +/- 0.16 at -1, -2, and -3 Gx, respectively. At -1 Gx, PBF was greatest in the ventral and cranial and lowest in the dorsal and caudal regions of the lung. With increased -Gx, this gradient was augmented in both directions. Extrapolation of these values to 0 G predicts a slight dorsal (nondependent) region dominance of PBF and a coefficient of variation of 0.22 in microgravity. Analysis of variance revealed that a fixed component (vascular structure) accounted for 81% and nonstructure components (including gravity) accounted for the remaining 19% of the PBF variance across the entire experiment (all 3 gravitational levels). The results are inconsistent with the predictions of the zone model.

Hlastala, M. P.; Chornuk, M. A.; Self, D. A.; Kallas, H. J.; Burns, J. W.; Bernard, S.; Polissar, N. L.; Glenny, R. W.



Pulmonary and systemic blood flow contributions to upper airways in canine lung  

SciTech Connect

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))



Abnormalities of pulmonary blood flow during cold exposure in systemic lupus erythematosus.  


The aim is to determine whether pulmonary blood flow is altered during cold exposure of the hands in individuals with systemic lupus erythematosus (SLE). Cold exposure was induced by immersion of the hands, one at a time, in 10 degrees C water in nine SLE patients in whom pulmonary fibrosis had been ruled out by a routine examination. Lung perfusion was measured by continuous venous infusion of krypton 81 m. Cold exposure to at least one of the hands caused an 8 to 22% decrease of pulmonary blood flow in five of the nine patients. A 10 to 33% increase in flow developed in three of the nine patients during cold exposure of the hands. We conclude that these abnormalities in pulmonary blood flow during cold exposure were revealed in SLE patients with scarcely any clinical symptoms. PMID:3412732

Yamauchi, K; Suzuki, Y; Ichikawa, Y; Takaya, M; Arimori, S



[A case of pulmonary tuberculosis complicated with tuberculosis of bilateral cervical lymph nodes and exacerbated pericostal abscess].  


A 23-year-old man was admitted to our hospital because of cough and sputum in April 2001. A chest roentgenogram revealed infiltrative shadow with cavity formation in the bilateral lung fields. He was treated with sensitive antituberculous drugs. After starting the antituberculous therapy with INH, RFP, EB and PZA, bilateral cervical lymphadenopathy developed. Three months later, pericostal abscess appeared in the left anterior chest wall. Microscopic examination of the specimen obtained by needle aspiration biopsy disclosed positive for acid-fast bacilli. Smears of the pus showed acidfast bacilli identified as Mycobacterium tuberculosis by DNA-DNA PCR method. He developed tuberculous bilateral cervical lymphadenopathy and pericostal abscess during the course of antituberculosis chemotherapy. Drug sensitivity test revealed that tubercle bacilli in this case were sensitive. One year after the administration of chemotherapy, cervical lymphadenopathy and pericostal abscess were improved. Both masses were discontinuous with pulmonary tuberculosis and the possibility of lymphogenous spread of organism was speculated as its etiology. We assumed that both masses were due to paradoxical response to the antituberculosis chemotherapy. PMID:14969083

Yamada, Noritaka; Ito, Yuko; Goto, Kunihiko; Ando, Takayuki; Sudo, Yukio; Ogawa, Kenji; Tano, Masao



Blood Flow Vortices along the Main Pulmonary Artery Measured with MR Imaging for Diagnosis of Pulmonary Hypertension.  


Purpose To approximate the functional relationship between invasively measured mean pulmonary arterial pressure (mPAP) and the phase-contrast magnetic resonance (MR) imaging-derived duration of vortical blood flow along the main pulmonary artery and to analyze its applicability for noninvasive diagnosis of pulmonary hypertension (PH) and borderline mPAP. Materials and Methods The local ethics review board approved this prospective study of 145 patients suspected of having PH (69 patients with PH, 19 patients with borderline mPAP, and 57 patients with normal mPAP) who underwent right heart catheterization (RHC) and three-directional phase-contrast MR imaging of the main pulmonary artery. Velocity fields were viewed with dedicated software and evaluated for the duration of vortical blood flow in the main pulmonary artery (tvortex, the percentage of cardiac phases with vortex present). The relationship between mPAP at RHC and tvortex was assessed by means of a segmented linear regression model, and by Bland-Altman and receiver operating characteristic curve analyses. Results The relationship between mPAP and tvortex was described adequately (R(2) = 0.95) as linearly increasing, from tvortex of 0% (mPAP ? 16.0 mm Hg) with a slope of 1.59% per millimeter of mercury. The standard deviation between mPAP values derived from RHC and those estimated by using tvortex was 3.9 mm Hg. The area under the curve for tvortex-based diagnosis of PH was 0.994 (95% confidence interval [CI]: 0.982, 0.998), and the calculated PH cut-off value (tvortex ? 14.3%) resulted in sensitivity of 0.97 (95% CI: 0.90, 0.99) and specificity of 0.96 (95% CI: 0.89, 0.99). Vortical blood flow with tvortex less than 14.3% was specific for borderline mPAP. Conclusion Duration of vortical blood flow in the main pulmonary artery that is determined by using phase-contrast MR imaging allows accurate estimation of elevated mPAP and diagnosis of PH. © RSNA, 2014 Clinical trial registration no. NCT00575692. PMID:25372980

Reiter, Gert; Reiter, Ursula; Kovacs, Gabor; Olschewski, Horst; Fuchsjäger, Michael



Inspiratory Muscle Training May Increase Peak Inspiratory Flow in Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Background: When choosing a specific inhalation device for a chronic obstructive pulmonary disease (COPD) patient, the internal airflow resistance and the ability of the patient to overcome it and to create an optimal inspiratory flow are essential. Objectives: The purpose of the present study was to investigate: (1) the peak inspiratory flow (PIF) that a patient with COPD can generate

Paltiel Weiner; Margalit Weiner



Pulmonary vascular effects of fat emulsion infusion in unanesthetized sheep. Prevention by indomethacin.  


Pulmonary diffusing capacity and arterial blood Po(2) decrease in humans when 10% fat emulsion is infused. To study its effects on the pulmonary circulation and lung fluid balance, we infused 0.25 g/kg x h of a 10% fat emulsion (Intralipid, Cutter Laboratories, Inc., Berkeley, Calif.) into an awake sheep lung lymph preparation. The emulsion caused a sustained increase in pulmonary artery pressure to approximately twice base line with little change in left atrial pressure. Pa(O2) decreased an average 13 torr and lung lymph flow increased two- to threefold. Lymph/plasma total protein concentration fell as lymph flow increased; the magnitude of the lymph/plasma protein decrease was similar to that reported previously when lung vascular pressures were mechanically elevated. Heparin infusion (loading dose = 4,000 U, maintenance dose = 2,000 U/h) cleared the serum of triglycerides but did not alter the response to fat emulsion. Indomethacin infusion (loading dose = 5 mg/kg, maintenance dose = 3 mg/kg x h) blocked the rise in pulmonary artery pressure, the increase in lung lymph flow, and the fall in Pa(O2). Neither extravascular lung water nor [(14)C]urea lung vascular permeability surface area products were altered by fat emulsion infusion. We conclude that fat emulsion infusion in sheep increases lung microvascular filtration by increasing vascular pressures, but has no effect on vascular permeability. Since the effects are blocked by indomethacin, they may be prostaglandin mediated. PMID:659593

McKeen, C R; Brigham, K L; Bowers, R E; Harris, T R



Dynamic blood flow and wall shear stress in pulmonary hypertensive disease.  


This study provides new model of pulsatile flow in the pulmonary circulation in health and pulmonary hypertensive disease. Structural vascular remodeling typical of pulmonary hypertensive disease was implemented in the model by progressively altering the mechanical properties of the arterial geometry and progressively increasing the inlet pulse pressure (PP). The transmission of PP throughout the tree was shown to increase in advanced stages of disease, creating the potential for a `vicious-cycle' of damage to vasculature. Wall shear stress (WSS) was shown to be highest in the terminal arteries of the model and increased significantly with disease. A further trend observed in WSS results was that high WSS values began to `climb' the arterial tree towards the proximal vessels as disease progressed. This suggests a link between WSS and distal remodeling in pulmonary hypertensive disease, which initiates in the small muscular arteries and arterioles and spreads into larger arteries as the disease progresses. PMID:25571282

Postles, Arthur; Clark, Alys R; Tawhai, Merryn H



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.



Effect of gravitational and inertial forces on vertical distribution of pulmonary blood flow  

NASA Technical Reports Server (NTRS)

Vertical distribution of pulmonary blood flow (VDPBF) was studied, using radioactive microsphere emboli, in dogs without thoracotomy in the right decubitus position during exposure to lateral accelerations of 1, 2, 4, and 6 G. At all levels of force environment studied, an inverse linear relationship was observed between vertical height in the thorax and pulmonary blood flow (ml/min/ml lung tissue) with a decrease in flow to the most dependent region of the lung despite large increases in intravascular pressures at this site. Changes in blood flow were smallest at the mid-lung level, the hydrostatic 'balance point' for vascular and pleural pressures. These force environment-dependent changes in VDPBF are not readily explainable by the Starling resistor analog. Gravity-dependent regional differences in pleural and associated interstitial pressures, plus possible changes in vascular tone resulting from inadequate aeration of blood in the most dependent regions of the lung, probably also affect VDPBF.

Chevalier, P. A.; Reed, J. H., Jr.; Vandenberg, R. A.; Wood, E. H.



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  

PubMed Central

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?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. PMID:24625242



Numerical simulation of blood flow and pressure drop in the pulmonary arterial and venous circulation.  


A novel multiscale mathematical and computational model of the pulmonary circulation is presented and used to analyse both arterial and venous pressure and flow. This work is a major advance over previous studies by Olufsen et al. (Ann Biomed Eng 28:1281-1299, 2012) which only considered the arterial circulation. For the first three generations of vessels within the pulmonary circulation, geometry is specified from patient-specific measurements obtained using magnetic resonance imaging (MRI). Blood flow and pressure in the larger arteries and veins are predicted using a nonlinear, cross-sectional-area-averaged system of equations for a Newtonian fluid in an elastic tube. Inflow into the main pulmonary artery is obtained from MRI measurements, while pressure entering the left atrium from the main pulmonary vein is kept constant at the normal mean value of 2 mmHg. Each terminal vessel in the network of 'large' arteries is connected to its corresponding terminal vein via a network of vessels representing the vascular bed of smaller arteries and veins. We develop and implement an algorithm to calculate the admittance of each vascular bed, using bifurcating structured trees and recursion. The structured-tree models take into account the geometry and material properties of the 'smaller' arteries and veins of radii ? 50 ?m. We study the effects on flow and pressure associated with three classes of pulmonary hypertension expressed via stiffening of larger and smaller vessels, and vascular rarefaction. The results of simulating these pathological conditions are in agreement with clinical observations, showing that the model has potential for assisting with diagnosis and treatment for circulatory diseases within the lung. PMID:24610385

Qureshi, M Umar; Vaughan, Gareth D A; Sainsbury, Christopher; Johnson, Martin; Peskin, Charles S; Olufsen, Mette S; Hill, N A



Numerical simulation of blood flow and pressure drop in the pulmonary arterial and venous circulation  

PubMed Central

A novel multiscale mathematical and computational model of the pulmonary circulation is presented and used to analyse both arterial and venous pressure and flow. This work is a major advance over previous studies by Olufsen and coworkers (Ottesen et al., 2003; Olufsen et al., 2012) which only considered the arterial circulation. For the first three generations of vessels within the pulmonary circulation, geometry is specified from patient-specific measurements obtained using magnetic resonance imaging (MRI). Blood flow and pressure in the larger arteries and veins are predicted using a nonlinear, cross-sectional-area-averaged system of equations for a Newtonian fluid in an elastic tube. Inflow into the main pulmonary artery is obtained from MRI measurements, while pressure entering the left atrium from the main pulmonary vein is kept constant at the normal mean value of 2 mmHg. Each terminal vessel in the network of ‘large’ arteries is connected to its corresponding terminal vein via a network of vessels representing the vascular bed of smaller arteries and veins. We develop and implement an algorithm to calculate the admittance of each vascular bed, using bifurcating structured trees and recursion. The structured-tree models take into account the geometry and material properties of the ‘smaller’ arteries and veins of radii ? 50µm. We study the effects on flow and pressure associated with three classes of pulmonary hypertension expressed via stiffening of larger and smaller vessels, and vascular rarefaction. The results of simulating these pathological conditions are in agreement with clinical observations, showing that the model has potential for assisting with diagnosis and treatment of circulatory diseases within the lung. PMID:24610385

Qureshi, M. Umar; Vaughan, Gareth D.A.; Sainsbury, Christopher; Johnson, Martin; Peskin, Charles S.; Olufsen, Mette S.; Hill, N.A.



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.



Spatial distribution of pulmonary blood flow in dogs in increased force environments  

NASA Technical Reports Server (NTRS)

Spatial distribution of pulmonary blood flow during 2- to 3-min exposures to 6-8 Gy acceleration was studied, using radioactive microspheres in dogs, and compared to previously reported 1 Gy control distributions. Isotope distributions were measured by scintiscanning individual 1-cm-thick cross sections of excised, fixed lungs. Results indicate: (1) the fraction of cardiac output traversing left and right lungs did not change systematically with the duration and magnitude of acceleration; but (2) the fraction is strongly affected by the occurrence or absence of fast deep breaths, which cause an increase or decrease, respectively, in blood flow through the dependent lung; and (3) Gy acceleration caused a significant increase in relative pulmonary vascular resistance (PVR) in nondependent and dependent regions of the lung concurrent with a decrease in PVR in the midsagittal region of the thorax.

Greenleaf, J. F.; Ritman, E. L.; Chevalier, P. A.; Sass, D. J.; Wood, E. H.



Lymph node biopsy  


Biopsy - lymph nodes; Open lymph node biopsy; Fine needle aspiration biopsy; Sentinel lymph node biopsy ... A lymph node biopsy is done in an operating room in a hospital. Or, it is done at an outpatient ...


The influence of atrioventricular conduction and heart rate on the pulmonary venous flow pattern.  


The pulmonary venous flow (PVQ) pattern usually has two antegrade flow waves, corresponding to ventricular systole and diastole, respectively, and is used to assess left atrial pressure. To study the effects of atrioventricular conduction (AVD) and heart rate (HR) on the PVQ pattern, transthoracic pulsed Doppler recordings of pulmonary venous, transmitral, and aortic flow were made in five healthy subjects with dual-chamber pacemakers. Recordings were made at HRs of 80, 100, and 120 beats/min, with AVDs of 75, 150, and 220 msec at each HR. When the AVD was increased, the biphasic PVQ changed to a monophasic pattern in which a single flow wave covered the transition between ventricular diastole and systole. There was a shift of flow from ventricular systole to diastole. When HR was increased, the systolic fraction of the PVQ increased as a result of an increase in the relative duration of systole. In conclusion, AVD and HR influenced the PVQ pattern in subjects without signs of ventricular dysfunction. This may be a limitation to the use of the flow pattern to assess left atrial pressure. PMID:8849608

Steen, T; Kongsgaard, E; Soyland, E; Ihlen, H



Analysis of endotoxin effects on pulmonary circulation in terms of pressure-flow characteristics.  


The purpose of the present work was to explore the hypothesis that pulmonary vasoconstriction secondary to endotoxin insult results mainly from an increase in the critical closing pressure of the pulmonary vessels. Specifically, we reasoned that in the face of a Starling resistor located between pulmonary arteries and left atrium, upstream transmission of increased left atrial pressure (Pla) would be inversely related to the level of the pressure intercept (Pi) obtained by extrapolation from the linear pulmonary arterial pressure (Ppa)--flow (Q degrees) plot. Six dogs (group E) were infused with Escherichia coli endotoxin (0.25 microgram/kg/min) for 2 hr, whereas six additional dogs (group C) served as control. During baseline conditions, Pi approximated LAP in both groups. In group C dogs, increasing LAP at constant Q degrees led to a proportional augmentation of Ppa. In group E dogs, endotoxin resulted in a shift of the Ppa-Q relationships to higher pressures due to both increases in Pi and slope. In addition, changes in Pla over the same range as in control dogs affected Ppa only at the highest levels of Pla. We conclude that endotoxin insult increases the critical closing pressure that exceeds Pla and induces the occurrence of a Starling resistor responsible for the production of an effective vascular waterfall. PMID:8485820

D'Orio, V; Fatemi, M; Marnette, J M; Fossion, A; Marcelle, R



Functional assessment of a left coronary-pulmonary artery fistula by coronary flow reserve  

PubMed Central

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. PMID:25061466

Sasi, Viktor; Forster, Tamás; 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



In situ enhancement of pulmonary surfactant function using temporary flow reversal  

PubMed Central

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. PMID:21998268

Glindmeyer, Henry W.; Smith, Bradford J.



Hypoxia has a greater effect than exercise on the redistribution of pulmonary blood flow in swine.  


Strenuous exercise combined with hypoxia is implicated in the development of high-altitude pulmonary edema (HAPE), which is believed to result from rupture of pulmonary capillaries secondary to high vascular pressures. The relative importance of hypoxia and exercise in altering the distribution of pulmonary blood flow (PBF) is unknown. Six chronically catheterized specific pathogen-free Yorkshire hybrid pigs (25.5 +/- 0.7 kg, means +/- SD) underwent incremental treadmill exercise tests in normoxia (Fi(O(2)) = 0.21) and hypoxia (Fi(O(2)) = 0.125, balanced order), consisting of 5 min at 30, 60, and 90% of the previously determined Vo(2max). At steady state (~4 min), metabolic and cardiac output data were collected and fluorescent microspheres were injected over approximately 30 s. Later the fluorescent intensity of each color in each 2-cm(3) lung piece was determined and regional perfusion was calculated from the weight-normalized fluorescence. Both hypoxia and exercise shifted PBF away from the ventral cranial lung regions toward the dorsal caudal regions of the lung, but hypoxia caused a greater dorsal caudal shift in PBF at rest than did near-maximal exercise in normoxia. The variance in PBF due to hypoxia, exercise, and vascular structure was 16 +/- 4.2, 4.0 +/- 4.4, and 59.4 +/- 11.4%, respectively, and the interaction between hypoxia and exercise represented 12 +/- 6.5%. This observation implies that there is already a maximal shift with in PBF with hypoxia in the dorsal-caudal regions in pigs that cannot be exceeded with the addition of exercise. However, exercise greatly increases the pulmonary arterial pressures and therefore the risk of capillary rupture in high flow regions. PMID:17872407

Hopkins, Susan R; Kleinsasser, Axel; Bernard, Susan; Loeckinger, Alex; Falor, Eric; Neradilek, Blazej; Polissar, Nayak L; Hlastala, Michael P



In vivo Raman flow cytometry for real-time detection of carbon nanotube kinetics in lymph, blood, and tissues  

Microsoft Academic Search

Nanoparticles are intensively being explored as contrast agents for medical diagnostics and therapies using various optical methods. We present the first demonstration of the use of time-resolved Raman spectroscopy for in vivo real-time detection of circulating carbon nanotubes (CNTs) or cancer cells labeled with CNTs in the lymph, blood, and tissues of live animals with fast spectral acquisition times of

Alexandru S. Biris; Ekaterina I. Galanzha; Zhongrui Li; Meena Mahmood; Yang Xu; Vladimir P. Zharov



First application of coronary flow reserve measurement for the assessment of left main compression syndrome in pulmonary hypertension.  


Left main compression syndrome (LMCS) refers to extrinsic compression of the left main coronary artery because of a dilated pulmonary artery trunk. The condition represents an unusual cause of angina, left ventricular dysfunction, and sudden cardiac death in patients with pulmonary hypertension. We present 2 patients with the syndrome who were followed with serial assessments of coronary flow reserve by transthoracic echocardiography to screen for LMCS-related ischemia. PMID:25595033

Demerouti, Eftychia; Petrou, Emmanouil; Karatasakis, George; Mastorakou, Irene; Athanassopoulos, George



Imaging of Lymph Flow in Breast Cancer Patients after Microdose Administration of a Near-Infrared Fluorophore: Feasibility Study1  

PubMed Central

Purpose To prospectively demonstrate the feasibility of using indocyanine green, a near-infrared (NIR) fluorophore at the minimum dose needed for noninvasive optical imaging of lymph nodes (LNs) in breast cancer patients undergoing sentinel lymph node mapping (SLNM). Materials and Methods Informed consent was obtained from 24 women (age range, 30–85 years) who received intradermal subcutaneous injections of 0.31–100 ?g indocyanine green in the breast in this IRB-approved, HIPAA-compliant, dose escalation study to find the minimum microdose for imaging. The breast, axilla, and sternum were illuminated with NIR light and the fluorescence generated in the tissue was collected with an NIR-sensitive intensified charged-coupled device. Lymphoscintigraphy was also performed. Resected LNs were evaluated for the presence of radioactivity, blue dye accumulation, and fluorescence. The associations between the resected LNs that were fluorescent and (a) the time elapsed between NIR fluorophore administration and resection and (b) the dosage of NIR fluorophores were tested with the Spearman rank and Pearson product moment correlation tests, respectively. Results Lymph imaging consistently failed with indocyanine green microdosages between 0.31 and 0.77 ?g. When indocyanine green dosages were 10 ?g or higher, lymph drainage pathways from the injection site to LNs were imaged in eight of nine women; lymph propulsion was observed in seven of those eight. When propulsion in the breast and axilla regions was present, the mean apparent velocities ranged from 0.08 to 0.32 cm/sec, the time elapsed between “packets” of propelled fluid varied from 14 to 92 seconds. In patients who received 10 ?g of indocyanine green or more, a weak negative correlation between the fluorescence status of resected LNs and the time between NIR fluorophore administration and LN resection was found. No statistical association was found between the fluorescence status of resected LNs and the dose of NIR fluorophore. Conclusion NIR fluorescence imaging of lymph function and LNs is feasible in humans at microdoses that would be needed for future molecular imaging of cancer-positive LNs. PMID:18223125

Sevick-Muraca, Eva M.; Sharma, Ruchi; Rasmussen, John C.; Marshall, Milton V.; Wendt, Juliet A.; Pham, Hoang Q.; Bonefas, Elizabeth; Houston, Jessica P.; Sampath, Lakshmi; Adams, Kristen E.; Blanchard, Darlene Kay; Fisher, Ronald E.; Chiang, Stephen B.; Elledge, Richard; Mawad, Michel E.



Smoke aldehyde component influences pulmonary edema  

SciTech Connect

The pulmonary edema of smoke inhalation is caused by the toxins of smoke and not the heat. We investigated the potential of smoke consisting of carbon in combination with either acrolein or formaldehyde (both common components of smoke) to cause pulmonary edema in anesthetized sheep. Seven animals received acrolein smoke, seven animals received a low-dose formaldehyde smoke, and five animals received a high-dose formaldehyde smoke. Pulmonary arterial pressure, pulmonary capillary wedge pressure, and cardiac output were not affected by smoke in any group. Peak airway pressure increased after acrolein (14 +/- 1 to 21 +/- 2 mmHg; P less than 0.05) and after low- and high-dose formaldehyde (14 +/- 1 to 21 +/- 1 and 20 +/- 1 mmHg, respectively; both P less than 0.05). The partial pressure of O2 in arterial blood fell sharply after acrolein (219 +/- 29 to 86 +/- 9 (SE) Torr; P less than 0.05) but not after formaldehyde. Only acrolein resulted in a rise in lung lymph flow (6.5 +/- 2.2 to 17.9 +/- 2.6 ml/h; P less than 0.05). Lung lymph-to-plasma protein ratio was unchanged for all three groups, but clearance of lymph protein was increased after acrolein. After acrolein, the blood-free extravascular lung water-to-lung dry weight ratio was elevated (P less than 0.05) compared with both low- and high-dose formaldehyde groups (4.8 +/- 0.4 to 3.3 +/- 0.2 and 3.6 +/- 0.2, respectively). Lymph clearance (ng/h) of thromboxane B2, leukotriene B4, and the sulfidopeptide leukotrienes was elevated after acrolein but not formaldehyde.(ABSTRACT TRUNCATED AT 250 WORDS)

Hales, C.A.; Musto, S.W.; Janssens, S.; Jung, W.; Quinn, D.A.; Witten, M. (Department of Medicine (Pulmonary/Critical Care Unit), Massachusetts General Hospital, Boston (United States))



Dynamic pulmonary hyperinflation occurs without expiratory flow limitation in chronic heart failure during exercise.  


To assess the occurrence of tidal expiratory flow limitation (EFL) and/or dynamic pulmonary hyperinflation (DH) in chronic heart failure (CHF) during exercise 15 patients with stable systolic CHF, aged 69 ± 6yr, underwent pulmonary function testing and incremental cardio-pulmonary exercise testing. They subsequently performed constant load exercise testing at 30, 60 and 90% of respective maximum workload. At each step the presence of EFL, by negative expiratory pressure technique, and changes in inspiratory capacity (IC) were assessed. Ejection fraction amounted to 36 ± 6% and VO?, peak (77 ± 19% pred.) was reduced. EFL was absent at any step during constant load exercise. In 6 patients IC decreased more than 10% pred. at highest step. Only in these patients TLC, FRC, RV FEF(25-75%) and DL(CO) were decreased at rest. VO?, peak correlated with DL(CO), TLC and IC at rest and with IC (r(2)=0.59; p<0.001) and decrease in IC (r(2)=0.44; p<0.001) at 90% of maximum workload. During exercise CHF patients do not exhibit EFL, but some of them develop DH that is associated with lower VO?, peak. PMID:23851110

Chiari, Stefania; Torregiani, Chiara; Boni, Enrico; Bassini, Sonia; Vizzardi, Enrico; Tantucci, Claudio



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.



The acute effects of low flow oxygen and isosorbide dinitrate on left and right ventricular ejection fractions in chronic obstructive pulmonary disease  

SciTech Connect

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.



Circulation of lymph (image)  


... the bloodstream during normal circulation is filtered through lymph nodes to remove bacteria, abnormal cells and other ... then transported back into the bloodstream via the lymph vessels. Lymph only moves in one direction, toward ...


Swollen lymph nodes  


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 ...


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.



PPAR-? Regulates Carnitine Homeostasis and Mitochondrial Function in a Lamb Model of Increased Pulmonary Blood Flow  

PubMed Central

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. PMID:22962578

Rafikov, Ruslan; Kumar, Sanjiv; Hou, Yali; Oishi, Peter E.; Datar, Sanjeev A.; Raff, Gary; Fineman, Jeffrey R.; Black, Stephen M.



Pulmonary hypertension  


Pulmonary arterial hypertension; Sporadic primary pulmonary hypertension; Familial primary pulmonary hypertension; Idiopathic pulmonary arterial hypertension; Primary pulmonary hypertension; PPH; Secondary pulmonary hypertension


Patterns of forced expiratory flows in groups at risk for chronic obstructive pulmonary disease.  


In a modified case-control study of obstructive pulmonary disease (COPD), airways obstruction has been found to be associated with age, sex, protease inhibitor type, socioeconomic status (SES) and smoking. In this paper patterns of forced expiratory flows are examined in persons demonstrating various risk factors. Two broad patterns of flow limitation emerge. The first pattern, characterized by lower flows at high lung volumes, is found in first-degree relatives of patients with COPD and subjects with a low SES. This pattern, consistent dysfunction of large airways, may reflect reversible decreases of airway caliber. The second pattern, characterized by lower flows at low lung volumes, is found in older subjects. This pattern, consistent with nonhomogeneously emptying lungs or dysfunction of small airways, may reflect more chronic irreversible changes. Smokers and male subjects exhibit both patterns of flow limitation when compared with subjects who had never smoked and female subjects. It is possible that the combination of the patterns reflects a particularly high risk for the development of COPD in male smokers. PMID:7354580

Graves, C G; Menkes, H A; Chase, G A; Cohen, B H; Diamond, E L; Levy, D A; Permutt, S; Tockman, M S



Regional pulmonary blood flow measurement in humans with electron-beam computed tomography  

NASA Astrophysics Data System (ADS)

Electron beam computed tomography (EBCT) is a potentially useful modality to quantitate regional pulmonary flow (RPF) with minimal invasiveness, in part because it has good spatial and temporal resolution. The present studies used a single compartment model of indicator transport and EBCT to measure regional tissue flow in the lungs of human subjects. The model postulates that flow is proportional to maximal enhancement and assumes complete tissue accumulation of indicator before significant indicator washout (WO). EBCT flow studies were retrospectively analyzed with respect to RPF in 10 adult patients who had undergone clinically indicated or research cardiovascular studies. Time density curves from the left atrial (LA) cavity and one-third segments of left (LL) and right (RL) lungs (A: anterior, M: middle, and P: posterior segments) were used to calculate RPF. Washout was determined as the percent of the LA curve at the time of peak parenchymal opacification using gamma curve fits to both tissue data and the LA curve data. Mean +/- standard deviation RPF in ml/min/ml was 0.8 +/- 0.4, 1.1 +/- 0.4, and 1.3 +/- 0.4 for A, M, and P respectively for one-third regions in the left lung. Similar results were found in the right lung. No difference in RPF was found when images were measured either by including the largest of visible parenchymal vessels or when such vessels were excluded. Flow in A of LL and RL was less than that in M or P. Average WO was about 10%, with a range of 0-41% of the LA curve area. There was no significant difference between one-third segment WO using pairwise comparison on the left and right sides when tested separately. RPF values were greater in the posterior vs anterior regions of these supine patients. In conclusion, EBCT can detect gravity related flow differences in the human lung. EBCT has potential for clinical assessment of absolute regional pulmonary flow determination in animals and man.

Holt, William W.; Konhilas, John; Wolfkiel, Christopher J.



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  

PubMed Central

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. PMID:23883669



Acute postobstructive pulmonary edema  

Microsoft Academic Search

Acute postobstructive pulmonary edema may occur after airway obstruction. A decrease in intrathoracic and intraalveolar pressures causes an increased blood flow into the pulmonary vasculature and favors the development of pulmonary edema. Two mechanisms for the development of acute postobstructive pulmonary edema are proposed: type 1 follows acute airway obstruction, and type 2 follows relief of chronic airway obstruction. (OTOLARYNGOL




SEER Lymph Node Fields

1 1 SEER Lymph Node Codes SEER Lymph Node Codes Revisited SEER Program Training Materials October 2002 2 SEER Lymph Node Codes EOD Lymph Node Involvement Number of Regional Nodes Positive Number of Regional


L-Carnitine Preserves Endothelial Function in a Lamb Model of Increased Pulmonary Blood Flow  

PubMed Central

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. PMID:23628882

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.



The effects of artificial lung inflation on pulmonary blood flow and heart rate in the turtle Trachemys scripta.  


As for most ectothermic vertebrates, the breathing pattern of turtles is episodic, and pulmonary blood flow (Qpul) and heart rate (fH) normally increase several-fold during spontaneous ventilation. While some previous studies suggest that these cardiovascular changes are caused by stimulation of pulmonary stretch receptors (PSRs) during ventilation, it has been noted in other studies that blood flows often change prior to the initiation of breathing. Given the uncertainty regarding the role of PSRs in the regulation of central vascular blood flows, we examined the effect of manipulating lung volume (and therefore PSR stimulation) on blood flows and heart rate in the freshwater turtle Trachemys scripta. Turtles were instrumented with blood flow probes on the left aortic arch and the left pulmonary artery for measurements of blood flow, and catheters were inserted into both lungs for manipulation of lung volume. In both anaesthetized and fully recovered animals, reductions or increases in lung volume by withdrawal of lung gas or injection of air, N2, O2 or 10% CO2 (in room air) had no effect on blood flows. Furthermore, simulations of normal breathing bouts by withdrawal and injection of lung gas did not alter Qpul or fH. We conclude that stimulation of PSRs is not sufficient to elicit cardiovascular changes and that the large increase in Qpul and fH normally observed during spontaneous ventilation are probably caused by a simultaneous feedforward control of central origin. PMID:9366085

Herman, J; Wang, T; Smits, A W; Hicks, J W



Redistribution of pulmonary blood flow impacts thermodilution-based extravascular lung water measurements in a model of acute lung injury  

PubMed Central

Background Studies using transthoracic thermodilution have demonstrated increased extravascular lung water (EVLW) measurements attributed to progression of edema and flooding during sepsis and acute lung injury. We hypothesize that redistribution of pulmonary blood flow can cause increased apparent EVLW secondary to increased perfusion of thermally silent tissue, not increased lung edema. Methods Anesthetized, mechanically ventilated canines were instrumented with PiCCO® (Pulsion Medical, Munich, Germany) catheters and underwent lung injury by repetitive saline lavage. Hemodynamic and respiratory physiologic data were recorded. After stabilized lung injury, endotoxin was administered to inactivate hypoxic pulmonary vasoconstriction. Computerized tomographic imaging was performed to quantify in vivo lung volume, total tissue (fluid) and air content, and regional distribution of blood flow. Results Lavage injury caused an increase in airway pressures and decreased arterial oxygen content with minimal hemodynamic effects. EVLW and shunt fraction increased after injury and then markedly following endotoxin administration. Computerized tomographic measurements quantified an endotoxin-induced increase in pulmonary blood flow to poorly aerated regions with no change in total lung tissue volume. Conclusions The abrupt increase in EVLW and shunt fraction after endotoxin administration is consistent with inactivation of hypoxic pulmonary vasoconstriction and increased perfusion to already flooded lung regions that were previously thermally silent. Computerized tomographic studies further demonstrate in vivo alterations in regional blood flow (but not lung water) and account for these alterations in shunt fraction and EVLW. PMID:19809280

Easley, R. Blaine; Mulreany, Daniel G.; Lancaster, Christopher T.; Custer, Jason W.; Fernandez-Bustamante, Ana; Colantuoni, Elizabeth; Simon, Brett A.



Non-invasive estimation of pulmonary vascular resistance in patients of pulmonary hypertension in congenital heart disease with unobstructed pulmonary flow  

PubMed Central

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. PMID:24987253

Pande, Arindam; Sarkar, Achyut; Ahmed, Imran; Naveen Chandra, GS; Patil, Shailesh Kumar; Kundu, Chanchal Kumar; Arora, Rahul; Samanta, Ajanta



Lymph Node Flow Cytometry as a Prompt Recognition of Ultra Early Onset PTLD: A Successful Case of Rituximab Treatment  

PubMed Central

Ultra early posttransplantation lymphoproliferative disorder (PTLD) is a rare and fatal complication after hematopoietic stem cell transplantation (HSCT). Here we report, by lymph node (LN) flowcytometry, that we early recognized ultra early PTLD after an HLA-matched sibling allo-HSCT followed by a successful treatment with anti-CD20 antibody (rituximab) in a patient in progress disease for angioimmunoblastic T-cell lymphoma (AITL). The patient was conditioned with a reduced intensity conditioning (RIC) regimen. One week after transplantation, the patient developed high fever, generalized fatigue, high Epstein-Barr virus (EBV) load, and LN enlargement. An LN lymphocyte suspension and peripheral blood flowcytometry was performed to find majority of LN lymphocytes highly expressed CD20. By highly suspicious PTLD, 4 doses of rituximab (375?mg/m2?qw) were given immediately followed by reducing and withdrawing immunosuppressant reagent. PTLD was later confirmed by pathology. The patient had good response to rituximab, showing absence of fever, reduction in LN size, and no detectable EBV-DNA. Twenty months after HSCT, the patient remains well without evidence of AITL and PTLD. The current report is one of the earliest cases of PTLD after HSCT. Taken together, by LN flowcytometry as a prompt recognition, rituximab can be an effective preemptive therapy for ultra early developed PTLD.

Li, Xiaofan; Li, Nainong; Yang, Ting; Chen, Zhizhe; Hu, Jianda



Perinatal changes in superoxide generation in the ovine lung: Alterations associated with increased pulmonary blood flow  

PubMed Central

Although alterations in ROS generating systems are well described in several vascular disorders, there is very limited information on the perinatal regulation of these systems in the lung both during normal development and in pulmonary hypertension. Thus, this study was undertaken to explore how the two predominant superoxide generating systems, nicotinamide adenine dinucleotide phosphate-oxidase (NADPH oxidase) and xanthine oxidase (XO), are developmentally regulated in control lambs and in our established lamb model of increased pulmonary blood flow (Shunt) over the first 2 months of life. We found that the levels of p47phox, p67phox, and Rac1 subunits of NADPH oxidase complex were altered. During the first two months of life there was no change in p47phox protein levels in either normal or Shunt lambs. However, both p67phox and Rac1 protein levels decreased over time. In addition, p47phox protein levels were significantly increased in shunt lambs at 2- and 4-, but not 8-weeks of age compared to age-matched controls while levels of the p67phox subunit were decreased at 8-weeks of age in the Shunts but unchanged at other time periods. Furthermore, Rac1 protein expression was significantly increased in the Shunts only at 4 weeks of age. These data correlated with a significant increase in NADPH oxidase-dependent superoxide generation at 2- and 4-, but not 8-weeks of age in the Shunts. During normal development XO levels significantly increased over time in normal lambs but significantly decreased in the Shunts. In addition, XO protein levels were significantly increased in the Shunt at 2- and 4-weeks of age but significantly decreased at 8-weeks. Again this correlated with a significant increase in XO-dependent superoxide generation at 2- and 4-, but not 8-weeks of age in the Shunts. Collectively, our findings suggest that NADPH oxidase and XO are major contributors to superoxide generation both during the normal development and during the development of pulmonary hypertension. PMID:20362073

Sharma, Shruti; Kumar, Sanjiv; Wiseman, Dean A.; Kallarackal, Suphin; Ponnala, Sumant; Elgaish, Manal; Fineman, Jeffrey R.; Black, Stephen M.



Role of Rho-kinase signaling and endothelial dysfunction in modulating blood flow distribution in pulmonary hypertension.  


Rho-kinase-mediated vasoconstriction and endothelial dysfunction are considered two primary instigators of pulmonary arterial hypertension (PAH). However, their contribution to the adverse changes in pulmonary blood flow distribution associated with PAH has not been addressed. This study utilizes synchrotron radiation microangiography to assess the specific role, and contribution of, Rho-kinase-mediated vasoconstriction and endothelial dysfunction in PAH. Male adult Sprague-Dawley rats were injected with saline (Cont-rats) or monocrotaline (MCT-rats) 3 wk before microangiography was performed on the left lung. We assessed dynamic changes in vessel internal diameter (ID) in response to 1) the Rho-kinase inhibitor fasudil (10 mg/kg iv); or 2) ACh (3 ?g · kg?¹ · min?¹), sodium nitroprusside (SNP, 5 ?g · kg?¹ · min?¹), and N(?)-nitro-l-arginine methyl ester (l-NAME, 50 mg/kg iv). We observed that MCT-rats had fewer vessels of the microcirculation compared with Cont-rats. The fundamental result of this study is that fasudil improved pulmonary blood flow distribution and reduced pulmonary pressure in PAH rats, not only by dilating already-perfused vessels (ID > 100 ?m), but also by restoring blood flow to vessels that had previously been constricted closed (ID < 100 ?m). Endothelium-dependent vasodilation was impaired in MCT-rats primarily in vessels with an ID < 200 ?m. Moreover the vasoconstrictor response to l-NAME was accentuated in MCT-rats, but only in the 200- to 300-?m vessels. These results highlight the importance of Rho-kinase-mediated control and endothelial control of pulmonary vascular tone in PAH. Indeed, an effective therapeutic strategy for treating PAH should target both the smooth muscle Rho-kinase and endothelial pathways. PMID:21212241

Schwenke, Daryl O; Pearson, James T; Sonobe, Takashi; Ishibashi-Ueda, Hatsue; Shimouchi, Akito; Kangawa, Kenji; Umetani, Keiji; Shirai, Mikiyasu



Swollen lymph node (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 ...


Transesophageal echocardiographic Doppler study of the pulmonary venous flow pattern in severe mitral stenosis with variable degrees of mitral regurgitation.  


The transesophageal echocardiographic data of 62 patients with severe, rheumatic mitral stenosis, which was either isolated or associated with different degrees of mitral regurgitation were reviewed to study and compare their pulmonary venous flow patterns. Peak systolic and peak diastolic flow velocities and their respective time intervals were measured, and the presence or absence of systolic flow reversal (SFR) was noted. The venous flow velocities and time integrals were all below normal and the ratio between the systolic and diastolic velocities were all blunted. Systolic flow reversal was observed in some patients with severe mitral stenosis with or without mitral regurgitation, and was highly correlated with the presence of atrial fibrillation. Among patients with mitral regurgitation and in atrial fibrillation, flow reversal timing was shorter in patients with significant mitral regurgitation than in patients with mild or no mitral regurgitation. PMID:9203494

Palileo, R A; Santos, R J



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.



Variations in Respiratory Excretion of Carbon Dioxide Can Be Used to Calculate Pulmonary Blood Flow  

PubMed Central

Background A non-invasive means of measuring pulmonary blood flow (PBF) would have numerous benefits in medicine. Traditionally, respiratory-based methods require breathing maneuvers, partial rebreathing, or foreign gas mixing because exhaled CO2 volume on a per-breath basis does not accurately represent alveolar exchange of CO2. We hypothesized that if the dilutional effect of the functional residual capacity was accounted for, the relationship between the calculated volume of CO2 removed per breath and the alveolar partial pressure of CO2 would be reversely linear. Methods A computer model was developed that uses variable tidal breathing to calculate CO2 removal per breath at the level of the alveoli. We iterated estimates for functional residual capacity to create the best linear fit of alveolar CO2 pressure and CO2 elimination for 10 minutes of breathing and incorporated the volume of CO2 elimination into the Fick equation to calculate PBF. Results The relationship between alveolar pressure of CO2 and CO2 elimination produced an R2 = 0.83. The optimal functional residual capacity differed from the “actual” capacity by 0.25 L (8.3%). The repeatability coefficient leveled at 0.09 at 10 breaths and the difference between the PBF calculated by the model and the preset blood flow was 0.62 ± 0.53 L/minute. Conclusions With variations in tidal breathing, a linear relationship exists between alveolar CO2 pressure and CO2 elimination. Existing technology may be used to calculate CO2 elimination during quiet breathing and might therefore be used to accurately calculate PBF in humans with healthy lungs. PMID:25436024

Preiss, David A.; Azami, Takafumi; Urman, Richard 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; Aricò, 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.



Pulmonary Extramedullary Hematopoiesis Involving the Pulmonary Artery  

PubMed Central

Extramedullary hematopoiesis (EMH) occurs as a complication of hematologic disorders such as myelofibrosis, sickle cell anemia and thalassemia. The extramedullary tissue usually involves liver, spleen and lymph nodes, less frequently the chest. We present a recent case of a man with myeloproliferative neoplasm who developed pulmonary hemorrhage secondary to EMH in the lung and pulmonary artery. Radiation therapy was considered the best approach, but it didn’t work and the patient died a week after radiation therapy was completed. We also review herein the present literature.

Monga, Varun; Silverman, Margarida



Video-assisted thoracoscopic surgery (VATS) right upper lobectomy and systematic lymph node dissection for lung cancer  

PubMed Central

Video-assisted thoracoscopic surgery (VATS) represents a new trend in the development of minimally invasive thoracic surgery. When applied in lung cancer surgeries, VATS can be used for both pulmonary lobectomy and regional lymph node dissection. Currently the main concerns are focused on the completeness of lymph node dissection for lung cancer and the safety of surgery. The lymph node dissection includes two parts: (I) dissection of interlobar and hilar lymph nodes; and (II) dissection of mediastinal lymph nodes. The demonstrated surgical procedures are featured by: (I) the interlobar and hilar lymph nodes are not removed separately; rathr, they are taken out en bloc with the pulmonary lobes during the surgery; and (II) systematic lymph node dissection, instead of systematic sampling, is applied for the removal of mediastinal lymph nodes. Also, during the fully anatomical resection, each blood vessel and bronchus underwent anatomical dissociation, indicating that this surgery is safe. PMID:24040542

Yang, Hong; Zheng, Ying-Bin; Huang, Qing-Yuan



Basic avian pulmonary design and flow-through ventilation in non-avian theropod dinosaurs  

E-print Network

respiratory system includes high-compliance air sacs that ventilate a dorsally fixed, non-expanding ancestors of living birds11,13 , have proposed a crocodylian-like pulmonary system with a hepatic-piston


Bidirectional Glenn shunt as an adjunct to surgical repair of congenital heart disease associated with pulmonary outflow obstruction: relevance of the fluid pressure drop-flow relationship.  


A bidirectional Glenn shunt (BGS) was successfully incorporated into a two-ventricle repair for 10 patients (age, 3-17 years) who had congenital heart disease associated with severe pulmonary outflow obstruction. The BGS was used to volume-unload the pulmonary ventricle faced with residual outflow obstruction, thereby avoiding the need for insertion of a ventricle-to-pulmonary artery conduit. Transthoracic Doppler flow velocity analysis was used to determine transpulmonary peak systolic pressure drops as a measure of obstruction. Preoperative values ranged from 70 to 100 mmHg, and postoperative values ranged from less than 10 to 16 mmHg. At this writing, all patients are doing well 15 to 52 months after surgery. To gain further insight into the reduced pressure drop that may be achieved by decreasing flow rate across obstruction, a computer-based description of fluid flow was used to simulate blood traversing circumferentially narrowed passages. Overall pressure drops and associated flow energy losses were determined from numeric solutions (using finite-element analysis) to the Navier-Stokes equations for the proposed fluid reactions. Pressure drops and flow energy losses were found to decrease dramatically as flow rate was progressively reduced. For selected patients, a BGS can be an effective adjunct to the surgical treatment of pulmonary outflow obstruction. This approach avoids the use of a ventricle-to-pulmonary artery conduit, and thus the inevitable need in most patients for reoperations because of somatic growth, conduit failure, or both. PMID:18551335

Ascuitto, Robert; Ross-Ascuitto, Nancy; Wiesman, Joshua; Deleon, Serafin



Vertical Distributions of Pulmonary Diffusing Capacity and Capillary Blood Flow in Man  

PubMed Central

In six normal upright subjects, a 100 mol bolus—composed of equal parts of neon, carbon monoxide, and acetylene (Ne, CO, and C2H2)—was inspired from either residual volume (RV) or functional residual capacity (FRC) during a slow inspiration from RV to total lung capacity (TLC). After breath holding and subsequent collection of the exhalate, diffusing capacity and pulmonary capillary blood flow per liter of lung volume (DL/VA and Q?C/VA) were calculated from the rates of CO and C2H2 disappearances relative to Ne. The means: DL/VA = 5.26 ml/min × mm Hg per liter (bolus at RV), 6.54 ml/min × mm Hg per liter (at FRC); Q?C/VA 0.537 liters/minute per liter (bolus at RV), 0.992 liters/minute per liter (at FRC). Similar maneuvers using Xenon-133 confirmed that, during inspiration, more of the bolus goes to the upper zone if introduced at RV and more to the lower, if at FRC. A lung model has been constructed which describes how DL/VA and Q?C/VA must be distributed to satisfy the experimental data. According to this model, there is a steep gradient of Q?C/VA, increasing from apex to base, similar to that previously determined by other techniques—and also a gradient in the same direction, although not as steep, for DL/VA. This more uniform distribution of DL/VA compared with Q?C/VA indicates a vertical unevenness of diffusing capacity with respect to blood flow (DL/Q?C). However, the relative degree of vertical unevenness of DL/VA compared with Q?C/VA can account only in part for previous observations attributed to the inhomogeneity of DL/VA and Q?C/VA. Thus, a more generalized unevennes of these ratios must exist throughout the lung, independent of gravitation. Images PMID:4683876

Michaelson, Edward D.; Sackner, Marvin A.; Johnson, Robert L.



Inspiratory flows through dry powder inhaler in chronic obstructive pulmonary disease: age and gender rather than severity matters  

PubMed Central

Background: Dry powder inhalers (DPIs) are inspiratory flow driven and hence flow dependent. Most patients with chronic obstructive pulmonary disease (COPD) are elderly and have poor lung function. The factors affecting their inspiratory flows through inhalers are unclear. Objective: To study peak inspiratory flows (PIFs) and their determinants through a DPI in COPD patients of varying age and severity. Methods: Flow-volume spirometry was performed in 93 COPD patients. Maximum PIF rates were recorded through an empty Easyhaler® (PIFEH; Orion Corporation, Espoo, Finland), a DPI that provides consistent dose delivery at inhalation rates through the inhaler of 28 L/min or higher. Results: The mean PIFEH was 54 L/min (range 26–95 L/min) with a coefficient of variation of 7%. All but two patients were able to generate a flow of ?28 L/min. In a general linear model, the independent determinants for PIFEH were age (P = 0.02) and gender (P = 0.01), and forced expiratory volume in 1 s (FEV1) expressed as percent predicted was not a significant factor. The regression model accounted only for 18% of the variation in PIFEH. Conclusion: In patients with COPD, age and gender are more important determinants of inspiratory flow through DPIs than the degree of expiratory airway obstruction. Most COPD patients with varying age and severity are able to generate inspiratory flows through the test inhaler that is sufficient for optimal drug delivery to the lower airways. PMID:20714380

Malmberg, L Pekka; Rytilä, Paula; Happonen, Pertti; Haahtela, Tari



Pulmonary venous flow determinants of left atrial pressure under different loading conditions in a chronic animal model with mitral regurgitation  

NASA Technical Reports Server (NTRS)

BACKGROUND: The aim of our study was to quantitatively compare the changes and correlations between pulmonary venous flow variables and mean left atrial pressure (mLAP) under different loading conditions in animals with chronic mitral regurgitation (MR) and without MR. METHODS: A total of 85 hemodynamic conditions were studied in 22 sheep, 12 without MR as control (NO-MR group) and 10 with MR (MR group). We obtained pulmonary venous flow systolic velocity (Sv) and diastolic velocity (Dv), Sv and Dv time integrals, their ratios (Sv/Dv and Sv/Dv time integral), mLAP, left ventricular end-diastolic pressure, and MR stroke volume. We also measured left atrial a, x, v, and y pressures and calculated the difference between v and y pressures. RESULTS: Average MR stroke volume was 10.6 +/- 4.3 mL/beat. There were good correlations between Sv (r = -0.64 and r = -0.59, P <.01), Sv/Dv (r = -0.62 and r = -0.74, P <.01), and mLAP in the MR and NO-MR groups, respectively. Correlations were also observed between Dv time integral (r = 0.61 and r = 0.57, P <.01) and left ventricular end-diastolic pressure in the MR and NO-MR groups. In velocity variables, Sv (r = -0.79, P <.001) was the best predictor of mLAP in both groups. The sensitivity and specificity of Sv = 0 in predicting mLAP 15 mm Hg or greater were 86% and 85%, respectively. CONCLUSION: Pulmonary venous flow variables correlated well with mLAP under altered loading conditions in the MR and NO-MR groups. They may be applied clinically as substitutes for invasively acquired indexes of mLAP to assess left atrial and left ventricular functional status.

Yang, Hua; Jones, Michael; Shiota, Takahiro; Qin, Jian Xin; Kim, Yong Jin; Popovic, Zoran B.; Pu, Min; Greenberg, Neil L.; Cardon, Lisa A.; Eto, Yoko; Sitges, Marta; Zetts, Arthur D.; Thomas, James D.



Reperfusion pulmonary edema  

SciTech Connect

Reperfusion following lower-torso ischemia in humans leads to respiratory failure manifest by pulmonary hypertension, hypoxemia, and noncardiogenic pulmonary edema. The mechanism of injury has been studied in the sheep lung lymph preparation, where it has been demonstrated that the reperfusion resulting in pulmonary edema is due to an increase in microvascular permeability of the lung to protein. This respiratory failure caused by reperfusion appears to be an inflammatory reaction associated with intravascular release of the chemoattractants leukotriene B{sub 4} and thromboxane. Histological studies of the lung in experimental animals revealed significant accumulation of neutrophils but not platelets in alveolar capillaries. The authors conclude that thromboxane generated and released from the ischemic tissue is responsible for the transient pulmonary hypertension. Second, it is likely that the chemoattractants are responsible for leukosequestration, and third, neutrophils, oxygen-derived free radicals, and thromboxane moderate the altered lung permeability.

Klausner, J.M.; Paterson, I.S.; Mannick, J.A.; Valeri, C.R.; Shepro, D.; Hechtman, H.B. (Harvard Medical School, Boston, MA (USA))



Mediastinal lymph node size in lung cancer  

SciTech Connect

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.



Facts about Pulmonary Atresia  


... of the heart where the valve that controls blood flow from the heart to the lungs doesnâ??t ... pulmonary valve, which is the valve that controls blood flow from the right ventricle (lower right chamber of ...


Aberrant Venous Flow Measurement May Predict the Clinical Behavior of a Fetal Extralobar Pulmonary Sequestration  

Microsoft Academic Search

Objective: Fetal extralobar pulmonary sequestration (EPS) is sometimes complicated by a massive pleural effusion, leading to tension hydrothorax and fetal hydrops. The goal of this study was to examine sonographic signs of venous obstruction in fetal EPS with or without pleural effusion. Methods: Records of fetal ultrasound from 6 patients with EPS were reviewed with special attention to aberrant arterial

Yoshihiro Kitano; Haruhiko Sago; Satoshi Hayashi; Tatsuo Kuroda; Toshiro Honna; Nobuyuki Morikawa



British Journal of Anaesthesia 1995; 74: 209-216 Effects of isoflurane on regional pulmonary blood flow during one-lung ventilation  

E-print Network

Isoflurane has been reported to inhibit hypoxic pulmonary vasoconstriction. However, the effects of one-lung ventilation and isoflurane on regional pulmonary blood flow (Qr) have not been investi-gated in detail. Therefore, using radionuclide labelled microspheres we measured Qr in rabbits (n = 8) in the left lateral decubitus position during two- and one-lung ventilation under i.v. baseline anaesthesia and during additional administration of 1.5 % isoflurane. Macrohaemodynamic variables were recorded continuously. Isoflurane increased non-dependent lung blood flow during two-lung ventilation. One-lung ventilation caused a homo-geneous decrease in Qr throughout the hypoxic lung, irrespective of isoflurane administration (P <

J. Groh; G. E. H. Kuhnle; L. Ney; A. Sckell; A. E. Goetz


Blood and Lymph Diseases  


... in direct contact with the external environment, the circulatory system acts as a transport system for these cells. Two distinct fluids move through the circulatory system: blood and lymph. Blood carries oxygen and nutrients ...


Sentinel Lymph Node Biopsy

A fact sheet that describes the sentinel lymph node biopsy (SLNB) procedure, its use in determining the extent, or stage, of cancer in the body, and the results of research on the use of SLNB in breast cancer and melanoma.


Leukocyte involvement in pulmonary localization of blood-borne microparticulates: relationship to altered lung fluid balance.  


The lung lymph fistula preparation in sheep was used to study the influence of localization of blood-borne foreign microparticulates in the lung on lymph flow (Qlym); lymph-to-plasma total protein concentration ratios (L/P); pulmonary transvascular protein clearance (Qlym X L/P); and pulmonary hemodynamics. Test particles small enough to readily pass through capillary beds were infused intraarterially to avoid acute lung vascular injury by macroembolism. In sheep, tissue distribution patterns demonstrated that by 15 min after intravenous infusion of the gelatinized reticuloendothelial (RE) test lipid emulsion (0.8-1.0 micron) or gelatinized colloidal carbon (250 A), 30-35% of the injected particle dose localized in the lung, with approximately 15-22% in RE cell-rich organs such as the liver. Particle infusion resulted in an acute neutropenia in the absence of a decline in platelets. Electron microscopy revealed that the increased particulate localization in the lung reflected particle uptake by marginated phagocytic cells as well as the presence of microaggregates within the vascular space. Lung localization of both particulates resulted in approximately a 200-300% increase in both lymph flow and transvascular protein clearance. The hemodynamic response coupled with the pattern of transvascular protein clearance in relationship to lymph flow suggests that the alterations in fluid and protein flux were due to both an increase in microvascular pressure as well as an increase in lung vascular permeability. Marginated phagocytic cells which rapidly ingest the blood-borne foreign test particles may contribute to the altered lung fluid balance seen with the entrance of foreign or abnormal microparticulates in the blood. PMID:6705154

Niehaus, G D; Saba, T M; Edmonds, R H; Dillon, B C



Pulmonary transvascular flux of transferrin  

SciTech Connect

We compared the pulmonary transvascular fluxes of transferrin and albumin in the intact sheep lung. Anesthetized sheep were prepared with lung lymph fistulas. The vascular blood pool was marked with {sup 99m}Tc-erythrocytes, autologous transferrin was labeled with {sup 113m}In, and albumin was labeled with {sup 125}I. Samples of blood, plasma, lymph, and lung were obtained up to 180 min after tracer infusion. Lymph tissue radioactivities were corrected for the intravascular component and expressed as extravascular-to-plasma concentration ratios. Clearance of transferrin and albumin from the plasma space followed a two-compartment model. The clearance rate constant was 2.1 {plus minus} 0.1 x 10(-3) min for albumin and 2.4 {plus minus} 0.1 x 10(-3) min for transferrin (P less than 0.05). Lymph-to-plasma ratios for albumin and transferrin were not different. However, the extravascular-to-plasma ratio for albumin was greater than transferrin (P less than 0.05). The lymph and lung data were deconvoluted for the plasma input function and fit to a two-compartment model. The results indicate that albumin and transferrin have similar permeabilities across the vascular barrier but have different pulmonary circulation to lymph kinetics because the extravascular volume of distribution of albumin is greater than transferrin.

Cooper, J.A.; Malik, A.B. (Albany Medical College of Union Univ., NY (USA))



Phase-Contrast MRI and CFD Modeling of Apparent 3He Gas Flow in Rat Pulmonary Airways  

PubMed Central

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. PMID:22771528

Minard, Kevin R.; Kuprat, Andrew P.; Kabilan, Senthil; Jacob, Richard E.; Einstein, Daniel R.; Carson, James P.; Corley, Richard A.



Left ventricular end-diastolic pressure can be estimated by either changes in transmitral inflow pattern during valsalva maneuver or analysis of pulmonary venous flow.  


We directly compared the transmitral inflow pattern during preload reduction and pulmonary venous flow velocities to determine left ventricular end-diastolic pressure (LVEDP) in 78 patients who underwent left heart catheterization. Transmitral inflow indexes (A-wave duration, ratio of peak flow velocity of early diastole [E] to peak flow velocity of late diastole during atrial contraction [A] [E/A ratio]) at rest and during the Valsalva maneuver (30 mm Hg for 15 seconds) and indexes of pulmonary venous flow (velocity and duration of the atrial reversal) were obtained. Fair correlations existed between LVEDP (mean 15+/-6 mm Hg) and the percentage decrease in the E/A ratio (r = 0.72), increase in duration of A wave during the Valsalva maneuver (r = 0.60), flow velocity of atrial reversal (r = 0.58), and difference of duration of atrial flow reversal and A wave (r = 0.62) (all P<.001). While sensitivity, specificity, and diagnostic accuracy to detect an elevated LVEDP were comparable, technically adequate Doppler recordings were obtained more often for the mitral inflow during the Valsalva maneuver than for the pulmonary venous flow (72 versus 66 patients, P< 0.05). PMID:10849514

Brunner-La Rocca, H P; Rickli, H; Attenhofer Jost, C H; Jenni, R



Progressive dysfunction of nitric oxide synthase in a lamb model of chronically increased pulmonary blood flow: a role for oxidative stress  

PubMed Central

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. PMID:18757524

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.



[Effects of millimetric electromagnetic waves on regional blood flow and effectiveness of multimodal therapy of patients with pulmonary tuberculosis].  


The impact of millimetric electromagnetic radiation (MER) on the natural history of the disease was studied in 54 patients with various types of pulmonary tuberculosis. The patients were treated using wavelengths of 6.4 and 7.1 mm on a YAVOR device. Following 10 sessions of MER therapy used in combination with specific drugs, caverns were found to close in 50% of patients at months 2-3 of therapy and in the controls at months 5-6. Infiltrative changes at the site of lesion resolved at weeks 2-3 of MER exposure, but in the controls at months 1-2 of drug therapy. In 5 (10%) out of 54 patients, regional blood flow parameters became normal, 27 (50%) patients were ascertained to have a partial improvement and 22 (40%) had no changes. No changes were seen in the controls as long as 2 weeks either. PMID:7670342

Khomenko, A G; Sigaev, A T; Chukanov, V I; Novikova, L N



Increased oxidative stress and severe arterial remodeling induced by permanent high-flow challenge in experimental pulmonary hypertension  

PubMed Central

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. PMID:21906276



Characterization of human afferent lymph dendritic cells from seroma fluids.  


Dendritic cells (DCs) migrate from peripheral tissues to secondary lymphoid organs (SLOs) through the afferent lymph. Owing to limitations in investigating human lymph, DCs flowing in afferent lymph have not been properly characterized in humans until now. In this study, DCs present in seroma, an accrual of human afferent lymph occurring after lymph node surgical dissection, were isolated and analyzed in detail. Two main DC subsets were identified in seroma that corresponded to the migratory DC subsets present in lymph nodes, that is, CD14(+) and CD1a(+). The latter also included CD1a(bright) Langerhans cells. The two DC subsets appeared to share the same monocytic precursor and to be developmentally related; both of them spontaneously released high levels of TGF-? and displayed similar T cell-activating and -polarizing properties. In contrast, they differed in the expression of surface molecules, including TLRs; in their phagocytic activity; and in the expression of proteins involved in Ag processing and presentation. It is worth noting that although both subsets were detected in seroma in the postsurgical inflammatory phase, only CD1a(+) DCs migrated via afferent lymph under steady-state conditions. In conclusion, the high numbers of DCs contained in seroma fluids allowed a proper characterization of human DCs migrating via afferent lymph, revealing a continuous stream of DCs from peripheral regions toward SLOs under normal conditions. Moreover, we showed that, in inflammatory conditions, distinct subsets of DCs can migrate to SLOs via afferent lymph. PMID:24078697

Morandi, Barbara; Bonaccorsi, Irene; Mesiti, Mario; Conte, Romana; Carrega, Paolo; Costa, Gregorio; Iemmo, Raffaella; Martini, Stefania; Ferrone, Soldano; Cantoni, Claudia; Mingari, Maria Cristina; Moretta, Lorenzo; Ferlazzo, Guido



Systemic-to-pulmonary collateral flow in patients with palliated univentricular heart physiology: measurement using cardiovascular magnetic resonance 4D velocity acquisition  

PubMed Central

Background Systemic-to-pulmonary collateral flow (SPCF) may constitute a risk factor for increased morbidity and mortality in patients with single-ventricle physiology (SV). However, clinical research is limited by the complexity of multi-vessel two-dimensional (2D) cardiovascular magnetic resonance (CMR) flow measurements. We sought to validate four-dimensional (4D) velocity acquisition sequence for concise quantification of SPCF and flow distribution in patients with SV. Methods 29 patients with SV physiology prospectively underwent CMR (1.5?T) (n?=?14 bidirectional cavopulmonary connection [BCPC], age 2.9?±?1.3?years; and n?=?15 Fontan, 14.4?±?5.9?years) and 20 healthy volunteers (age, 28.7?±?13.1?years) served as controls. A single whole-heart 4D velocity acquisition and five 2D flow acquisitions were performed in the aorta, superior/inferior caval veins, right/left pulmonary arteries to serve as gold-standard. The five 2D velocity acquisition measurements were compared with 4D velocity acquisition for validation of individual vessel flow quantification and time efficiency. The SPCF was calculated by evaluating the disparity between systemic (aortic minus caval vein flows) and pulmonary flows (arterial and venour return). The pulmonary right to left and the systemic lower to upper body flow distribution were also calculated. Results The comparison between 4D velocity and 2D flow acquisitions showed good Bland-Altman agreement for all individual vessels (mean bias, 0.05±0.24?l/min/m2), calculated SPCF (?0.02±0.18?l/min/m2) and significantly shorter 4D velocity acquisition-time (12:34?min/17:28?min,p?pulmonary estimator for SPFC; (2) significant SPCF in patients (BCPC 0.79±0.45?l/min/m2; Fontan 0.62±0.82?l/min/m2) and not in controls (0.01?+?0.16?l/min/m2), (3) inverse relation of right/left pulmonary artery perfusion and right/left SPCF (Pearson?=??0.47,p?=?0.01) and (4) upper to lower body flow distribution trend related to the weight (r?=?0.742, p?flow acquisition to quantify SPCF. There is considerable SPCF in BCPC and Fontan patients. SPCF was more pronounced towards the respective lung with less pulmonary arterial flow suggesting more collateral flow where less anterograde branch pulmonary artery perfusion. PMID:22541134



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.




PubMed Central

The pulmonary circulation is a high flow and low pressure circuit, with an average resistance of 1 mmHg.min.L?1 in young adults, increasing to 2.5 mmHg.min.L?1 over 4–6 decades of life. Pulmonary vascular mechanics at exercise are best described by distensible models. Exercise does not appear to affect the time constant of the pulmonary circulation or the longitudinal distribution of resistances. Very high flows are associated with high capillary pressures, up to a 20–25 mmHg threshold associated with interstitial lung edema and altered ventilation/perfusion relationships. Pulmonary artery pressures of 40–50 mmHg, which can be achieved at maximal exercise, may correspond to the extreme of tolerable right ventricular afterload. Distension of capillaries that decrease resistance may be of adaptative value during exercise, but this is limited by hypoxemia from altered diffusion/perfusion relationships. Exercise in hypoxia is associated with higher pulmonary vascular pressures and lower maximal cardiac output, with increased likelihood of right ventricular function limitation and altered gas exchange by interstitial lung edema. Pharmacological interventions aimed at the reduction of pulmonary vascular tone have little effect on pulmonary vascular pressure-flow relationships in normoxia, but may decrease resistance in hypoxia, unloading the right ventricle and thereby improving exercise capacity. Exercise in patients with pulmonary hypertension is associated with sharp increases in pulmonary artery pressure and a right ventricular limitation of aerobic capacity. Exercise stress testing to determine multipoint pulmonary vascular pressures-flow relationships may uncover early stage pulmonary vascular disease. PMID:23105961




The steady expiratory pressure-flow relation in a model pulmonary bifurcation.  


Experiments were conducted over a range of Reynolds numbers from 50 to 8000 to study the pressure-flow relationship for a single bifurcation in a multi-generation model during steady expiratory flow. Using the energy equation, the measured static pressure drop was decomposed into separate components due to fluid acceleration and viscous energy dissipation. The frictional pressure drop was found to closely approximate that for an equivalent length of curved tube with the same curvature ratio as in the model bifurcation. The sensitivity of these results to changes in airway cross-sectional shape, non-planar configuration, and flow regime (laminar-turbulent) was investigated. In separate experiments using dye visualization and hot-wire anemometry, a transition to turbulent flow was observed at Reynolds numbers between 1000 and 1500. Transition had very little effect on the pressure-flow relation. PMID:8231146

Collins, J M; Shapiro, A H; Kimmel, E; Kamm, R D



Axillary Lymph Nodes and Breast Cancer  


... to 10 PM EST. FACTS FOR LIFE Axillary Lymph Nodes Lymphatic system and axillary nodes Lymph vessels, like ... They carry lymph fluid, cells and other material. Lymph nodes are small clumps of immune cells that act ...


A water-filled body plethysmograph for the measurement of pulmonary capillary blood flow during changes of intrathoracic pressure  

PubMed Central

A water-filled body plethysmograph was constructed to measure gas exchange in man. As compared to an air-filled plethysmograph, its advantages were greater sensitivity, less thermal drift, and no change from adiabatic to isothermal conditions after a stepwise change of pressure. When five subjects were completely immersed within it and were breathing to the ambient atmosphere, they had a normal heart rate, oxygen consumption, CO2 output, and functional residual capacity. Pulmonary capillary blood flow ([unk]Qc) during and after Valsalva and Mueller maneuvers was calculated from measurements of N2O uptake. Control measurements of [unk]Qc were 2.58 liters/min per m2 at rest and 3.63 liters/min per m2 after moderate exercise. During the Valsalva maneuver at rest (intrapulmonary pressure: 24, SD 3.0, mm Hg), [unk]Qc decreased from a control of 2.58, SD 0.43, liters/min per m2 to 1.62, SD 0.26, liters/min per m2 with a decrease in pulmonary capillary stroke volume from a control of 42.4, SD 8.8, ml/stroke per m2 to 25.2, SD 5.5, ml/stroke per m2. After release of the Valsalva, there was an overshoot in [unk]Qc averaging +0.78, SD 0.41, liter/min per m2 accompanied by a significant increase in heart rate. Similar changes occurred during and after the Valsalva following moderate exercise. During the Mueller maneuver at rest and after exercise, [unk]Qc, heart rate, and central stroke volume did not change significantly. Images PMID:5422025

Kawakami, Yoshikazu; Menkes, Harold A.; DuBois, Arthur B.



PECAM-1 and caveolae form the mechanosensing complex necessary for NOX2 activation and angiogenic signaling with stopped flow in pulmonary endothelium  

PubMed Central

We showed that stop of flow triggers a mechanosignaling cascade that leads to the generation of reactive oxygen species (ROS); however, a mechanosensor coupled to the cytoskeleton that could potentially transduce flow stimulus has not been identified. We showed a role for KATP channel, caveolae (caveolin-1), and NADPH oxidase 2 (NOX2) in ROS production with stop of flow. Based on reports of a mechanosensory complex that includes platelet endothelial cell adhesion molecule-1 (PECAM-1) and initiates signaling with mechanical force, we hypothesized that PECAM-1 could serve as a mechanosensor in sensing disruption of flow. Using lungs in situ, we observed that ROS production with stop of flow was significantly reduced in PECAM-1?/? lungs compared with lungs from wild-type (WT) mice. Lack of PECAM-1 did not affect NOX2 activation machinery or the caveolin-1 expression or caveolae number in the pulmonary endothelium. Stop of flow in vitro triggered an increase in angiogenic potential of WT pulmonary microvascular endothelial cells (PMVEC) but not of PECAM-1?/? PMVEC. Obstruction of flow in lungs in vivo showed that the neutrophil infiltration as observed in WT mice was significantly lowered in PECAM-1?/? mice. With stop of flow, WT lungs showed higher expression of the angiogenic marker VEGF compared with untreated (sham) and PECAM-1?/? lungs. Thus PECAM-1 (and caveolae) are parts of the mechanosensing machinery that generates superoxide with loss of shear; the resultant ROS potentially drives neutrophil influx and acts as an angiogenic signal. PMID:24077950

Noel, John; Wang, Hui; Hong, Nankang; Tao, Jian-Qin; Yu, Kevin; Sorokina, Elena M.; DeBolt, Kristine; Heayn, Michelle; Rizzo, Victor; Delisser, Horace; Fisher, Aron B.



Pulmonary valve cusp augmentation for pulmonary regurgitation after repair of valvular pulmonary stenosis.  


A 23-year-old female patient with a history of pulmonary valvectomy for pulmonary stenosis at 2 years of age underwent pulmonary valve repair, which consisted of remnant cusp extension using a fresh pericardium and commissural resuspension. An immediate postoperative computed tomographic scan showed full movement of the extended anterior cusp during systole, yet flail motion during diastole. However, follow-up magnetic resonance imaging at 10 months postoperatively revealed a small amount of pulmonary flow regurgitation (2.0%). PMID:25742858

Shin, Yu Rim; Park, Han Ki; Park, Young Hwan; Jung, Jo Won; Kim, Young Jin; Shin, Hong Ju



Effects of an aging pulmonary system on expiratory flow limitation and dyspnoea during exercise in healthy women.  


Aging related changes in pulmonary function may make older women (OW) more susceptible to expiratory flow limitation (EFL) and lead to higher dyspnoea ratings during exercise relative to young women (YW). Accordingly, the purpose of this study was to compare sensory responses and EFL susceptibility and magnitude in 8 YW (29 ± 7 years) and 8 healthy OW (64 ± 3 years) matched for percentage-predicted forced vital capacity (% predicted FVC) and % predicted forced expiratory volume in 1 s. EFL was calculated as the percent overlap between tidal flow-volume loops during maximal exercise and the maximal expiratory flow-volume (MEFV) curve. Peak oxygen consumption (V'O(2peak)) was lower in the OW compared to the YW (29.4 ± 3.6 vs. 49.1 ± 8.9 ml kg(-1) min(-1), P < 0.05) as was maximal ventilation (73.7 ± 18.4 vs. 108.7 ± 14.1 l min(-1), P < 0.05). EFL at maximal exercise was present in 2 of 8 YW and in 5 of 8 OW. There were no significant differences in the magnitude of EFL between OW (23 ± 24, range: 0-69 %EFL) and YW (9 ± 18, range: 0-46 %EFL, P = 0.21). The magnitude of EFL in OW was inversely related to % predicted FVC (r = -0.69, P = 0.06), but this relationships was not observed in the YW (r = -0.23, P = 0.59). The OW consistently reported greater dyspnoea and leg discomfort for any given absolute work rate, but not when work was expressed as a percentage of maximum. Reduced ventilatory and exercise capacities may cause OW to be more susceptible to EFL during exercise and experience greater dyspnoea relative to YW for a standardized physical task. PMID:21971945

Wilkie, Sabrina S; Guenette, Jordan A; Dominelli, Paolo B; Sheel, A William



Pulmonary Rehabilitation  


... Topics Bronchitis COPD Cystic Fibrosis Idiopathic Pulmonary Fibrosis Sarcoidosis Send a link to NHLBI to someone by ... people who have COPD (chronic obstructive pulmonary disease), sarcoidosis (sar-koy-DOE-sis), idiopathic pulmonary fibrosis , or ...


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. PMID:22649718

Phillips, Robert A; Hood, Sally G; Jacobson, Beverley M; West, Malcolm J; Wan, Li; May, Clive N



Pulmonary Artery Catheter (PAC) Accuracy and Efficacy Compared with Flow Probe and Transcutaneous Doppler (USCOM): An Ovine Cardiac Output Validation  

PubMed Central

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. PMID:22649718

Phillips, Robert A.; Hood, Sally G.; Jacobson, Beverley M.; West, Malcolm J.; Wan, Li; May, Clive N.



Pulmonary and Renal Pressure-Flow Relationships: What Should Be Taught?  

NSDL National Science Digital Library

This article is from a symposium presented at the annual meeting of the Human Anatomy and Physiology Society (HAPS) on June 11, 2000. The presentation was funded under the auspices of a National Science Foundation Course, Curriculum, and Laboratory Improvement Program entitled "Development of Active Learning Materials for Physiology and Functional Anatomy: A Cooperative HAPS-APS Initiative." This symposium was part of the first module to be developed on "gradients and conductances: what flows where and why?" This presentation was designed to model the usefulness of the general model of gradients and conductances in the physiology and pathophysiology of the respiratory and renal systems. Thirteen different examples of pressure-flow-resistance and concentration-flux relationships are introduced; several ideas for active-learning activities and simple figures appropriate for undergraduate physiology classes are included. The symposium assumes that undergraduate students have already learned about diffusion, osmosis, and the basic principles of cardiovascular physiology. The presentation was designed to follow a symposium entitled: "Cardiovascular pressure-flow relationships: what should be taught?"

PhD Barbara E. Goodman (University of South Dakota School of Medicine Division of Basic Biomedical Sciences)



Pulmonary valve stenosis  


... 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 ...


The effect of supine exercise on the distribution of regional pulmonary blood flow measured using proton MRI  

PubMed Central

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.



Pulmonary and heart diseases with inhalation of atmospheric pressure plasma flow  

NASA Astrophysics Data System (ADS)

We examined blood pressure in the abdominal aorta of mini pig under plasma inhalation of atmospheric pressure plasma flow. The coaxial atmospheric pressure plasma source has a tungsten wire inside a glass capillary, that is surrounded by a grounded tubular electrode. Plasma was generated under the following conditions; applied voltage: 8 kVpp, frequency: 3 kHz, and helium (He) gas flow rate: 1 L/min. On the other hand, sphygmomanometry of a blood vessel proceeded using a device comprising a disposable force transducer, and a bedside monitor for simultaneous electrocardiography and signal pressure measurements. We directly measured Nitric oxide (NO) using a catheter-type NO sensor placed in the coronary sinus through an angiography catheter from the abdomen. Blood pressure decreased from 110/65 to 90/40 mm Hg in the animals in vivo under plasma inhalation. The NO concentration in the abdominal aorta like the blood pressure, reached a maximum value at about 40 s and then gradually decreased.

Hirata, Takamichi; Murata, Shigeru; Kishimoto, Takumi; Tsutsui, Chihiro; Kondo, Akane; Mori, Akira



Number of Lymph Nodes Harvested From a Mediastinal Lymphadenectomy  

PubMed Central

Background: Lymph node status is a major determinant of stage and survival in patients with lung cancer; however, little information is available about the expected yield of a mediastinal lymphadenectomy. Methods: The American College of Surgeons Oncology Group Z0030 prospective, randomized trial of mediastinal lymph node sampling vs complete mediastinal lymphadenectomy during pulmonary resection enrolled 1,111 patients from July 1999 to February 2004. Data from 524 patients who underwent complete mediastinal lymph node dissection were analyzed to determine the number of lymph nodes obtained. Results: The median number of additional lymph nodes harvested from a mediastinal lymphadenectomy following systematic sampling was 18 with a range of one to 72 for right-sided tumors, and 18 with a range of four to 69 for left-sided tumors. The median number of N2 nodes harvested was 11 on the right and 12 on the left. A median of at least six nodes was harvested from at least three stations in 99% of patients, and 90% of patients had at least 10 nodes harvested from three stations. Overall, 21 patients (4%) were found to have occult N2 disease. Conclusions: Although high variability exists in the actual number of lymph nodes obtained from various nodal stations, complete mediastinal lymphadenectomy removes one or more lymph nodes from all mediastinal stations. Adequate mediastinal lymphadenectomy should include stations 2R, 4R, 7, 8, and 9 for right-sided cancers and stations 4L, 5, 6, 7, 8, and 9 for left-sided cancers. Six or more nodes were resected in 99% of patients in this study. Trial registry:; No.: NCT00003831; URL: PMID:20829340

Allen, Mark S.; Decker, Paul A.; Ballman, Karla; Malthaner, Richard A.; Inculet, Richard I.; Jones, David R.; McKenna, Robert J.; Landreneau, Rodney J.; Putnam, Joe B.



Hantavirus pulmonary syndrome in the United States: a pathological description of a disease caused by a new agent.  


An outbreak of an acute respiratory disease in the southwestern United States has led to the recognition of a new hantaviral illness. This report describes a unique spectrum of antemortem and postmortem pathological findings seen in a case series of nine surviving patients and 13 who died. Clinical, laboratory, and autopsy findings were derived from a consecutive series of individuals confirmed to have hantavirus pulmonary syndrome. Laboratory studies included chemical, hematological, and bone marrow analyses as well as flow cytometric and immunohistochemical phenotyping. Autopsy tissues were examined by routine histological stains, immunohistochemical methods, and transmission electron microscopy. The lung is the primary target organ in this illness. Pulmonary abnormalities include pleural effusions, alveolar edema and fibrin, and an interstitial mononuclear cell infiltrate. Large immunoblast type cells are seen in the lungs, blood, bone marrow, lymph nodes, liver, and spleen. A tetrad of hematological findings includes left-shifted neutrophilic leukocytosis, thrombocytopenia, hemoconcentration in severe cases, and circulating immunoblasts. In contrast to previously described nephropathic hantaviral syndromes, hantavirus pulmonary syndrome is characterized by a unique constellation of pulmonary, hematological, and reticuloendothelial pathological findings. The pulmonary findings are distinguishable from fatal adult respiratory distress syndrome. The data suggest a capillary leak syndrome restricted to the pulmonary circulation. Likewise, the hematological picture is unique and may be valuable in the rapid identification of cases for further diagnostic studies. PMID:7821907

Nolte, K B; Feddersen, R M; Foucar, K; Zaki, S R; Koster, F T; Madar, D; Merlin, T L; McFeeley, P J; Umland, E T; Zumwalt, R E



Spatial-temporal dynamics of pulmonary blood flow in the healthy human lung in response to altered FiO2  

PubMed Central

The temporal dynamics of blood flow in the human lung have been largely unexplored due to the lack of appropriate technology. Using the magnetic resonance imaging method of arterial spin labeling (ASL) with subject-gated breathing, we produced a dynamic series of flow-weighted images in a single sagittal slice of the right lung with a spatial resolution of ?1 cm3 and a temporal resolution of ?10 s. The mean flow pattern determined from a set of reference images was removed to produce a time series of blood flow fluctuations. The fluctuation dispersion (FD), defined as the spatial standard deviation of each flow fluctuation map, was used to quantify the changes in distribution of flow in six healthy subjects in response to 100 breaths of hypoxia (FiO2 = 0.125) or hyperoxia (FiO2 = 1.0). Two reference frames were used in calculation, one determined from the initial set of images (FDglobal), and one determined from the mean of each corresponding baseline or challenge period (FDlocal). FDlocal thus represented changes in temporal variability as a result of intervention, whereas FDglobal encompasses both FDlocal and any generalized redistribution of flow associated with switching between two steady-state patterns. Hypoxic challenge resulted in a significant increase (96%, P < 0.001) in FDglobal from the normoxic control period and in FDlocal (46%, P = 0.0048), but there was no corresponding increase in spatial relative dispersion (spatial standard deviation of the images divided by the mean; 8%, not significant). There was a smaller increase in FDglobal in response to hyperoxia (47%, P = 0.0015) for the single slice, suggestive of a more general response of the pulmonary circulation to a change from normoxia to hyperoxia. These results clearly demonstrate a temporal change in the sampled distribution of pulmonary blood flow in response to hypoxia, which is not observed when considering only the relative dispersion of the spatial distribution. PMID:23104691

Asadi, Amran K.; Cronin, Matthew V.; Sá, Rui Carlos; Theilmann, Rebecca J.; Holverda, Sebastiaan; Hopkins, Susan R.; Buxton, Richard B.



Optimal surface segmentation using flow lines to quantify airway abnormalities in chronic obstructive pulmonary disease.  


This paper introduces a graph construction method for multi-dimensional and multi-surface segmentation problems. Such problems can be solved by searching for the optimal separating surfaces given the space of graph columns defined by an initial coarse surface. Conventional straight graph columns are not well suited for surfaces with high curvature, we therefore propose to derive columns from properly generated, non-intersecting flow lines. This guarantees solutions that do not self-intersect. The method is applied to segment human airway walls in computed tomography images in three-dimensions. Phantom measurements show that the inner and outer radii are estimated with sub-voxel accuracy. Two-dimensional manually annotated cross-sectional images were used to compare the results with those of another recently published graph based method. The proposed approach had an average overlap of 89.3±5.8%, and was on average within 0.096±0.097mm of the manually annotated surfaces, which is significantly better than what the previously published approach achieved. A medical expert visually evaluated 499 randomly extracted cross-sectional images from 499 scans and preferred the proposed approach in 68.5%, the alternative approach in 11.2%, and in 20.3% no method was favoured. Airway abnormality measurements obtained with the method on 490 scan pairs from a lung cancer screening trial correlate significantly with lung function and are reproducible; repeat scan R(2) of measures of the airway lumen diameter and wall area percentage in the airways from generation 0 (trachea) to 5 range from 0.96 to 0.73. PMID:24603047

Petersen, Jens; Nielsen, Mads; Lo, Pechin; Nordenmark, Lars Haug; Pedersen, Jesper Holst; Wille, Mathilde Marie Winkler; Dirksen, Asger; de Bruijne, Marleen



Pulmonary O2 uptake and leg blood flow kinetics during moderate exercise are slowed by hyperventilation-induced hypocapnic alkalosis  

PubMed Central

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. PMID:20339012

Chin, Lisa M. K.; Heigenhauser, George J. F.; Paterson, Donald H.



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



Pulmonary embolus  


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 clot ...


Pulmonary edema  


Pulmonary edema is an abnormal buildup of fluid in the lungs. This buildup of fluid leads to shortness of ... Pulmonary edema is often caused by congestive heart failure . When the heart is not able to pump efficiently, blood ...


Pulmonary atresia  


... Pulmonary atresia may occur with or without a ventricular septal defect (VSD) . If the person does not have a VSD, the condition is called pulmonary atresia with intact ventricular septum (PA/IVS). If the person has both ...


Pulmonary Fibrosis  


Pulmonary fibrosis is a condition in which the tissue deep in your lungs becomes scarred over time. This tissue ... may not get enough oxygen. Causes of pulmonary fibrosis include environmental pollutants, some medicines, some connective tissue ...


Transport parameter estimation from lymph measurements and the Patlak equation.  


Two methods of estimating protein transport parameters for plasma-to-lymph transport data are presented. Both use IBM-compatible computers to obtain least-squares parameters for the solvent drag reflection coefficient and the permeability-surface area product using the Patlak equation. A matrix search approach is described, and the speed and convenience of this are compared with a commercially available gradient method. The results from both of these methods were different from those of a method reported by Reed, Townsley, and Taylor [Am. J. Physiol. 257 (Heart Circ. Physiol. 26): H1037-H1041, 1989]. It is shown that the Reed et al. method contains a systematic error. It is also shown that diffusion always plays an important role for transmembrane transport at the exit end of a membrane channel under all conditions of lymph flow rate and that the statement that diffusion becomes zero at high lymph flow rate depends on a mathematical definition of diffusion. PMID:1301007

Watson, P D; Wolf, M B



The changes of pulmonary function and pulmonary strength according to time of day: a preliminary study  

PubMed Central

[Purpose] The purpose of this study was to identify changes in pulmonary function and pulmonary strength according to time of day. [Subjects and Methods] The subjects were 20 healthy adults who had no cardiopulmonary-related diseases. Pulmonary function and pulmonary strength tests were performed on the same subjects at 9:00 am, 1:00 pm, and 5:00 pm. The pulmonary function tests included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and forced expiratory flow between 25 and 75% of vital capacity (FEF25–75%). Pulmonary strength tests assessed maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). [Results] FEV1 showed statistically significant differences according to time of day. Other pulmonary function and pulmonary strength tests revealed no statistical differences in diurnal variations. [Conclusion] Our findings indicate that pulmonary function and pulmonary strength tests should be assessed considering the time of day and the morning dip phenomenon. PMID:25642028

Rhee, Min-Hyung; Kim, Laurentius Jongsoon



Appraisal of within- and between-laboratory reproducibility of non-radioisotopic local lymph node assay using flow cytometry, LLNA:BrdU-FCM: Comparison of OECD TG429 performance standard and statistical evaluation.  


Mouse local lymph node assay (LLNA, OECD TG429) is an alternative test replacing conventional guinea pig tests (OECD TG406) for the skin sensitization test but the use of a radioisotopic agent, (3)H-thymidine, deters its active dissemination. New non-radioisotopic LLNA, LLNA:BrdU-FCM employs a non-radioisotopic analog, 5-bromo-2'-deoxyuridine (BrdU) and flow cytometry. For an analogous method, OECD TG429 performance standard (PS) advises that two reference compounds be tested repeatedly and ECt(threshold) values obtained must fall within acceptable ranges to prove within- and between-laboratory reproducibility. However, this criteria is somewhat arbitrary and sample size of ECt is less than 5, raising concerns about insufficient reliability. Here, we explored various statistical methods to evaluate the reproducibility of LLNA:BrdU-FCM with stimulation index (SI), the raw data for ECt calculation, produced from 3 laboratories. Descriptive statistics along with graphical representation of SI was presented. For inferential statistics, parametric and non-parametric methods were applied to test the reproducibility of SI of a concurrent positive control and the robustness of results were investigated. Descriptive statistics and graphical representation of SI alone could illustrate the within- and between-laboratory reproducibility. Inferential statistics employing parametric and nonparametric methods drew similar conclusion. While all labs passed within- and between-laboratory reproducibility criteria given by OECD TG429 PS based on ECt values, statistical evaluation based on SI values showed that only two labs succeeded in achieving within-laboratory reproducibility. For those two labs that satisfied the within-lab reproducibility, between-laboratory reproducibility could be also attained based on inferential as well as descriptive statistics. PMID:25732604

Yang, Hyeri; Na, Jihye; Jang, Won-Hee; Jung, Mi-Sook; Jeon, Jun-Young; Heo, Yong; Yeo, Kyung-Wook; Jo, Ji-Hoon; Lim, Kyung-Min; Bae, SeungJin



Pulmonary epithelioid hemangioendothelioma coexisting with pulmonary nodular amyloidosis: case discussion and review of the literature  

PubMed Central

A 38-year-old female was found to have multiple bilateral lung nodules in a routine chest X-ray examination. Thoracoscopy was performed with biopsy of three nodules from the right lower lobe and Congo red staining showed typical amyloid pattern. Initial diagnosis of pulmonary nodular amyloidosis was made. However, one nodule in the right upper lobe enlarged as detected by follow-up CT scan. The patient underwent F-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET)/CT and a significant high FDG uptake in the largest nodule in right upper lobe was observed while the uptake was normal or mildly increased in the other nodules. Meanwhile, right hilar and mediastinal lymph nodes adenopathy was noted. Right upper lobe was resected by thoracotomy. Surprisingly, histopathological findings showed pulmonary epithelioid hemangioendothelioma (PEH) with metastasis of hilar and mediastinal lymph nodes. To our knowledge, this is the first described case of PEH coexisting with pulmonary nodular amyloidosis. PMID:25126197

Yi, Lingling; Cheng, Dan; Shi, Huimin; Zhang, Kan; Liao, Yongde; Ao, Qilin; Zhen, Guohua




PubMed Central

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. PMID:22961736

Rafikov, Ruslan; Aggarwal, Saurabh; Hou, Yali; Datar, Sanjeev A.; Sharma, Shruti; Azakie, Anthony; Fineman, Jeffrey R.; Black, Stephen M.



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 ...


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 coccidioidomycosis.  


Coccidioidomycosis refers to the spectrum of disease caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii. Clinical manifestations vary depending upon both the extent of infection and the immune status of the host. Coccidioidomycosis has been reported to involve almost all organ systems; however, pulmonary disease is the most common clinical manifestation. The incidence of coccidioidomycosis continues to rise, and primary coccidioidal pneumonia accounts for 17 to 29% of all cases of community-acquired pneumonia in endemic regions. The majority of patients with coccidioidomycosis resolve their initial infection without sequelae; however, several patients develop complications of disease ranging in severity from complicated pulmonary coccidioidomycosis to widely disseminated disease with immediately life-threatening manifestations. This review focuses on complications of pulmonary coccidioidomycosis with an emphasis on the management of primary coccidioidal infection, solitary pulmonary nodules, pleural effusions, cavitary disease, acute respiratory distress syndrome (ARDS), miliary disease, and sepsis. PMID:22167403

Thompson, George R



Pulmonary tuberculosis  


Pulmonary tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis (M. tuberculosis) . You can get TB by breathing ... chap 332. Fitzgerald DW, Sterling TR, Haas DW. Mycobacterium tuberculosis . In: Mandell GL, Bennett JE, Dolan R, eds. ...


Pulmonary Hypertension  


Pulmonary hypertension (PH) is high blood pressure in the arteries to your lungs. It is a serious condition. If you have ... and you can develop heart failure. Symptoms of PH include Shortness of breath during routine activity, such ...


Lymph node staging in prostate cancer.  


Nodal staging is important in prostate cancer treatment. While surgical lymph node dissection is the classic method of determining whether lymph nodes harbor malignancy, this is a very invasive technique. Current noninvasive approaches to identifying malignant lymph nodes are limited. Conventional imaging methods rely on size and morphology of lymph nodes and have notoriously low sensitivity for detecting malignant nodes. New imaging techniques such as targeted positron emission tomography (PET) imaging and magnetic resonance lymphography (MRL) with iron oxide particles are promising for nodal staging of prostate cancer. In this review, the strengths and limitations of imaging techniques for lymph node staging of prostate cancer are discussed. PMID:25773350

Sankineni, Sandeep; Brown, Anna M; Fascelli, Michele; Law, Yan Mee; Pinto, Peter A; Choyke, Peter L; Turkbey, Baris




EPA Science Inventory

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, ...


Is tuberculosis a lymphatic disease with a pulmonary portal  

Technology Transfer Automated Retrieval System (TEKTRAN)

Tuberculosis (TB) is commonly viewed as a pulmonary disease, in which infection, persistence, induction of pathology and bacterial expulsion all occur in the lungs. In this model, enlarged lymph nodes represent reactive adenitis and spread of organisms to extrapulmonary sites results in a non-transm...


Fontan hepatic fibrosis and pulmonary vascular development.  


Fontan patients are at risk for hepatic fibrosis; however, risk factors are unclear. We performed a multivariate analysis in a small cohort of 14 patients (7-24 years old, mean 15) with Fontan circulation, undergoing cardiac catheterization and transvenous liver biopsies, all demonstrating fibrosis. We found by stepwise regression analysis that the history of pulmonary atresia was a predictor of higher total hepatic fibrosis scores than a history of unobstructed pulmonary blood flow (p = 0.002). Other variables including age, time from Fontan, hemodynamic measurements, and laboratory values were not predictive of total fibrosis scores at p values <0.05. Hepatic fibrosis scores between those born with pulmonary atresia versus unrestricted pulmonary blood flow may reflect differences in pulmonary circulatory physiology, resulting from differences in pulmonary vascular development. PMID:25381625

Evans, William N; Acherman, Ruben J; Winn, Brody J; Yumiaco, Noel S; Galindo, Alvaro; Rothman, Abraham; Restrepo, Humberto



Living with Pulmonary Fibrosis  


... Home > Lung Disease > Pulmonary Fibrosis Living with Pulmonary Fibrosis If you have pulmonary fibrosis there are steps you can take to stay ... get you help. In depth resources on pulmonary fibrosis A A A Share Print State of Tobacco ...


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



Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small-cell lung carcinomas: Are these carcinomas candidates for video-assisted lobectomy?  

Microsoft Academic Search

To determine the clinicopathologic characteristics of peripheral non-small-cell carcinomas, the cases of 337 patients undergoing major pulmonary resection with complete lymphadenectomy were retrospectively reviewed with regard to lymph node involvement, recurrence, and prognosis. All of the tumors were 3.0 cm or less in diameter and were categorized as T1 (318 patients) or T2 (19). Eighty-eight patients (26.1%) had lymph node

Hisao Asamura; Haruhiko Nakayama; Haruhiko Kondo; Ryosuke Tsuchiya; Yukio Shimosato; Tsuguo Naruke



Evaluation of sentinel lymph node metastasis alone guided by three-dimensional computed tomographic lymphography in video-assisted breast surgery  

Microsoft Academic Search

Background  Detailed relations between lymph nodes and lymph flow can be clarified by three-dimensional computed tomographic (3D-CT) lymphangiography.\\u000a Systematic collection of lymph nodes based on 3D-CT lymphangiography can decrease unnecessary lymph node dissection and attendant\\u000a complications.\\u000a \\u000a \\u000a \\u000a Methods  To mark the sentinel lymph node (SLN) on the skin, 3D-CT lymphangiography was performed the day before the surgery. Iopamiron\\u000a 300 (2 ml) was injected subcutaneously.

K. Yamashita; K. Shimizu



Pulmonary microvascular hyperpermeability and expression of vascular endothelial growth factor in smoke inhalation- and pneumonia-induced acute lung injury  

PubMed Central

Introduction: Acute lung injury (ALI) and sepsis are major contributors to the morbidity and mortality of critically ill patients. The current study was designed further evaluate the mechanism of pulmonary vascular hyperpermeability in sheep with these injuries. Methods: Sheep were randomized to a sham-injured control group (n=6) or ALI/Sepsis group (n=7). The sheep in the ALI/Sepsis group received inhalation injury followed by instillation of Pseudomonas aeruginosa into the lungs. These groups were monitored for 24 hours. Additional sheep (n=16) received the injury and lung tissue was harvested at different time points to measure lung wet/dry weight ratio, vascular endothelial growth factor (VEGF) mRNA and protein expression as well as 3-nitrotyrosine protein expression in lung homogenates. Results: The injury induced severe deterioration in pulmonary gas exchange, increases in lung lymph flow and protein content, and lung water content (p<0.015 each). These alterations were associated with elevated lung and plasma nitrite/nitrate concentrations, increased tracheal blood flow, and enhanced VEGF mRNA and protein expression in lung tissue as well as enhanced 3-nitrotyrosine protein expression (p<0.05 each). Conclusions: This study describes the time course of pulmonary microvascular hyperpermeability in a clinical relevant large animal model and may improve the experimental design of future studies. PMID:22647495

Lange, Matthias; Hamahata, Atsumori; Traber, Daniel L.; Connelly, Rhykka; Nakano, Yoshimitsu; Traber, Lillian D.; Schmalstieg, Frank C.; Herndon, David N.; Enkhbaatar, Perenlei



Proteomic Analysis of Human Mesenteric Lymph  

PubMed Central

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. PMID:21192285

Dzieciatkowska, Monika; Wohlauer, Max V.; Moore, Ernest E.; Damle, Sagar; Peltz, Erik; Campsen, Jeffrey; Kelher, Marguerite; Silliman, Christopher; Banerjee, Anirban; Hansen, Kirk C.



Computed tomographic scan evaluation of pulmonary blastomycosis  

PubMed Central

BACKGROUND: Blastomycosis is an uncommon granulomatous pulmonary and extrapulmonary infectious disease caused by the thermally dimorphic fungus Blastomyces dermatitidis. Diagnosis may be delayed or difficult because of varied presentation. The characteristics of blastomycosis on computed tomographic (CT) scan of the chest are not well characterized. METHODS: The images from 34 chest CT scans from patients with confirmed pulmonary blastomycosis were retrospectively reviewed. RESULTS: The most common CT findings were air bronchograms in 22 patients (65%), consolidation in 21 patients (62%), nodules (smaller than 3 cm) in 21 patients (62%) and lymph node enlargement (mediastinal and hilar nodes combined) in 12 patients (35%). Only four patients (12%) had a miliary pattern. CONCLUSIONS: A specific abnormality characteristic of pulmonary blastomycosis was not identified on CT scanning. The diagnosis can only be made in the context of a high index of clinical suspicion with histological or culture confirmation. PMID:21119802

Ronald, Suzanne; Strzelczyk, Jacek; Moore, Sean; Trepman, Elly; Cheang, Mary; Limerick, Bill; Wiebe, Lyle; Sarsfield, Pete; MacDonald, Kerry; Meyers, Michael; Embil, John M



Trauma Hemorrhagic Shock-Induced Lung Injury Involves a Gut-Lymph-Induced TLR4 Pathway in Mice  

PubMed Central

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 naïve 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 naïve 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. PMID:21829592

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



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



Isolated cystic duct lymph node tuberculosis.  


Tuberculosis of the cystic duct lymph node without involvement of gall bladder is exceedingly rare. Cholelithiasis is a usual accompaniment. A case of 65-year-old woman was diagnosed to have cholelithiasis. Laparoscopic cholecystectomy was performed and a prominent cystic lymph node was excised for biopsy. Histopathology surprisingly reported tuberculosis of cystic duct lymph node without affecting the gall bladder. Thereupon, she was treated with antituberculous chemotherapy. PMID:18236910

Sidhu, D S; Singh, Mohinder; Jindal, Rajiv K; Gupta, Sanjeev; Simpy



Pulmonary function in space  

NASA Technical Reports Server (NTRS)

The lung is exquisitely sensitive to gravity, and so it is of interest to know how its function is altered in the weightlessness of space. Studies on National Aeronautics and Space Administration (NASA) Spacelabs during the last 4 years have provided the first comprehensive data on the extensive changes in pulmonary function that occur in sustained microgravity. Measurements of pulmonary function were made on astronauts during space shuttle flights lasting 9 and 14 days and were compared with extensive ground-based measurements before and after the flights. Compared with preflight measurements, cardiac output increased by 18% during space flight, and stroke volume increased by 46%. Paradoxically, the increase in stroke volume occurred in the face of reductions in central venous pressure and circulating blood volume. Diffusing capacity increased by 28%, and the increase in the diffusing capacity of the alveolar membrane was unexpectedly large based on findings in normal gravity. The change in the alveolar membrane may reflect the effects of uniform filling of the pulmonary capillary bed. Distributions of blood flow and ventilation throughout the lung were more uniform in space, but some unevenness remained, indicating the importance of nongravitational factors. A surprising finding was that airway closing volume was approximately the same in microgravity and in normal gravity, emphasizing the importance of mechanical properties of the airways in determining whether they close. Residual volume was unexpectedly reduced by 18% in microgravity, possibly because of uniform alveolar expansion. The findings indicate that pulmonary function is greatly altered in microgravity, but none of the changes observed so far will apparently limit long-term space flight. In addition, the data help to clarify how gravity affects pulmonary function in the normal gravity environment on Earth.

West, J. B.; Elliott, A. R.; Guy, H. J.; Prisk, G. K.



Clinical significance of low forced expiratory flow between 25% and 75% of vital capacity following treated pulmonary tuberculosis: a cross-sectional study  

PubMed Central

Objectives The aim of this study was to assess the prevalence and determinants of post-tuberculosis chronic respiratory signs, as well as the clinical impact of a low forced expiratory flow between 25% and 75% (FEF25–75%) in a group of individuals previously treated successfully for pulmonary tuberculosis. Design This was a cross-sectional study involving individuals in their post-tuberculosis treatment period. They all underwent a spirometry following the 2005 criteria of the American Thoracic Society/European Respiratory Society. Distal airflow obstruction (DAO) was defined by an FEF25–75% <65% and a ratio forced expiratory volume during the first second (FEV1)/forced vital capacity (FVC) ? 0.70. Logistic regression models were used to investigate the determinants of persisting respiratory symptoms following antituberculous treatment. Setting This study was carried out in the tuberculosis diagnosis and treatment centre at Yaounde Jamot Hospital, which serves as a referral centre for tuberculosis and respiratory diseases for the capital city of Cameroon (Yaounde) and surrounding areas. Participants All consecutive patients in their post-tuberculosis treatment period were consecutively enrolled between November 2012 and April 2013. Results Of the 177 patients included, 101 (57.1%) were men, whose median age (25th-75th centiles) was 32 (24–45.5) years. At least one chronic respiratory sign was present in 110 (62.1%) participants and DAO was found in 67 (62.9%). Independent determinants of persisting respiratory signs were the duration of symptoms prior to tuberculosis diagnosis higher than 12?weeks (adjusted OR 2.91; 95% CI 1.12 to 7.60, p=0.029) and presence of DAO (2.22; 1.13 to 4.38, p=0.021). Conclusions FEF25–75%<65% is useful for the assessment and diagnosis of post-tuberculous DAO. Mass education targeting early diagnosis of pulmonary tuberculosis can potentially reduce the prevalence of post-tuberculosis respiratory signs and distal airflow obstruction. PMID:25056978

Pefura-Yone, Eric Walter; Kengne, Andre Pascal; Tagne-Kamdem, Pierre Eugene; Afane-Ze, Emmanuel




EPA Science Inventory

Pulmonary disease and dysfunction exact a tremendous health burden on society. In a recent survey of lung disease published by the American Lung Association in 2012, upwards of 10 million Americans were diagnosed with chronic bronchitis while over 4 million Americans had emphysem...


Pulmonary Embolism  


... lung from a vein in the leg. A clot that forms in one part of the body and travels in the ... complications of PE. Rate This Content: Next >> July 1, 2011 Pulmonary Embolism Clinical Trials Clinical trials are research studies that explore whether ...


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



In vivo quantification of lymph viscosity and pressure in lymphatic vessels and draining lymph nodes of arthritic joints in mice  

PubMed Central

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?lymph node pressure (LNP) demonstrated a decrease in expanding PLN versus WT pressure (3.41?±?0.43 vs. 6.86?±?0.56?cmH2O; P?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 input impedance spectra in models of chronically altered pulmonary hemodynamics  

Microsoft Academic Search

Pulmonary input impedance spectra were estimated in one-month-old lambs whose circulation had been altered during the first few days of life to mimic the pulmonary. hemodynamic states observed in infants and children with left-to-right shunts (high flow) and \\/or pulmonary vascular obstructive disease (high pressure). Spectral results obtained from the animal models were compared with those obtained from a computer

C. L. Lucas; B. Ha; G. W. Henry; E. G. Frantz; J. I. Ferreiro; B. R. Wilcox



Mechanisms underlying CO2 retention during flow-resistive loading in patients with chronic obstructive pulmonary disease.  

PubMed Central

The present study examined the respiratory responses involved in the maintenance of eucapnea during acute airway obstruction in 12 patients with chronic obstructive disease (COPD) and 3 age-matched normal subjects. Acute airway obstruction was produced by application of external flow-resistive loads (2.5 to 30 cm H2O/liter per s) throughout inspiration and expiration while subjects breathed 100% O2. Application of loads of increasing severity caused progressive increases in PCO2 in the patients, but the magnitude of the increase in PCO2 varied substantially between subjects. On a resistance of 10 cm H2O/liter per s, the highest load that could be tolerated by all COPD patients, the increase in PCO2 ranged from 1 to 11 mm Hg, while none of the normal subjects retained CO2. Based on the magnitude of the increase in PCO2 the patients could be divided into two groups: seven subjects whose PCO2 increased by less than or equal to 3 mm Hg (group I) and five subjects whose PCO2 increased by greater than 6 mm Hg (group II). Base-line ventilation and the pattern of breathing were similar in the two groups. During loading group I subjects maintained or increased tidal volume while all group II patients decreased tidal volume (VT). The smaller tidal volume in group II subjects was mainly the result of their shorter inspiratory time as the changes in mean inspiratory flow were similar in the two groups. The magnitude of CO2 retention during loading was inversely related to the magnitude of the change in VT (r = -0.91) and inspiratory time (Ti) (r = -0.87) but only weakly related to the change in ventilation (r = -0.53). The changes in PCO2, VT, and Ti during loading correlated with the subjects' maximum static inspiratory pressure, which was significantly lower in group II as compared with group I patients. These results indicate that the tidal volume and respiratory timing responses to flow loads are impaired in some patients with COPD. This impairment, presumably due to poor inspiratory muscle function, appears to lead to CO2 retention during loaded breathing. PMID:6406550

Oliven, A; Kelsen, S G; Deal, E C; Cherniack, N S



Use of High Frequency Ultrasound to Monitor Cervical Lymph Node Alterations in Mice  

PubMed Central

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. PMID:24955984

Walk, Elyse L.; McLaughlin, Sarah; Coad, James; Weed, Scott A.



Axillary lymph node management in breast cancer with positive sentinel lymph node biopsy  

PubMed Central

The surgical treatment of localized breast cancer has become progressively less aggressive over the years. The management of the axillary lymph nodes has been modified by the introduction of sentinel lymph node biopsy. Axillary dissection can be avoided in patients with sentinel lymph node negative biopsies. Based on randomized trials data, it has been proposed that no lymph node dissection should be carried out even in certain patients with sentinel lymph node positive biopsies. This commentary discusses the basis of such recommendations and cautions against a general omission of lymph node dissection in breast cancer patients with positive sentinel lymph node biopsies. Instead, an individualized approach based on axillary tumor burden and biology of the cancer should be considered. PMID:25667909

Voutsadakis, Ioannis A; Spadafora, Silvana



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



The mesenteric lymph duct cannulated rat model: application to the assessment of intestinal lymphatic drug transport.  


The intestinal lymphatic system plays key roles in fluid transport, lipid absorption and immune function. Lymph flows directly from the small intestine via a series of lymphatic vessels and nodes that converge at the superior mesenteric lymph duct. Cannulation of the mesenteric lymph duct thus enables the collection of mesenteric lymph flowing from the intestine. Mesenteric lymph consists of a cellular fraction of immune cells (99% lymphocytes), aqueous fraction (fluid, peptides and proteins such as cytokines and gut hormones) and lipoprotein fraction (lipids, lipophilic molecules and apo-proteins). The mesenteric lymph duct cannulation model can therefore be used to measure the concentration and rate of transport of a range of factors from the intestine via the lymphatic system. Changes to these factors in response to different challenges (e.g., diets, antigens, drugs) and in disease (e.g., inflammatory bowel disease, HIV, diabetes) can also be determined. An area of expanding interest is the role of lymphatic transport in the absorption of orally administered lipophilic drugs and prodrugs that associate with intestinal lipid absorption pathways. Here we describe, in detail, a mesenteric lymph duct cannulated rat model which enables evaluation of the rate and extent of lipid and drug transport via the lymphatic system for several hours following intestinal delivery. The method is easily adaptable to the measurement of other parameters in lymph. We provide detailed descriptions of the difficulties that may be encountered when establishing this complex surgical method, as well as representative data from failed and successful experiments to provide instruction on how to confirm experimental success and interpret the data obtained. PMID:25866901

Trevaskis, Natalie L; Hu, Luojuan; Caliph, Suzanne M; Han, Sifei; Porter, Christopher J H



Flow-cytometric evaluation of lymphocyte subpopulations in synchronously developing Schistosoma mansoni egg and Sephadex bead pulmonary granulomas.  

PubMed Central

Synchronous models of T-cell-mediated and foreign body granulomas were induced in mice by intravenous embolization of Schistosoma mansoni eggs and Sephadex beads, respectively. The authors then performed flow-cytometric analysis of lymphocytes from dispersed granulomas, spleens, and peripheral blood at 4, 8, 16, and 32 days corresponding to the induction, growth, and maintenance, and resolution of these lesions. Lymphocytes were identified on the basis of light scatter characteristics, and the nature of the cells was confirmed by cell sorting and electron-microscopic examination. Lymphocyte subpopulations were characterized with antibodies to lymphocyte surface markers, specifically Ig, Thy 1.2, Lyt 1, Lyt 2, and L3T4. Natural killer cells were identified with anti-asialo GM1. Egg-induced granulomas had more lymphocytes of all phenotypes at all time points. Surprisingly, there was a significant number of cells staining positive for asialo GM1. On Day 16 after embolization there was a greater percentage of helper T cells, as defined by positive staining with L3T4, in the egg model, compared with the bead model. There was no obvious shift of lymphocytes from either the blood or spleen into the granuloma. These data confirm the importance of T cells in the direct participation of granulomatous inflammation, and the large numbers of asialo GM1-positive cells suggest a role for natural killer cells. Images Figure 4 PMID:2451888

Remick, D. G.; Chensue, S. W.; Hiserodt, J. C.; Higashi, G. I.; Kunkel, S. L.



Hantavirus Pulmonary Syndrome  


... Pulmonary Syndrome Hantavirus Pulmonary Syndrome Hantavirus pulmonary syndrome (HPS) is a disease that comes from contact with ... rodents or their urine, droppings or saliva. The HPS infection cannot be transmitted from one person to ...


Idiopathic Pulmonary Fibrosis  


... the NHLBI on Twitter. What Is Idiopathic Pulmonary Fibrosis? Pulmonary fibrosis (PULL-mun-ary fi-BRO-sis) ... is safe and effective for humans. Idiopathic Pulmonary Fibrosis in the News May 19, 2014 Common treatment ...


About Familial Pulmonary Fibrosis  


About Familial Pulmonary Fibrosis An estimated 10-15 percent of patients with idiopathic pulmonary fibrosis (IPF) have a form of the pulmonary fibrosis that runs in families. This is called Familial ...


Sentinel Lymph Node (SLN) Biopsy  


... it's filled with cancer. It may block the flow of both the radioactive material, injected earlier by ... filters are plugged with cancer cells, there's no flow of the tissue fluid, or the lymphatic fluid ...


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.



Animal Models Related to Congenital Heart Disease and Clinical Research in Pulmonary Hypertension  

Microsoft Academic Search

There are several animal models for studying human pulmonary hypertension (PH). An increased flow model in pigs was developed at the University Hospital in Heidelberg in order to simulate congenital heart disease. The high pulmonary blood flow is achieved by installation of a Blalock-Taussig anastomosis. In order to further improve this model by adding a pressure component, the left pulmonary

Tsvetomir Loukanov; Ralf Geiger; Rahul Agrawal



Pulmonary dendritic cell development and antigen acquisition  

PubMed Central

Pulmonary dendritic cells (DCs) constantly sample the tissue and traffic inhaled antigens to the lung-draining lymph node where they normally orchestrate an appropriate immune response. The dynamic ability of these professional antigen-presenting cells to promote tolerance or immunity has been intensively studied by several groups, including ours. Distinct DC subsets in both lymphoid and non-lymphoid tissues have been described based on their surface molecule expression and location. Current efforts to unravel DC development and function are providing insight into the various roles each subset offers the immune system. Elucidating DC functions, particularly in the lung, may then allow use of the inherent ability of these cells for enhanced vaccine strategies and therapeutics for pulmonary infections and diseases. PMID:22968708

Desch, A. Nicole; Henson, Peter M.



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


Unnecessary axillary node dissections in the sentinel lymph node era  

Microsoft Academic Search

In the sentinel lymph node era, axillary lymph node dissection (ALND) for uninvolved axillary lymph nodes should be considered unnecessary and inappropriate. Between January 2000 and August 2005, 3487 out of 10,031 invasive breast cancer patients consecutively operated at the European Institute of Oncology were considered not suitable for sentinel lymph node biopsy (SNB) and were directly submitted to ALND

Mattia Intra; Nicole Rotmensz; Denise Mattar; Oreste D. Gentilini; Annarita Vento; Paolo Veronesi; Marco Colleoni; Concetta De Cicco; Enrico Cassano; Alberto Luini; Umberto Veronesi



Primary Neuroendocrine Carcinoma of Inguinal Lymph Node  

Microsoft Academic Search

Ninety-seven percent of neuroendocrine carcinomas are located in the gastrointestinal tract or in the bronchopulmonary tree. Inguinal lymph nodes as the primary tumor site for neuroendocrine carcinoma represent a very unusual location, and have only been described in 2 patient series in the literature. A 64-year-old, previously healthy, Caucasian female presented with a 2-month history of an enlarged inguinal lymph

H. Biering; J. Bauditz; N. Brenner; H. Stein; H. Lochs; C. J. Strasburger



Sentinel Lymph Node Biopsy in Prostatic Cancer  

Microsoft Academic Search

\\u000a The identification of lymph drainage has significant clinical importance for tumor spread in prostatic cancer. Pelvic lymph\\u000a node metastases indicate a poor prognosis for patients with clinically localized prostate cancer. The prognosis depends on\\u000a nodal cancer volume (1), extracapsular extension (2), and the number of prostatic nodes affected (3). It is not clear whether the more valuable prognostic factor is

Alexander Winter; Harry Vogt; Dorothea Weckermann; Rolf Harzmann; Friedhelm Wawroschek


Congenital unilateral pulmonary atresia with coronary-to-pulmonary collateral artery originating from left circumflex coronary artery.  


Major aortopulmonary collateral artery (MAPCA) is a rare vessel anomaly defect arising from the systemic arteries and supplying flow to the pulmonary capillary circulation, which frequently associates with cyanotic heart disease, particularly pulmonary atresia coexisting with ventricular septal defect and tetralogy of Fallot. The branches of MAPCA usually originate from the descending aorta, while a feeding vessel from a coronary artery directed to the pulmonary vasculature is a rare occurrence. Herein, we present the first case of right side pulmonary atresia with a variant of MAPCA originating from the left circumflex coronary artery to the pulmonary capillary circulation in a patient who presented with acute coronary syndrome. PMID:24872474

Nakwan, Narongwit



Pulmonary artery segmentation and quantification in sickle cell associated pulmonary hypertension  

NASA Astrophysics Data System (ADS)

Pulmonary arterial hypertension is a known complication associated with sickle-cell disease; roughly 75% of sickle cell disease-afflicted patients have pulmonary arterial hypertension at the time of death. This prospective study investigates the potential of image analysis to act as a surrogate for presence and extent of disease, and whether the size change of the pulmonary arteries of sickle cell patients could be linked to sickle-cell associated pulmonary hypertension. Pulmonary CT-Angiography scans from sickle-cell patients were obtained and retrospectively analyzed. Randomly selected pulmonary CT-Angiography studies from patients without sickle-cell anemia were used as negative controls. First, images were smoothed using anisotropic diffusion. Then, a combination of fast marching and geodesic active contours level sets were employed to segment the pulmonary artery. An algorithm based on fast marching methods was used to compute the centerline of the segmented arteries. From the centerline, the diameters at the pulmonary trunk and first branch of the pulmonary arteries were measured automatically. Arterial diameters were normalized to the width of the thoracic cavity, patient weight and body surface. Results show that the pulmonary trunk and first right and left pulmonary arterial branches at the pulmonary trunk junction are significantly larger in diameter with increased blood flow in sickle-cell anemia patients as compared to controls (p values of 0.0278 for trunk and 0.0007 for branches). CT with image processing shows great potential as a surrogate indicator of pulmonary hemodynamics or response to therapy, which could be an important tool for drug discovery and noninvasive clinical surveillance.

Linguraru, Marius George; Mukherjee, Nisha; Van Uitert, Robert L.; Summers, Ronald M.; Gladwin, Mark T.; Machado, Roberto F.; Wood, Bradford J.



Cervical lymph node diseases in children  

PubMed Central

The lymph nodes are an essential part of the body’s immune system and as such are affected in many infectious, autoimmune, metabolic and malignant diseases. The cervical lymph nodes are particularly important because they are the first drainage stations for key points of contact with the outside world (mouth/throat/nose/eyes/ears/respiratory system) – a critical aspect especially among children – and can represent an early clinical sign in their exposed position on a child’s slim neck. Involvement of the lymph nodes in multiple conditions is accompanied by a correspondingly large number of available diagnostic procedures. In the interests of time, patient wellbeing and cost, a careful choice of these must be made to permit appropriate treatment. The basis of diagnostic decisions is a detailed anamnesis and clinical examination. Sonography also plays an important role in differential diagnosis of lymph node swelling in children and is useful in answering one of the critical diagnostic questions: is there a suspicion of malignancy? If so, full dissection of the most conspicuous lymph node may be necessary to obtain histological confirmation. Diagnosis and treatment of childhood cervical lymph node disorders present the attending pediatric and ENT physicians with some particular challenges. The spectrum of differential diagnoses and the varying degrees of clinical relevance – from banal infections to malignant diseases – demand a clear and considered approach to the child’s individual clinical presentation. Such an approach is described in the following paper. PMID:25587368

Lang, Stephan; Kansy, Benjamin



Simultaneous pulmonary trunk and pulmonary arterial wave intensity analysis in fetal lambs: evidence for cyclical, midsystolic pulmonary vasoconstriction.  


The physiological basis of a characteristically low blood flow to the fetal lungs is incompletely understood. To determine the potential role of pulmonary vascular interaction in this phenomenon, simultaneous wave intensity analysis (WIA) was performed in the pulmonary trunk (PT) and left pulmonary artery (LPA) of 10 anesthetized late-gestation fetal sheep instrumented with PT and LPA micromanometer catheters to measure pressure (P) and transit-time flow probes to obtain blood velocity (U). Studies were performed at rest and during brief complete occlusion of the ductus arteriosus to augment pulmonary vasoconstriction (n = 4) or main pulmonary artery to abolish wave transmission from the lungs (n = 3). Wave intensity (dI(W)) was calculated as the product of the P and U rates of change. Forward and backward components of dI(W) were determined after calculation of wave speed. PT and LPA WIA displayed an early systolic forward compression wave (FCW(is)) increasing P and U, and a late systolic forward expansion wave decreasing P and U. However, a marked midsystolic fall in LPA U to near-zero was related to an extremely prominent midsystolic backward compression wave (BCW(ms)) that arose approximately 5 cm distal to the LPA, was threefold larger than the PT BCW(ms) (P < 0.001), of similar size to FCW(is) at rest (P > 0.6), larger than FCW(is) following ductal occlusion (P < 0.05) and abolished after main pulmonary artery occlusion. These findings suggest that the absence of pulmonary arterial midsystolic forward flow which accompanies a low fetal lung blood flow is due to a BCW(ms) generated in part by cyclical vasoconstriction within the pulmonary microcirculation. PMID:18287223

Smolich, Joseph J; Mynard, Jonathan P; Penny, Daniel J



Interspecific comparisons of lymph volume and lymphatic fluxes: do lymph reserves and lymph mobilization capacities vary in anurans from different environments?  


The femoral lymph sac volumes and lymph mobilization capacity were compared in three anuran species that span a range of environments, dehydration tolerance, ability to maintain blood volume with dehydration, and degrees of development of skeletal muscles putatively involved in moving lymph vertically to the posterior lymph hearts. The femoral lymph sac volume determined by Evans blue injection and dilution in the femoral lymph sac varied interspecifically. The semiaquatic species, Lithobates catesbeianus, had the greatest apparent lymph volume expressed either as 18.7 mL kg body mass?¹ or 94 mL kg thigh mass?¹, compared with both the terrestrial and aquatic species, Rhinella marina (7.3 mL kg body mass?¹ and 57 mL kg thigh mass?¹) and Xenopus laevis (6.5 mL kg body mass?¹ and 40 mL kg thigh mass?¹, respectively. Injections of Evans blue into the subvertebral lymph sac, which communicates with both pairs of lymph hearts, yielded the highest rates of lymph return to the circulation in all three species. The most terrestrial species had a greater rate of lymphatic return from the subvertebral lymph sac, compared with the other two species. The rate of lymph flux from the femoral sac varied interspecifically and was correlated with the number and development of skeletal muscles involved in lymph movement. The results indicated that the three species differ in both the volume of lymph present and the capacity to return lymph. Lymph flux was correlated with habitat and the ability to maintain blood volume when challenged by dehydration or hemorrhage, whereas femoral lymph volume was not correlated with these factors. PMID:21527817

Hillman, Stanley S; Drewes, Robert C; Hedrick, Michael S; Withers, Philip C



Pulmonary Vasculitis  

PubMed Central

Pulmonary vasculitis describes a number of distinct disorders that are pathologically characterized by the destruction of blood vessels. The clinical manifestations of each disorder are defined by the size, type, and location of the affected vasculature. The clinical approach to these disorders rests upon an astute clinician considering the diagnosis and identifying the specific patterns of clinical, radiologic, laboratory, and pathologic abnormalities. Lung involvement is most commonly seen with the primary, idiopathic, small-vessel, or antineutrophil cytoplasmic antibody–associated vasculitides; Wegener's granulomatosis, microscopic polyangiitis, and Churg-Strauss syndrome. However, primary, idiopathic medium and large-vessel vasculitis, primary immune complex–mediated vasculitis, and secondary vasculitis are all capable of presenting with lung involvement. In this article, we focus on the more common, antineutrophil cytoplasmic antibody–associated disorder, vasculitides. PMID:16493151

Brown, Kevin K.



Plasmacytoid dendritic cells (PDC) are the major DC subset innately producing cytokines in human lymph nodes  

Microsoft Academic Search

Plasmacytoid dendritic cells (PDC) constitute a distinct subset of DC found in human peripheral lymph nodes (LN), but little is known about their function. Cell suspensions were pre- pared from tumor draining LN (n20) and control LN (n11) of women undergoing surgical resec- tion for primary breast cancer and elective surgery for benign conditions, respectively. Using four- color flow cytometry,

Karina Cox; Margaret North; Michael Burke; Hemant Singhal; Sophie Renton; Nayef Aqel; Sabita Islam; Stella C. Knight




Technology Transfer Automated Retrieval System (TEKTRAN)

Previous analysis by flow cytometry and RT-PCR showed immune modulation by both beta-glucan and ascorbic acid in mesenteric lymph nodes and blood. The objective of this study was to determine if the beta-glucan was acting locally or systemically. Calves were placed onto treatments at 3 d-of-age (d 0...


Pulmonary arterial changes in patients with ventricular septal defects and severe pulmonary hypertension.  


In 25 patients, aged eight months to 31 years, with ventricular septal defect (VSD; isolated in 15, the others with atrial septal defect, PDA, coarctation or patent ductus arteriosus + coarctation), each with severe pulmonary artery hypertension (pulmonary artery systolic pressure [Ppa] at least 75% of systemic and an elevated pulmonary vascular resistance), we related morphologic and morphometric data from open-lung biopsy to hemodynamic measurements obtained at cardiac catheterization during the same hospital admission. Of the hemodynamic features measured, only the ratios of pulmonary-to-systemic flow and pulmonary-to-systemic resistance correlated significantly with structure. Neither pulmonary artery pressure (Ppa) nor pulmonary vascular resistance correlated significantly with any structural feature studied. The increased external diameter of respiratory bronchiolar arteries in those with the more advanced Heath-Edwards grades reflects dilatation and suggests that it is in the small arteries of the distal arterial bed that the changes of pulmonary hypertension are most significant. Neither age nor body weight correlated significantly with the degree of structural or hemodynamic abnormality. In the ten patients who underwent VSD closure, Ppa was measured postoperatively. The Heath-Edwards grade (no more than one grade-III lesion) and arterial density (at least one-half that normal for age) were the best correlates of the difference between preoperative Ppa and Ppa immediately after corrective surgery. The presurgical catheterization data, including pulmonary resistance and the resistance ratio, did not correlate significantly with change in Ppa following VSD closure.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3808993

Fried, R; Falkovsky, G; Newburger, J; Gorchakova, A I; Rabinovitch, M; Gordonova, M I; Fyler, D; Reid, L; Burakovsky, V



Beneficial pulmonary effects of a metalloporphyrinic peroxynitrite decomposition catalyst in burn and smoke inhalation injury  

PubMed Central

During acute lung injury, nitric oxide (NO) exerts cytotoxic effects by reacting with superoxide radicals, yielding the reactive nitrogen species peroxynitrite (ONOO?). ONOO? exerts cytotoxic effects, among others, by nitrating/nitrosating proteins and lipids, by activating the nuclear repair enzyme poly(ADP-ribose) polymerase and inducing VEGF. Here we tested the effect of the ONOO? decomposition catalyst INO-4885 on the development of lung injury in chronically instrumented sheep with combined burn and smoke inhalation injury. The animals were randomized to a sham-injured group (n = 7), an injured control group [48 breaths of cotton smoke, 3rd-degree burn of 40% total body surface area (n = 7)], or an injured group treated with INO-4885 (n = 6). All sheep were mechanically ventilated and fluid-resuscitated according to the Parkland formula. The injury-related increases in the abundance of 3-nitrotyrosine, a marker of protein nitration by ONOO?, were prevented by INO-4885, providing evidence for the neutralization of ONOO? action by the compound. Burn and smoke injury induced a significant drop in arterial Po2-to-inspired O2 fraction ratio and significant increases in pulmonary shunt fraction, lung lymph flow, lung wet-to-dry weight ratio, and ventilatory pressures; all these changes were significantly attenuated by INO-4885 treatment. In addition, the increases in IL-8, VEGF, and poly(ADP-ribose) in lung tissue were significantly attenuated by the ONOO? decomposition catalyst. In conclusion, the current study suggests that ONOO? plays a crucial role in the pathogenesis of pulmonary microvascular hyperpermeability and pulmonary dysfunction following burn and smoke inhalation injury in sheep. Administration of an ONOO? decomposition catalyst may represent a potential treatment option for this injury. PMID:21075825

Szabo, Csaba; Enkhbaatar, Perenlei; Connelly, Rhykka; Horvath, Eszter; Hamahata, Atsumori; Cox, Robert A.; Esechie, Aimalohi; Nakano, Yoshimitsu; Traber, Lillian D.; Herndon, David N.; Traber, Daniel L.



Living with Idiopathic Pulmonary Fibrosis  


... the NHLBI on Twitter. Living With Idiopathic Pulmonary Fibrosis No cure is available for idiopathic pulmonary fibrosis ( ... Pulmonary Fibrosis, visit . Idiopathic Pulmonary Fibrosis in the News May 19, 2014 Common treatment ...


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. PMID:23369973

Niu, Chun-Yu; Zhao, Zi-Gang; Zhang, Yu-Ping; Hou, Ya-Li; Li, Jun-Jie; Jiang, Hua; Zhang, Jing



New ultrasound techniques for lymph node evaluation  

PubMed Central

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



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



[Pelvic lymph node dissection. Complication management].  


Extended pelvic lymph node dissection allows exact lymph node staging and has the potential to improve prognosis. In addition to these advantages, there are some perioperative and postoperative complications. In case of transection of the obturator nerve, a microsurgical end-to-end anastomosis should be performed. The most frequent postoperative complication is (symptomatic) lymphocele which is predominantly diagnosed after extraperitoneal surgery. Meticulous lymph node dissection with clipping of lymphatic vessels, sparing the lateral wall of the external iliac artery from dissection, sufficient postoperative drainage, and application of low molecular weight heparin in the upper arm may reduce their incidence. Instillation of sclerosing agents and sufficient drainage are normally successful. If not, laparoscopic fenestration of lymphocele should be performed. Regular ultrasound examinations are necessary to diagnose and treat postoperative lymphocele in a timely manner. PMID:24705476

Weckermann, D



[The lymph vessel system of fallow deer (Dama dama L. 1758)].  


In the present study the main lymph vessels of important lymph centres of fallow deer are described in detail and represented radiologically. The lymph flow from the periphery (Ear conch, distal extremity) to the entry into the venous angle is proved by means of simultaneous indirect lymphography (SIL). The vasa afferentia do not lead from the lateral ear conch to the NI. parotideus, as usually described with domestic animals, but run dorsally along the cervical vertebra to the NI. cervicalis superficialis. Therefore the Truncus jugularis does not drain the entire head. Furthermore, in view of the findings obtained with fallow deer, the general formation of a superficial and a deep lymphatic system in the distal zones of the extremities is questionable at least as far as domestic ruminants of comparable size are concerned. PMID:8319546

Müsse, E; Pohlmeyer, K; Berens von Rautenfeld, D



Pulmonary and thoracic macrophage subpopulations and clearance of particles from the lung  

SciTech Connect

Pulmonary macrophages consist of several subpopulations that can be defined by their anatomical locations as well as by other criteria. In addition to the well-known alveolar macrophages that reside on the alveolar surface, pulmonary macrophages also occur in the conducting airways, in various pulmonary interstitial regions, and, in some mammalian species, in the lung's intravascular compartment. Other thoracic macrophages of relevance to pulmonary defense and some lung disease processes are the pleural macrophages resident in the pleural space and macrophages present in regional lymph nodes that receive lymphatic drainage from the lung. Of the above subpopulations of pulmonary and thoracic macrophages, the alveolar macrophages have received the most experimental attention in the context of the pulmonary clearance and retention of deposited particles. Accordingly, less information is currently available regarding the roles other pulmonary and thoracic populations of macrophages may play in the removal of particles from the lower respiratory tract and associated tissue compartments. This report provides an overview of the various subpopulations of pulmonary and thoracic macrophages, as defined by their anatomical locations. The known and postulated roles of macrophages in the pulmonary clearance and retention of particles are reviewed, with particular emphasis on macrophage-associated processes involved in the pulmonary clearance of relatively insoluble particles. 270 refs., 22 figs., 1 tab.

Lehnert, B.E. (Los Alamos National Lab., NM (United States))



Pulmonary and thoracic macrophage subpopulations and clearance of particles from the lung.  

PubMed Central

Pulmonary macrophages consist of several subpopulations that can be defined by their anatomical locations as well as by other criteria. In addition to the well-known alveolar macrophages that reside on the alveolar surface, pulmonary macrophages also occur in the conducting airways, in various pulmonary interstitial regions, and, in some mammalian species, in the lung's intravascular compartment. Other thoracic macrophages of relevance to pulmonary defense and some lung disease processes are the pleural macrophages resident in the pleural space and macrophages present in regional lymph nodes that receive lymphatic drainage from the lung. Of the above subpopulations of pulmonary and thoracic macrophages, the alveolar macrophages have received the most experimental attention in the context of the pulmonary clearance and retention of deposited particles. Accordingly, less information is currently available regarding the roles other pulmonary and thoracic populations of macrophages may play in the removal of particles from the lower respiratory tract and associated tissue compartments. This report provides an overview of the various subpopulations of pulmonary and thoracic macrophages, as defined by their anatomical locations. The known and postulated roles of macrophages in the pulmonary clearance and retention of particles are reviewed, with particular emphasis on macrophage-associated processes involved in the pulmonary clearance of relatively insoluble particles. Images FIGURE 1. FIGURE 2. FIGURE 3. FIGURE 5. FIGURE 8. FIGURE 12. FIGURE 14. FIGURE 15. FIGURE 16. FIGURE 17. FIGURE 18. FIGURE 19. A FIGURE 19. B FIGURE 21. FIGURE 22. PMID:1396454

Lehnert, B E



Hantavirus Pulmonary Syndrome  


... Emerging and Zoonotic Infectious Diseases Division of High-Consequence Pathogens and Pathology Hantavirus Pulmonary Syndrome Hantavirus Pulmonary Syndrome (HPS) is a rare but severe, sometimes fatal, respiratory disease in humans caused by infection with hantavirus. What are the ...


What Is Pulmonary Hypertension?  


... Dizziness Shortness of breath Symptoms and diagnosis of primary pulmonary hypertension (PPH) can be tricky. Early on, you may ... a definite health problem that needs treatment. Although primary pulmonary hypertension (PPH) is rare, diagnosing and treating PPH is ...


Pulmonary Rehabilitation Program  


... covered? Search for covered items Pulmonary rehabilitation program How often is it covered? Medicare covers a comprehensive pulmonary rehabilitation program if you have moderate to very severe ...


Who Needs Pulmonary Rehabilitation?  


... Topics Bronchitis COPD Cystic Fibrosis Idiopathic Pulmonary Fibrosis Sarcoidosis Send a link to NHLBI to someone by ... other symptoms. Examples of interstitial lung diseases include sarcoidosis and idiopathic pulmonary fibrosis . Cystic fibrosis (CF). CF ...


Idiopathic Pulmonary Fibrosis (IPF)  


... PF is unknown, the diagnosis is idiopathic pulmonary fibrosis (IPF) . Idiopathic means there is no known cause ... this happens, the disease is called Familial Pulmonary Fibrosis . The fact that PF runs in certain families ...


Coalition for Pulmonary Fibrosis  


... Patient Education Resources Accomplishments About Us Coalition for Pulmonary Fibrosis 10866 W. Washington Blvd #343 • Culver City, CA ... of their respective owners. ©2001 – 2011 Coalition for Pulmonary Fibrosis Site Last Updated: March 25, 2015


Pulmonary hemorrhage in cryoglobulinemia.  


Pulmonary manifestations of cryoglobulinemia are uncommon and their clinical behaviour is unpredictable, ranging from mild dyspnea to life-threatening presentations. A patient with cryoglobulinemia who presented with hypoxic respiratory failure attributed to pulmonary hemorrhage is reported. PMID:25493699

Kirkpatrick, Gordon; Winstone, Tiffany; Wilcox, Pearce; Van Eeden, Stephan



Differentiating Blood, Lymph, and Primo Vessels by Residual Time Characteristic of Fluorescent Nanoparticles in a Tumor Model  

PubMed Central

Fluorescent nanoparticles (FNPs) which were injected into a tumor tissue flowed out through the blood and lymph vessels. The FNPs in blood vessels remained only in the order for few minutes while those in lymph vessels remained for a long time disappearing completely in 25 hours. We found a primo vessel inside a lymph vessel near a blood vessel, and FNPs remained in the primo vessel for longer than 25 hours. In addition, we examined in detail the residual time characteristics of lymph vessels because it could be useful in a future study of fluid dynamical comparison of the three conduits. These residual time characteristics of FNPs in the three kinds of vessels may have implications for the dynamics of nanoparticle drugs for cancer chemotherapy. PMID:23662147

Lee, Sungwoo; Lim, Jaekwan; Cha, Jinmyung; Lee, Jin-Kyu; Ryu, Yeon Hee; Kim, SungChul; Soh, Kwang-Sup



Hypoxic pulmonary vasoconstriction: physiology and anesthetic implications.  


Hypoxic pulmonary vasoconstriction (HPV) represents a fundamental difference between the pulmonary and systemic circulations. HPV is active in utero, reducing pulmonary blood flow, and in adults helps to match regional ventilation and perfusion although it has little effect in healthy lungs. Many factors affect HPV including pH or PCO2, cardiac output, and several drugs, including antihypertensives. In patients with lung pathology and any patient having one-lung ventilation, HPV contributes to maintaining oxygenation, so anesthesiologists should be aware of the effects of anesthesia on this protective reflex. Intravenous anesthetic drugs have little effect on HPV, but it is attenuated by inhaled anesthetics, although less so with newer agents. The reflex is biphasic, and once the second phase becomes active after about an hour of hypoxia, this pulmonary vasoconstriction takes hours to reverse when normoxia returns. This has significant clinical implications for repeated periods of one-lung ventilation. PMID:25587641

Lumb, Andrew B; Slinger, Peter



Idiopathic pulmonary arterial hypertension and pulmonary veno-occlusive disease: similarities and differences.  


Pulmonary veno-occlusive disease (PVOD) is a rare disorder and can be misdiagnosed as idiopathic pulmonary arterial hypertension (iPAH). PVOD and iPAH often share a similar clinical presentation, genetic background, and hemodynamic profile. PVOD accounts for 5 to 10% of cases initially considered as iPAH. When compared with iPAH, PVOD is characterized by a higher male:female ratio, higher tobacco exposure, and lower PaO (2) at rest, diffusing capacity for carbon monoxide (DLCO), and oxygen saturation nadir during the 6-minute walk test. High-resolution computed tomography (HRCT) of the chest may be suggestive of PVOD in the presence of centrilobular ground-glass opacities, septal lines, and lymph node enlargement. Additionally, occult alveolar hemorrhage is associated with PVOD. Definitive diagnosis necessitates a surgical lung biopsy; however, this procedure is exceedingly high risk in this patient population and is generally not recommended. Therefore, a noninvasive diagnostic approach using HRCT of the chest, arterial blood gases, pulmonary function tests, and bronchoalveolar lavage may be helpful to detect PVOD. In contrast with iPAH, PVOD is characterized by an even poorer prognosis and the possibility of developing severe pulmonary edema with specific PAH therapy. Lung transplantation remains the treatment of choice, but cautious use of specific PAH therapy can be helpful in select patients while awaiting this intervention. PMID:19634080

Montani, David; Kemp, Kristina; Dorfmuller, Peter; Sitbon, Olivier; Simonneau, Gérald; Humbert, Marc



Pulmonary hypertension in pulmonary langerhans cell granulomatosis.  


Introduction. Pulmonary Langerhans cell granulomatosis is a rare disease with a variable course. In pulmonary Langerhans cell granulomatosis pulmonary hypertension is frequent and has an independent prognostic impact. A vasculopathy which ist not related to ventilatory disturbance and fibrosis has been identified. An arteriopathy and even a venulopathy have been described. Due to this possible venulopathy vasodilators carry a significant risk for pulmonary congestion and edema. No drugs have been approved until now. Case Presentation. One female with PLCG developed severe PH four years after primary diagnosis of pulmonary Langerhans cell granulomatosis. Retrospective analysis of lung biopsies revealed an arterial vasculopathy at the time of primary diagnosis without clinical signs of PH at this time. Sildenafil led to a sustained improvement of hemodynamic features and exercise capacity. Conclusion. This paper underlines that patients with PLCG with an arterial vasculopathy-related PH might improve under sildenafil. Further trials addressing treatment of PH and vasculopathy are needed. PMID:22481950

Held, Matthias; Schnabel, Philipp; Warth, Arne; Jany, Berthold



Lymph node findings in generalized mastocytosis.  


Lymph nodes from 21 cases of generalized mastocytosis were studied histologically to confirm or exclude mast cell infiltration, and to investigate their micro-architecture. Mast cell infiltrates were detected in 17 (80%) of the lymph nodes and were found mainly in the medullary cords and sinuses. Diffuse infiltration was seen in 14 cases and focal infiltration in three cases. The following pathological findings were frequently observed: germinal centre hyperplasia (n = 14), which is probably a nonspecific finding; and hyperplasia of small blood vessels, which sometimes resembled high endothelial venules (14), eosinophilia (8), plasmacytosis (7) and collagen fibrosis (6), all of which may well be related to the effects of mediators released by mast cells. Infiltrates of acute or chronic myeloid leukaemia were seen in six lymph nodes. Division of the cases into two prognostically different groups, i.e. systemic mastocytosis, in which the skin lesions of urticaria pigmentosa are present and the prognosis is favourable, and malignant mastocytosis, in which there is no cutaneous involvement and the prognosis is poor, revealed that all six lymph nodes exhibiting leukaemic infiltrates came from the malignant mastocytosis group; eosinophilia, plasmacytosis and fibrosis were seen significantly more often in malignant than in systemic mastocytosis, but blood vessel hyperplasia and germinal centre hyperplasia were encountered with the same high frequency in both groups; and mast cell atypia tended to be more pronounced in malignant mastocytosis; this diagnosis could therefore easily be missed without naphthol AS-D chloroacetate esterase staining.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1452127

Horny, H P; Kaiserling, E; Parwaresch, M R; Lennert, K



Lymph node metastases arising from uveal melanoma  

Microsoft Academic Search

Summary Since the eye lacks lymphatic vessels, uveal melanomas primarily metastasize hematogenously. Here we report the case of a patient with ciliary body ring melanoma who developed lymph node metastases after a fistulating glaucoma operation. A 40-year-old female Caucasian patient presented with unilateral pigment dispersion. Pigment dispersion glaucoma was diagnosed and since the intraocular pressure could not be managed with

Navid Ardjomand; Peter Komericki; Gerald Langmann; Dietmar Mattes; Murat Moray; Michael Scarpatetti; Yosuf El-Shabrawi



Sentinel lymph node navigation surgery for early stage gastric cancer  

PubMed Central

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. PMID:24914329

Mitsumori, Norio; Nimura, Hiroshi; Takahashi, Naoto; Kawamura, Masahiko; Aoki, Hiroaki; Shida, Atsuo; Omura, Nobuo; Yanaga, Katsuhiko



Salmonella in lymph nodes of cattle presented for harvest  

Technology Transfer Automated Retrieval System (TEKTRAN)

This study was undertaken to determine the prevalence of Salmonella in the subiliac lymph nodes (LN) of cattle. Lymph node samples were obtained from carcasses of cull and feedlot cattle at commercial packing plants. Lymph nodes were trimmed of all fat, surface sterilized by submersion in boiling ...


Salmonella prevalence in bovine lymph nodes differs among feedyards  

Technology Transfer Automated Retrieval System (TEKTRAN)

Lymphatic tissue, specifically lymph nodes, is commonly incorporated into ground beef products as a component of lean trimmings. Salmonella and other pathogenic bacteria have been identified in bovine lymph nodes. Although Salmonella prevalence has been examined among lymph nodes within an animal,...


Protein predictive signatures for lymph node metastasis of gastric cancer.  


Lymph node status remains one of most crucial indicators of gastric cancer prognosis and treatment planning. Current imaging methods have limited accuracy in predicting lymph node metastasis. We sought to identify protein markers in primary gastric cancer and to define a risk model to predict lymph node metastasis. The Protein Pathway Array (PPA) (initial selection) and Western blot (confirmation) were used to assess the protein expression in a total of 190 freshly frozen gastric cancer samples. The protein expression levels were compared between samples with lymph node metastasis (n = 73) and those without lymph node metastasis (n = 57) using PPA. There were 27 proteins differentially expressed between lymph node positive samples and lymph node negative samples. Five proteins (Factor XIII B, TFIIH p89, ADAM8, COX-2 and CUL-1) were identified as independent predictors of lymph node metastasis. Together with vascular/lymphatic invasion status, a risk score model was established to determine the risk of lymph node metastasis for each individual gastric cancer patient. The ability of this model to predict lymph node metastasis was further confirmed in a second cohort of gastric cancer patients (33 with and 27 without lymph node metastasis) using Western blot. This study indicated that some proteins differentially expressed in gastric cancer can be selected as clinically useful biomarkers. The risk score model is useful for determining patients' risk of lymph node metastasis and prognosis. PMID:23011604

Li, Wei; Ye, Fei; Wang, Daguang; Sun, Xuan; Tong, Weihua; Lian, Guodong; Jiang, Jing; Suo, Jian; Zhang, David Y



[Squamous cell carcinoma of the trachea: imaging lymph node mapping].  


The anatomy of the trachea lymphatics is poorly understood and the only researches date back to more than one century. Tracheal tumors are very rare, miscellaneous and variously lymphophilic. The cancers of the trachea have no TNM and their lymph node metastases are little studied despite their poor prognosis. We observed 2 cases of squamous cell carcinoma, one in the cervical and the other in the intrathoracic trachea. TDM-3D reformats demonstrated metastatic lymph nodes of the right para-tracheal lymph node chain (2R and 4R) in both patients and in the cervical lymph nodes (right recurrent nerve lymph node chain) in the patient with cervical tumor. Right location of the mediastinal metastases may be explained by the anatomy of the lymph node chain drainage of the lung segments, the right para-tracheal chain being the only one to regularly possess lymph nodes at that level. The right recurrent nerve lymph node metastases of the cervical tumor are explained by common lymph drainage of the cervical trachea towards larynx lymph centres. Besides lymph node metastases, cancers prognosis may also depends on its location in the trachea. Thus, the tracheal tumors are complex and constitute quite as many orphan tumors. Multicentric studies are mandatory to better understand their behavior. Means provided by new imaging techniques might permit establishing a veritable TNM lymph node mapping of these tumors. PMID:25457221

Borik, W; Pricopi, C; Hernigou, A; Fabre, E; Laccourreye, O; Hidden, G; Le Pimpec Barthes, F; Riquet, M



PRECLINICAL STUDY Prediction of lymph node involvement in breast cancer  

E-print Network

PRECLINICAL STUDY Prediction of lymph node involvement in breast cancer from primary tumor tissue- ther lymph node involvement in breast cancer is influenced by gene or miRNA expression of the primary tissue from a group of 96 breast cancer patients balanced for lymph node involvement using Affymetrix


[Fine needle aspirate of lymph node as the analytical sample for immunophenotyping].  


In modern clinical laboratory routine, cell analysis by flow cytometry means help in setting up the diagnosis by determination of B-lymphocyte clonality and thus separation of benign and malignant lymphoproliferative diseases. The aim of this study was to assess the value of cytologic diagnosis and adequacy of the material obtained by fine needle aspiration (FNA) of lymph nodes for flow cytometry analysis in cases of benign lesions and primary malignant lesions of lymph nodes. In addition, the aim was to determine B-lymphocyte clonality in different groups of benign and malignant lymph node lesions. The study was based on medical documentation, cytologic smears of FNA lymph node samples and results of flow cytometry immunophenotyping. A total of 239 patients were included over a one-year period. Patients were classified according to cytologic findings in the groups of non-Hodgkin's lymphoma of B cell origin (55%), benign lymphoproliferative disease (22%), undefined group of monomorphic population of lymphatic cells (16%), and the rest in the group of non-Hodgkin's non B cell origin. Study results showed FNA to be an appropriate method for obtaining sufficient numbers of cells for analysis by flow cytometry because there was no inadequate samples in our study group. In some cases of monomorphic lymphoid cell population, cytologic diagnosis was limited to small cell lymphomas, so determining the clonality by flow cytometry is crucial in separating malignant from benign lymphoproliferative disease. It is concluded that FNA associated with the flow cytometry method is a simple and safe method in the diagnosis of lymphoproliferative disease. PMID:23126034

Svencbir, Viktorija; Ani?, Veronika; Siftar, Zoran; Paro, Mirjana Mariana Kardum; Koloni?, Slobodanka Ostoji?; Bolanca, Ines Krivak; Kardum-Skelin, Ika



Riociguat for pulmonary hypertension.  


Pulmonary hypertension, an elevation of the mean pulmonary artery pressure ?25 mmHg, ultimately leads to premature death due to right ventricular dysfunction. Ten treatments from three classes of drugs are licensed for the management of pulmonary arterial hypertension. These treatments have improved exercise capacity but median survival is still poor. Additionally there are no licensed therapies for the other groups of pulmonary hypertension. Riociguat is a novel drug that stimulates soluble guanylate cyclase independently of nitric oxide and in synergy with nitric oxide. This review summarises the available evidence for riociguat in the treatment across all groups of pulmonary hypertension with a focus on pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. PMID:24580082

Cannon, John E; Pepke-Zaba, Joanna



Chronic thromboembolic pulmonary hypertension.  


Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but debilitating and life-threatening complication of acute pulmonary embolism. CTEPH results from persistent obstruction of pulmonary arteries and progressive vascular remodelling. Not all patients presenting with CTEPH have a history of clinically overt pulmonary embolism. The diagnostic work-up to detect or rule out CTEPH should include ventilation-perfusion scintigraphy, which has high sensitivity and a negative predictive value of nearly 100%. CT angiography usually reveals typical features of CTEPH, including mosaic perfusion, part or complete occlusion of pulmonary arteries, and intraluminal bands and webs. Patients with suspected CTEPH should be referred to a specialist centre for right-heart catheterisation and pulmonary angiography. Surgical pulmonary endarterectomy remains the treatment of choice for CTEPH and is associated with excellent long-term results and a high probability of cure. For patients with inoperable CTEPH, various medical and interventional therapies are being developed. PMID:24898750

Hoeper, Marius M; Madani, Michael M; Nakanishi, Norifumi; Meyer, Bernhard; Cebotari, Serghei; Rubin, Lewis J



Primary pulmonary artery rhabdomyosarcoma.  


A 69-year-old woman presented with a 4-month history of dyspnoea and radiating upper-right quadrant pain and oedema in her lower extremities for more than 20 days. The ultrasonographic study of the heart revealed the adherence of a substantive hypoechoic mass (73 x 34 mm) to the antelateral wall of the pulmonary artery and resultant pulmonary stenosis. Computed tomographic imaging of the pulmonary artery revealed an irregularly shaped filling defect (approximately 41 x 39 x 59 mm) in the main pulmonary artery. The boundary of the defect was irregular, but demarcation with healthy tissue was clear. After surgical treatment, the histologic and immunohistochemical assays revealed a primary pulmonary artery rhabdomyosarcoma. Pulmonary artery rhabdomyosarcomas are usually misdiagnosed as other pulmonary artery obstructive diseases. There should be a greater focus of clinical attention and resection is the appropriate surgical treatment for such malignant tumours. PMID:21744714

Si, Daoyuan; Zhang, Bomin; Zhang, Xiuhe; Zhang, Mingqiu; Ni, Lujia; Yang, Ping



Pleomorphic malignant histiocytoma of pulmonary arteries presenting as pulmonary aneurysms.  


Pulmonary aneurysms and primary neoplasms of the great vessels are very rare entities; pulmonary aneurysms are commonly associated with congenital heart diseases, and less frequently in atherosclerosis, medial cystic necrosis, trauma, infection, and inflammatory processes. Many patients have pulmonary hypertension, most frequently resulting from pulmonary artery sarcomas mimicking pulmonary thromboembolism. Symptoms are vague. In 30% of cases, rupture and death occur, related to pulmonary aneurysms. We present the case of a patient with a diagnosis of pulmonary artery pleomorphic malignant histiocytoma that presented as a right pulmonary aneurysm thrombosis and a contained rupture of a left pulmonary aneurysm. PMID:23438543

De La Cerda Belmont, Gustavo Armando; Lezama Urtecho, Carlos Alberto



Pulmonary hemodynamics modify the rat pulmonary artery response to injury. A neointimal model of pulmonary hypertension.  

PubMed Central

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 PMID:9327735

Okada, K.; Tanaka, Y.; Bernstein, M.; Zhang, W.; Patterson, G. A.; Botney, M. D.



Lymph node fine needle Cytology in the staging and follow-up of Cutaneous Lymphomas  

PubMed Central

Background Lymph nodal involvement is an important clinical-pathological sign in primary cutaneous lymphoma (PCL), as it marks the transformation/evolution of the disease from localized to systemic; therefore the surveillance of lymph nodes is important in the staging and follow up of PCL. Fine needle cytology (FNC) is widely used in the diagnosis of lymphadenopathies but has rarely been reported in PCL staging and follow-up. In this study an experience on reactive and neoplastic lymphadenopathies arisen in PCL and investigated by FNC, combined to ancillary techniques, is reported. Methods Twenty-one lymph node FNC from as many PCL patients were retrieved; 17 patients had mycosis fungoides (MF) and 4 a primary cutaneous B-cell lymphoma (PBL). In all cases, rapid on site evaluation (ROSE) was performed and additional passes were used to perform flow cytometry (FC), immunocytochemistry (ICC) and/or polymerase chain reaction (PCR) to assess or rule out a possible clonality of the corresponding cell populations. Results FNC combined with FC, ICC, and PCR identified 12 cases of reactive, non specific, hyperplasia (BRH), 4 dermatopathic lymphadenopathy (DL), 4 lymph nodal involvement by MF and 1 lymph nodal involvement by cutaneous B-cell lymphoma. Conclusions FNC coupled with ancillary techniques is an effective tool to evaluate lymph node status in PCL patients, provided that ROSE and a rational usage of ancillary techniques is performed according to the clinical context and the available material. The method can be reasonably used as first line procedure in PCL staging and follow up, avoiding expensive and often ill tolerated biopsies when not strictly needed. PMID:24393425



Pulmonary veno-occlusive disease: recent progress and current challenges.  


Pulmonary veno-occlusive disease (PVOD) is an uncommon form of pulmonary arterial hypertension characterised by a progressive obstruction of small pulmonary veins that leads to elevation in pulmonary vascular resistance and right ventricular failure. Despite improved understanding and more efficacious treatment options for PAH overall, the prognosis of PVOD remains dismal. Without therapeutic intervention few patients would be expected to survive more than two years. PVOD may occur in both idiopathic and heritable forms, or develop in association with connective tissue disease, chronic respiratory disease, malignancy or bone marrow transplantation, among other causes. A widespread fibrous intimal proliferation that predominantly involves the pulmonary venules and small veins is the key histopathological hallmark. Surgical lung biopsy is considered the definitive diagnostic test but is associated with significant risk and is not recommended. Distinguishing PVOD from PAH on clinical grounds alone is generally not possible, although PVOD is characterised by a higher male/female ratio and higher tobacco exposure. Instead, non-invasive tests may be helpful and the diagnosis is usually based on an integrated assessment that incorporates high resolution computed tomography (septal lines, ground-glass opacities and lymph node enlargement), pulmonary function testing (lower DLCO), arterial blood gas analysis (lower PaO(2) at rest) and bronchoalveolar lavage (occult alveolar haemorrhage). Treatment of PVOD remains challenging as exposure to pulmonary vasodilators and PAH-specific agents may precipitate acute pulmonary oedema. Nonetheless, a number of successful outcomes describing cautious use of prostanoids, endothelin antagonists and phosphodiesterase type-5 inhibitors have been described. Unfortunately, the long term effects of these agents are variable and lung transplantation remains the treatment of choice. PMID:20456932

Montani, David; O'Callaghan, Dermot S; Savale, Laurent; Jaïs, Xavier; Yaïci, Azzedine; Maitre, Sophie; Dorfmuller, Peter; Sitbon, Olivier; Simonneau, Gérald; Humbert, Marc



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



[Lymph nodes of esophagus cancer: radiological approach].  


The cervico-thoracic-abdominal-pelvic CT-scan is a key examination of the staging of esophagus cancers. Anatomical and pathophysiological knowledge of the lymph nodes is an essential tool to establish a precise mapping. Imaging tests (such endoscopic ultrasound and PET scanning) will be very useful to determine clinical options and clinical target volume delineation for the radiotherapy of esophagus cancers. PMID:25205427

Aubert, E; Servois, V



Sentinel lymph node biopsy for gastrointestinal cancers.  


Sentinel lymph node biopsy (SLNB) in gastrointestinal-(GI)-tract cancer is not yet of clinical relevance. Nevertheless, the results in the upper GI-tract promise to be helpful to individualize the indication for surgical therapy. SLNB in colon cancer still fails to show high validity to predict the nodal status, but may be helpful to clarify the prognostic role of micrometastases/isolated tumor cells. In anal cancer SLNB is able to guide the indication for groin irradiation. PMID:17726666

Bembenek, A; Gretschel, S; Schlag, P M




Microsoft Academic Search

Gene flow and potential for Sin Nombre virus (SNV) trafficking of the deer mouse (Peromyscus maniculatus) was studied in Delta and Mesa counties of western Colorado (USA). The study areas included Grand Mesa and surrounding grazing and agricultural areas. This area has several natural potential barriers to rodent gene flow, including rivers, cliffs, and mountains. Ten study sites were utilized

J. Jeffrey Root; William C. Black; Charles H. Calisher; Kenneth R. Wilson; Ryan S. Mackie; Tony Schountz; James N. Mills; Barry J. Beaty



Pulmonary hypertension caused by pulmonary venous hypertension  

PubMed Central

Abstract The effect of pulmonary venous hypertension (PVH) on the pulmonary circulation is extraordinarily variable, ranging from no impact on pulmonary vascular resistance (PVR) to a marked increase. The reasons for this are unknown. Both acutely reversible pulmonary vasoconstriction and pathological remodeling (especially medial hypertrophy and intimal hyperplasia) account for increased PVR when present. The mechanisms involved in vasoconstriction and remodeling are not clearly defined, but increased wall stress, especially in small pulmonary arteries, presumably plays an important role. Myogenic contraction may account for increased vascular tone and also indirectly stimulate remodeling of the vessel wall. Increased wall stress may also directly cause smooth muscle growth, migration, and intimal hyperplasia. Even long-standing and severe pulmonary hypertension (PH) usually abates with elimination of PVH, but PVH-PH is an important clinical problem, especially because PVH due to left ventricular noncompliance lacks definitive therapy. The role of targeted PH therapy in patients with PVH-PH is unclear at this time. Most prospective studies indicate that these medications are not helpful or worse, but there is ample reason to think that a subset of patients with PVH-PH may benefit from phosphodiesterase inhibitors or other agents. A different approach to evaluating possible pharmacologic therapy for PVH-PH may be required to better define its possible utility. PMID:25610595



Pulmonary accumulation of propranolol in vivo: sites and physiochemical mechanism.  


Despite the therapeutic importance of propranolol and the potential usefulness of propranolol extraction measurements for the assessment of lung disorders, the pulmonary disposition of propranolol remains poorly understood. The extraction, accumulation and distribution of propranolol in lungs of conscious and anesthetized sheep were investigated by indicator-dilution methods, lung lymph fistula preparations and bronchoalveolar lavage. Pulmonary extraction of propranolol from plasma (0.81 +/- 0.03) was significantly less than that of imipramine (0.89 +/- 0.03), not significantly different from that of lidocaine (0.74 +/- 0.03) and much greater than that of water (0.44 +/- 0.02), whereas there were no differences in apparent red blood cell extraction of each indicator from plasma in vitro as determined under similar conditions (0.08-0.1). Pulmonary accumulation of imipramine (78 +/- 3%), lidocaine (52 +/- 4%), propranolol (37 +/- 4%) and water (7 +/- 2%), after a single pass through the pulmonary circulation, correlated positively with octanol/saline partition coefficients but not with pKa values. After bolus i.v. injection of [3H]propranolol, tritium concentrations in lung lymph increased rapidly to exceed plasma concentrations within 60 min and tritium concentrations in bronchoalveolar lavage equaled plasma concentrations 5 to 15 min after injection. It is concluded that by a mechanism not involving molecular charge, propranolol permeates capillary endothelium and alveolar epithelium to accumulate in hydrophobic regions of the lungs. This study in normal sheep suggests that reduced propranolol extraction by damaged lungs reflects pathological alterations other than endothelial cell dysfunction, such as pulmonary edema. PMID:1403778

Howell, R E; Lanken, P N



Handbook of pulmonary emergencies  

SciTech Connect

This book presents information on the following topics: clinical assessment of the patient with pulmonary disease; interpretation of arterial blood gases in the emergency patient; life-threatening pneumonia; extrapulmonic ventilatory failure; acute inhalation lung disease; pulmonary edema; near drowning; chest trauma; upper airway emergencies; chronic lung disease with acute respiratory decompensation; acute respiratory failure in the patient with chronic airflow obstruction; asthma; hemoptysis; embolic pulmonary disease; superior vena cava syndrome; catastrophic pleural disease; ventilatory assistance and its complications; and ventilator emergencies.

Spaquolo, S.V.; Medinger, A



What Causes Idiopathic Pulmonary Fibrosis?  


... the NHLBI on Twitter. What Causes Idiopathic Pulmonary Fibrosis? Sometimes doctors can find out what is causing ... Pulmonary Fibrosis, visit . Idiopathic Pulmonary Fibrosis in the News May 19, 2014 Common treatment ...


Primary pulmonary hypertension  

Microsoft Academic Search

SUMMARY Toevaluate theeffects ofprostacyclin (prostaglandin 12) on pulmonary vascular tonein primary pulmonary hypertension (PPH), we performed right-heart catheterization on sevenpatients with PPHandmadehemodynamic measurements before andafter infusing incremental doses ofprostacyclin. In maximaldoses of2-12ng\\/kg\\/min (mean5.7± 3.1ng\\/kg\\/min), prostacyclin reduced mean pulmonary arterial pressurefrom62± 15to55± 16mm Hg(p< 0.05) andtotal pulmonary resistance from17.1 8.7to9.7+ 5.9units (p< 0.005), andincreased cardiac output from4.22 ± 1.64to6.57 ± 2.041\\/min




Neostigmine and pulmonary oedema.  


A 1-year-old child with no pre-existing cardiac or respiratory disease developed frank pulmonary oedema after administration of a neostigmine-glycopyrrolate mixture to reverse neuromuscular blockade during general anaesthesia. Possible cardiac and extra-cardiac factors that could cause pulmonary oedema in this child were ruled out by appropriate investigations. As the pulmonary oedema manifested shortly after administration of the neostigmine-glycopyrrolate mixture, we concluded that neostigmine was the most probable cause. This article briefly reports the occurrence of events and successful management of perioperative pulmonary oedema. PMID:25199191

Nagella, Amrutha Bindu; Bijapur, Mubina Begum; Shreyavathi, Shreyavathi; Rao, Raghavendra R S



Immunophenotyping does not improve predictivity of the local lymph node assay in mice.  


The local lymph node assay (LLNA) is a regulatory accepted test for the identification of skin sensitizing substances by measuring radioactive thymidine incorporation into the lymph node. However, there is evidence that LLNA is overestimating the sensitization potential of certain substance classes in particular those exerting skin irritation. Some reports describe the additional use of flow cytometry-based immunophenotyping to better discriminate irritants from sensitizing irritants in LLNA. In the present study, the 22 performance standards plus 8 surfactants were assessed using the radioactive LLNA method. In addition, lymph node cells were immunophenotyped to evaluate the specificity of the lymph node response using cell surface markers such as B220 or CD19, CD3, CD4, CD8, I-A(?) and CD69 with the aim to allow a better discrimination above all between irritants and sensitizers, but also non-irritating sensitizers and non-sensitizers. However, the markers assessed in this study do not sufficiently differentiate between irritants and irritant sensitizers and therefore did not improve the predictive capacity of the LLNA. Copyright © 2014 John Wiley & Sons, Ltd. PMID:25186098

Strauss, Volker; Kolle, Susanne N; Honarvar, Naveed; Dammann, Martina; Groeters, Sibylle; Faulhammer, Frank; Landsiedel, Robert; van Ravenzwaay, Bennard



Lymph node, peritoneal and bone marrow micrometastases in gastric cancer: Their clinical significance.  


The 7th TNM classification clearly states that micrometastases detected by morphological techniques (HE stain and immunohistochemistry) should always be reported and calculated in the staging of the disease (pN1mi or M1), while patients in whom micrometastases are detected by non-morphological techniques (e.g., flow cytometry, reverse-transcriptase polymerase chain reaction) should still be classified as N0 or M0. In gastric cancer patients, micrometastases have been detected in lymph nodes, the peritoneal cavity and bone marrow. However, the clinical implications and/or their prognostic significance are still a matter of debate. Current literature suggests that lymph node micrometastases should be encountered for the loco-regional staging of the disease, while skip lymph node micrometastases should also be encountered in the total number of infiltrated lymph nodes. Peritoneal fluid cytology examination should be obligatorily performed in pT3 or pT4 tumors. A positive cytology classifies gastric cancer patients as stage IV. Although a curative resection is not precluded, these patients face an overall dismal prognosis. Whether patients with a positive cytology should be treated similarly to patients with macroscopic peritoneal recurrence should be evaluated further. Gastric cancer cells are detected with high incidence in the bone marrow. However, the published results make comparison of data between groups almost impossible due to severe methodological problems. If these methodological problems are overcome in the future, specific target therapies may be designed for specific groups of patients. PMID:22403737

Griniatsos, John; Michail, Othon; Dimitriou, Nikoletta; Karavokyros, Ioannis



Tumor Interstitial Fluid Pressure—A Link between Tumor Hypoxia, Microvascular Density, and Lymph Node Metastasis  

PubMed Central

High microvascular density (MVD) in the primary tumor has been shown to be associated with increased incidence of lymph node metastases and poor clinical outcome. Other investigations have revealed that a large fraction of hypoxic tissue in the primary tumor is associated with metastatic disease and impaired survival. These data are apparently incompatible because tumor hypoxia is primarily a consequence of poor oxygen supply caused by an inadequate vasculature with increased intervessel distances. Here, we provide an explanation of these observations. Human melanoma xenografts were used as preclinical cancer models. Tumors that metastasized to lymph nodes showed higher interstitial fluid pressure (IFP) than those that did not metastasize, and compared with tumors with low IFP, tumors with high IFP showed large hypoxic fractions centrally, high MVD in the periphery, high peritumoral density of lymphatics, and elevated expression of vascular endothelial growth factor A (VEGF-A) and VEGF-C. Significant correlations were found between peripheral MVD and central hypoxia, and lymph node metastasis was associated with high values of both parameters. These findings suggest that the outcome of cancer may be associated with both high MVD and extensive hypoxia in the primary tumor. We propose that proangiogenic factors are upregulated in the tumor center and that the outward interstitial fluid flow caused by the elevated IFP transports these factors to the tumor surface where they evoke hemangiogenesis and lymphangiogenesis, and consequently, that the IFP serves as a link between tumor hypoxia, peripheral tumor hemangiogenesis, peritumoral lymphangiogenesis, and lymph node metastasis. PMID:25117980

Rofstad, Einar K.; Galappathi, Kanthi; Mathiesen, Berit S.



Role of Nitric Oxide in the Regulation of Pulmonary Vascular Tone  

Microsoft Academic Search

\\u000a The pulmonary circulation is a low pressure, low resistance, high flow system regulated through both active and passive factors\\u000a [1–4]. Active factors alter pulmonary vascular resistance and tone by causing contraction or relaxation of vascular smooth muscle\\u000a and include neural and humoral mechanisms, and gaseous regulators. Passive factors alter pulmonary vascular resistance and\\/or\\u000a blood flow independently of changes in vascular

Shu F. Liu; Timothy W. Evans


How Many Sentinel Lymph Nodes Are Enough During Sentinel Lymph Node Dissection for Breast Cancer?  

PubMed Central

BACKGROUND It remains unclear how many sentinel lymph nodes (SLNs) must be removed to accurately predict lymph node status during SLN dissection in breast cancer. The objective of this study was to determine how many SLNs need to be removed for accurate lymph node staging and which patient and tumor characteristics influence this number. METHODS The authors reviewed data for all patients in their prospective database with clinical tumor, lymph node, metastasis (TNM) T1 through T3, N0, M0 breast cancer who underwent lymphatic mapping at their institution during the years 1994 through 2006. There were 777 patients who had at least 1 SLN that was positive for cancer. Simple and multiple quantile regression analyses were used to determine which patient and tumor characteristics were associated with the number of positive SLNs. The baseline number of SLNs that needed to be dissected for detection of 99% of positive SLNs in the total group of patients also was determined. RESULTS The mean number of SLNs removed in the 777 lymph node-positive patients was 2.9 (range, 1-13 SLNs). Greater than 99% of positive SLNs were identified in the first 5 lymph nodes removed. On univariate analysis, tumor histology, patient race, tumor location, and tumor size significantly affected the number of SLNs that needed to be removed to identify 99% of all positive SLNs. On multivariate analysis, mixed ductal and lobular histology, Caucasian race, inner quadrant tumor location, and T1 tumor classification significantly increased the number of SLNs that needed to be removed to achieve 99% recovery of all positive SLNs. CONCLUSIONS In general, the removal of a maximum of 5 SLNs at surgery allowed for the recovery of >99% of positive SLNs in patients with breast cancer. The current findings indicated that tumor histology, patient race, and tumor size and location may influence this number. PMID:18457326

Yi, Min; Meric-Bernstam, Funda; Ross, Merrick I.; Akins, Jeri S.; Hwang, Rosa F.; Lucci, Anthony; Kuerer, Henry M.; Babiera, Gildy V.; Gilcrease, Michael Z.; Hunt, Kelly K.



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



Ultrasound, hepatic lymph nodes and primary biliary cirrhosis.  


Thirty-five consecutive patients with primary biliary cirrhosis were examined using liver biopsy, laboratory tests and ultrasonography of the hepato-duodenal ligament to investigate the possible correlation between enlarged lymph nodes in the hepato-duodenal ligament and biochemical activity, histologic activity or stage and/or humoral immunoreactivity. We found a positive correlation between the size of the largest lymph node and laboratory values of cholestasis, hepatocellular damage and increased humoral immunoreactivity. On the other hand, we found a negative association between lymph node size and hepatocellular function. When twelve of the patients were reexamined after at least 10 months, in the majority of the patients changes in lymph node size were accompanied by similar changes in markers of cholestasis, hepatocellular damage and immunoreactivity. Prognostic index was also directly associated with lymph node size in most of these patients. No association between lymph node size and histologic stage was observed. PMID:1506630

Lyttkens, K; Prytz, H; Forsberg, L; Hederström, E; Hägerstrand, I



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



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. PMID:23457676

Kadakia, Kunal C; Patel, Sandeep M; Yi, Eunhee S; Limper, Andrew H



Risk of lymph node metastases after en bloc cold steel, en bloc laser-, and piecemeal laser surgical resection of auricular VX2 carcinoma.  


There is some controversy in the literature if lymph vessels are enduring sealed during piecemeal CO2 laser surgery of squamous cell carcinomas of the head and neck or a propagation of tumor cells into the lymphatics occurs. The aim of the present study was to analyze the incidence of lymph node and distant metastases after different methods of resection of a VX2 carcinoma in an animal model. A solid auricular VX2 carcinoma was induced in 200 rabbits. Seven days later, an en bloc cold steel (group A), en bloc laser surgical resection with CO2 laser in continuous wave mode with 2 W (group B), or piecemeal laser surgical resection after transection of the tumor with CO2 laser in continuous wave mode with 2 W (group C) or 20 W (group D) was performed. The animals were killed and the incidence of lymph node and distant metastases was compared between the different groups. Of the rabbits, 21.1 % developed lymph node metastases and 10 % pulmonary metastases. The incidence of lymph node metastases was 17.4 % in group A, 20.4 % in group B, 26 % in group C, and 20 % in group D. These differences were not statistically significant. En bloc cold steel, en bloc laser-, or piecemeal laser surgical resections include similar risk of postoperative metastases. Propagation of tumor cells cannot be excluded with certainty by any of these methods. PMID:23053248

Wiegand, Susanne; Wiemers, Christian; Murthum, Tobias; Zimmermann, Annette P; Bette, Michael; Mandic, Robert; Werner, Jochen A



Riociguat for pulmonary hypertension.  


Pulmonary hypertension (PH) encompasses a group of diseases associated with progressively increasing pulmonary vascular resistance, right heart failure and premature death. Riociguat is a novel, first-in-class oral drug that directly stimulates soluble guanylate cyclase, both independently of the endogenous vasodilator nitric oxide (NO) and in synergy with NO. Single oral doses of riociguat were well tolerated in a Phase I study of healthy volunteers. They had a favorable safety profile, and improved pulmonary hemodynamics and cardiac index to a greater extent than inhaled NO in a proof-of-concept study in patients with moderate-to-severe PH. In a 12-week Phase II trial in patients with chronic thromboembolic PH or pulmonary arterial hypertension, pulmonary hemodynamics and exercise capacity improved following individual dose titration with oral riociguat, which was generally well tolerated. Further trials in PH have been initiated. PMID:20230258

Ghofrani, Hossein-Ardeschir; Voswinckel, Robert; Gall, Henning; Schermuly, Ralph; Weissmann, Norbert; Seeger, Werner; Grimminger, Friedrich



Pulmonary Transfusion Reactions  

PubMed Central

Summary Background In recent years, pulmonary transfusion reactions have gained increasing importance as serious adverse transfusion events. Methods Review of the literature. Results Pulmonary transfusion reactions are not extremely rare and, according to hemovigilance data, important causes of transfusion-induced major morbidity and death. They can be classified as primary with predominant pulmonary injury and secondary as part of another transfusion reaction. Primary reactions include transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO) and transfusion-associated dyspnea (TAD). Secondary pulmonary reactions are often observed in the wake of hemolytic transfusion reactions, hypotensive/anaphylactic reactions, and transfusion-transmitted bacterial infections. Conclusion Knowledge and careful management of cases of pulmonary transfusion reactions are essential for correct reporting to blood services and hemovigilance systems. Careful differentiation between TRALI and TACO is important for taking adequate preventive measures. PMID:21512622

Bux, Jürgen; Sachs, Ulrich J. H.



Sarcoidosis: clinical mimicry of pulmonary embolism.  


Sarcoidosis can manifest with clinical signs suggestive of pulmonary embolism (PE). A 36-year-old male patient presented with a 2-day history of left-sided pleuritic chest pain and dyspnoea. He was hypoxicand tachypnoeic, and initial blood tests showed a positive plasma D-dimer. Subsequent arterial blood gas showed respiratory alkalosis with type 1 respiratory failure. He was suspected to have a PE, and CT pulmonary angiogram (CTPA) was urgently arranged. This latter investigation did not show any impairment in pulmonary arterial blood flow but revealed bilateral hilar and mediastinal lymphadenopathy suggesting sarcoidosis. Serum calcium and ACE were also elevated. The patient was treated conservatively and discharged after 2 days with out-patient endobronchial ultrasound and clinic follow-up arranged. PMID:24334473

Nasher, Omar; Boldy, David A



Changes in Large Pulmonary Arterial Viscoelasticity in Chronic Pulmonary Hypertension  

E-print Network

Changes in Large Pulmonary Arterial Viscoelasticity in Chronic Pulmonary Hypertension Zhijie Wang1, Wisconsin, United States of America Abstract Conduit pulmonary artery (PA) stiffening is characteristic of pulmonary arterial hypertension (PAH) and is an excellent predictor of mortality due to right ventricular

Lakes, Roderic


Cardiovascular, pulmonary, and cancer rehabilitation. 2. Pulmonary rehabilitation  

Microsoft Academic Search

This self-directed learning module highlights both pulmonary and nonpulmonary aspects in the rehabilitation of patients with pulmonary disease and the assessment and physical therapeutic options in the pulmonary management of patients with neurological disorders. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and

Jonathan R. Moldover



Automatic detection of pelvic lymph nodes using multiple MR sequences  

NASA Astrophysics Data System (ADS)

A system for automatic detection of pelvic lymph nodes is developed by incorporating complementary information extracted from multiple MR sequences. A single MR sequence lacks sufficient diagnostic information for lymph node localization and staging. Correct diagnosis often requires input from multiple complementary sequences which makes manual detection of lymph nodes very labor intensive. Small lymph nodes are often missed even by highly-trained radiologists. The proposed system is aimed at assisting radiologists in finding lymph nodes faster and more accurately. To the best of our knowledge, this is the first such system reported in the literature. A 3-dimensional (3D) MR angiography (MRA) image is employed for extracting blood vessels that serve as a guide in searching for pelvic lymph nodes. Segmentation, shape and location analysis of potential lymph nodes are then performed using a high resolution 3D T1-weighted VIBE (T1-vibe) MR sequence acquired by Siemens 3T scanner. An optional contrast-agent enhanced MR image, such as post ferumoxtran-10 T2*-weighted MEDIC sequence, can also be incorporated to further improve detection accuracy of malignant nodes. The system outputs a list of potential lymph node locations that are overlaid onto the corresponding MR sequences and presents them to users with associated confidence levels as well as their sizes and lengths in each axis. Preliminary studies demonstrates the feasibility of automatic lymph node detection and scenarios in which this system may be used to assist radiologists in diagnosis and reporting.

Yan, Michelle; Lu, Yue; Lu, Renzhi; Requardt, Martin; Moeller, Thomas; Takahashi, Satoru; Barentsz, Jelle



Lobectomy of pulmonary metastasis of endometrial stromal sarcoma.  


Pulmonary metastasis of low-grade endometrial stromal sarcoma is rare. A 61-year-old woman visited our hospital due to an abnormal chest shadow. Computed tomograhy showed a mass that was composed of a cystic and solid lesion, in the right lower lobe. She had undergone a combination of a hysterectomy and adnexectomy for a low-grade endometrial stromal sarcoma 57 months previously, and undergone adjuvant radiation therapy at the local site. To obtain a definitive diagnosis of the lung tumor, we performed lobectomy of the right lower lobe and lymph node dissection. To avoid possible dissemination, the tumor was resected not using video-assisted thoracic surgery but using thoracotomy. The pathologic diagnosis was pulmonary metastasis of the low-grade endometrial stromal sarcoma. Now, medroxyprogesterone acetate is being administered, and no signs of recurrence have been detected in the 24 months since the lung resection. PMID:24318286

Nakamura, Yusuke; Iwazaki, Masayuki; Masuda, Ryota; Nakano, Masao; Sato, Teiko; Shimada, Akihiko



Inhaled treprostinil and pulmonary arterial hypertension  

PubMed Central

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. PMID:21191432

Nadler, Samuel T; Edelman, Jeffrey D



Missing sentinel lymph node in cutaneous melanoma  

PubMed Central

The American Society of Clinical Oncology guidelines recommend sentinel lymph node biopsy (SLNB) for all patients with melanoma tumors of intermediate thickness (between 1 and 4 mm). In case of patients with thick melanoma tumors (>4 mm), SLNB may be recommended as well, for staging purposes and to facilitate regional disease control. We report a case of an 82-year-old man, undergone excision of a cutaneous melanoma of the right thigh, which shows some limitation of SLNB in thick melanoma. Lymphoscintigraphy, performed as single-photon emission computed tomography/computed tomography (SPECT/CT), failed to identify the real sentinel lymph node, as tracer uptake was seen in A right inguinal node. Due to the presence on CT co-registered images of another suspicious node (with no radiopharmaceutical uptake) in the crural region, and considering the “high-risk” pathologic features of the removed primary lesion, a 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) staging scan was planned. PET/CT showed high metabolic activity in the suspected crural lymphadenopathy. Histopathology demonstrated massive invasion of the crural (“sentinel”) node and no metastatic cells in the inguinal node. This report highlights both the higher accuracy of lymphoscintigraphy, when performed as SPECT/CT and the potential utility of 18F-FDG PET/CT in regional staging.

Dellavedova, Luca; Florimonte, Luigia; Carletto, Marco; Maffioli, Lorenzo Stefano



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



Social temperament and lymph node innervation  

PubMed Central

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. PMID:18068331

Sloan, Erica K.; Capitanio, John P.; Tarara, Ross P.; Cole, Steve W.



Haemodynamic evaluation of pulmonary hypertension  

Microsoft Academic Search

ABSTRACT: Pulmonary,hypertension,is characterised by the chronic elevation of pulmonary,artery pressure (PAP) and pulmonary,vascular resistance (PVR) leading to right ventricular enlargement,and,hypertrophy. Pulmonary,hypertension,may,result from respiratory and cardiac diseases, the most severe forms occurring in thrombo- embolic and primary,pulmonary,hypertension. Pulmonary,hypertension is most often defined as a mean,PAP w25 mmHg,at rest or w30 mmHg during exercise, the pressure being measured invasively with a pulmonary

D. Chemla; V. Castelain; P. Herve; Y. Lecarpentier; S. Brimioulle



Pulmonary vascular imaging  

SciTech Connect

A wide range of pulmonary vascular imaging techniques are available for the diagnostic evaluation of patients with suspected pulmonary vascular disease. The characteristics of any ideal technique would include high sensitivity and specificity, safety, simplicity, and sequential applicability. To date, no single technique meets these ideal characteristics. Conventional pulmonary angiography remains the gold standard for the diagnosis of acute thromboembolic disease despite the introduction of newer techniques such as digital subtraction angiography and magnetic resonance imaging. Improved noninvasive lower extremity venous testing methods, particularly impedance plethysmography, and ventilation-perfusion scanning can play significant roles in the noninvasive diagnosis of acute pulmonary emboli when properly applied. Ventilation-perfusion scanning may also be useful as a screening test to differentiate possible primary pulmonary hypertension from chronic thromboembolic pulmonary hypertension. And, finally, angioscopy may be a useful adjunctive technique to detect chronic thromboembolic disease and determine operability. Optimal clinical decision-making, however, will continue to require the proper interpretation of adjunctive information obtained from the less-invasive techniques, applied with an understanding of the natural history of the various forms of pulmonary vascular disease and with a knowledge of the capabilities and shortcomings of the individual techniques.

Fedullo, P.F.; Shure, D.



Diffuse Cutaneous Mastocytosis with Bullous Lesions and Pulmonary Involvement: A Rare Case  

PubMed Central

Mastocytosis is defined as a heterogeneous group of disorders characterized by an accumulation of mast cells in one or more organs, particularly in the skin, bone marrow, liver, spleen and lymph nodes. However here we describe an 11-month-old girl child presented with diffuse cutaneous mastocytosis with bullous lesion, having pulmonary involvement, which is very rare and there is no available case report from India.

Dhar, Sandipan; Maji, Biplab; Roy, Swapan; Dhar, Subhra



Comparative studies on the distribution and population of immunocompetent cells in bovine hemal node, lymph node and spleen.  


The distribution and population of immunocompetent cells in bovine hemal node, mesenteric lymph node and spleen were analyzed comparatively by immunohistochemistry and flow cytometry. Many CD8(+) cells, CD172a(+) cells and ?? T cells were found in the lymphatic cord along the sinus of the hemal node and the splenic red pulp. A few CD8(+) cells and ?? T cells were distributed diffusely in the paracortex and medullary cord of the mesenteric lymph node. Many germinal centers were recognized in the lymphatic regions such as the cortex and white pulp of these lymphoid organs. The populations of CD8(+) cells and ?? T cells in the hemal node and the spleen were higher than those of the mesenteric lymph node. In addition, the populations of CD21(+) cells and MHC class II(+) cells in the hemal node and the mesenteric lymph node were higher than those of the spleen. The results suggest that the hemal node has an important role in both cellular and humoral immunity as well as the lymph node and the spleen in cattle. PMID:22075708

Zhang, Weidong; Nasu, Tetsuo; Hosaka, Yoshinao Z; Yasuda, Masahiro



Pulmonary Hypertension: Evaluation and Management  

Microsoft Academic Search

Pulmonary hypertension (PH) is a hemodynamic state characterized by elevation in the mean pulmonary arterial pressure and\\u000a pulmonary vascular resistance leading to right ventricular failure and premature death. PH can be the result of a variety\\u000a of diseases of different etiologies. Pulmonary arterial hypertension (PAH) should be distinctly differentiated from pulmonary\\u000a venous hypertension (PVH) as a result of left heart

Gustavo A. Heresi; Raed A. Dweik



Innate immune protection against infectious diseases by pulmonary administration of a phospholipid conjugated TLR7 ligand  

PubMed Central

Pulmonary administration of Toll-like receptor (TLR) ligands protects hosts from inhaled pathogens. However, systemic side effects induced by TLR stimulation limit clinical development. Here, a small molecule TLR7 ligand conjugated with phospholipid, 1V270 (also designated TMX201), was tested for innate immune activation and for ability to prevent pulmonary infection in mice. We hypothesized that phospholipid conjugation would increase internalization by immune cells and localize the compound in the lungs, thus, avoiding side effects due to systemic cytokine release. Pulmonary 1V270 administration increased innate cytokines and chemokines in bronchial alveolar lavage fluids, but did not cause systemic induction of cytokines, nor B cell proliferation in distant lymphoid organs. 1V270 activated pulmonary CD11c+ dendritic cells, which migrated to local lymph nodes. However, there was minimal cell infiltration into the pulmonary parenchyma. Prophylactic administration of 1V270 significantly protected mice from lethal infection with Bacillus anthracis, Venezuelan equine encephalitis virus, and H1N1 influenza virus. The maximum tolerated dose of 1V270 by pulmonary administration was 75 times the effective therapeutic dose. These indicate that pulmonary 1V270 treatment can protect the host from different infectious agents by stimulating local innate immune responses, while exhibiting an excellent safety profile. PMID:24192551

Wu, Christina C.N.; Crain, Brian; Yao, Shiyin; Sabet, Mojgan; Lao, Fitzgerald S.; Tawatao, Rommel; Chan, Michael; Smee, Donald F.; Julander, Justin G.; Cottam, Howard B.; Guiney, Donald G.; Corr, Maripat; Carson, Dennis A.; Hayashi, Tomoko



Genetic diagnosis of lymph-node metastasis in colorectal cancer  

Microsoft Academic Search

If a regional lymph node taken during surgery for colorectal cancer is found to be free of tumour on histological examination this is taken to be a good sign. However, conventional staining may not be sensitive enough. Mutant-allele-specific amplification (MASA) is a technique that can detect, at the level of an individual cell, micrometastases to lymph nodes that are histologically

N. Hayashi; I. Ito; Y. Nakamura; A. Yanagisawa; Y. Kato; S. Nakamori; S. Imaoka; H. Watanabe; M. Ogawa



RESEARCH Open Access Proteomic biomarkers predicting lymph node  

E-print Network

of lymph node involvement. Other outcomes were histological type, lymphvascular space involvement (LVSI differentiation between various subtypes of cervical cancer. However, identification of the potential biomarkers, Lymph node, SELDI-TOF MS Background Cervical cancer is the seventh most common cancer in both sexes


Salmonella in lymph nodes of cattle presented for harvest  

Technology Transfer Automated Retrieval System (TEKTRAN)

Introduction: Salmonella can invade and survive within host immune cells. Once internalized, these pathogens have the potential to disseminate throughout the lymphatic system and reside within lymph nodes. If so, because some lymph nodes are located within muscle and fat tissues, Salmonella-positiv...


Processing of sentinel lymph nodes for detection of metastatic melanoma  

Microsoft Academic Search

Within the last years, evaluation of sentinel lymph nodes (SLN) has become the most popular method of early staging of several malignancies, including breast carcinoma and melanoma. Because SLN are reportedly the lymph nodes most likely to contain metastatic deposits, identification of such nodes allows pathologists to examine the tissue in a much more intense manner than with the usual

Victor G. Prieto; Sandra H. Clark



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.



Three-Dimensional Visualization of Lymph Node Morphology using OCT  

E-print Network

procedure that maps the lymphatic system and evaluates the status of the sentinel lymph node to determine of melanoma and solid tumors that metastasize through the lymphatic system. The sentinel lymph node for the SLN mapping The SLNB is performed once the lymphatic system has been mapped using a different number

Oldenburg, Amy



E-print Network

for quantitatively tracking probe transport through lymphatic system and for enabling accurate image guided lymph ABSTRACT This contribution describes a system and method for tomo- graphically imaging lymph nodes marked detection system was used to collect area measurements of fluorescence amplitude and phase on the il

Bangerth, Wolfgang


Prostate Cancer Metastatic to the Cervical Lymph Nodes  

PubMed Central

Prostate cancer is the most common cancer in men, often presenting with regional lymph node or bone metastasis and rarely with supradiaphragmatic lymph node involvement. Most metastatic cancers involving the cervical lymph nodes are from cancers of the upper aerodigestive tract. In this report, we describe two cases with cervical lymph node enlargement due to metastatic prostate cancer as the initial clinical presentation: a 43-year-old male, initially misdiagnosed with a tumor of the upper aerodigestive tract and an 87-year-old male with right lobe pneumonia and cervical lymph node enlargement, initially attributed to be an acute inflammatory lymph node reaction. To the best of our knowledge, there are less than 50 cases reported in the literature of adenocarcinoma of prostate metastatic to the cervical lymph nodes and only one case presenting in men younger than 45 years. The authors intend to highlight the importance of digital rectal exam and PSA test in case of persistent left cervical lymph node enlargement, including men younger than 45 years of age.

Sepúlveda, Luis; Gorgal, Tiago; Pires, Vanessa; Rodrigues, Filipe



Intraoperative lymph scintigraphy during radical surgery for cervical cancer  

Microsoft Academic Search

Intraoperative lymph scintigraphy during radical surgery for cervical cancer was developed in the course of a program covering three periods. During the last period technetium-99m antimony sulfide has been used to visualize pelvic lymph nodes. Surgery is done with a modified gamma camera serving as an operating table. This ensures intraoperative monitoring and greater thoroughness of lymphadenectomy. The introduction of

E. Gitsch; K. Philipp; N. Pateisky



Increased Lymph Node Yield in Colorectal Cancer Is Not Necessarily Associated with a Greater Number of Lymph Node Positive Cancers  

PubMed Central

The presence of lymph node metastasis is a key prognostic factor in colorectal cancer and lymph node yield is an important parameter in assessing the quality of histopathology reporting of colorectal cancer excision specimens. This study assesses the trend in lymph node evaluation over time in a single institution and the relationship with the identification of lymph node positive tumours. It compares the lymph node yield of a contemporary dataset compiled from the histopathology reports of 2178 patients who underwent surgery for primary colorectal cancer between 2005 and 2012 with that of a historic dataset compiled from the histopathology reports of 1038 patients who underwent surgery for colorectal cancer at 5 yearly intervals from 1975 to 2000. The mean lymph node yield was 14.91 in 2005 rising to 21.38 in 2012. In 2012 92.9% of all cases had at least 12 lymph nodes examined. Comparison of the mean lymph node yield and proportion of Dukes C cases shows a significant increase (Pearson correlation?=?0.927, p?=?0.001) in lymph node yield while there is no corresponding significant trend in the proportion of Dukes C cases (Pearson correlation?=??0.138, p?=?0.745). This study shows that there is increasing yield of lymph nodes from colorectal cancer excision specimens. However, this is not necessarily associated with an increase number of lymph node positive cancers. Further risk stratifying of colorectal cancer requires consideration of other pathological parameters especially the presence of extramural venous invasion and relevant biomarkers. PMID:25118594

O'Shea, Aisling; Aly, Omar; Parnaby, Craig N.; Loudon, Malcolm A.; Samuel, Leslie M.; Murray, Graeme I.



Modulation of pulmonary vasomotor tone in the fetus and neonate  

Microsoft Academic Search

The high pulmonary vascular resistance (PVR) of atelectatic, hypoxic, fetal lungs limits intrauterine pulmonary blood flow\\u000a (PBF) to less than 10% of combined right and left ventricular output. At birth, PVR decreases precipitously to accommodate\\u000a the entire cardiac output. The present review focuses on the role of endothelium-derived nitric oxide (NO), prostacyclin,\\u000a and vascular smooth muscle potassium channels in mediating

Nancy S Ghanayem; John B Gordon



Effect of Orciprenaline on Hypoxic Pulmonary Vasoconstriction in Dogs  

Microsoft Academic Search

The effect of orciprenaline on hypoxic pulmonary vasoconstriction and arterial oxygen tension (Pao2) was studied in 8 dogs by measuring the redistribution of blood flow in response to unilateral alveolar hypoxia. The distribution of blood flow was recorded continuously by measuring the radioactivity of the mixed expired gas from each lung during the continuous intravenous infusion of xenon-133. The hypoxic

A. Reyes; M. K. Sykes; M. K. Chakrabarti; B. Carruthers; A. Petrie



Percutaneous Pulmonary Valve Implantation  

PubMed Central

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. PMID:23170091

Lee, Hyoung-Doo



Pulmonary Fibrosis Foundation  


... find a cure for the deadly disease. BROADWAY STARS SHOW OFF THEIR BELTING TALENTS TO RAISE FUNDS ... Patients The Pulmonary Fibrosis Foundation has a four-star rating from Charity Navigator and is a Better ...


Chronic thromboembolic pulmonary hypertension  

PubMed Central

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rapidly progressive and deadly disease, resulting from incomplete resolution of acute pulmonary embolism. Historically, the incidence of CTEPH was significantly underestimated but it may be as high as 3.8% following acute pulmonary embolism. Although the medical management of CTEPH may be supportive, the only curative treatment is pulmonary endarterectomy (PEA). However, a careful screening programme is mandatory to select CTEPH patients who are likely to benefit from PEA. In this review we discuss the pathophysiology, clinical and diagnostic pitfalls, surgical treatment, outcome after surgery, and the potential benefit of medical treatment in inoperable CTEPH patients. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:25696637

Reesink, H.J.; Kloek, J.J.; Bresser, P.



Gas exchange and pulmonary hypertension following acute pulmonary thromboembolism: has the emperor got some new clothes yet?  

PubMed Central

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. PMID:25006441



Pulmonary Hypertension after Splenectomy?  

Microsoft Academic Search

Results: The prevalence of asplenia in patients with pul- monary hypertension was 11.5% (95% CI, 4.7% to 22.2%) compared with 0% (CI, 0% to 3.2%) in those without pulmonary hypertension (P , 0.001). Histopathologic ex- amination of lung specimens from patients with postsple- nectomy pulmonary hypertension showed intimal fibrosis, plexiform lesions, and abundant thrombotic lesions. Conclusion: Patients who have had

Marius M. Hoeper; Jost Niedermeyer; Frank Hoffmeyer; Peer Flemming; Helmut Fabel


Pulmonary manifestations of bioterrorism  

Microsoft Academic Search

Along with smallpox, inhalation anthrax and pneumonic plague are among the diseases most likely to be spread by biowarfare,\\u000a either from a rogue nation or terrorist group. Neither anthrax nor plague has been seen by many pulmonary (or any other) physicians\\u000a in the United States. This article summarizes these two diseases as pulmonary manifestations of bioterrorism and discusses\\u000a the possibility

Renuka Heddurshetti; Wadchara Pumpradit; Larry I. Lutwick



Calcular pulmonary embolism.  


Many complications of percutaneous nephrolithotomy(PNL) were reported. In this report, we present a rare complication, which has never been reported. It is the migration of stone fragments into the venous system causing pulmonary emboli. We reviewed the literatures reporting complications following PNL, and there was no available previous report about such complication. It was suspected intraoperative and confirmed radiologically postoperative. In this case, pulmonary emboli have had no clinical consequences and were managed conservatively. PMID:24077988

Zahran, Mohamed H; Osman, Yasser; El-Diasty, Tarek



Management of pulmonary atresia  

PubMed Central

Based on experience with 48 patients, a new simple classification of pulmonary atresia, according to pulmonary artery development is suggested. The need for extensive investigation including biplane aortography and right ventricular angiocardiography is emphasized. Adequate display of the anatomy is required to plan the surgical management. Early palliative procedures are advised for hypoxia and later radical correction is possible in a large number of these patients. Images PMID:5470046

Somerville, Jane



Acute pulmonary edema  

Microsoft Academic Search

Opinion statement  Patients with acute cardiogenic pulmonary edema require rapid assessment and therapy to prevent progression to respiratory\\u000a failure and cardiovascular collapse. The goal of therapy is to decrease the pulmonary capillary wedge pressure by decreasing\\u000a intravascular volume and shifting the blood volume into peripheral vascular beds. Mainstays of therapy include morphine sulfate\\u000a (a venodilator and an anxiolytic), furosemide (a venodilator

Maryl R. Johnson



Pharmacotherapy of Pulmonary Hypertension  

PubMed Central

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. PMID:23036248

Steinhorn, Robin H.



Chronic Thromboembolic Pulmonary Hypertension  

Microsoft Academic Search

Chronic thromboembolic pulmonary hypertension (CTEPH) is an important form of pulmonary hypertension to detect because prompt\\u000a treatment can lead to a surgical cure. The true incidence is unknown, but it is estimated to occur in 1% to 3% of patients\\u000a following acute thromboembolism. Detection may be difficult, because symptoms are nonspecific and other diagnoses are often\\u000a made before that of

William R. Auger; Peter F. Fedullo


[Lymph node micrometastases in gastric cancer].  


Lymph node micrometastases in gastric cancer are based on the definition in the 6th version of the TNM classification of malignant tumours edited by the International Union Against Cancer, which is also quoted in the 14th version of the Japanese Classification of Gastric Carcinoma. Histopathologic examination such as immunohistochemistry and molecular biological techniques including RT-PCR and one-step nucleic acid amplification are used for the detection of micrometastases. Because the time required for such detection is shortened to 30 to 40 min, intraoperative detection is feasible. Many papers have reported the correlation between micrometastases and prognosis in gastric cancer, although whether micrometastases are correlated with poor prognosis even when completely resected remains unknown. Intraoperative detection of micrometastases is important to decide the operative procedure in sentinel node navigation surgery. PMID:23457939

Fujimura, Takashi; Tsukada, Tomoya; Kinoshita, Jun; Oyama, Katsunobu; Fushida, Sachio; Ohta, Tetsuo



Successful pharmacomechanical intervention with ultrasonic-accelerated thrombolytic catheter for massive pulmonary embolism  

PubMed Central

An 86-year-old male with history of metastatic prostate carcinoma and hypertension was admitted due to acute onset dyspnea and lower extremity pain and swelling. Transthoracic echocardiography revealed a large right atrial thrombus extending in to the right ventricle. Within 12 h, the patient developed severe hypoxemia, tachypnea with sustained hypotension and cardiogenic shock due to presumed massive pulmonary embolism. The patient underwent emergency pulmonary angiography which showed large emboli in the right main pulmonary artery extending in to the middle and lower lobe branches. An ultrasonic-accelerated thrombolytic catheter was placed in the right main pulmonary artery for continuous infusion of alteplase for 20 h. Repeat pulmonary angiogram showed resolution of the large pulmonary emboli, with normal flow in to the distal pulmonary arteries. Significant improvement of hemodynamics, symptoms and hypoxemia occurred as well. PMID:24407541

Porres-Aguilar, Mateo; Burgos, Jose D.; Munoz, Oscar C.; Soto-Cora, Ediberto; Mukherjee, Debabrata



Successful pharmacomechanical intervention with ultrasonic-accelerated thrombolytic catheter for massive pulmonary embolism.  


An 86-year-old male with history of metastatic prostate carcinoma and hypertension was admitted due to acute onset dyspnea and lower extremity pain and swelling. Transthoracic echocardiography revealed a large right atrial thrombus extending in to the right ventricle. Within 12 h, the patient developed severe hypoxemia, tachypnea with sustained hypotension and cardiogenic shock due to presumed massive pulmonary embolism. The patient underwent emergency pulmonary angiography which showed large emboli in the right main pulmonary artery extending in to the middle and lower lobe branches. An ultrasonic-accelerated thrombolytic catheter was placed in the right main pulmonary artery for continuous infusion of alteplase for 20 h. Repeat pulmonary angiogram showed resolution of the large pulmonary emboli, with normal flow in to the distal pulmonary arteries. Significant improvement of hemodynamics, symptoms and hypoxemia occurred as well. PMID:24407541

Porres-Aguilar, Mateo; Burgos, Jose D; Munoz, Oscar C; Soto-Cora, Ediberto; Mukherjee, Debabrata



Apelin and pulmonary hypertension  

PubMed Central

Pulmonary arterial hypertension (PAH) is a devastating disease characterized by pulmonary vasoconstriction, pulmonary arterial remodeling, abnormal angiogenesis and impaired right ventricular function. Despite progress in pharmacological therapy, there is still no cure for PAH. The peptide apelin and the G-protein coupled apelin receptor (APLNR) are expressed in several tissues throughout the organism. Apelin is localized in vascular endothelial cells while the APLNR is localized in both endothelial and smooth muscle cells in vessels and in the heart. Apelin is regulated by hypoxia inducible factor -1? and bone morphogenetic protein receptor-2. Patients with PAH have lower levels of plasma-apelin, and decreased apelin expression in pulmonary endothelial cells. Apelin has therefore been proposed as a potential biomarker for PAH. Furthermore, apelin plays a role in angiogenesis and regulates endothelial and smooth muscle cell apoptosis and proliferation complementary and opposite to vascular endothelial growth factor. In the systemic circulation, apelin modulates endothelial nitric oxide synthase (eNOS) expression, induces eNOS-dependent vasodilatation, counteracts angiotensin-II mediated vasoconstriction, and has positive inotropic and cardioprotective effects. Apelin attenuates vasoconstriction in isolated rat pulmonary arteries, and chronic treatment with apelin attenuates the development of pulmonary hypertension in animal models. The existing literature thus renders APLNR an interesting potential new therapeutic target for PH. PMID:22140623

Andersen, Charlotte U.; Hilberg, Ole; Mellemkjær, Søren; Nielsen-Kudsk, Jens E.; Simonsen, U.



AB 32. Pulmonary nodular lymphoid hyperplasia. Case report  

PubMed Central

Background Nodular lymphoid hyperplasia is considered to represent a localized form of lymphoid hyperplasia, which presents as a discreet pulmonary mass or masses Median age of diagnosis are 65 years (range, 19-80 years). Chest X-ray and CT scan show an isolated mass (64%) or multiple nodules (36%). Hilar or mediastinal adenopathy may be present is some patients. Patients and methods We describe the case of nodular lymphoid hyperplasia in a 52 year-old woman who presented with pulmonary multiple nodules, bilateral and mediastinal adenopathy, apparent by chest X-ray and CT-scan. Open biopsy was performed from the upper and down lobe of the right lung and from the mediastinal lymph nodes. Macroscopic examination revealed small white nodules, measuring 0.3 to 0.7 cm in maximum diameter. The sections were examined with H+E and followed by immunohistochemical study. Results Histological examination revealed multiple well demarcated nodules consisting of aggregates of lymphoid follicles and sheets of interfollicular small lymphocytes and plasma cells. Lymphoepithelial lesions were absent. The immunohistochemical stains for lymphoid markers were consistent with a reactive process. Bcl-2 protein expression was absent in germinal centers, but presented in the mantle zone and interfollicular T-cells. Similar were the immunohistochemical findings of the lymph nodes study. Conclusions Nodular lymphoid hyperplasia is a benign lesion, although surgical excision is usually needed to allow correct diagnosis. The main entity in the differential diagnosis of nodular lymphoid hyperplasia is BALT lymphoma.

Papaemmanouil, Stiliani; Iordanidis, Fotis; Moraitis, Dimitrios; Sakkas, Leonidas



How Is Idiopathic Pulmonary Fibrosis Treated?  


... the NHLBI on Twitter. How Is Idiopathic Pulmonary Fibrosis Treated? Doctors may prescribe medicines, oxygen therapy , pulmonary ... Pulmonary Fibrosis, visit . Idiopathic Pulmonary Fibrosis in the News May 19, 2014 Common treatment ...


Nitric oxide, oxygen, and prostacyclin in children with pulmonary hypertension  

PubMed Central

Objective—To test the vasodilatory response of the pulmonary vascular bed in children with pulmonary hypertension.?Design—Prospective dose response study in which the effects of inhaled nitric oxide (NO) are compared with those of oxygen and intravenous prostacyclin.?Patients and interventions—The vasodilator test was performed in 20 patients in whom mean pulmonary artery pressure (PAPm) was ? 40 mm Hg and/or pulmonary vascular resistance index was ? 4 Um2. Haemodynamic effects of inhaled NO (20, 40, and 80 ppm) at a fractional inspired oxygen (FiO2) value of 0.3, pure oxygen, oxygen at FiO2 0.9-1.0 combined with NO as above or with intravenous prostacyclin at 10 and 20 ng/kg/min were measured.?Result—NO decreased PAPm with a dose response from 20 to 40 ppm (mean change at 40 ppm ?5.50, 95% confidence interval (CI) ?7.98 to ?3.02 mm Hg). Maximal decrease in the ratio of pulmonary to systemic vascular resistance was achieved with a combination of NO 80 ppm and oxygen (?0.18, 95% CI ?0.26 to ?0.10). Increase in the pulmonary flow index was greatest with pure oxygen in those with an intracardiac shunt (8.52, 95% CI ?0.15 to 17.20 l/min/m2). Neither NO nor oxygen altered systemic arterial pressure but intravenous prostacyclin lowered systemic arterial pressure and resistance.?Conclusions—NO selectively reduces pulmonary vascular resistance and pressure maximally at 40 ppm. Oxygen reduces pulmonary vascular resistance and NO potentiates this reduction without affecting the systemic circulation. Prostacyclin vasodilates the pulmonary and the systemic circulations.?? Keywords: pulmonary hypertension;  nitric oxide;  prostacyclin;  congenital heart disease;  children PMID:9538311

Turanlahti, M; Laitinen, P; Sarna, S; Pesonen, E



Whole Proteome Analysis of Mouse Lymph Nodes in Cutaneous Anthrax  

PubMed Central

This study aimed to characterize a soluble proteome of popliteal lymph nodes during lymphadenitis induced by intradermal injection of Bacillus anthracis Sterne spores in mice using tandem LC-MS/MS and reverse-phase protein microarray with antibodies specific to epitopes of phosphorylated proteins. More than 380 proteins were detected in the normal intra-nodal lymph, while the infectious process resulted in the profound changes in the protein abundances and appearance of 297 unique proteins. These proteins belong to an array of processes reflecting response to wounding, inflammation and perturbations of hemostasis, innate immune response, coagulation and fibrinolysis, regulation of body fluid levels and vascular disturbance among others. Comparison of lymph and serum revealed 83 common proteins. Also, using 71 antibodies specific to total and phosphorylated forms of proteins we carried initial characterization of circulating lymph phosphoproteome which brought additional information regarding signaling pathways operating in the lymphatics. The results demonstrate that the proteome of intra-nodal lymph serves as a sensitive sentinel of the processes occurring within the lymph nodes during infection. The acute innate response of the lymph nodes to anthrax is accompanied by cellular damage and inflammation with a large number of up- and down-regulated proteins many of which are distinct from those detected in serum. MS data are available via ProteomeXchange with identifier PXD001342. PMID:25329596

Zhou, Weidong; Mueller, Claudius; Liotta, Lance; Popov, Serguei G.



Plasmacytoid dendritic cells migrate in afferent skin lymph.  


Conventional dendritic cells enter lymph nodes by migrating from peripheral tissues via the lymphatic route, whereas plasmacytoid dendritic cells (pDC), also called IFN-producing cells (IPC), are described to gain nodes from blood via the high endothelial venules. We demonstrate here that IPC/pDC migrate in the afferent lymph of two large mammals. In sheep, injection of type A CpG oligodinucleotide (ODN) induced lymph cells to produce type I IFN. Furthermore, low-density lymph cells collected at steady state produced type I IFN after stimulation with type A CpG ODN and enveloped viruses. Sheep lymph IPC were found within a minor B(neg)CD11c(neg) subset expressing CD45RB. They presented a plasmacytoid morphology, expressed high levels of TLR-7, TLR-9, and IFN regulatory factor 7 mRNA, induced IFN-gamma production in allogeneic CD4(pos) T cells, and differentiated into dendritic cell-like cells under viral stimulation, thus fulfilling criteria of bona fide pDC. In mini-pig, a CD4(pos)SIRP(pos) subset in afferent lymph cells, corresponding to pDC homologs, produced type I IFN after type A CpG-ODN triggering. Thus, pDC can link innate and acquired immunity by migrating from tissue to draining node via lymph, similarly to conventional dendritic cells. PMID:18424716

Pascale, Florentina; Pascale, Florentia; Contreras, Vanessa; Bonneau, Michel; Courbet, Alexandre; Chilmonczyk, Stefan; Bevilacqua, Claudia; Epardaud, Mathieu; Eparaud, Mathieu; Niborski, Violeta; Riffault, Sabine; Balazuc, Anne-Marie; Foulon, Eliane; Guzylack-Piriou, Laurence; Riteau, Beatrice; Hope, Jayne; Bertho, Nicolas; Charley, Bernard; Schwartz-Cornil, Isabelle



Protocol for the observation of the primo vascular system in the lymph vessels of rabbits.  


Molecular-level understanding of the structure and the functions of the lymphatic system has greatly enhanced the importance of this second circulation system, especially in connection with cancer metastasis and inflammation. Recently, a third circulatory system, the primo vascular system (PVS) was found in various parts of an animal's body, especially as threadlike structures floating in the lymphatic flow in lymph vessels. Although the medical significance of this emerging system will require much work in the future, at present, several important suggestions in connection with immune cells, stem cells, and cancer metastasis have already appeared. Experiments to observe the PVS in the lymph vessels near the caudal vena cava of rabbits and rats have been performed by several independent teams, but reproduction requires considerable skill and technical know-how. In this article, we provide a detailed protocol to detect the PVS inside the lymph vessels of a rabbit. Detection and isolation are the first steps in unraveling the physiological functions of the PVS, which awaits intensive research. PMID:23040104

Jung, Sharon Jiyoon; Cho, Sang Yeon; Bae, Kyoung-Hee; Hwang, Sun Hee; Lee, Byung-Cheon; Kim, Sungchul; Kwon, Byoung Se; Kwon, Hee Min; Song, Yoon-Kyu; Soh, Kwang-Sup



CD169 mediates the capture of exosomes in spleen and lymph node  

PubMed Central

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. PMID:24255917

Dunn, Amy C.; Crocker, Paul R.



Changes in pulmonary hemodynamics in acute pulmonary edema  

Microsoft Academic Search

Experiments were made on dogs to study the hemodynamic changes following intravenous injections of chloramine and adrenaline. Chloramine injections were followed by the development of a severe pulmonary edema in an of the dogs. In most of them, however, the capillary pressure in the pulmonary circulation increased, but insignificantly. The great increase in the pulmonary capillary pressure following adrenaline injection

I. A. Serebrovskaya; É. P. Rubin



An uncommon pulmonary embolism  

PubMed Central

Objectives: To report an unusual case of suicide attempt secondary complicated of pulmonary and systemic embolisms. Data Source: A 49-year-old-woman, with a factor V Leiden mutation and a notion of chronic depression, admitted to our intensive care unit for a suicide attempt by ingestion ofmepronizine and lormetazepam. Data Extraction: We report the rare evolution of this patient with a persistent alteration of consciousness associating a respiratory degradation. Despite the drug intoxication and possibility of aspiration, we performed a computed tomography (CT) angiography which confirmed the presence of a bilateral, proximal, pulmonary embolism suspected on transthoracic echocardiography. A cerebral CT showed left sylvian and cerebellar infarctions complicated of perilesional edema. Association of stroke and pulmonary embolism led us to suspect a patent foramen ovale (PFO). There was also a context of genetical perturbation of hemostasis. Transesophageal echocardiography confirmed the presence of a PFO undiagnosed by transthoracic echography. The PFO was complicated by an entrapped thrombus. The thrombotic complications were treated by unfractionated heparin. Data Synthesis: Neurological and respiratory degradation following voluntary drug intoxication led to the discovery of both a pulmonary and cerebral embolism secondary to a PFO entrapped thrombus. Conclusions: An entrapped thrombus in a PFO is a rare and dangerous situation, associated with many complications. Association of systemic and pulmonary embolisms should lead to PFO detection to guide therapeutic interventions.

Prevel, Renaud; Garcon, Philippe; Philippart, François



Methamphetamine Use and Pulmonary Hypertension  


... known as the pulmonary arteries) About Pulmonary Hypertension sickle cell disease and HIV infection. Finally, PAH can ... between stimulants and PH? Information from a new study suggests that methamphetamine (speed) use is associated with ...


Signaling Proteins Are Represented in Tissue Fluid/Lymph from Soft Tissues of Normal Human Legs at Concentrations Different from Serum  

PubMed Central

Abstract Background: The mobile intercellular fluid flowing to and in the lymphatics contains filtered plasma products and substances synthesized and excreted by tissue cells. Among them are signaling proteins such as cytokines, chemokines, enzymes, and growth factors. They act locally in autocrine and paracrine systems regulating cell metabolism, proliferation, and formation of the ground matrix. They play an immunoregulatory role in infections, wound healing, and tumor cell growth. Methods and Results: In this study we measured the concentration of selected cytokines, chemokines, tissue enzymes, and growth factors in tissue fluid/lymph drained from normal human leg soft tissues. Legs exposed to infections and trauma often result in development of lymphedema. Lymph was drained from superficial calf lymphatics using microsurgical techniques. Our studies showed generally higher concentrations of cytokines, chemokines, enzymes, and growth factors in lymph than in serum. The total protein L/S ratio was 0.22, whereas that of various lymph signaling proteins ranged between 1 and 10. Conclusions: This indicates that in addition to proteins filtered from blood, local cells contribute to lymph concentration by own production, depending on the actual cell requirement. Moreover, there were major individual differences of lymph levels with simultaneous stable serum levels. This suggests existence of a local autonomous regulatory humoral mechanism in tissues, not reflected in serum. PMID:24364843

Zaleska, Marzanna; Durlik, Marek; Miller, Norman E.



Isolated dysphagia unmasking bulbar neurosarcoidosis and pulmonary sarcoidosis.  


Dysphagia is a rare manifestation of sarcoidosis. It is more commonly the result of esophageal compression by enlarged mediastinal lymph nodes rather than direct esophageal involvement and rarely secondary to neurosarcoidosis and oropharyngeal dysphagia. We report a 54 year old female presenting with a six month history of worsening dysphagia. She denied respiratory symptoms. Physical exam was normal. ESR was 61 mm/hr. Serum ACE level was 65 mcg/L. Chest X-ray was normal. Esophagram revealed a large amount of contrast pooling in pharyngeal recesses with intermittent laryngeal aspiration. Swallow videofluorography showed a decreased retraction of the base of the tongue, limited laryngeal elevation, and a large amount of contrast pooling in pharyngeal recesses with intermittent laryngeal aspiration. EGD showed a normal opening of the upper esophageal sphincter and the cricopharyngeus appeared normal. Proximal esophageal biopsies were normal. Brain MRI with gadolinium was normal. Lumbar puncture was performed. CSF showed a moderate pleocytosis, a WBC count of 19 with 97% lymphocytes, an elevated total protein level of 85 mg/dl (15-60). Neck CT scan showed no oropharyngeal tissue thickening or infiltration, no masses or enlarged lymph nodes. Chest CT scan showed enlarged intrathoracic lymph nodes and no esophageal compression. Bronchoscopy showed the vocal cords to be intact, and the CD4/CD8 ratio in BAL was 5.3. Subcarinal lymph node EBUS biopsy revealed non caseating granulomas. The patient was started on IV methylprednisolone. Three days later, the swallow videofluorography showed a near complete response to steroids. The patient tolerated regular consistency diet with thin liquids, and she was discharged on a slow taper of prednisone over a period of three months. A unique case of isolated dysphagia unmasking bulbar neurosarcoidosis and pulmonary sarcoidosis is herein reported. PMID:25097053

Abdallah, Tarek; Abdallah, Mokhtar; Elsayegh, Dany; Chalhoub, Michel; Khoueiry, Georges; Glatman, Alex; Maniatis, Theodore



High-Altitude Pulmonary Edema  

Microsoft Academic Search

\\u000a High-altitude pulmonary edema (HAPE) is an uncommon form of pulmonary edema that occurs in healthy individuals within a few\\u000a days of arrival at altitudes above 2,500–3,000 m. The crucial pathophysiology is an excessive hypoxia-mediated rise in pulmonary\\u000a vascular resistance (PVR) or hypoxic pulmonary vasoconstriction (HPV) leading to increased microvascular hydrostatic pressures\\u000a despite normal left atrial pressure. The resultant hydrostatic stress

Erik R. Swenson


Echocardiography in Pulmonary Vascular Disease  

Microsoft Academic Search

\\u000a This chapter will focus on the principles and uses of the Doppler echocardiography (DE) examination in patients with pulmonary\\u000a vascular disease (PVD). That is, patients who have pulmonary hypertension that is related to a marked increase in the pulmonary\\u000a vascular resistance (PVR) and loss of large pulmonary artery (PA) compliance. We will also address the role of DE in the

Paul R. Forfia


Pulmonary Veno-occlusive Disease  

Microsoft Academic Search

\\u000a Pulmonary veno-occlusive disease (PVOD) is a rare and highly lethal disorder of the pulmonary vasculature. In contrast to\\u000a the insights into pathophysiology and management that have characterized the diagnosis and treatment of idiopathic pulmonary\\u000a arterial hypertension (IPAH; formerly known as primary pulmonary hypertension) over the past decade, the pathophysiologic\\u000a mechanisms underlying PVOD are incompletely understood, the clinical diagnosis is notoriously

Peter F. Clardy; Jess Mandel


Effects of ambient air pollution on pulmonary function among schoolchildren.  


Literature has shown adverse effects of ambient air pollution exposure on various asthma related outcomes in childhood. However, the associated evidence on pulmonary function effects is still inconsistent. We conducted a population-based study comprised of seventh-grade children in 14 Taiwanese communities. Pulmonary function tests and questionnaires were completed on 3957 subjects. We evaluated the effects of ambient air pollution exposures based on the data collected in 2005-2007 by existing air monitoring stations. Multiple linear mixed effect models were fitted to estimate the relationship between community pollutant levels and pulmonary function indices. After adjustment for individual-level confounders, pulmonary function differed only slightly between communities with different levels of air pollution. We found greater effects of ambient air pollutants on pulmonary function for boys than for girls. Among boys, traffic-related pollutants CO, NOx, NO(2), and NO were generally associated with chronic adverse effects on FVC and FEV(1), and subchronic adverse effects mainly on maximal mid-expiratory flow (MMEF) and peak expiratory flow rate. Among girls, only NOx and NO(2) showed subchronic adverse effects on MMEF. Although effect estimates of SO(2), PM(10), and PM(2.5) were generally negative for boys, none achieved statistical significance. Our data suggests that ambient traffic-related pollution had chronic adverse effects on pulmonary function in schoolchildren, especially for boys. PMID:21680243

Lee, Yungling Leo; Wang, Wen-Hua; Lu, Chia-Wen; Lin, Ya-Hui; Hwang, Bing-Fang



Pulmonary vascular remodeling before and after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: a cardiac magnetic resonance study.  


Phase-contrast magnetic resonance imaging (PC-MRI) offers a range of surrogate markers to quantify the hemodynamic changes associated with chronic thromboembolic pulmonary hypertension (CTEPH). Our aim was to noninvasively monitor effects of pulmonary vascular remodeling before and after endarterectomy (PEA) in patients with CTEPH by using PC-MRI. Fifty-seven consecutive patients (mean age 56.7 ± 16, 28 female) underwent PC-MRI before and after PEA as part of their peri-operative routine workup. Pulmonary artery (PA) maximum flow velocity (maxV), acceleration time/ejection time (AT/ET), distensibility [(PA maximum area - PA minimum area)/PA minimum area], mid-systolic flow deceleration (notch), and the timing of deceleration (notch ratio) were recorded. Mean PA pressure was obtained from standard right heart catheter procedures. maxV and AT/ET were decreased before PEA and significantly improved afterwards (60.8 ± 16 vs. 73.8 ± 19 cm/s, p = 0.007; 0.32 ± 0.06 vs. 0.36 ± 0.09, p = 0.0015). Surprisingly, distensibility did not change significantly (30 ± 19 vs. 26 ± 12 %, p = 0.11). Forty-five patients (78 %) had a systolic notch before PEA that persisted in only 10 (18 %; p = 0.00001). Among patients with a persisting notch, the notch ratio did not significantly increase (1.3 ± 0.2 vs. 1.6 ± 1.5, p = 0.32). Our data show early PA reverse remodeling after PEA. Flow velocities increase while PA flow wave reflections represented by mid-systolic flow deceleration are abolished. In some patients a mid-systolic notch persists, suggesting increased downstream resistance as a consequence of small vessel arteriopathy. PMID:25519191

Rolf, Andreas; Rixe, Johannes; Kim, Won K; Guth, Stefan; Körlings, Nils; Möllmann, Helge; Nef, Holger M; Liebetrau, Christoph; Krombach, Gabriele; Kramm, Thorsten; Mayer, Eckhard; Hamm, Christian W



Neonatal pulmonary hemosiderosis.  


Idiopathic pulmonary hemosiderosis (IPH) is a rare complex entity characterized clinically by acute or recurrent episodes of hemoptysis secondary to diffuse alveolar hemorrhage. The radiographic features are variable, including diffuse alveolar-type infiltrates, and interstitial reticular and micronodular patterns. We describe a 3-week-old infant presenting with hemoptysis and moderate respiratory distress. Idiopathic pulmonary hemosiderosis was the first working diagnosis at the Emergency Department and was confirmed, 2 weeks later, by histological studies (bronchoalveolar lavage). The immunosuppressive therapy by 1?mg/kg/d prednisone was immediately started, the baby returned home on steroid therapy at a dose of 0,5?mg/kg/d. The diagnosis of idiopathic pulmonary hemosiderosis should be evocated at any age, even in the neonate, when the clinical presentation (hemoptysis and abnormal radiological chest images) is strongly suggestive. PMID:25389504

Limme, Boris; Nicolescu, Ramona; Misson, Jean-Paul



Neonatal Pulmonary Hemosiderosis  

PubMed Central

Idiopathic pulmonary hemosiderosis (IPH) is a rare complex entity characterized clinically by acute or recurrent episodes of hemoptysis secondary to diffuse alveolar hemorrhage. The radiographic features are variable, including diffuse alveolar-type infiltrates, and interstitial reticular and micronodular patterns. We describe a 3-week-old infant presenting with hemoptysis and moderate respiratory distress. Idiopathic pulmonary hemosiderosis was the first working diagnosis at the Emergency Department and was confirmed, 2 weeks later, by histological studies (bronchoalveolar lavage). The immunosuppressive therapy by 1?mg/kg/d prednisone was immediately started, the baby returned home on steroid therapy at a dose of 0,5?mg/kg/d. The diagnosis of idiopathic pulmonary hemosiderosis should be evocated at any age, even in the neonate, when the clinical presentation (hemoptysis and abnormal radiological chest images) is strongly suggestive. PMID:25389504

Limme, Boris; Nicolescu, Ramona; Misson, Jean-Paul



Apelin promotes lymphangiogenesis and lymph node metastasis  

PubMed Central

Whereas the role of the G-protein-coupled APJ receptor and its ligand, apelin, in angiogenesis has been well documented, the ability of the apelin/APJ system to induce lymphangiogenesis and lymphatic metastasis has been largely unexplored. To this end, we first show that APJ is expressed in lymphatic endothelial cells (LECs) and, moreover, that it responds to apelin by activating the apelinergic signaling cascade. We find that although apelin treatment does not influence the proliferation of LECs in vitro, it enhances their migration, protects them against UV irradiation-induced apoptosis, increases their spheroid numbers in 3D culture, stimulates their in vitro capillary-like tube formation and, furthermore, promotes the invasive growth of lymphatic microvessels in vivo in the matrigel plug assay. We also demonstrate that apelin overexpression in malignant cells is associated with accelerated in vivo tumor growth and with increased intratumoral lymphangiogenesis and lymph node metastasis. These results indicate that apelin induces lymphangiogenesis and, accordingly, plays an important role in lymphatic tumor progression. Our study does not only reveal apelin as a novel lymphangiogenic factor but might also open the door for the development of novel anticancer therapies targeting lymphangiogenesis. PMID:24962866

Laszlo, Viktoria; Rozsas, Anita; Garay, Tamas; Torok, Szilvia; Grusch, Michael; Berger, Walter; Paku, Sandor; Renyi-Vamos, Ferenc; Masri, Bernard; Tovari, Jozsef; Groger, Marion; Klepetko, Walter; Hegedus, Balazs; Dome, Balazs



Sentinel lymph node biopsy in Japan.  


Similar to the practice in Western countries, intraoperative lymphatic mapping and selected lymphadenectomy (SLNB) have been validated and are widely performed for the staging of melanoma in Japan. Recent studies have shown that approximately 90% (73/81) of university hospitals and several cancer hospitals routinely perform SLNB, and half of all melanoma patients receive this examination. SLNB is performed according to a variation of the standard procedure described by Morton and Cochran. The most frequently used tracers are Tc(99m)-tin colloid or Tc(99m)-phytate for scintigraphy and patent blue violet or indigo carmine as a blue dye. Some institutions use indocyanine green, which is fluorescent and can be used to visualize sentinel lymph node(s) (SLNs) under an infrared camera. The recent detection rate of SLNs has increased to more than 95% with the method using blue dye, lymphoscintigraphy, and a handheld gamma probe. In a multicenter study, the rates of metastasis in SLN were as follows: pTis, 0% (0/36); pT1, 10.7% (6/56); pT2, 21.0% (13/63); pT3, 34.0% (35/103); and pT4, 62.4% (63/101). The metastasis rate was also significantly related to ulceration of the primary tumor. Here, we discuss data from Japanese patients and the present status of SLNB in Japan. PMID:19967483

Uhara, Hisashi; Takata, Minoru; Saida, Toshiaki



Lymph Node Ratio for Postoperative Staging of Laryngeal Squamous Cell Carcinoma with Lymph Node Metastasis  

PubMed Central

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. PMID:24475216

Wang, Yu-Long; Li, Duan-Shu; Wang, Yu; Wang, Zhuo-Ying; Ji, Qing-Hai



Pulmonary talcosis: imaging findings.  


Talc is a mineral widely used in the ceramic, paper, plastics, rubber, paint, and cosmetic industries. Four distinct forms of pulmonary disease caused by talc have been defined. Three of them (talcosilicosis, talcoasbestosis, and pure talcosis) are associated with aspiration and differ in the composition of the inhaled substance. The fourth form, a result of intravenous administration of talc, is seen in drug users who inject medications intended for oral use. The disease most commonly affects men, with a mean age in the fourth decade of life. Presentation of patients with talc granulomatosis can range from asymptomatic to fulminant disease. Symptomatic patients typically present with nonspecific complaints, including progressive exertional dyspnea, and cough. Late complications include chronic respiratory failure, emphysema, pulmonary arterial hypertension, and cor pulmonale. History of occupational exposure or of drug addiction is the major clue to the diagnosis. The high-resolution computed tomography (HRCT) finding of small centrilobular nodules associated with heterogeneous conglomerate masses containing high-density amorphous areas, with or without panlobular emphysema in the lower lobes, is highly suggestive of pulmonary talcosis. The characteristic histopathologic feature in talc pneumoconiosis is the striking appearance of birefringent, needle-shaped particles of talc seen within the giant cells and in the areas of pulmonary fibrosis with the use of polarized light. In conclusion, computed tomography can play an important role in the diagnosis of pulmonary talcosis, since suggestive patterns may be observed. The presence of these patterns in drug abusers or in patients with an occupational history of exposure to talc is highly suggestive of pulmonary talcosis. PMID:20155272

Marchiori, Edson; Lourenço, Sílvia; Gasparetto, Taisa Davaus; Zanetti, Gláucia; Mano, Cláudia Mauro; Nobre, Luiz Felipe



Considerations for numerical modeling of the pulmonary circulation--a review with a focus on pulmonary hypertension.  


Both in academic research and in clinical settings, virtual simulation of the cardiovascular system can be used to rapidly assess complex multivariable interactions between blood vessels, blood flow, and the heart. Moreover, metrics that can only be predicted with computational simulations (e.g., mechanical wall stress, oscillatory shear index, etc.) can be used to assess disease progression, for presurgical planning, and for interventional outcomes. Because the pulmonary vasculature is susceptible to a wide range of pathologies that directly impact and are affected by the hemodynamics (e.g., pulmonary hypertension), the ability to develop numerical models of pulmonary blood flow can be invaluable to the clinical scientist. Pulmonary hypertension is a devastating disease that can directly benefit from computational hemodynamics when used for diagnosis and basic research. In the present work, we provide a clinical overview of pulmonary hypertension with a focus on the hemodynamics, current treatments, and their limitations. Even with a rich history in computational modeling of the human circulation, hemodynamics in the pulmonary vasculature remains largely unexplored. Thus, we review the tasks involved in developing a computational model of pulmonary blood flow, namely vasculature reconstruction, meshing, and boundary conditions. We also address how inconsistencies between models can result in drastically different flow solutions and suggest avenues for future research opportunities. In its current state, the interpretation of this modeling technology can be subjective in a research environment and impractical for clinical practice. Therefore, considerations must be taken into account to make modeling reliable and reproducible in a laboratory setting and amenable to the vascular clinic. Finally, we discuss relevant existing models and how they have been used to gain insight into cardiopulmonary physiology and pathology. PMID:23699723

Kheyfets, V O; O'Dell, W; Smith, T; Reilly, J J; Finol, E A



Fungal Pulmonary Valve Endocarditis Masquerading as a Pulmonary Embolism  

PubMed Central

Septic pulmonary emboli (SPE) can be a difficult clinical entity to distinguish from thromboembolic pulmonary embolism (TPE) in a patient with history of IV drug abuse (IVDA). We present a case of a patient who presented with failure to thrive and presumed diagnosis of recurrent PE that ultimately was discovered to have fungal pulmonary valve endocarditis resulting in a right ventricular outflow obstruction. This required replacement of the pulmonary valve and repair of the right ventricular outflow tract. This case highlights difficulty in differentiating pulmonary valve endocarditis with septic emboli from chronic PE in a patient with a complex medical history.

Ricci, Kevin B.; Lee, Peter H. U.; Essandoh, Michael



Ventilation-Synchronous Magnetic Resonance Microscopy of Pulmonary Structure and Ventilation in  

E-print Network

Ventilation-Synchronous Magnetic Resonance Microscopy of Pulmonary Structure and Ventilation helium (3 He) gas to acquire images that dem- onstrate pulmonary vasculature and ventilated airways of these structures relative to the less vascular surrounding tissues. A constant- flow ventilator was developed


Atrial Septal Defect with Normal Pulmonary Arterial Pressure in Adult Cyanotic Patient  

PubMed Central

A 22-year-old male presented with recurrent stroke, central cyanosis, and dyspnea. Transesophageal echocardiography and cardiac catheterization revealed bidirectional shunt flow through atrial septal defect (ASD) without pulmonary arterial hypertension. The orifice of inferior vena cava facing towards ASD opening led partially right to left shunt resulting in cyanosis with normal pulmonary arterial pressure. PMID:25580198

Kim, In-Cheol; Lee, Jeung-Eun; Yoon, Hyuck-Jun; Kim, Jae-Beom; Kim, Jae-Hyun



Pulsed Wave and Color Doppler Echocardiography and Cardiac Catheterization Findings in Bilateral Pulmonary Vein Stenosis  

Microsoft Academic Search

Pulmonary vein stenosis is a rare condition that usually is congenital in origin; it is almost invariably fatal in its bilateral and severe forms. It is often overlooked, however, during clinical examination, routine echocardiography, and even at cardiac catheterization. This report describes the pulsed Doppler, color flow echocardiography, and hemodynamic findings of bilateral pulmonary vein stenosis that accompany ventricular septal

Jong-Won Ha; Namsik Chung; Junghan Yoon; Yangsoo Jang; Byung-Ok Kim; Seung-Yun Cho; Bum-Koo Cho



Total repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals: An integrated approach  

Microsoft Academic Search

Background: Predicting postrepair right ventricular\\/left ventricular pressure ratio has prognostic relevance for patients undergoing total repair of pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. To this purpose, we currently rely on 2 novel parameters: (1) preoperative total neopulmonary arterial index and (2) mean pulmonary artery pressure changes during an intraoperative flow study. Methods: Since January 1994, 15

Adriano Carotti; Roberto M. Di Donato; Cosimo Squitieri; Paolo Guccione; Glauco Catena



Nanoparticle Transport from Mouse Vagina to Adjacent Lymph Nodes  

PubMed Central

To test the feasibility of localized intravaginal therapy directed to neighboring lymph nodes, the transport of quantum dots across the vaginal wall was investigated. Quantum dots instilled into the mouse vagina were transported across the vaginal mucosa into draining lymph nodes, but not into distant nodes. Most of the particles were transported to the lumbar nodes; far fewer were transported to the inguinal nodes. A low level of transport was evident at 4 hr after intravaginal instillation, and transport peaked at about 36 hr after instillation. Transport was greatly enhanced by prior vaginal instillation of Nonoxynol-9. Hundreds of micrograms of nanoparticles/kg tissue (ppb) were found in the lumbar lymph nodes at 36 hr post-instillation. Our results imply that targeted transport of microbicides or immunogens from the vagina to local lymph organs is feasible. They also offer an in vivo model for assessing the toxicity of compounds intended for intravaginal use. PMID:23284844

Ballou, Byron; Andreko, Susan K.; Osuna-Highley, Elvira; McRaven, Michael; Catalone, Tina; Bruchez, Marcel P.; Hope, Thomas J.; Labib, Mohamed E.



Ultrasound, hepatic lymph nodes and chronic active hepatitis.  


Thirty-two consecutive patients with a histological diagnosis of chronic active hepatitis were examined with liver biopsy, laboratory tests and ultrasonography of the hepato-duodenal ligament to investigate the possible correlation between enlarged lymph nodes in the hepato-duodenal ligament and biochemical activity, histological activity and/or humoral immunoreactivity. We found a significant correlation between lymph-node size and serum alkaline phosphatase in the total material. In the hepatitis C-virus-associated group of patients a significant correlation between the size of the lymph nodes and gamma-glutamyl transpeptidase was found. In the autoimmune group there was a trend towards a negative correlation between lymph-node size and albumin. PMID:7814804

Lyttkens, K; Prytz, H; Forsberg, L; Hederström, E; Hägerstrand, I



A gangliocytic patially glandular paraganglioma with lymph node metastasis  

PubMed Central

Gangliocytic paraganglioma (GP) is an infrequent neuroendocrine tumor usually with three elements as epithelioid cells, spindle-shaped cells and ganglion-like cells, which is generally regarded as a benign tumor. Only a few cases with lymph node metastasis have been reported. Herein, we reported a 47-year-old man of GP with distinct glandular component embedded in the spindle tumor cells in the primary tumor and the metastatic lymph nodes. The immunohistochemical profile was helpful to give the final diagnosis as gangliocytic paraganglioma. Here, we added one more GP case with regional lymph nodes metastasis. And particularly, there were small amount of distinct glandular component both in the primary tumor and the metastatic lymph nodes, which indicated that adenocarcinoma might coexist with GP. And GP should also be distinguished from carcinoid tumor, paraganglioma, ganglioneuroma, or GIST. PMID:24649939



A gangliocytic patially glandular paraganglioma with lymph node metastasis.  


Gangliocytic paraganglioma (GP) is an infrequent neuroendocrine tumor usually with three elements as epithelioid cells, spindle-shaped cells and ganglion-like cells, which is generally regarded as a benign tumor. Only a few cases with lymph node metastasis have been reported. Herein, we reported a 47-year-old man of GP with distinct glandular component embedded in the spindle tumor cells in the primary tumor and the metastatic lymph nodes. The immunohistochemical profile was helpful to give the final diagnosis as gangliocytic paraganglioma. Here, we added one more GP case with regional lymph nodes metastasis. And particularly, there were small amount of distinct glandular component both in the primary tumor and the metastatic lymph nodes, which indicated that adenocarcinoma might coexist with GP. And GP should also be distinguished from carcinoid tumor, paraganglioma, ganglioneuroma, or GIST. PMID:24649939

Shi, Huijuan; Han, Ju; Liu, Ni; Ye, Ziyin; Li, Zhixun; Li, Zhi; Peng, Tingsheng



[Lymph node inflammatory pseudotumor. Description of a case].  


A case of inflammatory pseudotumor of lymph node in a 56-year-old man is described. The awareness of this benign reaction pattern is of great importance for differential diagnosis with many nodal lesions. PMID:9549381

Tranchina, M G; Allegra, E; Greco, P; Puzzo, L



Pulmonary hypertension: pathology.  


Pulmonary hypertension (PH) is a life-threatening and often fatal disease, characterized by elevated pulmonary vascular resistance and secondary right ventricular failure. Since etiologies of PH are multiple and its pathogenesis is complex, histology from lungs of patients with PH may help us to determine different etiological factors of the disease. The degree of involvement of various cell types and structures within the lung tissue represents an important indicator of the pathophysiologal process. So even if the role for pathologists in routine management of PH is limited, lessons can be learned from morphology. The present chapter outlines the current understanding of this disease from the pathologist's point of view. PMID:24092336

Dorfmüller, Peter



Intraoperative Evaluation of Sentinel Lymph Nodes for Metastatic Breast Carcinoma by Imprint Cytology  

Microsoft Academic Search

Background: The increasing utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes attractive. Axillary lymph node dissection can be performed during the initial surgery if the sentinel lymph node is positive, potentially avoiding a second operative procedure. At present the optimal technique for rapid sentinel lymph node assessment has not been determined. Both

Andrew J. Creager; Kim R. Geisinger; Stephen A. Shiver; Nancy D. Perrier; Perry Shen; Jo Ann Shaw; Peter R. Young; Edward A. Levine



[Localized lymph node lymphangiomyoma. Description of 2 cases].  


Lymphangioleiomyomatosis is a rare disease characterized by an immature-appearing smooth muscle proliferation in the lung and along axial lymphatics. Rarely it is limited to lymph nodes, without extranodal disease. Two cases of localized nodal lymphangiomyoma in a 48 and 54 year-old women are presented: in both cases the lesion was limited to pelvic lymph nodes and it was an incidental finding during staging for tumours of the gynaecological tract. PMID:11234304

Cavazza, A; Abrate, M; Corrado, S; Ciamprone, G; Putrino, I; Scotti, R; De Marco, L; Piana, S



Bosentan for pulmonary hypertension secondary to idiopathic pulmonary fibrosis  

PubMed Central

Pulmonary hypertension is a poor prognostic factor in patients with interstitial lung disease. No established treatment exists for pulmonary hypertension secondary to interstitial pneumonia. We describe the case of an 81-year-old woman with idiopathic pulmonary fibrosis (IPF), who was admitted to our hospital due to aggravation of dyspnea and decreased oxygen saturation, as well as onset of orthopnea and rapidly progressing edema. The transthoracic echocardiography and right heart catheterization showed the mean pulmonary artery pressure was 39 mmHg and the mean pulmonary capillary wedge pressure was 9 mmHg. After various examinations, the diagnoses of pulmonary hypertension (PH) due to IPF and of congestive heart failure secondary to PH were established. Diuretic therapy was started, but the patient's condition showed poor improvement. Subsequent initiation of oral bosentan therapy led to improvement in symptoms and findings. At the follow-up assessment one year later her pulmonary function showed no significant changes and no apparent worsening of arterial blood gases, with evident improvement of PH, WHO functional class, maximum exercise tolerance on treadmill exercise testing, right heart catheterization, and transthoracic echocardiography. This report describes a case of successful treatment with bosentan for severe pulmonary hypertension in a patient with idiopathic pulmonary fibrosis. We also present a review of the literature on treatment of pulmonary hypertension in patients with chronic lung disease. Bosentan appears to be efficacious in some patients with pulmonary hypertension secondary to idiopathic interstitial pneumonitis.

Onda, Naomi; Tanaka, Yosuke; Hino, Mitsunori; Gemma, Akihiko



[Pulmonary surgery for pulmonary lesion with pulmonary tuberculosis or of tuberculosis].  


Nine patients with pulmonary tuberculosis underwent open chest surgery for pulmonary lesions of tuberculosis or other than tubercolosis. They were 1 case of lung cancer, 4 cases of pneumothorax, 1 case of multi drug resistant pulmonary tuberculosis and 3 cases of tuberculoma. Postoperative complications developed in 3 cases including 2 of pneumothorax and 1 of lung collapse. PMID:11712371

Niimi, S; Kato, T; Hayakawa, Y; Hirota, M; Kako, T



Thin-section CT findings in Pseudomonas aeruginosa pulmonary infection  

PubMed Central

Objective The aim of this study was to assess clinical and pulmonary thin-section CT findings in patients with acute Pseudomonas aeruginosa (PA) pulmonary infection. Methods We retrospectively identified 44 patients with acute PA pneumonia who had undergone chest thin-section CT examinations between January 2004 and December 2010. We excluded nine patients with concurrent infections. The final study group comprised 35 patients (21 males, 14 females; age range 30–89 years, mean age 66.9 years) with PA pneumonia. The patients' clinical findings were assessed. Parenchymal abnormalities, enlarged lymph nodes and pleural effusion were evaluated on thin-section CT. Results Underlying diseases included malignancy (n=13), a smoking habit (n=11) and cardiac disease (n=8). CT scans of all patients revealed abnormal findings, including ground-glass opacity (n=34), bronchial wall thickening (n=31), consolidation (n=23) and cavities (n=5). Pleural effusion was found in 15 patients. Conclusion PA pulmonary infection was observed in patients with underlying diseases such as malignancy or a smoking habit. The CT findings in patients with PA consisted mainly of ground-glass attenuation and bronchial wall thickening. Advances in knowledge The CT findings consisted mainly of ground-glass attenuation, bronchial wall thickening and cavities. These findings in patients with an underlying disease such as malignancy or a smoking habit may be suggestive of pneumonia caused by PA infection. PMID:22844034

Okada, F; Ono, A; Ando, Y; Nakayama, T; Ishii, R; Sato, H; Kira, A; Tokimatsu, I; Kadota, J; Mori, H



Idiopathic pulmonary arterial hypertension.  


Idiopathic pulmonary arterial hypertension (IPAH), formerly called primary pulmonary hypertension, is a rare disease (incidence and prevalence rates of approximately one and six cases per million inhabitants, respectively) with different clinical phenotypes. A group of diverse conditions manifest pulmonary arterial hypertension (PAH) and share similar pathological and/or clinical findings with IPAH. By definition, IPAH is diagnosed only after alternative diagnoses have been ruled out. Extensive investigation is needed to determine if PAH is associated with thyroid diseases, infectious diseases, autoimmune conditions, exposure to certain drugs (particularly anorexigens), certain genetic mutations, and so on. The presence of genetic abnormalities and risk factors (such as specific drug exposures) reinforces the "multiple hit" concept for the development of pulmonary hypertension. Fortunately, within the past two decades, therapeutic options have become available for IPAH, resulting in improved survival and clinical outcomes. At least seven different compounds have been registered for PAH treatment. However, even with aggressive PAH-specific therapy, mortality rates remain high (?40% at 5 years). Given the high mortality rates, the use of combinations of agents that work by different pathways has been advocated (either as "add-on" therapy or initial "up front" therapy). Further, new therapeutic agents and treatment strategies are on the near horizon, aiming to further improve survival from the remarkable progress already seen. PMID:24037625

Souza, Rogerio; Jardim, Carlos; Humbert, Marc



Acute cardiogenic pulmonary edema  

Microsoft Academic Search

The frequency distribution and severity of the cardiac disease underlying acute cardiogenic pulmonary edema (APE) to define appropriate subsequent diagnostic and management strategies were investigated in 216 consecutive patients. To this effect, the clinical, electrocardiographic, ecocardiographic and angiographic characteristics were analyzed. Coronary artery disease was identified in 185 patients (86%)—146 with acute myocardial infarction—as the underlying cause, isolated valvular disease

Carlos Pena-Gil; Jaume Figueras; Jordi Soler-Soler



Cytokines and Pulmonary Fibrosis  

Microsoft Academic Search

In the past several years, significant progress in many aspects of pulmonary fibrosis research has been made. Among them, the finding that a variety of cytokines play important roles in the complex process appears most intriguing. These cytokines include at least transforming growth factor-? (TGF-?), tumor necrosis factor-? (TNF-?), platelet-derived growth factor, fibroblast growth factors, (TGF-?), interleukin-1, monocyte chemoattractant protein-1

Kai Zhang; Sem H. Phan



Idiopathic pulmonary artery aneursym.  


Idopathic pulmonary artery aneurysm (PAA) is a rare lesion. Clinical experience with this condition is limited and current knowledge is mainly derived from autopsy findings. We report a patient who came to us with complaints of chest pain, breathlessness on exertion and pedal oedema and was diagnosed to have PAA. PMID:24930208

Singh, Urvinderpal; Singh, Kulbir; Aditi; Singh, Parminderpal; Aneja, Pooja



Pattern of lymph node involvement and prognosis in pancreatic adenocarcinoma: direct lymph node invasion has similar survival to node-negative disease.  


Lymph node status is one of the most important predictors of survival in pancreatic ductal adenocarcinoma. Surgically resected pancreatic adenocarcinoma is often locally invasive and may invade directly into peripancreatic lymph nodes. The significance of direct invasion into lymph nodes in the absence of true lymphatic metastases is unclear. The purpose of this study was to retrospectively compare clinical outcome in patients with pancreatic ductal adenocarcinoma with direct invasion into peripancreatic lymph nodes with patients with node-negative adenocarcinomas and patients with true lymphatic lymph node metastasis. A total of 380 patients with invasive pancreatic ductal adenocarcinoma classified as pT3, were evaluated: ductal adenocarcinoma with true lymphatic metastasis to regional lymph nodes (248 cases), ductal adenocarcinoma without lymph node involvement (97 cases), and ductal adenocarcinoma with regional lymph nodes involved only by direct invasion from the main tumor mass (35 cases). Isolated lymph node involvement by direct invasion occurred in 35 of 380 (9%) patients. Overall survival for patients with direct invasion of lymph nodes (median survival, 21 mo; 5-year overall survival, 36%) was not statistically different from patients with node-negative adenocarcinomas (median survival, 30 mo; 5-year overall survival, 31%) (P=0.609). Patients with node-negative adenocarcinomas had an improved survival compared with patients with lymph node involvement by true lymphatic metastasis (median survival, 15 mo; 5-year overall survival, 8%) (P<0.001) regardless of the number of lymph nodes involved by adenocarcinoma. There was a trend toward decreased overall survival for patients with 1 or 2 lymph nodes involved by true lymphatic metastasis compared with patients with direct invasion of tumor into lymph nodes (P=0.056). However, this did not reach statistical significance. Our results indicate that patients with isolated direct lymph node invasion have a comparable overall survival with patients with node-negative adenocarcinomas as opposed to true lymphatic lymph node metastasis. PMID:21263243

Pai, Rish K; Beck, Andrew H; Mitchem, Jonathan; Linehan, David C; Chang, Daniel T; Norton, Jeffrey A; Pai, Reetesh K



Altered Immune Phenotype in Peripheral Blood Cells of Patients with Scleroderma-Associated Pulmonary Hypertension  

PubMed Central

Pulmonary arterial hypertension is a common and fatal complication of scleroderma that may involve inflammatory and autoimmune mechanisms. Alterations in the gene expression of peripheral blood mononuclear cells have been previously described in patients with pulmonary arterial hypertension. Our goal is to identify differentially expressed genes in peripheral blood mononuclear cells in scleroderma patients with and without pulmonary hypertension as biomarkers of disease. Gene expression analysis was performed on a Microarray Cohort of scleroderma patients with (n=10) and without (n=10) pulmonary hypertension. Differentially expressed genes were confirmed in the Microarray Cohort and validated in a Validation Cohort of scleroderma patients with (n=15) and without (n=19) pulmonary hypertension by RT-qPCR. We identified inflammatory and immune-related genes including interleukin-7 receptor (IL-7R) and chemokine receptor 7 as differentially expressed in patients with scleroderma-associated pulmonary hypertension. Flow cytometry confirmed decreased expression of IL-7R on circulating CD4+ T-cells from scleroderma patients with pulmonary hypertension. Differences exist in the expression of inflammatory and immune-related genes in peripheral blood cells from patients with scleroderma-related pulmonary hypertension compared to those with normal pulmonary artery pressures. These findings may have implications as biomarkers to screen at-risk populations for early diagnosis and provide insight into mechanisms of scleroderma-related pulmonary hypertension. PMID:20973920

Risbano, Michael G; Meadows, Christina A; Coldren, Christopher D; Jenkins, Tiffany J.; Edwards, Michael G; Collier, David; Huber, Wendy; Mack, Douglas G; Fontenot, Andrew P; Geraci, Mark W; Bull, Todd M



Pulmonary uptake of morphine (M)  

SciTech Connect

Previously the authors reported less than 5% of M was taken up during the first pass through the human lung. The low uptake of this basic lipophilic amine was further investigated in a single pass isolated perfused rat lung (IPL) in comparison to uptake of radiolabelled H/sub 2/O, antipyrine (A), aminopyrine (AM), nicotine (N) and phenylethylamine (P). The IPL was perfused for 5 min with each drug (5nmol/ml) and effluent collected in 10 sec fractions. Pulmonary extraction was calculated using indocyanine green dye as a non-extractable reference indicator. Accumulation of all compounds in the IPL reached an apparent equilibrium within 4 min. At equilibrium lung/perfusate conc. ratios for H/sub 2/O, A, AM, N, P and M were 1.04, 0.84, 0.85, 1.44, 2.57 and 1.13 respectively. The time course of M uptake differed from the other compounds since initial extraction of M was low (23%) compared to 75%, 53%, 35%, 82% and 86% for H/sub 2/O, A, AM, N and P respectively. Also, the half time to equilibrium for M was longer (50 sec) compared to 18, 21, 26, 19 and 22 sec for H/sub 2/O, A, AM, N and P respectively. The low initial pulmonary extraction of M compared to these compounds followed by greater M extraction during the remainder of drug infusion suggests uptake mechanisms for M different than the flow limited uptake for water and other basic amine drugs.

Roerig, D.L.; Bunke, S.S.; Kotrly, K.J.; Dawson, C.A.; Kampine, J.P.



Pulmonary arterial hypertension  

PubMed Central

Pulmonary arterial hypertension (PAH) is a chronic and progressive disease leading to right heart failure and ultimately death if untreated. The first classification of PH was proposed in 1973. In 2008, the fourth World Symposium on PH held in Dana Point (California, USA) revised previous classifications. Currently, PH is devided into five subgroups. Group 1 includes patients suffering from idiopathic or familial PAH with or without germline mutations. Patients with a diagnosis of PAH should systematically been screened regarding to underlying mutations of BMPR2 gene (bone morphogenetic protein receptor type 2) or more rarely of ACVRL1 (activine receptor-like kinase type 1), ENG (endogline) or Smad8 genes. Pulmonary veno occusive disease and pulmonary capillary hemagiomatosis are individualized and designated as clinical group 1'. Group 2 'Pulmonary hypertension due to left heart diseases' is divided into three sub-groups: systolic dysfonction, diastolic dysfonction and valvular dysfonction. Group 3 'Pulmonary hypertension due to respiratory diseases' includes a heterogenous subgroup of respiratory diseases like PH due to pulmonary fibrosis, COPD, lung emphysema or interstitial lung disease for exemple. Group 4 includes chronic thromboembolic pulmonary hypertension without any distinction of proximal or distal forms. Group 5 regroup PH patients with unclear multifactorial mechanisms. Invasive hemodynamic assessment with right heart catheterization is requested to confirm the definite diagnosis of PH showing a resting mean pulmonary artery pressure (mPAP) of ? 25 mmHg and a normal pulmonary capillary wedge pressure (PCWP) of ? 15 mmHg. The assessment of PCWP may allow the distinction between pre-capillary and post-capillary PH (PCWP > 15 mmHg). Echocardiography is an important tool in the management of patients with underlying suspicion of PH. The European Society of Cardiology and the European Respiratory Society (ESC-ERS) guidelines specify its role, essentially in the screening proposing criteria for estimating the presence of PH mainly based on tricuspid regurgitation peak velocity and systolic artery pressure (sPAP). The therapy of PAH consists of non-specific drugs including oral anticoagulation and diuretics as well as PAH specific therapy. Diuretics are one of the most important treatment in the setting of PH because right heart failure leads to fluid retention, hepatic congestion, ascites and peripheral edema. Current recommendations propose oral anticoagulation aiming for targeting an International Normalized Ratio (INR) between 1.5-2.5. Target INR for patients displaying chronic thromboembolic PH is between 2–3. Better understanding in pathophysiological mechanisms of PH over the past quarter of a century has led to the development of medical therapeutics, even though no cure for PAH exists. Several specific therapeutic agents were developed for the medical management of PAH including prostanoids (epoprostenol, trepoprostenil, iloprost), endothelin receptor antagonists (bosentan, ambrisentan) and phosphodiesterase type 5 inhibitors (sildenafil, tadalafil). This review discusses the current state of art regarding to epidemiologic aspects of PH, diagnostic approaches and the current classification of PH. In addition, currently available specific PAH therapy is discussed as well as future treatments. PMID:23829793



Vascular Remodeling in Pulmonary Hypertension  

PubMed Central

Pulmonary hypertension is a complex, progressive condition arising from a variety of genetic and pathogenic causes. Patients present with a spectrum of histologic and pathophysiological features, likely reflecting the diversity in underlying pathogenesis. It is widely recognized that structural alterations in the vascular wall contribute to all forms of pulmonary hypertension. Features characteristic of the remodeled vasculature in patients with pulmonary hypertension include increased stiffening of the elastic proximal pulmonary arteries, thickening of the intimal and/or medial layer of muscular arteries, development of vaso-occlusive lesions and the appearance of cells expressing smooth muscle specific markers in normally non-muscular small diameter vessels, resulting from proliferation and migration of pulmonary arterial smooth muscle cells and cellular trans-differentiation. The development of several animal models of pulmonary hypertension has provided the means to explore the mechanistic underpinnings of pulmonary vascular remodeling, although none of the experimental models currently used entirely replicates the pulmonary arterial hypertension observed in patients. Herein, we provide an overview of the histological abnormalities observed in humans with pulmonary hypertension and in preclinical models and discuss insights gained regarding several key signaling pathways contributing to the remodeling process. In particular, we will focus on the roles of ion homeostasis, endothelin-1, serotonin, bone morphogenetic proteins, Rho kinase and hypoxia-inducible factor 1 in pulmonary arterial smooth muscle and endothelial cells, highlighting areas of cross-talk between these pathways and potentials for therapeutic targeting. PMID:23334338

Shimoda, Larissa A; Laurie, Steven S.



Learning from the pulmonary veins.  


The purpose of this article is to review the basic embryology and anatomy of the pulmonary veins and the various imaging techniques used to evaluate the pulmonary veins, as well as the radiologic findings in diseases affecting these structures. Specific cases highlight the clinical importance of the imaging features, particularly the findings obtained with multidetector computed tomography (CT). Pulmonary vein disease can be broadly classified into congenital or acquired conditions. Congenital disease, which often goes unnoticed until patients are adults, mainly includes (a) anomalies in the number or diameter of the vessels and (b) abnormal drainage or connection with the pulmonary arterial tree. Acquired disease can be grouped into (a) stenosis and obstruction, (b) hypertension, (c) thrombosis, (d) calcifications, and (e) collateral circulation. Pulmonary vein stenosis or obstruction, which often has important clinical repercussions, is frequently a result of radiofrequency ablation complications, neoplastic infiltration, or fibrosing mediastinitis. The most common cause of pulmonary venous hypertension is chronic left ventricular failure. This condition is difficult to differentiate from veno-occlusive pulmonary disease, which requires a completely different treatment. Pulmonary vein thrombosis is a rare, potentially severe condition that can have a local or distant cause. Calcifications have been described in rheumatic mitral valve disease and chronic renal failure. Finally, the pulmonary veins can act as conduits for collateral circulation in cases of obstruction of the superior vena cava. Multidetector CT is an excellent modality for imaging evaluation of the pulmonary veins, even when the examination is not specifically tailored for their assessment. PMID:23842969

Porres, Diego Varona; Morenza, Oscar Persiva; Pallisa, Esther; Roque, Alberto; Andreu, Jorge; Martínez, Manel



Hantavirus Pulmonary Syndrome  

PubMed Central

A recent outbreak of a severe pulmonary disease in the southwestern United States was etiologically linked to a previously unrecognized bantavirus. The virus has been isolated from its majorreservoir, the deer mouse, Peromyscus maniculatus,and recently named Sin Nombre virus. Clinically, the disease has become known as the bantavirus pulmonary syndrome (HPS). Since May 1993, 44 fatal cases of HPS have been identified through clinicopathological review and immunobistochemical(IHC) testing of tissues from 273 patients who died of an unexplained noncardiogenic pulmonary edema. In 158 cases for which suitable specimens were available, serologicaltesting and/or reverse transcription-polymerase chain reaction (RT-PCR) amplification of extracted RNA was also performed. IHC, serological, and PCR results were concordant for virtually all HPS and non-HPS patients when more than one assay was performed. The prodromal ilness of HPS is similar to that of many other viral diseases. Consistent bematological features include thrombocytopenia, bemoconcentration, neutropbilic leukocytosis with a left shift, and reactivel lymphocytes. Pulmonary bistopatbological features were similar in most of the fatal HPS cases (40/44) and consisted of an interstitial pneumonitis with a variable mononuclear cell infiltrate, edema, and focal byaline membranes. In four cases, bowever, pulmonary features were significantly different and included diffuse alveolar damage and variable degrees of severe air space disorganization. IHC analysis showed widespread presence of bantaviral antigens in endothelial cells of the microvasculature, particularly in the lung. Hantaviral antigens were also observed within follicular dendritic cells, macrophages, and lymphocytes. Hantaviral inclusions were observed in endothelial cells of lungs by thinsection electron microscopy, and their identity was verified by immunogold labeling. Virus-like particles were seen in pulmonary endothelial cells and macropbages. HPS is a newly recognized, often fatal disease, with a spectrum of microscopic morphological changes, which may be an important cause of severe and fatal illness presenting as adult respiratory distress syndrome. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8Figure 9Figure 10Figure 11Figure 12Figure 13Figure 14Figure 15 PMID:7887439

Zaki, Sherif R.; Greer, Patricia w.; Coffield, Lisa M.; Goldsmith, Cynthia S.; Nolte, Kurt B.; Foucar, Kathy; Feddersen, Richard M.; Zumwalt, Ross E.; Miller, Gayle L.; Khan, Ali S.; Rollin, Pierre E.; Ksiazek, Thomas G.; Nichol, Stuart T.; Mahy, Brian W.J.; Peters, Clarence J.



[Gastric cancer--Japanese Classification, sentinel lymph nodes and lymph dissection].  


The aim of Japanese Classification is to provide a common language for the clinical and pathological description of gastric cancer and thereby contribute to continued research and improvements in treatment and diagnosis. Lymph-node dissection has been regarded as an effective surgical treatment for gastric cancer in Japan. It reduces local recurrences and improves survival rate. Japanese-style systematic D2 lymphadenectomy is now being introduced in western countries for treatment of gastric cancer. This surgical procedure, however, is not simple and shoul be performed by experienced surgeons. And it is too early to apply sentinel node biopsy for reducing extent of lymphadenectomy because of so complicated lymphatic streams from the stomach and frequent skip- and micrometastases. PMID:20509523

Jarumov, N; Angelov, K; Toshev, S; Sokolov, M



Proteome changes in mesenteric lymph induced by sepsis  

PubMed Central

The present study aimed to examine the changes in mesenteric lymph during the development of sepsis and to identify the distinct proteins involved, as targets for further study. The sepsis animal model was constructed by cecal ligation and puncture (CLP). The mesenteric lymph was collected from 28 adult male Sprague-Dawley rats, which were randomly divided into the following four groups (n=7 per group): CLP-6 h, CLP-24 h, sham-6 h and sham-24 h groups. Capillary high performance liquid chromatography-tandem mass spectrometry was performed to analyze the proteome in mesenteric lymph. A comprehensive bioinformatic analysis was then conducted to investigate the distinct proteins. Compared with the sham group, 158 distinct proteins were identified in the lymph samples from the CLP group. Five of these proteins associated with the same lipid metabolism pathway were selected, apolipoprotein E (ApoE), annexin A1 (Anxa1), neutrophil gelatinase-associated lipocalin (NGAL), S100a8 and S100a9. The expression of ApoE, Anxa1, NGAL, S100a8 and S100a9 were all elevated in the progression of sepsis. The five proteins were reported to be closely associated with disease development and may be a potential target for the diagnosis and treatment of sepsis. In conclusion, identifying proteome changes in mesenteric lymph provides a novel perspective to understand the pathological mechanisms underlying sepsis. PMID:25242054




Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View  

PubMed Central

One of the most important prognostic factors in esophageal carcinoma is lymph node metastasis, and in particular, the number of affected lymph nodes, which influences long-term outcomes. The esophageal lymphatic system is connected longitudinally and transversally; thus, the pattern of lymph node metastases is very complex. Early esophageal cancer frequently exhibits skipped metastasis, and minimal surgery using sentinel node navigation cannot be performed. In Korea, most esophageal cancer cases are squamous cell carcinoma (SCC), although the incidence of adenocarcinoma has started to increase recently. Most previous reports have failed to differentiate between SCC and adenocarcinoma, despite the fact that the Union for International Cancer Control (7th edition) and American Joint Committee on Cancer staging systems both consider these separately because they differ in cause, biology, lymph node metastasis, and outcome. Endoscopic tumor resection is an effective and safe treatment for lesions with no associated lymph node metastasis. Esophageal mucosal cancer confined to the lamina propria is an absolute indication for endoscopic resection, and a lesion that has invaded the muscularis mucosae can be cured by local resection if invasion to the lymphatic system has not occurred. PMID:25505718

Cho, Jin Woong; Jang, Jae Young; Shin, Sung Kwan; Choi, Kee Don; Lee, Jun Haeng; Kim, Sang Gyun; Sung, Jae Kyu; Jeon, Seong Woo; Choi, Il Ju; Kim, Gwang Ha; Jee, Sam Ryong; Lee, Wan Sik; Jung, Hwoon-Yong



Tumor immunity in rat lymph nodes following transplantation.  

PubMed Central

Inguinal lymph nodes in the Buffalo rat were autotransplanted to the popliteal fossa by an intact vascular pedicle or by microvascular anastomosis. These revascularized nodes had normal histology and made spontaneous afferent and efferent lymphatic reconnection with surrounding lymphatic vessels, as documented by ink and silicone rubber injection studies. Lymphoscintigraphy with 99mTc antimony sulfide colloid correctly predicted the 44 of 120 node transplants that had made afferent reconnection. To demonstrate immunologic activity of lymph nodes following transplantation, a cellular adherance assay was employed to detect cell-mediated cytotoxicity of lymph node cells isolated from rats sensitized to an allogeneic gliosarcoma. Cytotoxicity was detected in nontransplanted regional nodes sensitized to tumor (p less than 0.01) and in nodes transplanted by vascular pedicle and then sensitized to tumor (p less than 0.001). This study demonstrates that lymph nodes can be transplanted with restoration of functional lymphatic anatomy, and that following transplantation, lymph nodes retain the ability to mount an immune response against tumor. Images Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. PMID:7092359

Rabson, J A; Geyer, S J; Levine, G; Swartz, W M; Futrell, J W



Virtual lymph node analysis to evaluate axillary lymph node coverage provided by tangential breast irradiation  

PubMed Central

Purpose To investigate the coverage of axillary lymph node with tangential breast irradiation fields by using virtual lymph node (LN) analysis. Materials and Methods Forty-eight women who were treated with whole breast irradiation after breast-conserving surgery were analyzed. The axillary and breast volumes were delineated according to the Radiation Therapy Oncology Group (RTOG) contouring atlas. To generate virtual LN contours, preoperative fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans with identifiable LN were fused with the CT scans, and the virtual LN contour were delineated on the CT. Results The median level I and II axillary volume coverage percentages at the VD95% line were 33.5% (range, 5.3% to 90.4%) and 0.6% (range, 0.0% to 14.6%), respectively. Thirty-one LNs in 18 patients were delineated (26 in level I and 5 in level II). In the level I axilla, 84.6% of virtual LNs were encompassed by the 95% isodose line. In the level II axilla, by contrast, none of the virtual LNs were encompassed by the 95% isodose volumes. There was a substantial discrepancy between the RTOG contouring atlas-based axillary volume analysis and the virtual LN analysis, especially for the level I axillary coverage. The axillary volume coverage was associated with the body mass index (BMI) and breast volume. Conclusion The tangential breast irradiation did not deliver adequate therapeutic doses to the axillary region, particularly those in the level II axilla. Patients with small breast volumes or lower BMI showed reduced axillary coverage from the tangential breast fields. For axillary LN irradiation, individualized anatomy-based radiation fields for patients would be necessary.

Park, Shin-Hyung; Lee, Jeong Eun; Park, In-Kyu



Pulmonary stenosis in recipient twins in twin-to-twin transfusion syndrome: report on 3 cases and review of literature.  


This report describes 3 cases of pulmonary stenosis in the recipient twin in twin-twin transfusion syndrome. Fetal echocardiography showed cardiomegaly, tricuspid valve regurgitation, and increased reverse flow in the inferior vena cava, as signs of congestive heart failure in all 3 cases. We diagnosed 2 cases of pulmonary stenosis by fetal echocardiography prenatally and confirmed our findings in all 3 cases postnatally. Two cases underwent postnatal balloon valvuloplasty to release the pulmonary valvular stenosis in neonatal period. The third one died soon after delivery and autopsy showed a slightly thickened pulmonary valve. One of the cases was diagnosed in the early second trimester (20 weeks of pregnancy), the earliest detection of fetal pulmonary stenosis reported in literature. The presence of high peak velocity of the pulmonary artery at 20 weeks of pregnancy preceded the development of pulmonary stenosis in this case. This supports the hypothesis that alterations in fetal hemodynamics may result in structural cardiac abnormality. PMID:10962042

Murakoshi, T; Yamamori, K; Tojo, Y; Naruse, H; Seguchi, M; Torii, Y; Maeda, K



Chronic obstructive pulmonary disease, pulmonary function and cardiovascular disease   

E-print Network

Cardiovascular disease is common in Chronic Obstructive Pulmonary Disease (COPD), and forced expiratory volume in one second (FEV1) independently predicts cardiovascular morbidity and mortality. Pathological changes in ...

McAllister, David Anthony



Prognostic factors of primary pulmonary mucoepidermoid carcinoma: a clinical and pathological analysis of 34 cases  

PubMed Central

Pulmonary mucoepidermoid carcinoma (PMEC) is a rare malignant neoplasm, and little is known about the prognostic factors. The aim of the present study was to identify the relationship between tumor’s histological features and clinical behaviors and to analyze the survival of patients with PMEC. A total of 34 patients with PMEC from May 2001 to April 2013 were included in the investigation. The clinical data, radiological manifestation, pathological findings, treatment strategy, and prognoses of all patients were analyzed retrospectively. The patients were classified into low-grade group (n = 25) and high-grade group (n = 9), based on histological grades. High-grade PMEC was more common in patient with elevated serum carcinoembryonic antigen (CEA) (P = 0.033), advanced tumor-node-metastasis (TNM) stage (P = 0.004) and lymph node metastasis (P < 0.001). The 5-year PFS and OS of all patients were 75.7% and 83.6%, respectively. Age, pathological grade, lymph node metastasis and TNM stage were correlated with the survival of PMEC patients. Lymph node metastasis was an independent predictor of OS (HR, 0.080; P = 0.029) and PFS (HR, 0.090; P = 0. 004). A higher tumor histological grade indicated a more aggressive behavior. Patients who had undergone complete resection for PMEC without any lymph node metastasis were expected to be cured. PMID:25400760

Jiang, Li; Li, Pengfei; Xiao, Zizheng; Qiu, Huijuan; Zhang, Xinke; Xiao, Yongbo; Zhang, Bei



Stream tube and velocity profile analysis of pulmonary arterial angiograms  

NASA Astrophysics Data System (ADS)

The distribution of blood transit times within the pulmonary arterial tree has important implications with regards to overall lung function. Previously, we showed that the pulmonary arterial tree imparts little dispersion to an injected bolus, so that the bolus arrives at downstream arteries with a time delay, but little increase in variance. Furthermore, the arterial time delay is nearly the same for all pathways to arteries of the same diameter, independent of their pathway length. This small amount of dispersion was observed despite the velocity profile within the arterial tree and the substantial variation in arterial pathway lengths. Thus, we have begun to ask why velocity profile effects and pathway length heterogeneity within the pulmonary arterial tree have so little influence on bolus dispersion. X-ray angiography studies were used to visualize streamtube pathways within the pulmonary arterial tree. Full bolus injections were used to visualize all flow streamlines within the tree, while 'streamtube' injections labeled only about 1% of the inlet arterial cross-section. By changing the injector position within the arterial cross-section, different streamtubes were traced and found to remain intact downstream to vessels less than 200 micrometer in diameter. Thus, it appears that lower velocity streamtubes tend to peel off from the full velocity profile at arterial bifurcations, while flow streamtubes with higher average velocity travel down the main arterial trunk. The net result is that dispersive velocity profile effects are mitigated by the interaction between the distributed velocity profile and the branching pattern of the pulmonary arterial tree.

Clough, Anne V.; Haworth, Steven T.; Manuel, Albert J.; Dawson, Christopher A.



An Earth-Based Model of Microgravity Pulmonary Physiology  

NASA Technical Reports Server (NTRS)

There are currently only two practical methods of achieving micro G for experimentation: parabolic flight in an aircraft or space flight, both of which have limitations. As a result, there are many important aspects of pulmonary physiology that have not been investigated in micro G. We propose to develop an earth-based animal model of micro G by using liquid ventilation, which will allow us to fill the lungs with perfluorocarbon, and submersing the animal in water such that the density of the lungs is the same as the surrounding environment. By so doing, we will eliminate the effects of gravity on respiration. We will first validate the model by comparing measures of pulmonary physiology, including cardiac output, central venous pressures, lung volumes, and pulmonary mechanics, to previous space flight and parabolic flight measurements. After validating the model, we will investigate the impact of micro G on aspects of lung physiology that have not been previously measured. These will include pulmonary blood flow distribution, ventilation distribution, pulmonary capillary wedge pressure, ventilation-perfusion matching, and pleural pressures and flows. We expect that this earth-based model of micro G will enhance our knowledge and understanding of lung physiology in space which will increase in importance as space flights increase in time and distance.

Hirschl, Ronald B.; Bull, Joseph L.; Grothberg, James B.



An image analysis system for near-infrared (NIR) fluorescence lymph imaging  

NASA Astrophysics Data System (ADS)

Quantitative analysis of lymphatic function is crucial for understanding the lymphatic system and diagnosing the associated diseases. Recently, a near-infrared (NIR) fluorescence imaging system is developed for real-time imaging lymphatic propulsion by intradermal injection of microdose of a NIR fluorophore distal to the lymphatics of interest. However, the previous analysis software3, 4 is underdeveloped, requiring extensive time and effort to analyze a NIR image sequence. In this paper, we develop a number of image processing techniques to automate the data analysis workflow, including an object tracking algorithm to stabilize the subject and remove the motion artifacts, an image representation named flow map to characterize lymphatic flow more reliably, and an automatic algorithm to compute lymph velocity and frequency of propulsion. By integrating all these techniques to a system, the analysis workflow significantly reduces the amount of required user interaction and improves the reliability of the measurement.

Zhang, Jingdan; Zhou, Shaohua Kevin; Xiang, Xiaoyan; Rasmussen, John C.; Sevick-Muraca, Eva M.



MyD88- and TRIF-Independent Induction of Type I Interferon Drives Naive B Cell Accumulation but Not Loss of Lymph Node Architecture in Lyme Disease  

PubMed Central

Rapidly after infection, live Borrelia burgdorferi, the causative agent of Lyme disease, is found within lymph nodes, causing rapid and strong tissue enlargement, a loss of demarcation between B cell follicles and T cell zones, and an unusually large accumulation of B cells. We sought to explore the mechanisms underlying these changes, as lymph tissue disruption could be detrimental for the development of robust Borrelia-specific immunity. A time course study demonstrated that the loss of the normal lymph node structure was a distinct process that preceded the strong increases in B cells at the site. The selective increases in B cell frequencies were due not to proliferation but rather to cytokine-mediated repositioning of B cells to the lymph nodes, as shown with various gene-targeted and bone marrow irradiation chimeras. These studies demonstrated that B. burgdorferi infection induced type I interferon receptor (IFNR) signaling in lymph nodes in a MyD88- and TRIF-independent manner and that type I IFNR indirect signaling was required for the excessive increases of naive B cells at those sites. It did not, however, drive the observed histopathological changes, which occurred independently also from major shifts in the lymphocyte-homing chemokines, CXCL12, CXCL13, and CCL19/21, as shown by quantitative reverse transcription-PCR (qRT-PCR), flow cytometry, and transwell migration experiments. Thus, B. burgdorferi infection drives the production of type I IFN in lymph nodes and in so doing strongly alters the cellular composition of the lymph nodes, with potential detrimental effects for the development of robust Borrelia-specific immunity. PMID:24452685

Hastey, Christine J.; Ochoa, Jennine; Olsen, Kimberley J.; Barthold, Stephen W.



Infant Pulmonary Function Testing  

PubMed Central

Infant pulmonary function testing has evolved from a research technique into a diagnostic tool. As such, new current procedural terminology (CPT) codes have been created and are available for use as of January 1, 2010. The technology now available has a range of applications. Through a series of vignettes, this article illustrates the methodology of the tests, some of their applications, and how to code and bill for the procedures. PMID:21540218

Davis, Stephanie D.



Pulmonary Complications of Cirrhosis  

Microsoft Academic Search

Pulmonary vascular complications of liver disease comprise two distinct clinical entities: hepatopulmonary syndrome (HPS—microvascular\\u000a dilatation and angiogenesis) and portopulmonary hypertension (POPH—vasoconstriction and remodeling in resistance vessels).\\u000a These complications occur in similar pathophysiologic environments and may share pathogenic mechanisms. HPS is found in 15%\\u000a to 30% of patients with cirrhosis and its presence increases mortality and the risks of liver transplantation,

Rajan Kochar; Moises I. Nevah Rubin; Michael B. Fallon



Nanoparticles for Pulmonary Delivery  

Microsoft Academic Search

\\u000a This chapter aims to provide a rational for the use of nanoparticles in pulmonary delivery as well as an overview of strategies\\u000a and physiological implications of nanoparticle delivery to the lungs. Formulation aspects of nanoparticle systems in the form\\u000a of liquid dispersions and inhaled dry powders are also reviewed. The chapter also addresses the expanse of lung toxicology\\u000a research surrounding

Alan B. Watts; Robert O. Williams


High Altitude Pulmonary Edema  

Microsoft Academic Search

Altitude, speed and mode of ascent and, above all, individual susceptibility are the most important determinants for the occurrence of high-altitude pulmonary edema (HAPE). This illness usually occurs only 2-5 days after acute exposure to altitudes above 2,500-3,000 m. Chest radiographs and CT scans show a patchy predominantly peripheral distribution of edema. Wedge pressure is normal at rest, and there

Peter Bärtsch; Heimo Mairbäurl; Erik R. Swenson; Marco Maggiorini



Asthma Outcomes: Pulmonary Physiology  

PubMed Central

Background Outcomes of pulmonary physiology have a central place in asthma clinical research. Objective At the request of National Institutes of Health (NIH) institutes and other federal agencies, an expert group was convened to provide recommendations on the use of pulmonary function measures as asthma outcomes that should be assessed in a standardized fashion in future asthma clinical trials and studies to allow for cross-study comparisons. Methods Our subcommittee conducted a comprehensive search of PubMed to identify studies that focused on the validation of various airway response tests used in asthma clinical research. The subcommittee classified the instruments as core (to be required in future studies), supplemental (to be used according to study aims and in a standardized fashion), or emerging (requiring validation and standardization). This work was discussed at an NIH-organized workshop in March 2010 and finalized in September 2011. Results A list of pulmonary physiology outcomes that applies to both adults and children older than 6 years was created. These outcomes were then categorized into core, supplemental, and emerging. Spirometric outcomes (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], and FEV1/FVC) are proposed as core outcomes for study population characterization, for observational studies, and for prospective clinical trials. Bronchodilator reversibility and pre- and post-bronchodilator FEV1 also are core outcomes for study population characterization and observational studies. Conclusions The subcommittee considers pulmonary physiology outcomes of central importance in asthma and proposes spirometric outcomes as core outcomes for all future NIH-initiated asthma clinical research. PMID:22386510

Tepper, Robert S.; Wise, Robert S.; Covar, Ronina; Irvin, Charles G.; Kercsmar, Carolyn M.; Kraft, Monica; Liu, Mark C.; O’Connor, George T.; Peters, Stephen P.; Sorkness, Ronald; Togias, Alkis



Nanomedicine in pulmonary delivery  

PubMed Central

The lung is an attractive target for drug delivery due to noninvasive administration via inhalation aerosols, avoidance of first-pass metabolism, direct delivery to the site of action for the treatment of respiratory diseases, and the availability of a huge surface area for local drug action and systemic absorption of drug. Colloidal carriers (ie, nanocarrier systems) in pulmonary drug delivery offer many advantages such as the potential to achieve relatively uniform distribution of drug dose among the alveoli, achievement of improved solubility of the drug from its own aqueous solubility, a sustained drug release which consequently reduces dosing frequency, improves patient compliance, decreases incidence of side effects, and the potential of drug internalization by cells. This review focuses on the current status and explores the potential of colloidal carriers (ie, nanocarrier systems) in pulmonary drug delivery with special attention to their pharmaceutical aspects. Manufacturing processes, in vitro/in vivo evaluation methods, and regulatory/toxicity issues of nanomedicines in pulmonary delivery are also discussed. PMID:20054434

Mansour, Heidi M; Rhee, Yun-Seok; Wu, Xiao



Pulmonary fungal infections.  


This review details some of the advances that have been made in the recent decade in the diagnosis, treatment and epidemiology of pulmonary fungal infections. These advances have occurred because of increasing knowledge regarding the fungal genome, better understanding of the structures of the fungal cell wall and cell membrane and the use of molecular epidemiological techniques. The clinical implications of these advances are more rapid diagnosis and more effective and less toxic antifungal agents. For example, the diagnosis of invasive pulmonary aspergillosis, as well as histoplasmosis and blastomycosis, has improved with the use of easily performed antigen detection systems in serum and bronchoalveolar lavage fluid. Treatment of angioinvasive moulds has improved with the introduction of the new azoles, voriconazole and posaconazole that have broad antifungal activity. Amphotericin B is less frequently used, and when used is often given as lipid formulation to decrease toxicity. The newest agents, the echinocandins, are especially safe as they interfere with the metabolism of the fungal cell wall, a structure not shared with humans cells. Epidemiological advances include the description of the emergence of Cryptococcus gattii in North America and the increase in pulmonary mucormycosis and pneumonia due to Fusarium and Scedosporium species in transplant recipients and patients with haematological malignancies. The emergence of azole resistance among Aspergillus species is especially worrisome and is likely related to increased azole use for treatment of patients, but also to agricultural use of azoles as fungicides in certain countries. PMID:22335254

Smith, Jeannina A; Kauffman, Carol A



Diagnosing pulmonary embolism  

PubMed Central

Objective testing for pulmonary embolism is necessary, because clinical assessment alone is unreliable and the consequences of misdiagnosis are serious. No single test has ideal properties (100% sensitivity and specificity, no risk, low cost). Pulmonary angiography is regarded as the final arbiter but is ill suited for diagnosing a disease present in only a third of patients in whom it is suspected. Some tests are good for confirmation and some for exclusion of embolism; others are able to do both but are often non-diagnostic. For optimal efficiency, choice of the initial test should be guided by clinical assessment of the likelihood of embolism and by patient characteristics that may influence test accuracy. Standardised clinical estimates can be used to give a pre-test probability to assess, after appropriate objective testing, the post-test probability of embolism. Multidetector computed tomography can replace both scintigraphy and angiography for the exclusion and diagnosis of this disease and should now be considered the central imaging investigation in suspected pulmonary embolism. PMID:15192162

Riedel, M



Pulmonary Hypertension in Cardiac Surgery  

PubMed Central

Pulmonary hypertension is an important prognostic factor in cardiac surgery associated with increased morbidity and mortality. With the aging population and the associated increase severity of illness, the prevalence of pulmonary hypertension in cardiac surgical patients will increase. In this review, the definition of pulmonary hypertension, the mechanisms and its relationship to right ventricular dysfunction will be presented. Finally, pharmacological and non-pharmacological therapeutic and preventive approaches will be presented. PMID:21286273

Denault, André; Deschamps, Alain; Tardif, Jean-Claude; Lambert, Jean; Perrault, Louis



Conventional ultrasound for lymph node evaluation, update 2013.  


Conventional ultrasound is regarded as the first method of choice to evaluate lymph node disease due to its high resolution. The combination of various features obtained from the patients history including age, acute or chronic onset, symptoms, and a knowledge of underlying systemic diseases as well as imaging criteria, most importantly B-mode (gray-scale) and colour Doppler imaging (CDI) are the basis for the differential diagnosis of lymphadenopathy. New ultrasound techniques such as elastography and contrast-enhanced ultrasound may provide further information. In addition, ultrasound evaluation of lymph nodes is an essential adjunct to the clinical investigation in staging of malignant neoplasia and lymphoma. In this paper the current literature is reviewed regarding conventional B-mode and Doppler ultrasound for the evaluation of lymphadenopathy. The ultrasound criteria for the differential diagnosis of enlarged and structurally altered lymph nodes are summarized and also limitations are described. PMID:24526406

Cui, X W; Hocke, M; Jenssen, C; Ignee, A; Klein, S; Schreiber-Dietrich, D; Dietrich, C F



Radical lymph node dissection for gallbladder cancer: indications and limitations.  


Radical lymph node dissection provides survival benefit for patients with pT2 or more advanced gallbladder carcinoma tumors only if potentially curative resection is feasible; it must always be considered when planning a resection or re-resection for robust patients with pT2 or more advanced gallbladder carcinoma tumors. The degree of radical lymphadenectomy depends on clinically assessed nodal status: portal lymph node dissection is limited to cN0 disease; extended portal nodal dissection is indicated for cN0 and a modest degree of cN1 disease; peripancreatic lymph node dissection with pancreaticoduodenectomy is indicated for selected cases of evident peripancreatic nodal disease and/or direct organ involvement. Extended resection with extensive lymphadenectomy should be limited to expert surgeons because it may cause serious morbidity and mortality. PMID:17336245

Shirai, Yoshio; Wakai, Toshifumi; Hatakeyama, Katsuyoshi



Seven synchronous early gastric cancer with 28 lymph nodes metastasis  

PubMed Central

An 85 year male patient complaining epigastric discomfort was admitted. From the esophagogastroduodenoscopy, three early gastric cancer (EGCa) lesions had been identified and these were diagnosed as adenocarcinoma with poorly differentiated cell type. The patient underwent operation. From the post-operative mapping, however, additional 4 EGCa lesions were found, and the patient was diagnosed with 7 synchronous EGCa. Out of the 7 EGCa lesions, 6 had shown invasion only to the mucosal layer and one had shown invasion into the 1/3 layer of submucosa. In spite of such superficial invasions, 28 of 48 lymph nodes had been identified as metastases. The multiple lesions of EGCa do not increase the risk of lymph node metastasis, but if their differentiations are poor or if they have lympho-vascular invasion, multiple lymph node metastases could incur even if the depth of invasion is limited to the mucosal layer or the upper portion of the submucosal layer. PMID:24307810

Seong, Hyeonjin; Kim, Jin Il; Lee, Hyun Jeong; Kim, Hyun Jin; Cho, Hyung Joon; Kim, Hye Kang; Cheung, Dae Young; Kim, Dong Jin; Kim, Wook; Kim, Tae-Jung



What to Expect After Pulmonary Rehabilitation  


... NHLBI on Twitter. What To Expect After Pulmonary Rehabilitation Most pulmonary rehabilitation (PR) programs last a few months. At the ... Rate This Content: Next >> August 1, 2010 Pulmonary Rehabilitation Clinical Trials Clinical trials are research studies that ...


Genetics Home Reference: Idiopathic pulmonary fibrosis  


... literature OMIM Genetic disorder catalog Conditions > Idiopathic pulmonary fibrosis On this page: Description Genetic changes Inheritance Diagnosis ... definitions Reviewed October 2010 What is idiopathic pulmonary fibrosis? Idiopathic pulmonary fibrosis is a chronic, progressive lung ...


Animal models and molecular imaging tools to investigate lymph node metastases.  


Lymph node metastasis is a strong predictor of poor outcome in cancer patients. Animal studies of lymph node metastasis are constrained by difficulties in the establishment of appropriate animal models, limitations in the noninvasive monitoring of lymph node metastasis progression, and challenges in the pathologic confirmation of lymph node metastases. In this comprehensive review, we summarize available preclinical animal cancer models for noninvasive imaging and identification of lymph node metastases of non-hematogenous cancers. Furthermore, we discuss the strengths and weaknesses of common noninvasive imaging modalities used to identify tumor-bearing lymph nodes and provide guidelines for their pathological confirmation. PMID:21556810

Servais, Elliot L; Colovos, Christos; Bograd, Adam J; White, Julie; Sadelain, Michel; Adusumilli, Prasad S



Animal models and molecular imaging tools to investigate lymph node metastases  

PubMed Central

Lymph node metastasis is a strong predictor of poor outcome in cancer patients. Animal studies of lymph node metastasis are constrained by difficulties in the establishment of appropriate animal models, limitations in the noninvasive monitoring of lymph node metastasis progression, and challenges in the pathologic confirmation of lymph node metastases. In this comprehensive review, we summarize available preclinical animal cancer models for noninvasive imaging and identification of lymph node metastases of non-hematogenous cancers. Furthermore, we discuss the strengths and weaknesses of common noninvasive imaging modalities used to identify tumor-bearing lymph nodes and provide guidelines for their pathological confirmation. PMID:21556810

Servais, Elliot L.; Colovos, Christos; Bograd, Adam J.; White, Julie; Sadelain, Michel



Pulmonary function in children with idiopathic scoliosis  

PubMed Central

Idiopathic scoliosis, a common disorder of lateral displacement and rotation of vertebral bodies during periods of rapid somatic growth, has many effects on respiratory function. Scoliosis results in a restrictive lung disease with a multifactorial decrease in lung volumes, displaces the intrathoracic organs, impedes on the movement of ribs and affects the mechanics of the respiratory muscles. Scoliosis decreases the chest wall as well as the lung compliance and results in increased work of breathing at rest, during exercise and sleep. Pulmonary hypertension and respiratory failure may develop in severe disease. In this review the epidemiological and anatomical aspects of idiopathic scoliosis are noted, the pathophysiology and effects of idiopathic scoliosis on respiratory function are described, the pulmonary function testing including lung volumes, respiratory flow rates and airway resistance, chest wall movements, regional ventilation and perfusion, blood gases, response to exercise and sleep studies are presented. Preoperative pulmonary function testing required, as well as the effects of various surgical approaches on respiratory function are also discussed. PMID:22445133



“Denervation” of autonomous nervous system in idiopathic pulmonary arterial hypertension by low-dose radiation: a case report with an unexpected outcome  

PubMed Central

Vasointestinal peptide metabolism plays a key physiological role in multimodular levels of vasodilatory, smooth muscle cell proliferative, parenchymal, and inflammatory lung reactions. In animal studies, vasointestinal peptide relaxes isolated pulmonary arterial segments from several mammalian species in vitro and neutralizes the pulmonary vasoconstrictor effect of endothelin. In some animal models, it reduces pulmonary vascular resistance in vivo and in monocrotaline-induced pulmonary hypertension. A 58-year-old woman presented with dyspnea and mild edema of the lower extremities. A bronchoscopy was performed without any suspicious findings suggesting a central tumor or other infiltrative disease. Endobronchial ultrasound revealed enlarged pulmonary arteries containing thrombi, a few enlarged lymph nodes, and enlarged mediastinal tissue anatomy with suspicion for mediastinal infiltration of a malignant process. We estimated that less than 10% of the peripheral vascular bed of the lung was involved in direct consolidated fibrosis as demonstrated in the left upper lobe apex. Further, direct involvement of fibrosis around the main stems of the pulmonary arteries was assumed to be low from positron emission tomography and magnetic resonance imaging scans. Assuming a positive influence of low-dose radiation, it was not expected that this could have reduced pulmonary vascular resistance by over two thirds of the initial result. However; it was noted that this patient had idiopathic pulmonary arterial hypertension mixed with “acute” (mediastinal) fibrosis which could have contributed to the unexpected success of reduction of pulmonary vascular resistance. To the best of our knowledge, this is the first report of successful treatment of idiopathic pulmonary arterial hypertension, probably as a result of low-dose radiation to the pulmonary arterial main stems. The patient continues to have no specific complaints concerning her idiopathic pulmonary arterial hypertension. PMID:24707181

Hohenforst-Schmidt, Wolfgang; Zarogoulidis, Paul; Oezkan, Filiz; Mahnkopf, Christian; Grabenbauer, Gerhard; Kreczy, Alfons; Bartunek, Rudolf; Darwiche, Kaid; Freitag, Lutz; Li, Qiang; Huang, Haidong; Vogl, Thomas; LePilvert, Patrick; Tsiouda, Theodora; Tsakiridis, Kosmas; Zarogoulidis, Konstantinos; Brachmann, Johannes



Robust automated lymph node segmentation with random forests  

NASA Astrophysics Data System (ADS)

Enlarged lymph nodes may indicate the presence of illness. Therefore, identification and measurement of lymph nodes provide essential biomarkers for diagnosing disease. Accurate automatic detection and measurement of lymph nodes can assist radiologists for better repeatability and quality assurance, but is challenging as well because lymph nodes are often very small and have a highly variable shape. In this paper, we propose to tackle this problem via supervised statistical learning-based robust voxel labeling, specifically the random forest algorithm. Random forest employs an ensemble of decision trees that are trained on labeled multi-class data to recognize the data features and is adopted to handle lowlevel image features sampled and extracted from 3D medical scans. Here we exploit three types of image features (intensity, order-1 contrast and order-2 contrast) and evaluate their effectiveness in random forest feature selection setting. The trained forest can then be applied to unseen data by voxel scanning via sliding windows (11×11×11), to assign the class label and class-conditional probability to each unlabeled voxel at the center of window. Voxels from the manually annotated lymph nodes in a CT volume are treated as positive class; background non-lymph node voxels as negatives. We show that the random forest algorithm can be adapted and perform the voxel labeling task accurately and efficiently. The experimental results are very promising, with AUCs (area under curve) of the training and validation ROC (receiver operating characteristic) of 0.972 and 0.959, respectively. The visualized voxel labeling results also confirm the validity.

Allen, David; Lu, Le; Yao, Jianhua; Liu, Jiamin; Turkbey, Evrim; Summers, Ronald M.



Surgical management of pulmonary tuberculosis.  


Surgery for pulmonary tubercolosis (PTB) is now the second place treatment. Among the surgical indications the most debated is the multi-drug resistance of a focal pulmonary tuberculous disease. Other indications are: bronchiectasis, hemoptysis and the presence of a broncho-pleural fistula. Pulmonary Aspergilloma is a frequent indication for surgery; it is commonly a PTB sequela and causes severe complications. The presence of an unknown pulmonary mass or nodule is a surgical criterion because it might signal a cancer. Surgery therefore now constitutes a valid option for the treatment of clinical patterns of PTB unresponsive to medical treatment in severe, potentially fatal clinical conditions. PMID:9673145

Picciocchi, A; Granone, P; Margaritora, S; Cesario, A; Galetta, D



Fulvine and the pulmonary circulation  

PubMed Central

The pyrrolizidine alkaloid, fulvine, is now accepted as a major cause of veno-occlusive disease of the liver in the West Indies, where it is ingested as a decoction of the plant Crotalaria fulva in bush tea. Fulvine is similar in chemical structure to monocrotaline, which is known to cause pulmonary hypertension in rats. Thirty young female rats were given a single dose of fulvine either by intraperitoneal injection (50 mg/kg body weight) or by stomach tube (80 mg/kg body weight). Eleven of these rats died of acute haemorrhagic centrilobular necrosis of the liver, and two of pneumonia, within 23 days of receiving fulvine. These 13 showed no evidence of hypertensive pulmonary vascular disease. The remaining 17 rats (which survived from 24 to 37 days) developed hypertensive pulmonary vascular disease with right ventricular hypertrophy together with medial thickening of the pulmonary trunk and muscular pulmonary arteries. The pulmonary arterioles showed hypertensive changes and some contained thrombi. In four animals an acute necrotizing arteritis also occurred. We have shown that fulvine resembles monocrotaline in its ability to produce pulmonary hypertension in rats. We suggest that, in any patient presenting with unexplained pulmonary hypertension, a careful enquiry should be made to elicit the possibility of recent ingestion of drugs or plant extracts that may have caused a rise in the pulmonary arterial pressure. Images PMID:4253539

Kay, J. M.; Heath, Donald; Smith, Paul; Bras, G.; Summerell, Joan



Pulmonary hypertension in bronchopulmonary dysplasia.  


Pulmonary hypertension is common in bronchopulmonary dysplasia and is associated with increased mortality and morbidity. This pulmonary hypertension is due to abnormal microvascular development and pulmonary vascular remodeling resulting in reduced cross-sectional area of pulmonary vasculature. The epidemiology, etiology, clinical features, diagnosis, suggested management, and outcomes of pulmonary hypertension in the setting of bronchopulmonary dysplasia are reviewed. In summary, pulmonary hypertension is noted in a fifth of extremely low birth weight infants, primarily those with moderate or severe bronchopulmonary dysplasia, and persists to discharge in many infants. Diagnosis is generally by echocardiography, and some infants require cardiac catheterization to identify associated anatomic cardiac lesions or systemic-pulmonary collaterals, pulmonary venous obstruction or myocardial dysfunction. Serial echocardiography and B-type natriuretic peptide measurement may be useful for following the course of pulmonary hypertension. Currently, there is not much evidence to indicate optimal management approaches, but many clinicians maintain oxygen saturation in the range of 91 to 95%, avoiding hypoxia and hyperoxia, and often provide inhaled nitric oxide, sometimes combined with sildenafil, prostacyclin, or its analogs, and occasionally endothelin-receptor antagonists. PMID:24616323

Ambalavanan, Namasivayam; Mourani, Peter



Thermochemoradiation Therapy Using Superselective Intra-arterial Infusion via Superficial Temporal and Occipital Arteries for Oral Cancer With N3 Cervical Lymph Node Metastases  

SciTech Connect

Purpose: To evaluate the therapeutic results and histopathological effects of treatment with thermochemoradiation therapy using superselective intra-arterial infusion via the superficial temporal and occipital arteries for N3 cervical lymph node metastases of advanced oral cancer. Methods and Materials: Between April 2005 and September 2010, 9 patients with N3 cervical lymph node metastases of oral squamous cell carcinoma underwent thermochemoradiation therapy using superselective intra-arterial infusion with docetaxel (DOC) and cisplatin (CDDP). Treatment consisted of hyperthermia (2-8 sessions), superselective intra-arterial infusions (DOC, total 40-60 mg/m{sup 2}; CDDP, total 100-150 mg/m{sup 2}) and daily concurrent radiation therapy (total, 40-60 Gy) for 4-6 weeks. Results: Six of 9 patients underwent neck dissection 5-8 weeks after treatment. In four of these 6 patients, all metastatic lymph nodes, including those at N3, were grade 3 (non-viable tumor cells present) or grade 4 (no tumor cells present) tumors, as classified by the system by Shimosato et al (Shimosato et al Jpn J Clin Oncol 1971;1:19-35). In 2 of these 6 patients, the metastatic lymph nodes were grade 2b (destruction of tumor structures with a small amount of residual viable tumor cells). The other 3 patients did not undergo neck dissection due to distant metastasis after completion of thermochemoradiation therapy (n=2) and refusal (n=1). The patient who refused neck dissection underwent biopsy of the N3 lymph node and primary sites and showed grade 3 cancer. During follow-up, 5 patients were alive without disease, and 4 patients died due to pulmonary metastasis (n=3) and noncancer-related causes (n=1). Five-year survival and locoregional control rates were 51% and 88%, respectively. Conclusions: Thermochemoradiation therapy using intra-arterial infusion provided good histopathologic effects and locoregional control rates in patients with N3 metastatic lymph nodes. However, patients with N3 metastatic lymph nodes experienced a high rate of distant metastases.

Mitsudo, Kenji, E-mail: [Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama (Japan)] [Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama (Japan); Koizumi, Toshiyuki; Iida, Masaki; Iwai, Toshinori; Oguri, Senri [Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama (Japan)] [Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama (Japan); Yamamoto, Noriyuki [Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Nagoya (Japan)] [Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Nagoya (Japan); Itoh, Yoshiyuki [Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya (Japan)] [Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Kioi, Mitomu; Hirota, Makoto; Tohnai, Iwai [Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama (Japan)] [Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama (Japan)



Pathology Case Study: Enlarged Left Inguinal Lymph Node  

NSDL National Science Digital Library

The Department of Pathology at the University of Pittsburgh Medical Center has compiled a wide range of pathology case studies to aid students and instructors in the medical/health science field. This case involves the diagnosis of a fifty-nine year old female with an enlarged inguinal lymph node. Both gross and microscopic descriptions and images of the lymph node are provided to aid in the diagnosis of the patient. The final diagnosis is included, which allows students to check their own conclusions. This is an excellent resource for providing students experience with patient history, lab results and diagnostics.

Nine, Jeff S.


Cavitatory mesenteric lymph node syndrome: A rare entity.  


Celiac disease is a gluten sensitive enteropathy that involves an abnormal immunological response to glutens in wheat, rye etc. It predominantly involves the small intestinal mucosa, though, extra luminal manifestations can also occur. One rare extraluminal manifestation is cavitatory mesenteric lymph node syndrome. It occurs in refractory celiac disease and is associated with poor prognosis due to various complications. The diagnosis is often made on imaging when cystic mesenteric lymph nodes with fat-fluid levels are seen and this can then be confirmed by histopathological examination. We recently had a typical case where we were able to make this diagnosis. PMID:20351999

Vibhuti; Vishal, Kalia; Gill, Anakhvir



Intraoperative lymph scintigraphy during radical surgery for cervical cancer  

SciTech Connect

Intraoperative lymph scintigraphy during radical surgery for cervical cancer was developed in the course of a program covering three periods. During the last period technetium-99m antimony sulfide has been used to visualize pelvic lymph nodes. Surgery is done with a modified gamma camera serving as an operating table. This ensures intraoperative monitoring and greater thoroughness of lymphadenectomy. The introduction of the technique has improved the rate of total lymphadenectomies and has increased both the yields of involved nodes and the 3-yr survival rates.

Gitsch, E.; Philipp, K.; Pateisky, N.



Prediction of Lymph Node Status in Superficial Esophageal Carcinoma  

Microsoft Academic Search

Background  Esophageal carcinoma is among the cancers with the worst prognosis. Real chances for cure depend on both early recognition\\u000a and early treatment. The ability to predict lymph node involvement allows early curative treatment with less invasive approaches.\\u000a \\u000a \\u000a \\u000a Aims  To determine clinicohistopathological criteria correlated with lymph node involvement in patients with early esophageal cancer\\u000a (T1) and to identify the best candidate patients

Ermanno Ancona; Sabrina Rampado; Mauro Cassaro; Giorgio Battaglia; Alberto Ruol; Carlo Castoro; Giuseppe Portale; Francesco Cavallin; Massimo Rugge



Simulations reveal adverse hemodynamics in patients with multiple systemic to pulmonary shunts.  


For newborns diagnosed with pulmonary atresia or severe pulmonary stenosis leading to insufficient pulmonary blood flow, cyanosis can be mitigated with placement of a modified Blalock-Taussig shunt (MBTS) between the innominate and pulmonary arteries. In some clinical scenarios, patients receive two systemic-to-pulmonary connections, either by leaving the patent ductus arteriosus (PDA) open or by adding an additional central shunt (CS) in conjunction with the MBTS. This practice has been motivated by the thinking that an additional source of pulmonary blood flow could beneficially increase pulmonary flow and provide the security of an alternate pathway in case of thrombosis. However, there have been clinical reports of premature shunt occlusion when more than one shunt is employed, leading to speculation that multiple shunts may in fact lead to unfavorable hemodynamics and increased mortality. In this study, we hypothesize that multiple shunts may lead to undesirable flow competition, resulting in increased residence time (RT) and elevated risk of thrombosis, as well as pulmonary overcirculation. Computational fluid dynamics-based multiscale simulations were performed to compare a range of shunt configurations and systematically quantify flow competition, pulmonary circulation, and other clinically relevant parameters. In total, 23 cases were evaluated by systematically changing the PDA/CS diameter, pulmonary vascular resistance (PVR), and MBTS position and compared by quantifying oxygen delivery (OD) to the systemic and coronary beds, wall shear stress (WSS), oscillatory shear index (OSI), WSS gradient (WSSG), and RT in the pulmonary artery (PA), and MBTS. Results showed that smaller PDA/CS diameters can lead to flow conditions consistent with increased thrombus formation due to flow competition in the PA, and larger PDA/CS diameters can lead to insufficient OD due to pulmonary hyperfusion. In the worst case scenario, it was found that multiple shunts can lead to a 160% increase in RT and a 10% decrease in OD. Based on the simulation results presented in this study, clinical outcomes for patients receiving multiple shunts should be critically investigated, as this practice appears to provide no benefit in terms of OD and may actually increase thrombotic risk. PMID:25531794

Esmaily-Moghadam, Mahdi; Murtuza, Bari; Hsia, Tain-Yen; Marsden, Alison



Pulmonary atresia with ventricular septal defect, extremely hypoplastic pulmonary arteries, major aorto–pulmonary collaterals  

Microsoft Academic Search

Objective: Among 63 patients with pulmonary atresia and ventricular septal defect (VSD), 10 patients with extreme hypoplasia of the pulmonary arteries (PA) (mean Nakata index 20.6 mm2\\/m2), but with confluent arteries and a diminutive main PA, and major aorto–pulmonary collaterals (MAPCAS), have been submitted to a ‘rehabilitation’ of the PA with several stages: (i) connection between RV and PAs, (ii)

Dominique Metras; Philippe Chetaille; Bernard Kreitmann; Alain Fraisse; Olivier Ghez; Alberto Riberi



Preoperative risk factors of lymph node metastasis in cutaneous squamous cell carcinoma.  


Lymph node metastasis of cutaneous squamous cell carcinoma ("SCC") affects the prognosis. A variety of risk factors of lymph node metastasis have been reported. Predicting lymph node metastasis prior to surgery, which is a major treatment method for cutaneous SCC, contributes to the effects of treatment. Factors that can be obtained prior to surgery were weighed between a lymph node metastasis group and a non-metastasis lymph node group. One hundred and sixty-four cutaneous SCC patients were operated on. The following factors, which can be obtained prior to surgery, were compared between the lymph node metastasis group and the non-metastasis lymph node group: age, sex, tumour size, symptom period, lesions, and local recurrence. The detection rate from lymph node metastasis of the sentinel lymph node biopsy using the blue dye technique was studied. Among all subjects, lymph node metastasis was observed in 17 cases (10.4%). Lower lip SCC was observed only in the higher metastasis rate. Significant local recurrence occurred more frequently in the lymph node metastasis group. For other factors, no significant difference was observed between the lymph node metastasis group and the non-metastasis lymph node group. A sentinel lymph node biopsy was given in 21 cases, two false-negative cases were observed, and local recurrence and lymph node metastasis were observed postoperatively. Operation should be given to the lower lip SCC and local recurrence cases considering lymph node metastasis. It is hard to say that the sentinel lymph node biopsy of cutaneous SCC using the blue dye technique has sufficient detection rates. PMID:23621095

Takeda, Akira; Akimoto, Minekatsu; Nemoto, Mitsuru; Kounoike, Natsuko; Uchinuma, Eiju



Intraoperative identification of esophageal sentinel lymph nodes with near-infrared fluorescence imaging  

PubMed Central

Objective In esophageal cancer, selective removal of involved lymph nodes could improve survival and limit complications from extended lymphadenectomy. Mapping with vital blue dyes or technetium Tc-99m often fails to identify intrathoracic sentinel lymph nodes. Our purpose was to develop an intraoperative method for identifying sentinel lymph nodes of the esophagus with high-sensitivity near-infrared fluorescence imaging. Methods Six Yorkshire pigs underwent thoracotomy and received submucosal, esophageal injection of quantum dots, a novel near-infrared fluorescent lymph tracer designed for retention in sentinel lymph nodes. Six additional pigs underwent thoracotomy and received submucosal esophageal injection of CW800 conjugated to human serum albumin, another novel lymph tracer designed for uptake into distant lymph nodes. Finally, 6 pigs received submucosal injection of the fluorophore-conjugated albumin with an endoscopic needle through an esophagascope. These lymph tracers fluoresce in the near-infrared, permitting visualization of migration to sentinel lymph nodes with a custom intraoperative imaging system. Results Injection of the near-infrared fluorescent lymph tracers into the esophagus revealed communicating lymph nodes within 5 minutes of injection. In all 6 pigs that received quantum dot injection, only a single sentinel lymph node was identified. Among pigs that received fluorophore-conjugated albumin injection, in 5 o f 12 a single sentinel lymph node was revealed, but in 7 o f 12 two sentinel lymph nodes were identified. There was no dominant pattern in the appearance of the sentinel lymph nodes either cranial or caudal to the injection site. Conclusion Near-infrared fluorescence imaging of sentinel lymph nodes is a novel and reliable intraoperative technique with the power to assist with identification and resection of esophageal sentinel lymph nodes. PMID:15821653

Parungo, Cherie P.; Ohnishi, Shunsuke; Kim, Sang-Wook; Kim, Sunjee; Laurence, Rita G.; Soltesz, Edward G.; Chen, Frederick Y.; Colson, Yolonda L.; Cohn, Lawrence H.; Bawendi, Moungi G.; Frangioni, John V.



Genetics Home Reference: Pulmonary arterial hypertension  


... autosomal ; autosomal dominant ; cell ; cell division ; diameter ; dyspnea ; edema ; fainting ; familial ; family history ; gene ; hypertension ; idiopathic ; inherited ; mutation ; pulmonary ; pulmonary artery ; sporadic ; syndrome ; ventricle ...


Mesenchymal Stromal Cell Dependent Regression of Pulmonary Metastasis from Ewing’s  

PubMed Central

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. PMID:24910847

Hayes-Jordan, Andrea; Wang, Yong Xin; Walker, Peter; Cox, Charles S.



Pulmonary MRA: Differentiation of pulmonary embolism from truncation artifact  

PubMed Central

Purpose Truncation artifact (Gibbs ringing) causes central signal drop within vessels in pulmonary MRA that can be mistaken for emboli, reducing the diagnostic accuracy for pulmonary embolism (PE). We propose a quantitative approach to differentiate truncation artifact from PE. Methods Twenty-eight patients who underwent pulmonary CTA for suspected PE were recruited for pulmonary MRA. Signal intensity drops within pulmonary arteries that persisted on both arterial-phase and delayed-phase MRA were identified. The percent signal loss between the vessel lumen and central drop was measured. CTA served as the reference standard for presence of pulmonary emboli. Results A total of 65 signal intensity drops were identified on MRA. 48 (74%) of these were artifact and 17 (26%) were PE, as confirmed by CTA. Truncation artifacts had a significantly lower median signal drop than PE at both arterial-phase (26% [range 12–58%] vs. 85% [range 53–91%]) and at delayed-phase MRA (26% [range 11–55%] vs. 77% [range 47–89%]), p<0.0001 for both. ROC analyses revealed a threshold value of 51% (arterial-phase) and 47%-signal drop (delayed-phase) to differentiate between truncation artifact and PE with 100% sensitivity and >90% specificity. Conclusion Quantitative signal drop is an objective tool to help differentiate truncation artifact and pulmonary embolism in pulmonary MRA. PMID:24863886

Bannas, Peter; Schiebler, Mark L; Motosugi, Utaroh; François, Christopher J; Reeder, Scott B; Nagle, Scott K



New method of dynamic color doppler signal quantification in metastatic lymph nodes compared to direct polarographic measurements of tissue oxygenation.  


Tumor growth depends on sufficient blood and oxygen supply. Hypoxia stimulates neovascularization and is a known cause for radio- and chemoresistance. The objective of this study was to investigate the use of a novel ultrasound technique for the dynamic assessment of vascularization and oxygenation in metastatic lymph nodes. Twenty-four patients (age 44-78 years) with cervical lymph node metastases of squamous cell head and neck cancer were investigated by color duplex sonography and 17 (age 46-78 years) were investigated additionally with polarography. Sonography was performed after contrast enhancer infusion under defined conditions. Intranodal perfusion data (color hue, colored area) were measured automatically by a novel software technique. This allows an evaluation of blood flow dynamics by calculating perfusion intensity--velocity, perfused area, as well as the novel parameters tissue resistance index (TRI) and tissue pulsatility index (TPI)--for each point of a complete heart cycle. Tumor tissue pO(2) was measured by means of polarographic needle electrodes placed intranodally. The sonographic and polarographic data were correlated using Pearson's test. Sonography demonstrated a statistically significant inverse correlation between hypoxia and perfusion and significant TPI and TRI changes with different N-stages. The percentage of nodal fraction with less than 10 mmHg oxygen saturation was significantly inversely correlated with lymph node perfusion (r = -0.551; p = 0.021). Nodes with a perfusion of less than 0.05 cm/sec flow velocity showed significantly larger hypoxic areas (p = 0.006). Significant differences of TPI and TRI existed between nodes in stage N(1) and N(2)/N(3) (p = 0.028 and 0.048, respectively). This new method of dynamic signal quantification allows a noninvasive and quantitative assessment of tumor and metastatic lymph node perfusion by means of commonly available ultrasound equipment. PMID:15645426

Scholbach, Thomas; Scholbach, Jakob; Krombach, Gabriele A; Gagel, Bernd; Maneschi, Payam; Di Martino, Ercole



Preoperative pulmonary evaluation: identifying and reducing risks for pulmonary complications.  


Postoperative pulmonary complications are among the most common sources of morbidity in patients undergoing major surgery. For this reason, the preoperative patient evaluation should emphasize risk factors for pulmonary complications as well as for traditional cardiac complications, as the former are comparably frequent and associated with longer hospital stays. Procedure-related risk factors are more important than patient-related risk factors for predicting pulmonary events, but clinicians should assess both types of factors. Pulmonary function testing has a limited role and should not be the basis for denying surgery if the surgical indication is compelling. Strategies to reduce the risk of postoperative pulmonary complications include optimizing management of chronic lung disease before surgery, lung expansion maneuvers, pain control, and selective placement of nasogastric tubes. PMID:16570546

Smetana, Gerald W



Abnormal lung gallium-67 uptake preceding pulmonary physiologic impairment in an asymptomatic patient with Pneumocystis carinii pneumonia  

SciTech Connect

Pneumocystis carinii pneumonia was suggested by a diffuse, bilateral pulmonary uptake of gallium-67 in an asymptomatic, homosexual male with the antibody to the immunodeficiency virus (HIV) who was undergoing staging evaluation for lymphoma clinically localized to a left inguinal lymph node. Chest radiograph and pulmonary function evaluation, including lung volumes, diffusing capacity and arterial blood gases, were within normal limits. Bronchoalveolar lavage revealed Pneumocystis carinii organisms. In this asymptomatic, HIV-positive patient, active alveolar infection, evidenced by abnormal gallium-67 scanning, predated pulmonary physiologic abnormalities. This observation raises questions concerning the natural history of this disease process and the specificity of physiologic tests for excluding disease. It also has implications for the treatment of neoplasia in the HIV-positive patient population.

Reiss, T.F.; Golden, J. (Univ. of California, San Francisco (USA))



Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism, Thrombolysis, Catheter Fragmentation, and Embolectomy  

PubMed Central

A 21-year-old male patient with massive acute pulmonary embolism was treated by thrombolysis, interventional thrombus fragmentation, and surgical pulmonary embolectomy. Within the following 2 years, the patient developed progressive dyspnea at exertion. Chronic thromboembolic pulmonary hypertension was diagnosed by right-heart catheter, VQ scan, magnetic resonance, and conventional pulmonary angiography. A normalization of the patient's exercise capacity and pulmonary hemodynamics could be achieved by pulmonary endarterectomy and patch reconstruction of the right main pulmonary artery.

Wiedenroth, Christoph B.; Guth, Stefan; Rolf, Andreas; Mayer, Eckhard



Clinical and research measurement techniques of the pulmonary circulation: the present and the future.  


There has been a lot of progress in measurement techniques of the pulmonary circulation in recent years, and this has required updating of basic physiological knowledge. Pulmonary artery pressures (PAP) are normally low and dependent on left atrial pressure (LAP) and cardiac output (CO). Therefore, defining the functional state of the pulmonary circulation for the detection of pulmonary vascular disease or evaluation of disease progression requires measurements of PAP, LAP and CO. Invasive measurements have lately improved by a better definition of zero leveling and of the effects of intrathoracic pressure changes, and understanding of the inherent limitations of fluid-filled thermodilution catheters. The effects of LAP and pulmonary flow on PAP in health and disease are now integrated in the hemodynamic diagnosis of pulmonary hypertension. Development of alternative noninvasive approaches is critically dependent on their potential to quantify pulmonary vascular pressures and CO. Doppler echocardiography and magnetic resonance imaging are coming close. Both approaches are performant for flow measurements, but pressures remain indirectly assessed from flow velocities and/or structural changes. Doppler echocardiography or magnetic resonance imaging has been shown to be accurate, allowing for valid population studies, but with insufficient precision for single number-derived clinical decision making. PMID:25534670

Naeije, Robert; D'Alto, Michele; Forfia, Paul R



Particle velocity measurements with macroscopic fluorescence imaging in lymph tissue mimicking microfluidic phantoms  

NASA Astrophysics Data System (ADS)

Ultrasound poroelastography can quantify structural and mechanical properties of tissues such as stiffness, compressibility, and fluid flow rate. This novel ultrasound technique is being explored to detect tissue changes associated with lymphatic disease. We have constructed a macroscopic fluorescence imaging system to validate ultrasonic fluid flow measurements and to provide high resolution imaging of microfluidic phantoms. The optical imaging system is composed of a white light source, excitation and emission filters, and a camera with a zoom lens. The field of view can be adjusted from 100 mm x 75 mm to 10 mm x 7.5 mm. The microfluidic device is made of polydimethylsiloxane (PDMS) and has 9 channels, each 40 ?m deep with widths ranging from 30 ?m to 200 ?m. A syringe pump was used to propel water containing 15 ?m diameter fluorescent microspheres through the microchannels, with flow rates ranging from 0.5 ?l/min to 10 ?l/min. Video was captured at a rate of 25 frames/sec. The velocity of the microspheres in the microchannels was calculated using an algorithm that tracked the movement of the fluorescent microspheres. The imaging system was able to measure particle velocities ranging from 0.2 mm/sec to 10 mm/sec. The range of flow velocities of interest in lymph vessels is between 1 mm/sec to 10 mm/sec; therefore our imaging system is sufficient to measure particle velocity in phantoms modeling lymphatic flow.

Hennessy, Ricky; Koo, Chiwan; Ton, Phuc; Han, Arum; Righetti, Raffaella; Maitland, Kristen C.



If I Had - An Enlarged Painless Lymph Node in My Neck  


... Infants VIDEO: If I Had - An Enlarged Painless Lymph Node and In My Neck - Dr. Jonathan W. Friedberg, ... Page VIDEO: If I Had - An Enlarged Painless Lymph Node and In My Neck - Dr. Jonathan W. Friedberg, ...


Pulmonary haemorrhage following renal transplantation.  

PubMed Central

The case history is presented of a 32 year old black man who developed haemoptysis leading to pulmonary haemorrhage and bilateral pulmonary infiltrates. He was found to have Kaposi's sarcoma of the lung with no evidence of skin or endobronchial lesions. PMID:7886663

Khan, G. A.; Klapper, P.



Pulmonary emphysema and proteolysis: 1986  

SciTech Connect

This book deals with the topic of pulmonary emphysema. Included are the following chapters: Abnormality of secretion of Z Alpha-1-antitrypsin, Proteases, antiproteases, and oxidants in the pathogenesis of pulmonary emphysema, Alveolar Leukocytes and protease responses with continuous vs. intermittent exposures to NO{sub 2}.

Taylor, J.C.; Mittman, C. (City of Hope National Medical Center, Duarte, CA (US))



Increased secretion of insulin and proliferation of islet {beta}-cells in rats with mesenteric lymph duct ligation  

SciTech Connect

Highlights: Black-Right-Pointing-Pointer Insulin secretion was increased during the OGTT or IVGTT in mesenteric lymph duct-ligated rats. Black-Right-Pointing-Pointer Proliferation of islet {beta}-cells was upregulated in lymph duct-ligated rats. Black-Right-Pointing-Pointer Mesenteric lymph duct flow has a role in glucose metabolism. -- Abstract: Background and aims: It has been suggested that intestinal lymph flow plays an important role in insulin secretion and glucose metabolism after meals. In this study, we investigated the influence of ligation of the mesenteric lymph duct on glucose metabolism and islet {beta}-cells in rats. Methods: Male Sprague-Dawley rats (10 weeks old) were divided into two groups: one underwent ligation of the mesenteric lymph duct above the cistern (ligation group), and the other underwent a sham operation (sham group). After 1 and 2 weeks, fasting plasma concentrations of glucose, insulin, triglyceride, glucose-dependent insulinotropic polypeptide (GIP), and the active form of glucagon-like peptide-1 (GLP-1) were measured. At 2 weeks after the operation, the oral glucose tolerance test (OGTT) and intravenous glucose tolerance test (IVGTT) were performed. After the rats had been sacrificed, the insulin content of the pancreas was measured and the proliferation of {beta}-cells was assessed immunohistochemically using antibodies against insulin and Ki-67. Results: During the OGTT, the ligation group showed a significant decrease in the plasma glucose concentration at 120 min (p < 0.05) and a significant increase in the plasma insulin concentration by more than 2-fold at 15 min (p < 0.01). On the other hand, the plasma GIP concentration was significantly decreased at 60 min (p < 0.01) in the ligated group, while the active form of GLP-1 showed a significantly higher level at 90 min (1.7-fold; p < 0.05) and 120 min (2.5-fold; p < 0.01). During the IVGTT, the plasma insulin concentration in the ligation group was significantly higher at 2 min (more than 1.4-fold; p < 0.05). Immunohistochemistry showed that the ratios of {beta}-cell area/acinar cell area and {beta}-cell area/islet area, and also {beta}-cell proliferation, were significantly higher in the ligation group than in the sham group (p < 0.05, p < 0.01 and p < 0.01, respectively). The insulin content per unit wet weight of pancreas was also significantly increased in the ligation group (p < 0.05). Conclusions: In rats with ligation of the mesenteric lymph duct, insulin secretion during the OGTT or IVGTT was higher, and the insulin content and {beta}-cell proliferation in the pancreas were also increased. Our data show that mesenteric lymph duct flow has a role in glucose metabolism.

Nagino, Ko; Yokozawa, Junji; Sasaki, Yu; Matsuda, Akiko; Takeda, Hiroaki [Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata 990-9585 (Japan)] [Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata 990-9585 (Japan); Kawata, Sumio, E-mail: [Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata 990-9585 (Japan) [Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata 990-9585 (Japan); Hyogo Prefectural Nishinomiya Hospital, 13-9 Rokutanji-cho, Nishinomiya 662-0918 (Japan)



Chronic obstructive pulmonary disease  

PubMed Central

The global prevalence of physiologically defined chronic obstructive pulmonary disease (COPD) in adults aged >40 yr is approximately 9-10 per cent. Recently, the Indian Study on Epidemiology of Asthma, Respiratory Symptoms and Chronic Bronchitis in Adults had shown that the overall prevalence of chronic bronchitis in adults >35 yr is 3.49 per cent. The development of COPD is multifactorial and the risk factors of COPD include genetic and environmental factors. Pathological changes in COPD are observed in central airways, small airways and alveolar space. The proposed pathogenesis of COPD includes proteinase-antiproteinase hypothesis, immunological mechanisms, oxidant-antioxidant balance, systemic inflammation, apoptosis and ineffective repair. Airflow limitation in COPD is defined as a postbronchodilator FEV1 (forced expiratory volume in 1 sec) to FVC (forced vital capacity) ratio <0.70. COPD is characterized by an accelerated decline in FEV1. Co morbidities associated with COPD are cardiovascular disorders (coronary artery disease and chronic heart failure), hypertension, metabolic diseases (diabetes mellitus, metabolic syndrome and obesity), bone disease (osteoporosis and osteopenia), stroke, lung cancer, cachexia, skeletal muscle weakness, anaemia, depression and cognitive decline. The assessment of COPD is required to determine the severity of the disease, its impact on the health status and the risk of future events (e.g., exacerbations, hospital admissions or death) and this is essential to guide therapy. COPD is treated with inhaled bronchodilators, inhaled corticosteroids, oral theophylline and oral phosphodiesterase-4 inhibitor. Non pharmacological treatment of COPD includes smoking cessation, pulmonary rehabilitation and nutritional support. Lung volume reduction surgery and lung transplantation are advised in selected severe patients. Global strategy for the diagnosis, management and prevention of Chronic Obstructive Pulmonary Disease guidelines recommend influenza and pneumococcal vaccinations. PMID:23563369

Vijayan, V.K.



Pulmonary arteriovenous malformations.  


Within the past decade, pulmonary arteriovenous malformations (PAVMs) have evolved from rare curiosities to not uncommon clinical states, with the latest estimates suggesting a prevalence of ~1 in 2,600. PAVMs provide anatomic right-to-left shunts, allowing systemic venous blood to bypass gas exchange and pulmonary capillary bed processing. Hypoxemia and enhanced ventilatory demands result, although both are usually asymptomatic. Paradoxical emboli lead to strokes and cerebral abscesses, and these commonly occur in individuals with previously undiagnosed PAVMs. PAVM hemorrhage is rare but is the main cause of maternal death in pregnancy. PAVM occlusion by embolization is the standard of care to reduce these risks. However, recent data demonstrate that currently recommended management protocols can result in levels of radiation exposure that would be classified as harmful. Recent publications also provide a better appreciation of the hematologic and cardiovascular demands required to maintain arterial oxygen content and oxygen consumption in hypoxemic patients, identify patient subgroups at higher risk of complications, and emphasize the proportion of radiologically visible PAVMs too small to treat by embolization. This review, therefore, outlines medical states that exacerbate the consequences of PAVMs. Chief among these is iron deficiency, which is commonly present due to concurrent hereditary hemorrhagic telangiectasia: iron deficiency impairs hypoxemia compensations by restricting erythropoiesis and increases the risk of ischemic strokes. Management of periodontal disease, dental interventions, pulmonary hypertension, and pregnancy also requires specific consideration in the setting of PAVMs. The review concludes by discussing to what extent previously recommended protocols may benefit from modification or revision. PMID:25420112

Shovlin, Claire L



Chronic obstructive pulmonary disease.  


The global prevalence of physiologically defined chronic obstructive pulmonary disease (COPD) in adults aged >40 yr is approximately 9-10 per cent. Recently, the Indian Study on Epidemiology of Asthma, Respiratory Symptoms and Chronic Bronchitis in Adults had shown that the overall prevalence of chronic bronchitis in adults >35 yr is 3.49 per cent. The development of COPD is multifactorial and the risk factors of COPD include genetic and environmental factors. Pathological changes in COPD are observed in central airways, small airways and alveolar space. The proposed pathogenesis of COPD includes proteinase-antiproteinase hypothesis, immunological mechanisms, oxidant-antioxidant balance, systemic inflammation, apoptosis and ineffective repair. Airflow limitation in COPD is defined as a postbronchodilator FEV1 (forced expiratory volume in 1 sec) to FVC (forced vital capacity) ratio <0.70. COPD is characterized by an accelerated decline in FEV1. Co morbidities associated with COPD are cardiovascular disorders (coronary artery disease and chronic heart failure), hypertension, metabolic diseases (diabetes mellitus, metabolic syndrome and obesity), bone disease (osteoporosis and osteopenia), stroke, lung cancer, cachexia, skeletal muscle weakness, anaemia, depression and cognitive decline. The assessment of COPD is required to determine the severity of the disease, its impact on the health status and the risk of future events (e.g., exacerbations, hospital admissions or death) and this is essential to guide therapy. COPD is treated with inhaled bronchodilators, inhaled corticosteroids, oral theophylline and oral phosphodiesterase-4 inhibitor. Non pharmacological treatment of COPD includes smoking cessation, pulmonary rehabilitation and nutritional support. Lung volume reduction surgery and lung transplantation are advised in selected severe patients. Global strategy for the diagnosis, management and prevention of Chronic Obstructive Pulmonary Disease guidelines recommend influenza and pneumococcal vaccinations. PMID:23563369

Vijayan, V K



A fibrillar elastic apparatus around human lymph capillaries  

Microsoft Academic Search

A fibrillar elastic apparatus around the wall of human lymph capillaries is demonstrated by means of histochemical and ultrastructural techniques. This apparatus consists of three interlinked components listed here in order of increasing distance from the capillary wall: 1) oxytalan fibres connected to the abluminal surface of the endothelial cells, known also as “anchoring filaments” and consisting of bundles of

R. Gerli; L. Ibba; C. Fruschelli



Sentinel Lymph Node Technique for Staging of Breast Cancer  

Microsoft Academic Search

Lymphatic mapping and sentinel lymphadenectomy is becoming an important surgical technique for assessing axillary status in breast cancer. In experienced hands, it can be successfully performed in >90% of cases. The mor- bidity of sentinel lymphadenectomy is minimal, consider- ably less than the 15%-20% rate of complications associated with axillary lymph node dissection. Moreover, excision of the sentinel node provides



Breast Cancer Surgery Now Often Involves Fewer Lymph Nodes  


... sharing features on this page, please enable JavaScript. Breast Cancer Surgery Now Often Involves Fewer Lymph Nodes 2010 ... Preidt Friday, April 3, 2015 Related MedlinePlus Pages Breast Cancer Mastectomy FRIDAY, April 3, 2015 (HealthDay News) -- Compared ...


Diagnostic Features and Subtyping of Thymoma Lymph Node Metastases  

PubMed Central

Aim. The purpose of the present study was to characterize the morphological features of thymoma metastases in lymph nodes and to evaluate the possibility of their subtyping according to the 2004 WHO classification of thymus tumors. Materials and Methods. We reviewed 210 thymoma cases in our series of thymic epithelial tumors (TET), including their recurrences and lymphogenous metastases. Three cases of lymph node metastases, one case occurring synchronously with the primary tumor and one synchronously with the first relapse (both in intrathoracic location) and one case of metastasis observed in a laterocervical lymph node subsequently to two thymoma relapses were found. Results. The metastatic nodes were variably but extensively involved in all cases. The histological features were similar in both primary tumors and metastases. Thymoma metastases were subtyped according to the WHO classification as B3 (one case) and B2 (two cases), and distinctive features in comparison to metastatic epithelial neoplasias from other sites were observed. Conclusion. Thymoma lymph node metastases, although rare, can be subtyped according to the WHO classification on the basis of their morphological and immunohistochemical features. Clinically, the presence of nodal metastases may herald subsequent relapses and further metastases even in extrathoracic sites. PMID:25105128

Sioletic, Stefano; Lauriola, Libero; Martucci, Robert; Evoli, Amelia; Palmieri, Giovannella; Melis, Enrico; Rinaldi, Massimo; Lalle, Maurizio; Pescarmona, Edoardo; Granone, Pierluigi; Facciolo, Francesco



Prostanoid induces premetastatic niche in regional lymph nodes  

PubMed Central

The lymphatic system is an important route for cancer dissemination, and lymph node metastasis (LNM) serves as a critical prognostic determinant in cancer patients. We investigated the contribution of COX-2–derived prostaglandin E2 (PGE2) in the formation of a premetastatic niche and LNM. A murine model of Lewis lung carcinoma (LLC) cell metastasis revealed that COX-2 is expressed in DCs from the early stage in the lymph node subcapsular regions, and COX-2 inhibition markedly suppressed mediastinal LNM. Stromal cell–derived factor-1 (SDF-1) was elevated in DCs before LLC cell infiltration to the lymph nodes, and a COX-2 inhibitor, an SDF-1 antagonist, and a CXCR4 neutralizing antibody all reduced LNM. Moreover, LNM was reduced in mice lacking the PGE2 receptor EP3, and stimulation of cultured DCs with an EP3 agonist increased SDF-1 production. Compared with WT CD11c+ DCs, injection of EP3-deficient CD11c+ DCs dramatically reduced accumulation of SDF-1+CD11c+ DCs in regional LNs and LNM in LLC-injected mice. Accumulation of Tregs and lymph node lymphangiogenesis, which may influence the fate of metastasized tumor cells, was also COX-2/EP3–dependent. These results indicate that DCs induce a premetastatic niche during LNM via COX-2/EP3–dependent induction of SDF-1 and suggest that inhibition of this signaling axis may be an effective strategy to suppress premetastatic niche formation and LNM. PMID:25271626

Ogawa, Fumihiro; Amano, Hideki; Eshima, Koji; Ito, Yoshiya; Matsui, Yoshio; Hosono, Kanako; Kitasato, Hidero; Iyoda, Akira; Iwabuchi, Kazuya; Kumagai, Yuji; Satoh, Yukitoshi; Narumiya, Shuh; Majima, Masataka



Tissue-Specific Function of Lymph Node Fibroblastic Reticulum Cells  

Microsoft Academic Search

Objective: We present the first characterization of the cytokine expression pattern of lymph node fibroblastic reticulum cells (FRC), which are the stromal cells responsible for maintaining the highly structured nodal reticular fiber framework. Methods: Microarray expression profiles of cultured nodal FRC and dermal fibroblasts (DF) were compared as well as their response to TNF, IL-4, IL-6 and IL-13, cytokines responsible

Francisco Vega; Kevin R. Coombes; Vilmos A. Thomazy; Kaushali Patel; Wenhua Lang; Dan Jones



The diagnosis of lymph microcirculation in experimental studies on rat mesentery in vivo  

NASA Astrophysics Data System (ADS)

The many biological and medical problems associated with microlymphatic functioning and its disturbances at different diseases, include primary and secondary lymphedema, inflammation, lymphatic malformations, and so on. It is important both to establish an adequate animal model for study ly