Sample records for pulmonary lymph flow

  1. Value of systematic mediastinal lymph node dissection during pulmonary metastasectomy

    Microsoft Academic Search

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

    2001-01-01

    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

  2. Lymph node pathology in pulmonary veno-occlusive disease and pulmonary capillary heamangiomatosis

    Microsoft Academic Search

    Vincent Thomas de Montpréville; Élisabeth Dulmet; Élie Fadel; Philippe Dartevelle

    2008-01-01

    To assess the histological bases of lymphadenomegaly, which has been reported as a frequent radiological finding in pulmonary\\u000a veno-occlusive disease (PVOD), we have reviewed pulmonary and mediastinal lymph nodes resected during lung transplantations\\u000a in 19 patients suffering from PVOD and related pulmonary capillary haemangiomatosis (PCH). Lymphatic congestion was common\\u000a and was often obvious in subsegmental and segmental lymph nodes. Vascular

  3. Test performance of PET-CT for mediastinal lymph node staging of pulmonary carcinoid tumours.

    PubMed

    Pattenden, Holly A; Leung, Maria; Beddow, Emma; Dusmet, Michael; Nicholson, Andrew G; Shackcloth, Michael; Mohamed, Saifullah; Darr, Adnan; Naidu, Babu; Iyer, Swetha; Marchbank, Adrian; Greenwood, Amy; West, Doug; Granato, Felice; Kirk, Alan; Ariyaratnam, Priyadharshanan; Loubani, Mahmoud; Lim, Eric

    2015-04-01

    Positron emission tomography-CT (PET-CT) is one of the initial mediastinal staging modality for non-small cell lung cancer; however, the clinical utility in carcinoid tumours is uncertain. We sought to determine the test performance of PET-CT for mediastinal lymph node staging of pulmonary carcinoid tumours. We collated data from seven institutions, performing a retrospective search on pathological databases for a consecutive series of patients who underwent thoracic surgery (with lymph nodal dissection) for carcinoid tumours with preoperative PET-CT staging. PET-CT results were compared with the reference standard of pathologic results obtained from lymph node dissection and test performance reported using sensitivity and specificity. From November 1999 to January 2013, 247 patients from seven institutions underwent surgery for carcinoid tumours with a corresponding preoperative PET-CT scan. The mean age of the patients was 61 (SD 15, range 73) and 84 were male patients (34%). The pathologic subtype was typical carcinoid in 217 patients (88%) and atypical carcinoid in 30 patients (12%). Results from lymph node dissection were obtained in 207 patients. The calculated sensitivity and specificity of PET-CT to identify mediastinal lymph node disease was 33% (95% CI 4% to 78%) and 94% (95% CI 89% to 97%), respectively. Our results indicate that PET-CT has a poor sensitivity but good specificity to detect the presence of mediastinal lymph node metastases in pulmonary carcinoid tumours. Mediastinal lymph node metastases cannot be ruled out with negative PET-CT uptake, and if the absence of mediastinal lymph node disease is a prerequisite for directing management, tissue sampling should be undertaken. PMID:25124060

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

    PubMed

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

    2011-10-01

    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

  5. Chylothorax and re-expansion pulmonary edema following myocardial re-vascularization: role of lymph vessel insufficiency.

    PubMed

    Riquet, Marc; Assouad, Jalal; D'Attellis, Nicola; Gandjbakhch, Iradj

    2004-09-01

    Chylothorax is a rare complication following coronary artery bypass graft surgery. In the following case, we report a chylothorax complicating left internal mammary artery harvesting due to injury of the left anterior mediastinal lymph node chain (LAMLNC) at the level of the proximal pedicle of the mammary artery. Re-expansion pulmonary edema occurred during re-operation for chylothorax following suturing of this lymph node chain. This observation demonstrates the role of the LAMLNC in both complications when injured or interrupted. PMID:17670279

  6. Adrenomedullin alleviates pulmonary artery collagen accumulation in rats with pulmonary hypertension induced by high blood flow.

    PubMed

    Pang, Lulu; Qi, Jianguang; Gao, Yang; Jin, Hongfang; Du, Junbao

    2014-04-01

    Collagen accumulation is one of the important pathologic changes in the development of pulmonary hypertension. Previous research showed that adrenomedullin (ADM) mitigates the development of pulmonary hypertension. The present study explored the role of ADM in the development of pulmonary artery collagen accumulation induced by high pulmonary blood flow, by investigating the effect of ADM [1.5 ?g/(kg h)] subcutaneously administered by mini-osmotic pump on pulmonary hemodynamics, pulmonary vascular structure and pulmonary artery collagen accumulation and synthesis in rats with high pulmonary blood flow induced by aortocaval shunting. The results showed that ADM significantly decreased mean pulmonary artery pressure (mPAP) and the ratio of right ventricular mass to left ventricular plus septal mass [RV/(LV+SP)], attenuated the muscularization of small pulmonary vessels and relative medial thickness (RMT) of pulmonary arteries in rats with high pulmonary blood flow. Meanwhile, ADM ameliorated pulmonary artery collagen deposition represented by a decrease in lung tissue hydroxyproline, collagens I and III content and pulmonary artery collagens I and III expression, reduced collagen synthesis represented by a decrease in lung tissue procollagens I and III mRNA expression. The results suggest that ADM plays a protective role in the development of pulmonary hypertension induced by high blood flow, by inhibiting pulmonary procollagen synthesis and alleviating pulmonary artery collagen accumulation. PMID:24480725

  7. [Characteristics of lymph flow in patients with post-mastectomy syndrome, based on lymphoscintigraphy data].

    PubMed

    Sedov, V M; Miasnikova, M O; Katsev, V M; Ermoshchenkova, M V

    2002-01-01

    Lymphoscintigraphy allows to get intravital contrast of functionally valuable lymph collectors of the extremity. A comparative analysis was made of the state of lymph flow in healthy subjects, in patients with breast cancer and in patients with the completed cycle of treatment of breast cancer having postmastectomy edema and without it. The investigation was performed in 280 extremities. Principal variants of the normal lymph flow (collector, diffuse, nodal) were marked out. Possible compensatory mechanisms ameliorating the draining function of the extremity were followed in patients with blocked lymph outflow. Programs of prognosis and treatment of patients with preclinical stage of postmastectomy edema are outlined. PMID:12528618

  8. 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

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

    2014-01-01

    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

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

    PubMed Central

    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.

    2012-01-01

    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

  10. Adjustable tourniquet to manipulate pulmonary blood flow after Norwood operations

    Microsoft Academic Search

    Franz X Schmid; Christoph Kampmann; Wlodimierz Kuroczynski; Yeong-Hoon Choi; Markus Knuf; Irene Tzanova; Hellmut Oelert

    1999-01-01

    Background. Survival after first-stage palliative Norwood operations for single ventricle with systemic outflow obstruction is mainly dependent on a balanced ratio of pulmonary blood flow to systemic blood flow. Here we report the clinical results using a modified technique that allows a controlled systemic-to-pulmonary shunt flow to prevent pulmonary overcirculation.Methods. From 1995 to 1998, of 26 infants undergoing first-stage palliative

  11. Monitoring of lymph flow in microvessels by biomicroscopy and speckle-interferometry

    NASA Astrophysics Data System (ADS)

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

    2001-05-01

    In the paper lymph flow in microvessels by two methods in norm and under influence of vasoactive drugs: N-nitro-L- Arginine (L-NNA, 10-4M and dimethyl sufoxide (DMSO, 30%) was studied. We measured absolute linear flow velocity by microscopic method and parameter proportional to velocity (M1) using the speckle-interferometry. Also other parameters of lymph and blood microcirculation were measured. The lymph flow differs from blood flow. The average flow velocity for the lymphatics is more than for the blood microvessels. The negative correlation between blood flow velocity and diameter of vessel absents in lymphatics. The phase contractions contribute to the lymph flow. The M1 in contracting lymphatics are of the same values in different vessels. But the non-contracting microvessels has very varying indexes of M1. Probably the wall movements during phasic contractions led to the change of speckle signals. The action of vasoactive drugs (L-NNA and DMSO) stimulates the lymph flow and phasic activity in microvessels of rat mesentery. The effects of L-NNA and DMSO on diameters are different. The constriction of microvessels prevailed at the DMSO application. The dilatation dominated at the L-NNA action.

  12. Evaluation of pulmonary lesions with F-18 FDG PET: Comparison of findings in patients with primary pulmonary lesions, pulmonary lesions with history of prior malignancey, and clinically or radiographically suspicious thoracic lymph nodes

    SciTech Connect

    Knight, S.B.; Delbeke, D.; Campbell, M.G. [Vanderbilt Univ. Medical Center, Nashville, TN (United States)] [and others

    1994-05-01

    The efficacy of Positron Emission Tomography with F-18 FDG in distinguishing benign from malignant lesions is evaluated and compared in three clinically distinct patient populations. Twenty-four patients with pulmonary lesions or thoracic lymph nodes suspicious for malignancy underwent FDG PET scanning. Pathologic proof of diagnosis was obtained for all patients by thoracotomy (n=18), endobronchial biopsy (n=3), mediastinoscopy (n=2) or sputum cytology (n=1).

  13. Incidental Pelvic and Para-aortic Lymph Node Lymphangioleiomyomatosis Detected During Surgical Staging of Pelvic Cancer in Women Without Symptomatic Pulmonary Lymphangioleiomyomatosis or Tuberous Sclerosis Complex.

    PubMed

    Rabban, Joseph T; Firetag, Brandie; Sangoi, Ankur R; Post, Miriam D; Zaloudek, Charles J

    2015-08-01

    Extrapulmonary lymphangioleiomyomatosis (LAM) is a rare neoplasm of spindle cells exhibiting melanocytic and myoid differentiation that arises as a mass in the mediastinum, retroperitoneum, uterine wall, and/or intraperitoneal lymph nodes. Many patients also have pulmonary LAM, tuberous sclerosis complex (TSC), and/or other neoplasms of the perivascular epithelioid cell tumor family. This study reports 26 patients with clinically occult LAM involving pelvic/para-aortic lymph nodes removed from women undergoing surgical staging of a uterine (17), ovarian (5), cervical (3), or urinary bladder (1) neoplasm. None of the patients exhibited symptoms of pulmonary LAM, and the median patient age (56 y) was older than what would be expected for patients presenting with pulmonary LAM. Only 2/26 patients had TSC. Four patients also had uterine LAM. One of these 4 had uterine perivascular epithelioid cell tumor, and 1 had vaginal angiomyolipoma. In all 26 patients the lymph node LAM was grossly occult, measured 3.5 mm on average (1 to 19 mm), and involved either a single lymph node (12/26) or multiple lymph nodes (14/26). HMB45 was positive in 24/25 cases, mostly in a focal or patchy distribution. Other melanocytic markers included MiTF (12/14) and MelanA (2/12). Myoid markers included smooth muscle actin (23/23) and desmin (15/16), mostly in a diffuse distribution. Estrogen receptor was positive in all cases tested, as was D240 expression in the lymphatic endothelium lining the spindle cell bundles. Concurrent findings in the involved lymph nodes included metastatic carcinoma (3/26), endosalpingiosis (3/26), and reactive lymphoid hyperplasia (13/26). This study demonstrates that clinically occult lymph node LAM can be detected during surgical staging of pelvic cancer and is not commonly associated with pulmonary LAM or TSC, although these patients should still be formally evaluated for both of these diseases. PMID:25786086

  14. Lymph flow and contractile activity of mesenteric lymph nodes in rats with toxic hepatitis effects of antioxidants.

    PubMed

    Abdreshov, S N; Bulekbayeva, L E; Demshenko, G A

    2013-05-01

    We studied contractile function of isolated mesenteric lymph nodes in rats with toxic hepatitis. We observed suppression of spontaneous and stimulated contractile activity of mesenteric lymph nodes and changes in biochemical composition of the lymph. We propose a method of correction of these dysfunctions with antioxidant ?-tocopherol and Selen-Active. PMID:23667863

  15. Biomicroscopic and speckle-interferometric measurement of lymph flow velocity in single microvessels in norm and in drug application

    NASA Astrophysics Data System (ADS)

    Galanzha, Ekateryna I.

    2001-05-01

    In this paper we investigated the lymph flow and other parameters of lymph microcirculation in vivo. The analysis of lymphatic functions in norm and at the topical application of N-nitro-L-arginin (L-NNA, 10-4M), dimethylsulfoxide (DMSO, 30%) was performed. We observed lymph microvessels of rat mesentery with diameter from 50 to 270 micrometers . The lymph flow velocity was determined by the biomicroscopic (V) and speckle-interferometrical (M1) methods. L-NNA and DMSO led to different effects on diameters of lymphatics. L-NNA as well as DMSO stimulated the phasic activity and lymph flow in microvessels of rat mesentery. We suggested that used vasoactive drugs stimulated lymph pumping by different ways.

  16. Lymphatic Fluid Mechanics: An In Situ and Computational Analysis of Lymph Flow 

    E-print Network

    Rahbar, Elaheh

    2012-10-19

    lymph ducts which drain into their respective subclavian veins, as illustrated in Figure 1.1. The right duct is much smaller, collecting fluid only from the head, neck, thorax and right arm. The left lymph duct, or better known as the thoracic duct... entered the lymphatic system it must be transported a long distance “uphill” towards the dumping site in the subclavian veins. Unlike the cardiovascular system where the heart serves as the central pumping source for blood flow; the lymphatics have two...

  17. Immunoglobulin related amyloidosis presenting as isolated lymph node and pulmonary involvement.

    PubMed

    Meeus, G; Ponette, J; Delabie, J; Verschakelen, J; Blockmans, D

    2000-07-01

    Here we present an unusual case of a 53-year old patient presenting AL-kappa amyloidosis with diffuse-type amyloidosis of lungs, lymph nodes and pleura. The underlying pathology was a B-cell immunoglobulin-secreting non-Hodgkin lymphoma, as proven by the presence of a monoclonal B-cell population in the bone marrow. Diffuse parenchymal infiltration of the lungs is extremely rare in non-systemic amyloidosis, with only 4 previous cases having been reported in the English literature. PMID:10830751

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

    PubMed Central

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

    2008-01-01

    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

  19. Feasibility of Computed Tomography Pulmonary Angiography with Low Flow Rates

    PubMed Central

    Gossner, J.

    2012-01-01

    Computed tomography pulmonary angiography (CTPA) is the imaging test of choice in suspected pulmonary embolism. High flow rates for the administration of contrast medium are recommended, but these cannot be achieved in a number of patients due to poor peripheral venous access or when using certain central venous catheters. This small feasibility study has examined the CTPA data in a set of 22 patients in whom contrast medium was given at low flow rates (2.0 or 2.5 mL/s). Subjectively, all but one of the patients was judged to be diagnostic. Objectively, enhancement values ?200 HU were reached in 92% of the examined central vessels (pulmonary trunk, main pulmonary arteries, and lobar arteries). In conclusion, even with a low injection rate CTPA is of diagnostic value in most patients. PMID:23230539

  20. Increasing pulmonary artery pulsatile flow improves hypoxic pulmonary hypertension in piglets.

    PubMed

    Courboulin, Audrey; Kang, Chantal; Baillard, Olivier; Bonnet, Sebastien; Bonnet, Pierre

    2015-01-01

    Pulmonary arterial hypertension (PAH) is a disease affecting distal pulmonary arteries (PA). These arteries are deformed, leading to right ventricular failure. Current treatments are limited. Physiologically, pulsatile blood flow is detrimental to the vasculature. In response to sustained pulsatile stress, vessels release nitric oxide (NO) to induce vasodilation for self-protection. Based on this observation, this study developed a protocol to assess whether an artificial pulmonary pulsatile blood flow could induce an NO-dependent decrease in pulmonary artery pressure. One group of piglets was exposed to chronic hypoxia for 3 weeks and compared to a control group of piglets. Once a week, the piglets underwent echocardiography to assess PAH severity. At the end of hypoxia exposure, the piglets were subjected to a pulsatile protocol using a pulsatile catheter. After being anesthetized and prepared for surgery, the jugular vein of the piglet was isolated and the catheter was introduced through the right atrium, the right ventricle and the pulmonary artery, under radioscopic control. Pulmonary artery pressure (PAP) was measured before (T0), immediately after (T1) and 30 min after (T2) the pulsatile protocol. It was demonstrated that this pulsatile protocol is a safe and efficient method of inducing a significant reduction in mean PAP via an NO-dependent mechanism. These data open up new avenues for the clinical management of PAH. PMID:25993379

  1. Stratified Pulmonary Blood Flow: Some Consequences in Emphysema and Pulmonary Embolism

    PubMed Central

    Read, John

    1969-01-01

    Both ventilation and blood flow in the secondary lobule of the lung are stratified; each unit of lung tissue in the proximal portion of the lobule receives up to four times the blood flow of units in the peripheral portion. Questions of the limiting role of gas diffusion within the small airways become virtually irrelevant in the face of this stratification of function. The central portion of the lobule, with its high ventilation, blood flow, and gas exchange, is very vulnerable; small lesions at this site will produce disproportionately large disturbances of gas exchange and of pulmonary vascular resistance. This may well account for some of the phenomena of conditions such as centrilobular emphysema and pulmonary microembolism. PMID:5776220

  2. Quantification of regional pulmonary blood flow using ASL-FAIRER

    Microsoft Academic Search

    D. S. Bolar; D. L. Levin; S. R. Hopkins; L. F. Frank; T. T. Liu; E. C. Wong; R. B. Buxton

    2006-01-01

    Pulsed arterial spin labeling (ASL) techniques have been theo- retically and experimentally validated for cerebral blood flow (CBF) quantification. In this study ASL-FAIRER was used to measure regional pulmonary blood flow (rPBF) in seven healthy subjects. Two general ASL strategies were investigated: 1) a single-subtraction approach using one tag-control pair acqui- sition at an inversion time (TI) matched to the

  3. Assessment of cumulative allergen-activated lymph node cell proliferation using flow cytometry.

    PubMed

    Humphreys, Neil E; Dearman, Rebecca J; Kimber, Ian

    2003-05-01

    The murine local lymph node assay (LLNA) is a method for the prospective identification of chemical contact allergens. The current validated protocol assesses lymphocyte proliferation induced in the draining lymph node as a function of in situ incorporation of radiolabeled thymidine. We have explored the potential utility of an alternative nonradioisotopic marker of cell division, the cytoplasmic dye carboxyfluoresein succinimidyl ester (CFSE). Using this method, the cell phenotype and the number of divisions each cell has undergone can be tracked using flow cytometry. BALB/c strain mice were exposed topically to various concentrations of the contact allergens 2,4-dinitrochlorobenzene (DNCB), oxazolone (ox) or hexyl cinnamic aldehyde (HCA), or to the nonsensitizing skin irritant methyl salicylate (MS). Five days later, lymph node cells (LNC) were labeled with CFSE, cultured for 96 h, then incubated with fluorescent labeled anti-CD4 (T helper) and -CD8 (T cytotoxic) cell antibodies, and proliferating CD4+ and CD8+ cells analyzed by flow cytometry. In LNC populations derived from vehicle-treated animals, less than 1% of either cell population had undergone one cell division or more. Topical exposure to MS (2.5 to 20%) did not increase the frequencies of proliferating cells. Exposure to all three allergens, however, resulted in a marked increase in the percentages of both CD4+ and CD8+ cells undergoing division, with up to 5% and 3% of these cells, respectively, proliferating in response to DNCB and oxazolone, and with lower levels of proliferation stimulated by HCA. These preliminary data suggest that this method may be applied to provide the basis of a nonradioisotopic end point for the LLNA, particularly for the identification of potent contact allergens. PMID:12700420

  4. Nodal lymph flow quantified with afferent vessel input function allows differentiation between normal and cancer-bearing nodes.

    PubMed

    DSouza, Alisha V; Elliott, Jonathan T; Gunn, Jason R; Barth, Richard J; Samkoe, Kimberley S; Tichauer, Kenneth M; Pogue, Brian W

    2015-04-01

    Morbidity and complexity involved in lymph node staging via surgical resection and biopsy could ideally be improved using node assay techniques that are non-invasive. While visible blue dyes are often used to locate the sentinel lymph nodes from draining lymphatic vessels near a tumor, they do not provide an in situ metric to evaluate presence of cancer. In this study, the transport kinetics of methylene blue were analyzed to determine the potential for better in situ information about metastatic involvement in the nodes. A rat model with cancer cells in the axillary lymph nodes was used, with methylene blue injection to image the fluorescence kinetics. The lymphatic flow from injection sites to nodes was imaged and the relative kinetics from feeding lymphatic ducts relative to lymph nodes was quantified. Large variability existed in raw fluorescence and transport patterns within each cohort resulting in no systematic difference between average nodal uptake in normal, sham control and cancer-bearing nodes. However, when the signal from the afferent lymph vessel fluorescence was used to normalize the signal of the lymph nodes, the high signal heterogeneity was reduced. Using a model, the lymph flow through the nodes [Formula: see text] was estimated to be 1.49 ± 0.64 ml/g/min in normal nodes, 1.53 ± 0.45 ml/g/min in sham control nodes, and reduced to 0.50 ± 0.24 ml/g/min in cancer-cell injected nodes. This summarizes the significant difference (p = 0.0002) between cancer-free and cancer-bearing nodes in normalized flow. This process of normalized flow imaging could be used as an in situ tool to detect metastatic involvement in nodes. PMID:25909014

  5. Nodal lymph flow quantified with afferent vessel input function allows differentiation between normal and cancer-bearing nodes

    PubMed Central

    DSouza, Alisha V.; Elliott, Jonathan T.; Gunn, Jason R.; Barth, Richard J.; Samkoe, Kimberley S.; Tichauer, Kenneth M.; Pogue, Brian W.

    2015-01-01

    Morbidity and complexity involved in lymph node staging via surgical resection and biopsy could ideally be improved using node assay techniques that are non-invasive. While visible blue dyes are often used to locate the sentinel lymph nodes from draining lymphatic vessels near a tumor, they do not provide an in situ metric to evaluate presence of cancer. In this study, the transport kinetics of methylene blue were analyzed to determine the potential for better in situ information about metastatic involvement in the nodes. A rat model with cancer cells in the axillary lymph nodes was used, with methylene blue injection to image the fluorescence kinetics. The lymphatic flow from injection sites to nodes was imaged and the relative kinetics from feeding lymphatic ducts relative to lymph nodes was quantified. Large variability existed in raw fluorescence and transport patterns within each cohort resulting in no systematic difference between average nodal uptake in normal, sham control and cancer-bearing nodes. However, when the signal from the afferent lymph vessel fluorescence was used to normalize the signal of the lymph nodes, the high signal heterogeneity was reduced. Using a model, the lymph flow through the nodes (FLN) was estimated to be 1.49 ± 0.64 ml/g/min in normal nodes, 1.53 ± 0.45 ml/g/min in sham control nodes, and reduced to 0.50 ± 0.24 ml/g/min in cancer-cell injected nodes. This summarizes the significant difference (p = 0.0002) between cancer-free and cancer-bearing nodes in normalized flow. This process of normalized flow imaging could be used as an in situ tool to detect metastatic involvement in nodes. PMID:25909014

  6. LASER BIOLOGY AND MEDICINE: Recording of lymph flow dynamics in microvessels using correlation properties of scattered coherent radiation

    NASA Astrophysics Data System (ADS)

    Fedosov, I. V.; Tuchin, Valerii V.; Galanzha, E. I.; Solov'eva, A. V.; Stepanova, T. V.

    2002-11-01

    The direction-sensitive method of microflow velocity measurements based on the space — time correlation properties of the dynamic speckle field is described and used for in vivo monitoring of lymph flow in the vessels of rat mesentery. The results of measurements are compared with the data obtained from functional video microscopy of the microvessel region.

  7. A Case of Pulmonary Cryptococcosis in an Immunocompetent Male Patient Diagnosed by a Percutaneous Supraclavicular Lymph Node Biopsy

    PubMed Central

    Sung, Ji Hee; Oh, Mi-Jung; Lee, Kyoung Ju; Bae, Young A; Kwon, Kye Won; Lee, Seung Min; Kang, Ho Joon; Choi, Jinyoung

    2015-01-01

    Cryptococcal pneumonia usually occurs in immunocompromised patients with malignancy, acquired immune deficiency syndrome, organ transplantations, immunosuppressive chemotherapies, catheter insertion, or dialysis. It can be diagnosed by gaining tissues in lung parenchyma or detecting antigen in blood or bronchoalveolar lavage fluid. Here we report an immunocompetent 32-year-old male patient with diabetes mellitus diagnosed with cryptococcal pneumonia after a ultrasound-guided percutaneous supraclavicular lymph node core needle biopsy. We treated him with fluconazole at 400 mg/day for 9 months according to the guideline. This is the first case that cryptococcal pneumonia was diagnosed from a percutaneous lymph node biopsy in South Korea.

  8. Assessment of Cumulative Allergen-Activated Lymph Node Cell Proliferation Using Flow Cytometry

    Microsoft Academic Search

    Neil E. Humphreys; Rebecca J. Dearman; Ian Kimber

    2003-01-01

    The murine local lymph node assay (LLNA) is a method for the prospective identification of chemical contact allergens. The cur- rent validated protocol assesses lymphocyte proliferation induced in the draining lymph node as a function of in situ incorporation of radiolabeled thymidine. We have explored the potential utility of an alternative nonradioisotopic marker of cell division, the cytoplasmic dye carboxyfluoresein

  9. A computational approach to study the effect of multiple lymphangion coordination on lymph flow

    E-print Network

    Madabushi Venugopal, Arun

    2005-11-01

    The lymphatic system acts to return fluid from the interstitial space back into the blood circulation. In normal conditions, lymphangions, the segment of lymphatic vessel in between valves, cyclically contract and can pump lymph from low pressure...

  10. EFFECTS OF PATHOLOGIC FLOW ON PULMONARY ARTERY ENDOTHELIAL PRODUCTION OF VASOACTIVE MEDIATORS AND GROWTH FACTORS

    PubMed Central

    Li, Min; Stenmark, Kurt R.; Shandas, Robin; Tan, Wei

    2011-01-01

    Background Alterations in pulmonary blood flow are often associated with the initiation and progression of pulmonary vascular disease. However, the cellular mechanisms involved in mediating flow effects in the pulmonary circulation remain unclear. Depending on the disease condition flow may be extremely low or high. We therefore examined effects of pathologically low and high flow on endothelial production of factors capable of affecting pulmonary vascular tone and structure and on potential underlying mechanisms. Methods Flow effects on pulmonary endothelial release of NO, PGF1a, ET-1 and TxB2, and on expression of total and phosphorylated eNOS and Akt, and VEGF were examined. Additionally, in a co-culture system, effects of flow-exposed endothelial cells on smooth muscle (SM) proliferation and contractile protein were studied. Results Compared to physiological flow, pathologically high and low flow attenuated endothelial release of NO, PGF1a, and enhanced release of ET-1. Physiological flow activated Akt/eNOS pathway while pathological flow depressed it. Pathologically high flow altered VE-cadherin expression. Pathologically high flow on the endothelium upregulated alpha-SM-actin and SM-MHC without affecting SM proliferation. Conclusion Physiological flow leads to production of mediators which favor vasodilation. Pathological flow alters the balance of mediator production which favors vasoconstriction. PMID:19571576

  11. Problems in cerebral blood flow calculation using xenon-133 in patients with pulmonary diseases

    SciTech Connect

    Hansen, M.; Jakobsen, M.; Enevoldsen, E.; Egede, F. (Odense Univ. Hospital (Denmark))

    1990-05-01

    We used the end-tidal concentration of xenon-133 (air curve) to estimate the profile of its arterial concentration in calculating cerebral blood flow. We examined the effects of pulmonary disease and artificial ventilation on the air curve and the calculated cerebral blood flow. We studied the relation between arterial and end-tidal xenon activities in 19 subjects, of whom 15 had pulmonary dysfunction. The t 1/2 of the declining phases of the arterial and air curves were used to express their shapes. The mean +/- SD reference t 1/2 from 15 normal volunteers was 26.8 +/- 8.4 seconds. The mean +/- SD t 1/2 s of the air and arterial curves from the 15 patients with pulmonary dysfunction were 10.4 +/- 2.9 and 33.8 +/- 10.9 seconds. The degree of pulmonary dysfunction (expressed as the pulmonary shunt percentage) correlated with distortion of the air curve. Substituting the arterial for the air curve, mean calculated cerebral blood flow (as the initial slope index) increased from 40 to 61 for the 12 patients with chronic obstructive pulmonary disease. The degree of underestimation of cerebral blood flow using the air curve correlated with the pulmonary shunt percentage. Our work confirms the problems of estimating cerebral blood flow in subjects with pulmonary dysfunction.

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

    PubMed

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

    2015-04-01

    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

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

    PubMed Central

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

    2014-01-01

    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

  14. Pulmonary blood flow redistribution by increased gravitational force

    NASA Technical Reports Server (NTRS)

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

    1998-01-01

    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.

  15. Dynamics of monocytes flowing in a model pulmonary capillary bed

    NASA Astrophysics Data System (ADS)

    Viallat, Annie; Dupire, Jules; Adhesion and Inflammation lab Team

    2012-11-01

    The dynamics of blood cells in the pulmonary bed is an issue for tissue perfusion and host defense. The capillary segments in the lungs are smaller than the size of leukocytes so that most of them change their shape to enter and travel through a capillary pathway. During inflammation, changes in the cytoskeleton of leukocytes may stiffen them, resulting in their massive stop and sequestration within lung capillaries. However, due to difficulties of in vivo studies, little is known about the dynamics of leukocytes in the microcirculation and about the coupling between cellular rheology, capillary geometry and flow. We report the dynamics of monocytes (THP-1 cell line) flowing under constant pressure drop in a periodic network of capillaries that mimics the capillary bed. The analysis of cell entrance in the first segment allows the estimation of effective cellular elasticity, viscosity and cortical tension. Cells then present an unsteady regime, with a non-periodic trajectory, a stretching of their average shape and an increase of their velocity. This regime is interpreted from a parameter equivalent to the Deborah number of the system. Finally, a periodic regime is reached with alternatively left and right turns at capillary bifurcations. The reduced cell velocity is governed by an effective friction coefficient between the cell and the capillary walls. Both transient and final regimes depend on cell deformability, as shown by modifying the cortical actin of the cytoskeleton. This work has been supported by the French Research. National Agency (ANR) under reference ChipCellTrap.

  16. Perfluorohexane Vapor Has Only Minor Effects on Spatial Pulmonary Blood Flow Distribution in Isolated Rabbit Lungs

    Microsoft Academic Search

    Axel R. Heller; Marcelo Gama de Abreu; Tobias Kroll; Thea Koch

    2005-01-01

    We tested the hypothesis that administration of perflu- orohexane (PFH) vapor does not significantly affect the relative pulmonary blood flow (Q ú rel) distribution in iso- lated rabbit lungs. Fourteen isolated rabbit lungs were perfused with a Krebs-Henseleit buffer solution (flow 150 mL\\/min). Pulmonary afterload was set to 3 mm Hg. The lungs were ventilated with 4% CO2 in room

  17. Comparison of bronchopulmonary collaterals and collateral blood flow in patients with chronic thromboembolic and primary pulmonary hypertension.

    PubMed Central

    Endrys, J.; Hayat, N.; Cherian, G.

    1997-01-01

    OBJECTIVE: To compare the visualisation of bronchopulmonary collaterals and bronchopulmonary collateral blood flow in patients with chronic thromboembolic pulmonary hypertension 2nd primary pulmonary hypertension. SETTING: Referral centre for cardiology at an academic hospital. PATIENTS: Nine patients with chronic thromboembolic pulmonary hypertension and 17 with primary pulmonary hypertension. INTERVENTIONS: Bronchopulmonary collaterals were visualised by selective bronchial arteriography or thoracic aortography. Bronchopulmonary collateral blood flow was estimated by injecting indocyanine green into the ascending aorta and sampling below the mitral valve from the left ventricle. RESULTS: The degree of pulmonary hypertension was comparable in the two groups. Large bronchopulmonary collaterals were visualised in all the patients with thromboembolic pulmonary hypertension who had bronchial arteriography or aortography or both. None of the primary pulmonary hypertension group studied by aortography had bronchopulmonary collaterals (P < < 0.001). All the patients with chronic thromboembolic pulmonary hypertension had significant bronchopulmonary collateral blood flow, which was (mean (SD)) 29.8 (18.6)% of the systemic blood flow. There was no recordable collateral blood flow in 11 of 15 patients with primary pulmonary hypertension. In the remaining four patients the mean value was 1.1 (1.8)% of the systemic blood flow (P < < 0.001). CONCLUSIONS: Visualisation of bronchopulmonary collaterals by thoracic aortography or by bronchial arteriography, or the demonstration of an increased bronchopulmonary collateral flow, helps to distinguish patients with chronic thromboembolic pulmonary hypertension from those with primary pulmonary hypertension. Images PMID:9326993

  18. Effects of a localized high-flow anastomosis between aorta and left lower lobe pulmonary artery on great vessel flow and pulmonary arterial reactivity in the contralateral lung

    PubMed Central

    Somberg, Lewis; Nirula, Ram; Bousamra, Michael; Friesema, Jill; Zhu, Daling; Medhora, Meetha; Jacobs, Elizabeth R.

    2010-01-01

    Objectives To assess effects of a localized anastomosis between the aorta and left lower lobe pulmonary artery (LLLPA) on flows through central vessels, and on vascular reactivity of small PAs distal or contralateral to the shunt. Methods Flow rates in major vessels and tensions from small PAs from left and right lower lobes were determined 48 hours after creation of an end-to-side anastomosis of the LLLPA to the aorta. Results Anastomoses increased flow through the LLLPA from 194 ± 6 to 452 ± 18 ml/min immediately after anastomosis and to 756 ± 19 ml/min by the time of harvest (n=88, p<0.05). Flow rates in main PAs from hosts with anastomoses were lower (557 ± 26 versus1033 ± 244 ml/min) while aortic root flows were not different from controls (1370 ± 53 compared to 1120 ± 111 ml/min; p = 0.07). Wet-to-dry weights of the both lungs and aortic flow rates were proportional to shunt flow rates. PA rings harvested from the right (unshunted) lobe of high flow hosts exhibited increased reactivity to the thromboxane agonist U46619 and phenylephrine relative to those of left PAs from the same animal or those of control hosts. Conclusions Our studies are the first to identify enhanced reactivity of PAs in a lung contralateral to a localized high output shunt between an aorta and pulmonary artery. These observations suggest that patients with localized systemic-to-pulmonary shunt could exhibit modified vascular tone in remote pulmonary arteries. PMID:21075384

  19. Remote control of pulmonary blood flow: a dream comes true.

    PubMed

    Corno, Antonio F; Sekarski, Nicole; von Segesser, Ludwig K

    2002-07-27

    The indication for pulmonary artery banding is currently limited by several factors. Previous attempts have failed to produce adjustable pulmonary artery banding with reliable external regulation. An implantable, telemetrically controlled, battery-free device (FloWatch) developed by EndoArt SA, a medical company established in Lausanne, Switzerland, for externally adjustable pulmonary artery banding was evaluated on minipigs and proved to be effective for up to 6 months. The first human implant was performed on a girl with complete atrioventricular septal defect with unbalanced ventricles, large patent ductus arteriosus and pulmonary hypertension. At one month of age she underwent closure of the patent ductus arteriosus and FloWatch implantation around the pulmonary artery through conventional left thoracotomy. The surgical procedure was rapid and uneventful. During the entire postoperative period bedside adjustments (narrowing or release of pulmonary artery banding with echocardiographic assessment) were repeatedly required to maintain an adequate pressure gradient. The early clinical results demonstrated the clinical benefits of unlimited external telemetric adjustments. The next step will be a multi-centre clinical trial to confirm the early results and adapt therapeutic strategies to this promising technology. PMID:12428188

  20. [Lymph mobilization].

    PubMed

    Froneberg, W; Fabian, G

    1989-07-01

    Following a review of the literature lymph mobilization is described. Function and causalities of lymph mobilization and their interactions are explained giving examples and an evaluation of the experience available up to date. In many cases, manual neurotherapy may result in coordination and normalization of disorders which do not respond to other forms of therapy. PMID:2672664

  1. Anomalous origin of the left coronary artery from the pulmonary trunk: elucidation with colour Doppler flow mapping

    Microsoft Academic Search

    A B Houston; J C Pollock; W B Doig; J Gnanapragasam; M P Jamieson; S Lilley; E P Murtagh

    1990-01-01

    Four infants and children with anomalous connection of the left coronary artery to the pulmonary trunk were studied with colour Doppler flow mapping. In three the diagnosis was only suspected when the colour Doppler study showed dilated intraseptal and epicardial vessels and an abnormal flow signal into the pulmonary artery in diastole; this latter signal localised the exact site of

  2. [Lung cancer and lymph drainage].

    PubMed

    Riquet, M

    2007-01-01

    Lung cancer is lymphophile and may involve lymph nodes (LN) belonging to lung lymph drainage. LN metastases are figured within stations numbered 1 to 14. These stations are located along lymph vessels. The lymph vessels and the LN are forming together anatomical chains. Lymph vessels are valved and pulsatile and travel to the cervical venous confluence where they pour the lung lymph into the blood circulation. They may be totally or partly nodeless along their travel, anastomose with each other around the trachea, and connect with the thoracic duct within the mediastinum. Within the anatomical LN chains, LN are variable in number and in size from one individual to another. They may be absent from one or several stations of the international mapping. Stations are located along the anatomical chains: pulmonary ligament (9), tracheal bifurcation(8 and 7), right paratracheal (4R, 2R and 1), preaortic (5 and 6), left paratracheal (4L, 2L and 1). Station 3 is located on 2 differents chains (phrenic and right esophagotracheal). Station 10 are located at the beginning of the mediastinal lymph nodes chains. Each chain connects with the blood circulation, anastomoses with he neighbouring chains and behave as an own entity whatever the number of its LN. International station mapping misknowns this anatomy and occults the true pronostic value of lung lymph drainage. PMID:16928459

  3. Stochastic simulation of human pulmonary blood flow and transit time frequency distribution based on anatomic and elasticity data.

    PubMed

    Huang, Wei; Shi, Jun; Yen, R T

    2012-12-01

    The objective of our study was to develop a computing program for computing the transit time frequency distributions of red blood cell in human pulmonary circulation, based on our anatomic and elasticity data of blood vessels in human lung. A stochastic simulation model was introduced to simulate blood flow in human pulmonary circulation. In the stochastic simulation model, the connectivity data of pulmonary blood vessels in human lung was converted into a probability matrix. Based on this model, the transit time of red blood cell in human pulmonary circulation and the output blood pressure were studied. Additionally, the stochastic simulation model can be used to predict the changes of blood flow in human pulmonary circulation with the advantage of the lower computing cost and the higher flexibility. In conclusion, a stochastic simulation approach was introduced to simulate the blood flow in the hierarchical structure of a pulmonary circulation system, and to calculate the transit time distributions and the blood pressure outputs. PMID:23724431

  4. Flow characteristics of the proximal pulmonary arteries and vena cava in patients with chronic thromboembolic pulmonary hypertension: correlation between 3.0 T phase-contrast MRI and right heart catheterization

    PubMed Central

    Guo, Xiaojuan; Liu, Min; Ma, Zhanhong; Wang, Shuangkun; Yang, Yuanhua; Zhai, Zhenguo; Wang, Chen; Zhai, Renyou

    2014-01-01

    PURPOSE We aimed to determine the correlation between flow characteristics of the proximal pulmonary arteries and vena cava obtained by 3.0 T phase-contrast magnetic resonance imaging (MRI) and hemodynamic characteristics by right heart catheterization in patients with chronic thromboembolic pulmonary hypertension. MATERIALS AND METHODS Twenty consecutive patients with chronic thromboembolic pulmonary hypertension and 20 sex- and age-matched healthy volunteers were included prospectively. All patients and controls underwent phase-contrast MRI to determine the flow characteristics including peak velocity, mean velocity, and mean blood flow of the proximal pulmonary artery and vena cava. All patients underwent right heart catheterization to determine the hemodynamics. RESULTS Peak velocity and mean velocity of the proximal pulmonary artery were significantly lower in the patient group. In patients, both peak velocity and mean blood flow were sequentially decreased in the main pulmonary artery, left and right pulmonary arteries, and left and right interlobar pulmonary arteries. Inferior vena cava had higher peak velocity, mean velocity, and mean blood flow than superior vena cava. Peak velocity of the main pulmonary artery correlated with mean and diastolic pulmonary artery pressure. Peak velocity of both inferior and superior vena cava strongly correlated with the pulmonary vascular resistance index (PVRI) (r=?0.68, P < 0.001 and r=?0.74, P < 0.001, respectively). Mean velocity of the main pulmonary artery and right pulmonary artery strongly correlated with PVRI and mean pulmonary artery pressure. Mean velocity of the superior vena cava and mean blood flow of the main pulmonary artery strongly correlated with PVRI and right cardiac work index. CONCLUSION Blood flow in the proximal pulmonary artery and vena cava evaluated by phase-contrast MRI correlate with hemodynamic parameters of right heart catheterization and can be used to noninvasively evaluate the severity of chronic thromboembolic pulmonary hypertension and, potentially, to follow up the treatment response. PMID:25163757

  5. 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)

    Kassis, Timothy; Weiler, Michael J.; Dixon, J. Brandon

    2012-03-01

    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.

  6. Automated Measurement of Microcirculatory Blood Flow Velocity in Pulmonary Metastases of Rats

    PubMed Central

    Fontanella, Andrew N.; Palmer, Gregory M.; Boico, Alina; Min, Hooney; Dewhirst, Mark W.; Irwin, David C.; Zhao, Yulin; Schroeder, Thies

    2014-01-01

    Because the lung is a major target organ of metastatic disease, animal models to study the physiology of pulmonary metastases are of great importance. However, very few methods exist to date to investigate lung metastases in a dynamic fashion at the microcirculatory level, due to the difficulty to access the lung with a microscope. Here, an intravital microscopy method is presented to functionally image and quantify the microcirculation of superficial pulmonary metastases in rats, using a closed-chest pulmonary window and automated analysis of blood flow velocity and direction. The utility of this method is demonstrated to measure increases in blood flow velocity in response to pharmacological intervention, and to image the well-known tortuous vasculature of solid tumors. This is the first demonstration of intravital microscopy on pulmonary metastases in a closed-chest model. Because of its minimized invasiveness, as well as due to its relative ease and practicality, this technology has the potential to experience widespread use in laboratories that specialize on pulmonary tumor research. PMID:25490280

  7. Effects of posture on blood flow diversion by hypoxic pulmonary vasoconstriction in dogs

    NASA Technical Reports Server (NTRS)

    Walther, S. M.; Domino, K. B.; Hlastala, M. P.

    1998-01-01

    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.

  8. Flow velocity profile of the pulmonary artery measured by the continuous cardiac output monitoring catheter

    Microsoft Academic Search

    Keiko Miyasaka; Masao Takata; Katsuyuki Miyasaka MO

    1993-01-01

    The KATS catheter (continuous arterial thermodeprivation system catheter) measures the blood flow velocity of the pulmonary\\u000a artery (PA) by thermodeprivation which enables continuous determination of cardiac output. The accuracy of this system may\\u000a depend on the degree of uniformity of flow velocity in the PA, because small movements of the catheter within the PA are inevitable\\u000a with a beating heart.

  9. Status of systemic to pulmonary arterial collateral flow after the fontan procedure.

    PubMed

    Whitehead, Kevin K; Harris, Matthew A; Glatz, Andrew C; Gillespie, Matthew J; DiMaria, Michael V; Harrison, Neil E; Dori, Yoav; Keller, Marc S; Rome, Jonathan J; Fogel, Mark A

    2015-06-15

    The investigators recently validated a method of quantifying systemic-to-pulmonary arterial collateral flow using phase-contrast magnetic resonance imaging velocity mapping. Cross-sectional data suggest decreased collateral flow in patients with total cavopulmonary connections (TCPCs) compared with those with superior cavopulmonary connections (SCPCs). However, no studies have examined serial changes in collateral flow from SCPCs to TCPCs in the same patients. The aim of this study was to examine differences in collateral flow between patients with SCPCs and those with TCPCs. Collateral flow was quantified by 2 independent measures from 250 single-ventricle studies in 219 different patients (115 SCPC and 135 TCPC studies, 31 patients with both) and 18 controls, during routine studies using through-plane phase-contrast magnetic resonance imaging. Collateral flow was indexed to body surface area, aortic flow, and pulmonary venous flow. Regardless of indexing method, SCPC patients had significantly higher collateral flow than TCPC patients (1.64 ± 0.8 vs 1.03 ± 0.8 L/min/m(2), p <0.001). In 31 patients who underwent serial examinations, collateral flow as a fraction of aortic flow increased early after TCPC completion. In TCPC patients, indexed collateral flow demonstrated a significant negative correlation with time from TCPC. In conclusion, SCPC and TCPC patients demonstrate substantial collateral flow, with SCPC patients having higher collateral flow than TCPC patients overall. On the basis of the paired subset analysis, collateral flow does not decrease in the short term after TCPC completion and trends toward an increase. In the long term, however, collateral flow decreases over time after TCPC completion. PMID:25907503

  10. A computational approach to study the effect of multiple lymphangion coordination on lymph flow 

    E-print Network

    Madabushi Venugopal, Arun

    2005-11-01

    and ventricles ............................................................9 1.6 Ventricular pressure-volume loops .....................................................................10 1.7 Influence of preload and afterload on cardiac function... the effect of electrogenic and myogenic coupling of lymphangions on flow in a lymphatic vessel (28). Their model was based on time- varying elastance concept typically used to characterize ventricular contraction (19), and they assumed a representative...

  11. 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

    2014-01-01

    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

  12. Effect of Pulmonary Blood Flow on Lung Water and Pulmonary Hemodynamics in the Canine Lung Lobe

    Microsoft Academic Search

    K. Nakahara; S. Nanjo; A. Matsumura; Y. Kawashima

    1990-01-01

    The isolated left middle lobes of canine lungs were perfused in situ, by stepwise elevation of the blood flow. The weight gain of the lung lobe per initial bloodless dry lung weight (?w g\\/min·IdQl) showed a significant (p < 0.001) correlation with the blood flow per body weight (F, ml\\/min·kg) with a regression line of ?w = 8.3 × 10–4

  13. B-Flow Twinkling Sign in Preoperative Evaluation of Cervical Lymph Nodes in Patients with Papillary Thyroid Carcinoma

    PubMed Central

    Bianco, Andrea; Gasperi, Maurizio; Zeppa, Pio; Brunese, Luca

    2013-01-01

    Papillary thyroid cancer (PTC) is the most common histologic type of differentiated thyroid cancer. The first site of metastasis is the cervical lymph nodes (LNs). The ultrasonography (US) is the best diagnostic method for the detection of cervical metastatic LNs. We use a new technique, B-flow imaging (BFI), recently used for evaluation of thyroid nodules, to estimate the presence of BFI twinkling signs (BFI-TS), within metastatic LNs in patients with PTC. Two hundred and fifty-two patients with known PTC were examined for preoperative evaluation with conventional US and BFI. Only 83 with at least one metastatic LN were included. All patients included underwent surgery; the final diagnosis was based on the results of histology. The following LN characteristics were evaluated: shape, abnormal echogenicity, absent hilum, calcifications, cystic appearance, peripheral vascularization, and BFI-TS. A total of 604 LNs were analyzed. Of these, 298 were metastatic, according to histopathology. The BFI-TS showed high values of specificity (99.7%) and sensitivity (80.9%). The combination of each conventional US sign with the BF-TS increases the specificity. Our findings suggest that BFI can be helpful in the selection of suspicious neck LNs that should be examined at cytologic examination for accurate preoperative staging and individual therapy selection. PMID:23878537

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

    PubMed

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

    2014-10-01

    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

  15. Immediate change in pulmonary venous flow pattern after deployment of occluder device for atrial septal defect.

    PubMed

    Lin, Wei-Wen; Fu, Yun-Ching; Jan, Sheng-Ling; Wang, Kuo-Yang; Ho, Hung-Chin; Lin, Fang-Yi; Ting, Chih-Tai; Chen, Ying-Tsung

    2009-04-01

    Transcatheter closure of a secundum defect using a septal occluder is a safe and effective procedure based on long-term follow-up, but no clinical studies have examined immediate hemodynamic changes. We evaluated pulmonary venous flow velocity pattern before and immediately after deployment of the Amplatzer septal occluder for closure of atrial septal defect. From May 2003 to January 2005, 48 patients with secundum atrial septal defect received transcatheter closure with complete occlusion. Patients were divided into two groups according to age: pediatric group, under 16 years (n = 30, age 7.3 +/- 3.2 years), and adult group, 16 years or older (n = 18, age 30.1 +/- 11.4 years). Pulmonary venous flow pattern was recorded by transesophageal echocardiography before and immediately after occluder deployment. Immediately after deployment in both patient groups, pulmonary vein systolic (S) and diastolic (D) wave velocity decreased, but atrial reversal (AR) wave velocity increased. In the pediatric group, S-wave was 56.1 +/- 17.1 versus 35.5 +/- 11.3 cm/sec (P < 0.001); D-wave was 57.6 +/- 12.5 versus 42.9 +/- 11.8 cm/sec (P < 0.001); and AR wave velocity was 12.2 +/- 3.8 versus 15.5 +/- 4.1 cm/sec (P < 0.001). In the adult group, S-wave was 48.4 +/- 13.7 versus 32.7 +/- 10.3 cm/sec (P < 0.001); D-wave was 51.9 +/- 11.7 versus 38.0 +/- 8.5 m/sec (P < 0.001); and AR wave velocity was 12.1 +/- 4.1 versus 16.2 +/- 4.9 cm/sec (P < 0.001). Comparison of pulmonary venous flow before and immediately after deployment of the Amplatzer septal occluder provides an excellent model to evaluate the influence of an atrial communication on pulmonary venous flow. Pulmonary venous forward flow decreases following atrial septal defect (ASD) closure. PMID:19382945

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

    NASA Technical Reports Server (NTRS)

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

    1978-01-01

    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.

  17. Lymph pathways of the medial retropharyngeal lymph node in dogs.

    PubMed Central

    Belz, G T; Heath, T J

    1995-01-01

    In dogs, lymph drains from tissues throughout the head, including the tonsils, along lymphatic vessels to the facial, parotid, lateral retropharyngeal and mandibular lymph nodes. From the mandibular lymph nodes, lymph may flow to the ipsilateral medial retropharyngeal lymph nodes, or along anastomotic connections to the contralateral node. Afferent lymphatics convey lymph from these nodes to defined areas in the medial retropharyngeal nodes. They divide over the surface of the node, and within trabeculae. Terminal afferent lymphatics are connected to the subcapsular and trabecular sinuses either through circular or oval holes in the vessel wall, or terminate at the sinus where the vessel contains a valve adjacent to the point of entry. The subcapsular sinus surrounds the entire node, and is continuous with an interconnecting network of trabecular and cortical sinuses which convey lymph through the cortex. Connective tissue septa extend through the sinuses and lymph flows freely between adjacent sinuses through holes in the septal walls. Initial efferent lymphatic vessels, which arise from the medullary sinuses between medullary cords, converge towards and unite within the network of medullary trabeculae. Other vessels, which contain valve-like flaps, drain lymph from the subcapsular sinus. Efferent vessels emerge along the hilus and coalesce to form the tracheal trunk. The tracheal trunk has several layers of smooth muscle cells, well developed elastic laminae and connective tissue, surrounding the lymphatic endothelium. Images Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig. 18 PMID:7559125

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

    PubMed

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

    2013-10-01

    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

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

    SciTech Connect

    Morrison, D.; Caldwell, J.; Lakshminaryan, S.; Ritchie, J.L.; Kennedy, J.W.

    1983-10-01

    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.

  20. Redistribution of pulmonary blood flow during unilateral hypoxia in prone and supine dogs

    NASA Technical Reports Server (NTRS)

    Mann, C. M.; Domino, K. B.; Walther, S. M.; Glenny, R. W.; Polissar, N. L.; Hlastala, M. P.

    1998-01-01

    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.

  1. Pulmonary (cardio) diagnostic system for combat casualty care capable of extracting embedded characteristics of obstructive or restrictive flow

    NASA Astrophysics Data System (ADS)

    Allgood, Glenn O.; Treece, Dale A.; Pearce, Fred J.; Bentley, Timothy B.

    2000-08-01

    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.

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

    PubMed Central

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

    2012-01-01

    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

  3. An analysis of estimation of pulmonary blood flow by the single-breath method

    NASA Technical Reports Server (NTRS)

    Srinivasan, R.

    1986-01-01

    The single-breath method represents a simple noninvasive technique for the assessment of capillary blood flow across the lung. However, this method has not gained widespread acceptance, because its accuracy is still being questioned. A rigorous procedure is described for estimating pulmonary blood flow (PBF) using data obtained with the aid of the single-breath method. Attention is given to the minimization of data-processing errors in the presence of measurement errors and to questions regarding a correction for possible loss of CO2 in the lung tissue. It is pointed out that the estimations are based on the exact solution of the underlying differential equations which describe the dynamics of gas exchange in the lung. The reported study demonstrates the feasibility of obtaining highly reliable estimates of PBF from expiratory data in the presence of random measurement errors.

  4. Pulmonary intravascular blood volume changes through the cardiac cycle in healthy volunteers studied by cardiovascular magnetic resonance measurements of arterial and venous flow

    PubMed Central

    Ugander, Martin; Jense, Erik; Arheden, Hakan

    2009-01-01

    Background This study aims to present a novel method for using cardiovascular magnetic resonance (CMR) to non-invasively quantify the variation in pulmonary blood volume throughout the cardiac cycle in humans. Methods 10 healthy volunteers (7 males, 3 female, age range 21-32 years) were studied. The blood flow in the pulmonary artery and all pulmonary veins was quantified during free breathing using phase contrast velocity encoded CMR. The difference in flow between the pulmonary artery and the pulmonary veins was integrated to calculate the change in pulmonary blood volume throughout the cardiac cycle. Results The stroke volumes in the pulmonary artery and the sum of the pulmonary veins were (mean ± SEM) 103 ± 6 ml and 95 ± 6 ml, respectively. The pulmonary blood volume variation (PBVV) was 48 ± 5 ml, and the PBVV expressed as percent of the pulmonary artery stroke volume was 46 ± 3%. The maximum increase in pulmonary blood volume occurred 310 ± 12 ms after the R-wave from the ECG (32 ± 2% of the cardiac cycle). PBVV did not correlate to change in cross-sectional area in the pulmonary artery (R2 = 0.03, p = 0.66). Conclusion It is feasible to non-invasively quantify the change in pulmonary blood volume during the cardiac cycle in humans using CMR. The average pulmonary blood volume variation in healthy volunteers was approximately 50 ml and this was approximately 50% of the stroke volume. Further studies are needed to assess the utility of the pulmonary blood volume variation as a measure for identifying cardiac and pulmonary vascular disease. PMID:19878570

  5. Wood smoke inhalation increases pulmonary microvascular permeability

    SciTech Connect

    Nieman, G.F.; Clark, W.R. Jr.; Goyette, D.; Hart, A.K.; Bredenberg, C.E.

    1989-04-01

    The effect of wood smoke inhalation (SI) on pulmonary vascular permeability was studied in open-chested, anesthetized dogs. Animals were divided into two groups. A prenodal lymphatic vessel was cannulated in group I (n = 7), and baseline (BL) lung lymph flow (QL) and lymph (CL) and plasma (CP) protein concentrations were measured. The animals' lungs were then ventilated with wood smoke for 5 minutes. Left atrial pressure (Pla) was increased above baseline (mean 16.7 +/- 2.2 mm Hg), and the ratio of CL to CP was used to assess endothelial permeability at high lymph flows. There was little change in either QL (BL: 27 +/- 9; SI: 27 +/- 5 microliters/min) or CL/CP (BL: 0.76 +/- 0.03; SI: 0.74 +/- 0.02) after SI at normal Pla. Elevation of Pla caused a significant increase in QL (136 +/- 15 microliters/min), but CL/CP (0.67 +/- 0.02) failed to decrease significantly at high lymph flows. In group II (n = 15) total protein concentration of airway fluid was compared with that of plasma after smoke inhalation, intravenous alloxan, and increased Pla. The ratio of protein concentration in airway fluid to plasma after SI (0.70 +/- 0.07) was greater than that obtained with increased Pla (0.64 +/- 0.07) but less than that after alloxan (0.85 +/- 0.04). These data indicate that SI in the dog results in a moderate increase in pulmonary vascular permeability that is less severe than that induced by alloxan.

  6. In vivo support for the new concept of pulmonary blood flow-mediated CO2 gas excretion in the lungs.

    PubMed

    Kawai, Yoshiko; Ajima, Kumiko; Kaidoh, Maki; Sakaguchi, Masao; Tanaka, Satoshi; Kawamata, Mikito; Kimura, Hiroko; Ohhashi, Toshio

    2015-06-15

    To further examine the validity of the proposed concept of pulmonary blood flow-dependent CO2 gas excretion in the lungs, we investigated the effects of intramediastinal balloon catheterization-, pulmonary artery catheterization-, or isoprenaline (ISP)-induced changes in pulmonary blood flow on the end-expiratory CO2 gas pressure (PeCO2 ), the maximal velocity of the pulmonary artery (Max Vp), systemic arterial pressure, and heart rate of anesthetized rabbits. We also evaluated the changes in the PeCO2 in clinical models of anemia or pulmonary embolism. An almost linear relationship was detected between the PeCO2 and Max Vp. In an experiment in which small pulmonary arteries were subjected to stenosis, the PeCO2 fell rapidly, and the speed of the reduction was dependent on the degree of stenosis. ISP produced significant increases in the PeCO2 of the anesthetized rabbits. Conversely, treatment with piceatannol or acetazolamide induced significant reductions in the PeCO2 . Treatment with a cell surface F1/FO ATP synthase antibody caused significant reductions in the PeCO2 itself and the ISP-induced increase in the PeCO2 . Neither the PeCO2 nor SAP was significantly influenced by marked anemia [%hematocrit (Ht), 70?47%]. On the other hand, in the presence of less severe anemia (%Ht: 100?70%) both the PeCO2 and SAP fell significantly when the rabbits' blood viscosity was decreased. The rabbits in which pulmonary embolisms were induced demonstrated significantly reduced PeCO2 values, which was compatible with the lowering of their Max Vp. In conclusion, we reaffirm the validity of the proposed concept of CO2 gas exchange in the lungs. PMID:25888575

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

    PubMed Central

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

    2014-01-01

    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

  8. [Examining the lymph nodes].

    PubMed

    Buis, Jaap; de Jongh, Tjeerd O H

    2011-01-01

    Enlarged lymph nodes occur frequently and imply a benign or systematic disorder. In primary care, only 1% of patients with an unexplained lymphadenopathy have a malignancy. In the case of unexplained lymphadenopathy the most important diagnostic dilemma is whether biopsy should be applied. In young patients the necessity of lymph node biopsy can be accurately predicted using the following parameters: abnormal chest X-ray; lymph node > 2 cm and ear, nose and throat symptoms. In adults the necessity of biopsy may be reliably predicted using the following parameters: age; lymph node tenderness; lymph node size; consistency, presence of supraclavicular lymph nodes and generalised pruritus. PMID:21262028

  9. Effects of air stacking on pulmonary function and peak cough flow in patients with cervical spinal cord injury

    PubMed Central

    Jeong, Jong-hwa; Yoo, Won-gyu

    2015-01-01

    [Purpose] This study evaluated the effects of air stacking on pulmonary function and peak cough flow in patients with cervical spinal cord injury. [Subjects] Twenty-six patients were included in the study and were randomized into experimental (n = 14) and control (n = 12) groups. [Methods] Both groups performed therapeutic exercises: the control group performed incentive spirometry, while the experimental group performed 20 repetitions of air stacking exercise twice a day. The training for both groups continued for 5 days a week for 6 weeks. [Results] Forced vital capacity and peak cough flow increased significantly in the experimental group compared to the controls. All within-group variables in the experimental group differed significantly at 6 weeks compared to baseline, while in the control group only Forced vital capacity differed significantly at 6 weeks compared to baseline. [Conclusion] Air stacking exercise significantly improved pulmonary function and peak cough flow in patients with a cervical spinal cord injury. PMID:26180355

  10. A left anterior extrapleural approach to adjust right ventricle-pulmonary artery shunt flow using hemostatic clips after the norwood operation.

    PubMed

    Matsushima, Shunsuke; Oshima, Yoshihiro; Maruo, Ayako; Hasegawa, Tomomi; Matsuhisa, Hironori; Noda, Rei; Iwaki, Ryuma

    2015-06-01

    Adjusting right ventricle-pulmonary artery shunt flow with placement of hemostatic clips in the Norwood operation is a useful technique for precise control of pulmonary blood flow in the acute postoperative period. This report describes our technique for optimizing right ventricle-pulmonary artery shunt flow with metal clips through a left anterior extrapleural approach, which can be performed safely and minimally invasively without sternal reopening. This procedure may decrease morbidity and contribute to long-term clinical improvement in patients undergoing the Norwood operation. doi: 10.1111/jocs.12545 (J Card Surg 2015;30:532-534). PMID:25854923

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

    PubMed Central

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

    2015-01-01

    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. PMID:25878909

  12. Architecture of fibrin network inside thrombotic material obtained from the right atrium and pulmonary arteries: flow and location matter.

    PubMed

    Mazur, Piotr; Sobczy?ski, Robert; Z?bczyk, Micha?; Babiarczyk, Paulina; Sadowski, Jerzy; Undas, Anetta

    2013-01-01

    Pulmonary embolectomy is a treatment option in selected patients with high-risk pulmonary embolism (PE). Efficiency of thrombus degradation in PE largely depends on the architecture of its fibrin network, however little is known about its determinants. We present the case of a 56-year-old woman with high-risk PE and proximal deep-vein thrombosis, whose thrombotic material removed during embolectomy from the right atrium and pulmonary (lobar and segmental) arteries has been studied using scanning electron microscopy (SEM). SEM images showed that distally located thrombi are richer in densely-packed fibrin fibers and contain more white cells and less erythrocytes than the proximal ones and the atrial thrombus. Fibrin fibers alignment along the flow vector was observed in the thrombi removed from high-velocity flow pulmonary arteries, and not in the atrial thrombus. The content of denser fibrin network and platelet aggregates was increased in segmental thromboemboli. Our findings describe the relation between thrombus architecture and location, and might help to elucidate thrombus resistance to anticoagulant therapy in some PE patients. PMID:23080213

  13. Synchronization of pulmonary scintigraphy by respiratory flow and by impedance plethysmography

    NASA Astrophysics Data System (ADS)

    Guivarc'h, Olivier; Turzo, Alexandre; Visvikis, Dimitris; Bizais, Yves

    2004-05-01

    Image blurring as a result of patient motion, including organ movement, can cause loss of sensitivity in the detection of disease. The use of gated protocols using external signals to synchronize the acquisition with the motion of the organ of interest may provide a solution. Although such a solution has been implemented in cardiac imaging, the implementation of respiratory gating is more challenging considering the irregular nature of respiratory motion. In this work we investigated the use of two different physiological signals; namely respiratory flow and impedance plethysmography for synchronization of pulmonary scintigraphy with respiratory motion. An acquisition and post-processing signal interface was developed using LabVIEW in order to allow detection and comparison of the two signals for the same patient. Methodology was also developed for the rejection of irregular respiratory cycles based on mean amplitude, overall cycle duration and the cycle inspiration to expiration duration ratio (I/E). Rejection criteria based on tidal volume were also examined using the respiratory flow signal. Our data demonstrate that the two respiratory signals investigated are equivalent with only a phase shift difference present. In the case of respiratory flow, irregular cycles were rejected by setting acceptance limits at 40% and 30% around the mean for the I/E and the amplitude or duration of the cycle respectively. In the case of impedance plethysmography a limit of 50% for all rejection criteria was found to be optimum. Finally, a dynamic acquisition protocol was developed and tested providing synchronized scintigraphic images using both types of recorded respiratory signals.

  14. Evaluation of Left Ventricular Diastolic Function in Coronary Artery Disease by Transthoracic Doppler Ultrasound Measurement of Mitral and Pulmonary Venous Flow Velocities

    Microsoft Academic Search

    Hui-Kyung Jeon; Ho-Joong Youn; Ki-Dong Yoo; Ji-Won Park; Doo-Soo Jeon; Wook-Sung Chung; Jang-Seong Chae; Jae-Hyung Kim; Kyu-Bo Choi; Soon-Jo Hong

    1998-01-01

    Background:A widened left atrial pressure A wave occurs when left ventricular end-diastolic pressure is increased. It has been reported that increased duration of pulmonary venous flow reversal at atrial systole might be a marker for elevated left ventricular end-diastolic pressure. Decreased systolic pulmonary venous flow is shown to be related to increased left ventricular filling pressure in studies using transesophageal

  15. Pulmonary venous flows reflect changes in left atrial hemodynamics during mitral balloon valvotomy

    NASA Technical Reports Server (NTRS)

    Yalcin, Fatih; El-Amrousy, Mahmoud; Muderrisoglu, Haldun; Korkmaz, Mehmet; Flachskampf, Frank; Tuzcu, Murat; Garcia, Mario G.; Thomas, James D.

    2002-01-01

    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.

  16. Noninvasive assessment of left atrial maximum dP/dt by a combination of transmitral and pulmonary venous flow

    NASA Technical Reports Server (NTRS)

    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.

    1999-01-01

    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.

  17. Epitrochlear Lymph Node Dissection

    Microsoft Academic Search

    Steven N. Hochwald; Nicole Kissane; Stephen R. Grobmyer; James Lopes

    2011-01-01

    Epitrochlear node involvement occurs in a small minority of patients with forearm or hand melanoma. Although in-transit sentinel\\u000a lymph nodes are identified infrequently, they contain metastatic disease at nearly the same frequency as sentinel lymph nodes\\u000a in cervical, axillary, and inguinal nodal basins. Positive in-transit sentinel lymph nodes are likely to be the only site\\u000a of nodal metastasis. Therefore, detailed

  18. Effect of ablated bronchial blood flow on survival rate and pulmonary function after burn and smoke inhalation in sheep

    PubMed Central

    Hamahata, Atsumori; Enkhbaatar, Perenlei; Hiroyuki, Sakurai; Nozaki, Motohiro; Traber, Daniel L.

    2009-01-01

    The bronchial circulation plays a significant role in the pathophysiological changes of burn and smoke inhalation injury. There is a marked increase in bronchial blood flow immediately after inhalation injury. In this study we examine the ablation of bronchial artery will attenuate the pathophysiological changes and improve survival rate after burn and smoke inhalation injury in ovine model. Acute lung injury was induced by 40% total body surface area 3rd degree cutaneous burn and cotton smoke (48 breaths of cotton smoke, <40°C) under deep anesthesia. Twelve adult female sheep were divided into two groups: 1) Sham (injured, not ablated bronchial artery, n=6); 2) Ablation (injured, ablated bronchial artery, n=6). Ablation of bronchial artery was performed 72h before-injury. The experiment was continued for 96h. Burn and smoke inhalation injury significantly increased the regional blood flow in Bronchi. Ablation of bronchial artery significantly reduced the acute regional blood flow increase in proximal and distal bronchi. All animals in the ablation group survived until 96h. Four of them were successfully weaned from the ventilator. Three of sham group animals met euthanasia criteria at 60h and one of them met the criteria at 78h. The lung wet/dry weight ratio, the histology score, and myeloperoxidase activity were significantly increased by the insult, but ablation of bronchial artery attenuated these changes. Burn and smoke inhalation injury induced a significant increase in bronchial blood flow and accelerated airway obstruction, pulmonary vascular changes, pulmonary edema and pulmonary dysfunction. The ablated bronchial circulation attenuated these pathophysiological changes. PMID:19303716

  19. Comparison of Lateral Flow Technology and Galactomannan and (1?3)-?-d-Glucan Assays for Detection of Invasive Pulmonary Aspergillosis ?

    PubMed Central

    Wiederhold, Nathan P.; Thornton, Christopher R.; Najvar, Laura K.; Kirkpatrick, William R.; Bocanegra, Rosie; Patterson, Thomas F.

    2009-01-01

    We compared a lateral flow device to galactomannan and (1?3)-?-d-glucan assays to detect invasive aspergillosis in an established guinea pig model of pulmonary disease. The lateral flow device became positive earlier (day 3) than the (1?3)-?-d-glucan and galactomannan assays (day 5), with all samples positive by each assay on day 7. PMID:19793899

  20. Pulmonary angiography

    MedlinePLUS

    ... narrowing of the pulmonary vessels Pulmonary artery aneurysms Pulmonary hypertension -- high blood pressure in the arteries of the ... the lungs (pulmonary embolism) Narrowed blood vessel Primary pulmonary hypertension Tumor in the lung

  1. Reperfusion pulmonary edema

    SciTech Connect

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

    1989-02-17

    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.

  2. Small airway dysfunction and flow and volume bronchodilator responsiveness in patients with chronic obstructive pulmonary disease

    PubMed Central

    Pisi, Roberta; Aiello, Marina; Zanini, Andrea; Tzani, Panagiota; Paleari, Davide; Marangio, Emilio; Spanevello, Antonio; Nicolini, Gabriele; Chetta, Alfredo

    2015-01-01

    Background We investigated whether a relationship between small airways dysfunction and bronchodilator responsiveness exists in patients with chronic obstructive pulmonary disease (COPD). Methods We studied 100 (20 female; mean age: 68±10 years) patients with COPD (forced expiratory volume in 1 second [FEV1]: 55% pred ±21%; FEV1/forced vital capacity [FVC]: 53%±10%) by impulse oscillometry system. Resistance at 5 Hz and 20 Hz (R5 and R20, in kPa·s·L?1) and the fall in resistance from 5 Hz to 20 Hz (R5 – R20) were used as indices of total, proximal, and peripheral airway resistance; reactance at 5 Hz (X5, in kPa·s·L?1) was also measured. Significant response to bronchodilator (salbutamol 400 ?g) was expressed as absolute (?0.2 L) and percentage (?12%) change relative to the prebronchodilator value of FEV1 (flow responders, FRs) and FVC (volume responders, VRs). Results Eighty out of 100 participants had R5 – R20 >0.03 kPa·s·L?1 (> upper normal limit) and, compared to patients with R5 – R20 ?0.030 kPa·s·L?1, showed a poorer health status, lower values of FEV1, FVC, FEV1/FVC, and X5, along with higher values of residual volume/total lung capacity and R5 (P<0.05 for all comparisons). Compared to the 69 nonresponders and the 8 FRs, the 16 VRs had significantly higher R5 and R5 – R20 values (P<0.05), lower X5 values (P<0.05), and greater airflow obstruction and lung hyperinflation. Conclusion This study shows that peripheral airway resistance is increased in the vast majority of patients with COPD, who showed worse respiratory reactance, worse spirometry results, more severe lung hyperinflation, and poorer health status. Small airway dysfunction was also associated with the bronchodilator responsiveness in terms of FVC, but not in terms of FEV1. PMID:26150710

  3. Effects of polycations on pulmonary vascular permeability in conscious sheep.

    PubMed Central

    Toyofuku, T; Koyama, S; Kobayashi, T; Kusama, S; Ueda, G

    1989-01-01

    The role of charged sites on the permeability characteristics of the pulmonary microvascular barrier were investigated using chronically instrumented unanesthetized sheep. In one series of experiments we studied the effects of the cationic amphiphile, dodecyl trimethylamine (DTA; 297 mol wt), and the anionic amphiphile, SDS (288 mol wt), on lung lymph flow rates (Ql), lung lymph to plasma protein ratios (L/P), pulmonary hemodynamics, and systemic hemodynamics. DTA significantly increased both Ql and L/P, whereas SDS had a more modest and transient effect on these variables. In a second series of experiments the polycations polybrene and poly-l-lysine were found to have very similar effects as those of DTA. In another series of experiments we tested the pretreatment inhibition potential of chlorpheniramine (an H1 receptor antagonist), dibutyryl-cyclic AMP (db-cAMP), and the calcium channel antagonists verapamil and nifedipine on polybrene-induced lung injury. We found that only verapamil and db-cAMP significantly attenuated the permeability effects of polybrene. We conclude that both cationic amphiphiles and polycations cause hemodynamic and permeability alterations in the pulmonary circulation of unanesthetized sheep. In addition, the permeability alterations induced by polybrene can be modulated by intracellular calcium and/or cAMP levels. PMID:2542380

  4. Effects of propofol on pulmonary and systemic arterial pressure-flow relationships in hyperoxic and hypoxic dogs.

    PubMed

    Naeije, R; Lejeune, P; Leeman, M; Melot, C; Deloof, T

    1989-05-01

    We have investigated the effects of a continuous infusion (18 mg kg-1 h-1) of the aqueous emulsion formulation of propofol on mean pulmonary arterial (PAP)/cardiac output (O) and mean systemic arterial pressure (SAP)/Q relationships in 15 intact pentobarbitone-anaesthetized dogs subjected to hyperoxia (F/O2 0.4) and hypoxia (F/O2 0.1). Five-point PAP/Q and SAP/Q plots were obtained by opening an arterio-venous femoral fistula or by stepwise inflations of an inferior vena cava balloon. Over the range of Q studied (2-5 litre min-1), hypoxia increased PAP in eight dogs ("responders") and did not affect PAP in seven others ("non-responders"). Hypoxic pulmonary vasoconstriction (HPV) was restored in non-responders by the administration of acetylsalicylic acid (ASA) 1 g i.v. Hypoxia did not affect SAP over the range of Q studied in the responders or in the non-responders treated with ASA. Propofol had no effect on hyperoxic or on hypoxic PAP at all values of Q either in responders or in non-responders with HPV restored by ASA. Propofol did not change Q at uncontrolled flow, but decreased SAP at the lowest Q (2 and 3 litre min-1) during hyperoxia and at all values of Q during hypoxia. The systemic vascular effects were the same in animals of both groups, treated with ASA or not. We conclude that propofol does not influence pulmonary vascular tone and does not inhibit HPV, but reduces systemic vascular tone when venous return or oxygenation is decreased. The haemodynamic response to propofol was not affected by cyclo-oxygenase inhibition. PMID:2786423

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

    PubMed Central

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

    2012-01-01

    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

  6. Calculating blood flow from Doppler measurements in the systemic-to-pulmonary artery shunt after the Norwood operation: a method based on computational fluid dynamics

    Microsoft Academic Search

    Francesco Migliavacca; Robert Yates; Giancarlo Pennati; Gabriele Dubini; Roberto Fumero; Marc R. de Leval

    2000-01-01

    Hypoplastic left heart syndrome is currently the most lethal cardiac malformation of the newborn infant. Survival following a Norwood operation depends on the balance between systemic and pulmonary blood flow, which is highly dependent on the fluid dynamics through the interposition shunt between the two circulations. We used computational fluid dynamic (CFD) models to determine the velocity profile in a

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

    PubMed Central

    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.

    2008-01-01

    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

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

    PubMed Central

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

    1970-01-01

    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

  9. Pulmonary Hypertension

    MedlinePLUS

    ... page from the NHLBI on Twitter. What Is Pulmonary Hypertension? Pulmonary hypertension (PULL-mun-ary HI-per-TEN-shun), or ... symptoms. Rate This Content: NEXT >> August 2, 2011 Pulmonary Hypertension Clinical Trials Clinical trials are research studies that ...

  10. Pulmonary Rehabilitation

    MedlinePLUS

    ... 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 ...

  11. Pulmonary Rehabilitation

    MedlinePLUS

    ... disease can benefit as well. What is Pulmonary Rehabilitation? Pulmonary rehabilitation is a program of education and ... to take? How much time does a Pulmonary Rehabilitation Program take? The amount of time it takes ...

  12. Flow and particle dispersion in a pulmonary alveolus--part II: effect of gravity on particle transport.

    PubMed

    Chhabra, Sudhaker; Prasad, Ajay K

    2010-05-01

    The acinar region of the human lung comprises about 300x10(6) alveoli, which are responsible for gas exchange between the lung and the blood. As discussed in Part I (Chhabra and Prasad, "Flow and Particle Dispersion in a Pulmonary Alveolus-Part I: Velocity Measurements and Convective Particle Transport," ASME J. Biomech. Eng., 132, p. 051009), the deposition of aerosols in the acinar region can either be detrimental to gas exchange (as in the case of harmful particulate matter) or beneficial (as in the case of inhalable pharmaceuticals). We measured the flow field inside an in-vitro model of a single alveolus mounted on a bronchiole and calculated the transport and deposition of massless particles in Part I. This paper focuses on the transport and deposition of finite-sized particles ranging from 0.25 microm to 4 microm under the combined influence of flow-induced advection (computed from velocity maps obtained by particle image velocimetry) and gravitational settling. Particles were introduced during the first inhalation cycle and their trajectories and deposition statistics were calculated for subsequent cycles for three different particle sizes (0.25 microm, 1 microm, and 4 microm) and three alveolar orientations. The key outcome of the study is that particles or=4 microm is dominated by gravitational settling and shows little effect of fluid advection. Additionally, small and midsize particles deposit at about two-thirds height in the alveolus irrespective of the gravitational orientation whereas the deposition of large particles is governed primarily by the orientation of the gravity vector. PMID:20459211

  13. Nasal high-flow oxygen therapy system for improving sleep-related hypoventilation in chronic obstructive pulmonary disease: a case report

    PubMed Central

    2014-01-01

    Introduction Sleep-related hypoventilation should be considered in patients with chronic obstructive pulmonary disease, because appropriate respiratory management during sleep is important for preventing elevation of PaCO2 levels. A nasal high-flow oxygen therapy system using a special nasal cannula can deliver suitably heated and humidified oxygen at up to 60 L/min. Since the oxygen concentration remains a constant independent of minute ventilation, this system is particularly useful in patients with chronic obstructive pulmonary disease who have hypercapnia. This is the first report of sleep-related hypoventilation with chronic obstructive pulmonary disease improving using a nasal high-flow oxygen therapy system. Case presentation We report the case of a 73-year-old Japanese female who started noninvasive positive-pressure ventilation for acute exacerbation of chronic obstructive pulmonary disease and CO2 narcosis due to respiratory infection. Since she became agitated as her level of consciousness improved, she was switched to a nasal high-flow oxygen therapy system. When a repeat polysomnography was performed while using the nasal high-flow oxygen therapy system, the Apnea Hypopnea Index was 3.7 times/h, her mean SpO2 had increased from 89 to 93%, percentage time with SpO2 ? 90% had decreased dramatically from 30.8 to 2.5%, and sleep stage 4 was now detected for 38.5 minutes. As these findings indicated marked improvements in sleep-related hypoventilation, nasal high-flow oxygen therapy was continued at home. She has since experienced no recurrences of CO2 narcosis and has been able to continue home treatment. Conclusions Use of a nasal high-flow oxygen therapy system proved effective in delivering a prescribed concentration of oxygen from the time of acute exacerbation until returning home in a patient with chronic obstructive pulmonary disease, dementia and sleep-related hypoventilation. The nasal high-flow oxygen therapy system is currently used as a device to administer high concentrations of oxygen in many patients with type I respiratory failure, but may also be useful instead of a Venturi mask in patients like ours with type II respiratory failure, additionally providing some positive end-expiratory pressure. PMID:25312578

  14. Quantification of pulmonary blood flow (PBF): validation of perfusion MRI and nonlinear contrast agent (CA) dose correction with H(2)15O positron emission tomography (PET)

    Microsoft Academic Search

    Daniel Neeb; Rainer Peter Kunz; Sebastian Ley; Gabor Szabo; Ludwig G. Strauss; Hans-Ulrich Kauczor; Karl-Friedrich Kreitner; Laura Maria Schreiber

    2009-01-01

    Validation of quantification of pulmonary blood flow (PBF) with dynamic, contrast-enhanced MRI is still missing. A possible reason certainly lies in difficulties based on the nonlinear dependence of signal intensity (SI) from contrast agent (CA) concentration. Both aspects were addressed in this study. Nine healthy pigs were examined by first-pass perfusion MRI using gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) and H(2)(15)O

  15. Effects of pulmonary and intercostal denervation on the response of breathing frequency to varying inspiratory flow

    Microsoft Academic Search

    I. Mitrouska; Z. Bshouty; M. Younes; D. Georgopoulos

    1998-01-01

    In mechanically ventilated awake and sleeping humans, it has been shown that increasing inspiratory flow rate (V'I) exerted a reflex excitatory effect on respiratory output. Mechanoreceptors located in intercostal muscles or within the lung have been suggested as possible pathways that may mediate the excitatory effect of V'I. To test this, five patients with bilateral lung transplantation (LTP) and eight

  16. Pulmonary valve stenosis

    MedlinePLUS

    ... 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 ...

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

    PubMed Central

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

    2012-01-01

    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

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

    NSDL National Science Digital Library

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

    2001-06-01

    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?"

  19. Pulmonary and heart diseases with inhalation of atmospheric pressure plasma flow

    NASA Astrophysics Data System (ADS)

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

    2012-10-01

    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.

  20. Pulmonary embolus

    MedlinePLUS

    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 ...

  1. Mediastinal lymph node metastasis model by orthotopic intrapulmonary implantation of Lewis lung carcinoma cells in mice

    Microsoft Academic Search

    Y Doki; K Murakami; T Yamaura; S Sugiyama; T Misaki; I Saiki

    1999-01-01

    This study is designed to establish a pulmonary tumour model to investigate the biology and therapy of lung cancer in mice. Current methods for forming a solitary intrapulmonary nodule and subsequent metastasis to mediastinal lymph nodes are not well defined. Lewis lung carcinoma (LLC) cell suspensions were orthotopically introduced into the lung parenchyma of C57\\/BL6 mice via a limited skin

  2. Pulmonary vasculitis.

    PubMed

    Lally, Lindsay; Spiera, Robert F

    2015-05-01

    Pulmonary vasculitis encompasses inflammation in the pulmonary vasculature with involved vessels varying in caliber from large elastic arteries to capillaries. Small pulmonary capillaries are the vessels most commonly involved in vasculitis affecting the lung. The antineutrophil cytoplasmic antibody-associated vasculitides, which include granulomatosis with polyangiitis (formerly Wegener granulomatosis), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome), are the small vessel vasculitides in which pulmonary vasculitis is most frequently observed and are the major focus of this review. Vasculitic involvement of the large pulmonary vessels as may occur in Behçet syndrome and Takayasu arteritis is also discussed. PMID:25836645

  3. [Changes of dynamics of the lymph production after the cannulation of the thoracic duct].

    PubMed

    Rozhkov, A G; Karandin, V I; Perekhodov, S N; Tsarev, M I; Nagaev, R M

    2010-06-01

    An adequate cannulation of the thoracic duct is always accompanied with appropriate dynamics of the lymph production. As a result, the daily output of lymph increases from 2.0 to 2.2 times during 4-5 days. To find out the reasons of the lymph production changes were examined 57 patients with acute purulent inflammatory diseases of abdominal and thoracic organs. It was determined that the lymph production change is conditioned by 2 factors: the first is the stopping of the flow into venous vessels via lympho-venous anastomosies of the thoracic duct, lymphatic trunks and large lymphatic vessels. It leads to a mobilization of the greater part of lymph in lymphatic vessels. The second is the speeding-up of lymph production. PMID:20731090

  4. Pulmonary Fibrosis

    MedlinePLUS

    ... may not get enough oxygen. Causes of pulmonary fibrosis include environmental pollutants, some medicines, some connective tissue diseases, and interstitial lung disease. Interstitial lung disease is the name ...

  5. Semi-automatic central-chest lymph-node definition from 3D MDCT images

    NASA Astrophysics Data System (ADS)

    Lu, Kongkuo; Higgins, William E.

    2010-03-01

    Central-chest lymph nodes play a vital role in lung-cancer staging. The three-dimensional (3D) definition of lymph nodes from multidetector computed-tomography (MDCT) images, however, remains an open problem. This is because of the limitations in the MDCT imaging of soft-tissue structures and the complicated phenomena that influence the appearance of a lymph node in an MDCT image. In the past, we have made significant efforts toward developing (1) live-wire-based segmentation methods for defining 2D and 3D chest structures and (2) a computer-based system for automatic definition and interactive visualization of the Mountain central-chest lymph-node stations. Based on these works, we propose new single-click and single-section live-wire methods for segmenting central-chest lymph nodes. The single-click live wire only requires the user to select an object pixel on one 2D MDCT section and is designed for typical lymph nodes. The single-section live wire requires the user to process one selected 2D section using standard 2D live wire, but it is more robust. We applied these methods to the segmentation of 20 lymph nodes from two human MDCT chest scans (10 per scan) drawn from our ground-truth database. The single-click live wire segmented 75% of the selected nodes successfully and reproducibly, while the success rate for the single-section live wire was 85%. We are able to segment the remaining nodes, using our previously derived (but more interaction intense) 2D live-wire method incorporated in our lymph-node analysis system. Both proposed methods are reliable and applicable to a wide range of pulmonary lymph nodes.

  6. Lymph node dissection – understanding the immunological function of lymph nodes

    PubMed Central

    Buettner, M; Bode, U

    2012-01-01

    Lymph nodes (LN) are one of the important sites in the body where immune responses to pathogenic antigens are initiated. This immunological function induced by cells within the LN is an extensive area of research. To clarify the general function of LN, to identify cell populations within the lymphatic system and to describe the regeneration of the lymph vessels, the experimental surgical technique of LN dissection has been established in various animal models. In this review different research areas in which LN dissection is used as an experimental tool will be highlighted. These include regeneration studies, immunological analysis and studies with clinical questions. LN were dissected in order to analyse the different cell subsets of the incoming lymph in detail. Furthermore, LN were identified as the place where the induction of an antigen-specific response occurs and, more significantly, where this immune response is regulated. During bacterial infection LN, as a filter of the lymph system, play a life-saving role. In addition, LN are essential for the induction of tolerance against harmless antigens, because tolerance could not be induced in LN-resected animals. Thus, the technique of LN dissection is an excellent and simple method to identify the important role of LN in immune responses, tolerance and infection. PMID:22861359

  7. Sentinel lymph node biopsy alone without axillary lymph node dissection – follow up of sentinel lymph node negative breast cancer patients

    Microsoft Academic Search

    R Reitsamer; F Peintinger; E Prokop; C Menzel; W Cimpoca; L Rettenbacher

    2003-01-01

    Aims: To evaluate the rate of axillary recurrences in sentinel lymph node (SLN) negative breast cancer patients after sentinel lymph node biopsy (SLNB) alone without further axillary lymph node dissection (ALND).Methods: Between May 1999 and February 2001 all patients who had primary invasive breast cancer and were SLN negative were eligible for this prospective study. SLNB was performed by using

  8. Appropriate lymph node dissection for early gastric cancer based on lymph node metastases

    Microsoft Academic Search

    Chikara Kunisaki; Hiroshi Shimada; Masato Nomura; Hirotoshi Akiyama

    2001-01-01

    Background. Lymph node dissection in patients with early gastric cancer is controversial because lymph node metastases are much less common than in advanced cancer. Therefore, routine extensive lymph node dissection with wide resection of the stomach may be excessive, and an appropriate lymph node dissection procedure in patients with early gastric cancer should be established. Methods. Retrospectively, 588 consecutive patients

  9. Sentinel lymph node detection ex vivo using

    E-print Network

    Wang, Lihong

    - tinel lymph nodes in breast cancer staging in vivo. © 2008 Society of Photo-Optical Instrumentation biopsy; breast cancer; axillary lymph node dissection; speckle contrast; acoustic bursts. Paper 07492LRSentinel lymph node detection ex vivo using ultrasound-modulated optical tomography Chulhong Kim

  10. Noninvasive Photoacoustic and Fluorescence Sentinel Lymph Node

    E-print Network

    Wang, Lihong

    nodes and the blood- stream, leading to a wider spread of the cancer. The closest lymph node that drainsNoninvasive Photoacoustic and Fluorescence Sentinel Lymph Node Identification using Dye the lymphatic system. Cancer cells that migrate from the primary tumor may become lodged in the first lymph

  11. EFFECTS OF INHALED HEXACHLOROBENZENE AEROSOLS ON RAT PULMONARY HOST DEFENSES

    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, ...

  12. Pulmonary Embolism

    MedlinePLUS

    ... is a sudden blockage in a lung artery. The cause is usually a blood clot in the leg called a deep vein thrombosis that breaks loose and travels through the bloodstream to the lung. Pulmonary embolism is a ...

  13. Visualising lymph movement in anuran amphibians with computed tomography.

    PubMed

    Hedrick, Michael S; Hansen, Kasper; Wang, Tobias; Lauridsen, Henrik; Thygesen, Jesper; Pedersen, Michael

    2014-09-01

    Lymph flux rates in anuran amphibians are high relative to those of other vertebrates owing to 'leaky' capillaries and a high interstitial compliance. Lymph movement is accomplished primarily by specialised lymph muscles and lung ventilation that move lymph through highly compartmentalised lymph sacs to the dorsally located lymph hearts, which are responsible for pumping lymph into the circulatory system; however, it is unclear how lymph reaches the lymph hearts. We used computed tomography (CT) to visualise an iodinated contrast agent, injected into various lymph sacs, through the lymph system in cane toads (Rhinella marina). We observed vertical movement of contrast agent from lymph sacs as predicted, but the precise pathways were sometimes unexpected. These visual results confirm predictions regarding lymph movement, but also provide some novel findings regarding the pathways for lymph movement and establish CT as a useful technique for visualising lymph movement in amphibians. PMID:25165132

  14. Lymph node staging in prostate cancer.

    PubMed

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

    2015-05-01

    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

  15. Idiopathic Pulmonary Fibrosis

    MedlinePLUS

    ... Related Topics How the Lungs Work Lung Transplant Pulmonary Hypertension Pulmonary Rehabilitation Respiratory Failure Send a link to ... is respiratory failure . Other causes of death include pulmonary hypertension (HI-per-TEN-shun), heart failure , pulmonary embolism ( ...

  16. Minimal risk of macrometastases in the non-sentinel axillary lymph nodes in breast cancer patients with micrometastatic sentinel lymph nodes and preoperatively ultrasonically uninvolved axillary lymph nodes

    Microsoft Academic Search

    Janez Zgajnar; Nikola Besic; Maja Podkrajsek; Kristijana Hertl; Snjezana Frkovic-Grazio; Marko Hocevar

    2005-01-01

    Micrometastases in the sentinel lymph node (SLN) carry a considerable risk of macrometastases in the non-sentinel lymph nodes (NSLN), resulting in axillary lymph node dissection (ALND). Preoperative ultrasound (US) examination of the axillary lymph nodes combined with a fine-needle aspiration biopsy (FNAB) has been proved to discover metastases in the axillary lymph nodes. The aim of our study was to

  17. 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

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

    1996-01-01

    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

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

    PubMed Central

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

    2013-01-01

    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

  19. Histopathology of the Lymph Nodes

    PubMed Central

    Elmore, Susan A.

    2007-01-01

    Lymph nodes function as filters of tissues and tissue fluids and are sites of origin and production of lymphocytes for normal physiological functions. As part of this normal function, they react to both endogenous and exogenous substances with a variety of specific morphological and functional responses. Lesions can be both proliferative and nonproliferative, and can be treatment-related or not. The histological evaluation of lymph nodes is necessary in order to understand the immunotoxic effects of chemicals with the resulting data providing an important component of human risk assessment. It is the challenge of the toxicologic pathologist to interpret the pathology data within the complete clinical evaluation of the entire animal. Daily insults, ageing and toxins can alter the normal histology and primary function of lymph nodes. Therefore it is important to distinguish and differentiate lesions that occur naturally during normal development and ageing from those that are induced by xenobiotics. To achieve this goal, comparison with strain- age- and sex-matched controls is crucial. PMID:17067938

  20. DEC-205 expression on migrating dendritic cells in afferent lymph.

    PubMed

    Gliddon, Daniel R; Hope, Jayne C; Brooke, Gareth P; Howard, Christopher J

    2004-03-01

    Previous studies have identified a 210 000-molecular weight molecule expressed at a high level on the surface of dendritic cells (DCs) in afferent lymph of cattle and evident on cells with the morphology of DCs in lymphoid tissues. Expression is either absent from other immune cells or is present at a lower level. The molecular weight and cellular distribution suggested that the molecule, called bovine WC6 antigen (workshop cluster), might be an orthologue of human DEC-205 (CD205). To establish whether this was the case, the open reading frame of bovine DEC-205 was amplified, by polymerase chain reaction, from thymic cDNA (accession no. AY264845). The cDNA sequence of bovine DEC-205 had 86% and 78% nucleic acid identity with human and mouse molecules, respectively. COS-7 cells transfected with a plasmid containing the cattle DEC-205 coding region expressed a molecule that stained with WC6-specific monoclonal antibody, showing that ruminant WC6 is an orthologue of DEC-205. Two-colour flow cytometry of mononuclear cells from afferent lymph draining cattle skin, and from blood, confirmed the high level of expression on large cells in lymph that were uniformly DC-LAMP positive and major histocompatibility complex class II positive. Within this DEC-205+ DC-LAMP+ population were subpopulations of cells that expressed the mannose receptor or SIRPalpha. The observations imply that DCs in afferent lymph are all DEC-205high, but not a uniform population of homogeneous mature DCs. PMID:15009426

  1. A novel bioreactor for mechanobiological studies of engineered heart valve tissue formation under pulmonary arterial physiological flow conditions.

    PubMed

    Ramaswamy, Sharan; Boronyak, Steven M; Le, Trung; Holmes, Andrew; Sotiropoulos, Fotis; Sacks, Michael S

    2014-12-01

    The ability to replicate physiological hemodynamic conditions during in vitro tissue development has been recognized as an important aspect in the development and in vitro assessment of engineered heart valve tissues. Moreover, we have demonstrated that studies aiming to understand mechanical conditioning require separation of the major heart valve deformation loading modes: flow, stretch, and flexure (FSF) (Sacks et al., 2009, "Bioengineering Challenges for Heart Valve Tissue Engineering," Annu. Rev. Biomed. Eng., 11(1), pp. 289-313). To achieve these goals in a novel bioreactor design, we utilized a cylindrical conduit configuration for the conditioning chamber to allow for higher fluid velocities, translating to higher shear stresses on the in situ tissue specimens while retaining laminar flow conditions. Moving boundary computational fluid dynamic (CFD) simulations were performed to predict the flow field under combined cyclic flexure and steady flow (cyclic-flex-flow) states using various combinations of flow rate, and media viscosity. The device was successfully constructed and tested for incubator housing, gas exchange, and sterility. In addition, we performed a pilot experiment using biodegradable polymer scaffolds seeded with bone marrow derived stem cells (BMSCs) at a seeding density of 5 × 10(6) cells/cm(2). The constructs were subjected to combined cyclic flexure (1 Hz frequency) and steady flow (Re = 1376; flow rate of 1.06 l/min (LPM); shear stress in the range of 0-9 dynes/cm(2) for 2 weeks to permit physiological shear stress conditions. Assays revealed significantly (P < 0.05) higher amounts of collagen (2051 ± 256 ?g/g) at the end of 2 weeks in comparison to similar experiments previously conducted in our laboratory but performed at subphysiological levels of shear stress (<2 dynes/cm(2); Engelmayr et al., 2006, "Cyclic Flexure and Laminar Flow Synergistically Accelerate Mesenchymal Stem Cell-Mediated Engineered Tissue Formation: Implications for Engineered Heart Valve Tissues," Biomaterials, 27(36), pp. 6083-6095). The implications of this novel design are that fully coupled or decoupled physiological flow, flexure, and stretch modes of engineered tissue conditioning investigations can be readily accomplished with the inclusion of this device in experimental protocols on engineered heart valve tissue formation. PMID:25321615

  2. Utility of pulmonary venous flow diastolic deceleration time in an adult patient undergoing surgical closure of atrial septal defect and coronary artery bypass grafting.

    PubMed

    Agrawal, Dharmesh R; Sayeed, Mohammed Rehan; Chakravarthy, Murali R; Patil, T A

    2013-01-01

    Acute left ventricular (LV) failure has been reported after surgical closure of atrial septal defect (ASD) in adult patients. We report acute LV failure in a 56 year old gentleman following coronary artery bypass grafting (CABG) and surgical closure of ASD. Transesophageal echocardiography examination of the patient following closure of ASD and CABG showed a residual ASD and a shunt (Qp :Qs = 1.5). The residual ASD was closed after re-institution of cardiopulmonary bypass (CPB) under cardioplegic cardiac arrest. However, the patient did not tolerate closure of the residual ASD. The CPB was re-established and under cardioplegic cardiac arrest residual ASD was reopened to create a fenestration. This time patient was weaned easily from CPB. Postoperatively, 16 hours after extubation, patient became hemodynamically unstable, the patient was electively put on ventilator and intra-aortic balloon pump. Later the patient was weaned off successfully from ventilator. Retrospective analysis of pulmonary venous flow diastolic deceleration time (PVDT D ) recorded during prebypass period measured 102 msec suggestive of high left atrial pressure which indicate possibility of LV failure after ASD closure. PMID:23287085

  3. Pulmonary pathology

    Microsoft Academic Search

    Daphne E. deMello

    2004-01-01

    Common causes of neonatal respiratory distress include meconium aspiration, pneumonia, persistent pulmonary hypertension of the newborn, pneumothorax and cystic adenomatoid malformation. Genomics and proteomics have enabled the recent recognition of several additional disorders that lead to neonatal death from respiratory disease. These are broadly classified as disorders of lung homeostasis and have pathological features of proteinosis, interstitial pneumonitis or lipidosis.

  4. Lymph Node Tumor Volumes in Patients Undergoing Sentinel Lymph Node Biopsy for Cutaneous Melanoma

    Microsoft Academic Search

    Jeffrey D. Wagner; Darrell Davidson; John J. Coleman III; Gary Hutchins; Donald Schauwecker; Hee-Myung Park; Robert J. Havlik

    1999-01-01

    Background: Regional lymph node tumor volumes in patients undergoing sentinel lymph node (SN) biopsy (SNB) for treatment of cutaneous melanoma have not been described. The objectives of this study were to describe the lymph node tumor volumes typically seen in this population and to correlate tumor volumes with tumor thickness and positive SN characteristics. Methods: Review of a consecutive series

  5. Radiological findings in acute Haemophilus influenzae pulmonary infection

    PubMed Central

    Okada, F; Ando, Y; Tanoue, S; Ishii, R; Matsushita, S; Ono, A; Maeda, T; Mori, H

    2012-01-01

    Objective The aim of this study was to assess pulmonary thin-section CT findings in patients with acute Haemophilus influenzae pulmonary infection. Methods Thin-section CT scans obtained between January 2004 and March 2009 from 434 patients with acute H. influenzae pulmonary infection were retrospectively evaluated. Patients with concurrent infection diseases, including Streptococcus pneumoniae (n=76), Staphylococcus aureus (n=58) or multiple pathogens (n=89) were excluded from this study. Thus, our study group comprised 211 patients (106 men, 105 women; age range, 16–91 years, mean, 63.9 years). Underlying diseases included cardiac disease (n=35), pulmonary emphysema (n=23), post-operative status for malignancy (n=20) and bronchial asthma (n=15). Frequencies of CT patterns and disease distribution of parenchymal abnormalities, lymph node enlargement and pleural effusion were assessed by thin-section CT. Results The CT findings in patients with H. influenzae pulmonary infection consisted mainly of ground-glass opacity (n=185), bronchial wall thickening (n=181), centrilobular nodules (n=137) and consolidation (n=112). These abnormalities were predominantly seen in the peripheral lung parenchyma (n=108). Pleural effusion was found in 22 patients. Two patients had mediastinal lymph node enlargement. Conclusion These findings in elderly patients with smoking habits or cardiac disease may be characteristic CT findings of H. influenzae pulmonary infection. PMID:21224303

  6. Stop the Flow: A Paradigm for Cell Signaling Mediated by Reactive Oxygen Species in the Pulmonary Endothelium

    PubMed Central

    Browning, Elizabeth A.; Chatterjee, Shampa; Fisher, Aron B.

    2015-01-01

    The lung endothelium is exposed to mechanical stimuli through shear stress arising from blood flow and responds to altered shear by activation of NADPH (NOX2) to generate reactive oxygen species (ROS). This review describes the pathway for NOX2 activation and the downstream ROS-mediated signaling events on the basis of studies of isolated lungs and flow-adapted endothelial cells in vitro that are subjected to acute flow cessation (ischemia). Altered mechanical stress is detected by a cell-associated complex involving caveolae and other membrane proteins that results in endothelial cell membrane depolarization and then the activation of specific kinases that lead to the assembly of NOX2 components. ROS generated by this enzyme amplify the mechanosignal within the endothelial cell to regulate activation and/or synthesis of proteins that participate in cell growth, proliferation, differentiation, apoptosis, and vascular remodeling. These responses indicate an important role for NOX2-derived ROS associated with mechanotransduction in promoting vascular homeostasis. PMID:22077215

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

    PubMed Central

    Bouta, Echoe M; Wood, Ronald W; Brown, Edward B; Rahimi, Homaira; Ritchlin, Christopher T; Schwarz, Edward M

    2014-01-01

    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

  8. A biomedical engineering approach to investigating flow and wall shear stress in contracting lymphatics 

    E-print Network

    Dixon, James Brandon

    2006-08-16

    Collecting microlymphatics play a vital role in promoting lymph flow from the initial lymphatics in the interstitial spaces to the large transport lymph ducts. In most tissues, the primary mechanism for producing this flow ...

  9. Use of high frequency ultrasound to monitor cervical lymph node alterations in mice.

    PubMed

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

    2014-01-01

    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

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

    PubMed Central

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

    2014-01-01

    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

  11. Three-dimensional quantitative ultrasound for detecting lymph node metastases

    E-print Network

    Illinois at Urbana-Champaign, University of

    -frequency ultrasound Lymph node metastases Lymph node micrometastases Breast cancer Colorectal cancer Gastric cancerThree-dimensional quantitative ultrasound for detecting lymph node metastases Emi Saegusa nodes (LNs) is critical for cancer management. Conventional histological methods may miss metastatic

  12. Colorectal Surgical Specimen Lymph Node Harvest: Improvement of Lymph Node Yield with a Pathology Assistant

    Microsoft Academic Search

    Jeffery A. Reese; Christopher Hall; Kelly Bowles; Robert C. Moesinger

    2009-01-01

    Introduction  Adequate lymph node harvest from colorectal cancer specimens has become a standard of care, influencing both staging and survival.\\u000a To improve lymph node harvests at our hospital, a pathology assistant was trained to meticulously harvest lymph nodes from\\u000a colorectal cancer specimens. An analysis of trends in lymph node harvests over time is presented.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The number of harvested lymph nodes from

  13. Sentinel Lymph Node in Nonmelanoma Skin Cancer

    Microsoft Academic Search

    I. Salguero-Fernández; L. Rios-Buceta; P. Jaén-Olasolo

    Sentinel lymph node biopsy is performed routinely in melanoma because lymph node progression has been shown to be the strongest predictor of survival. Given the proven relevance of biopsy findings in this type of skin cancer, the procedure has been extended to other skin tumors. Experience in nonmelanoma cancer is much more limited and the prognostic usefulness of biopsy results

  14. Multimodality imaging of pulmonary infarction.

    PubMed

    Bray, T J P; Mortensen, K H; Gopalan, D

    2014-12-01

    The impact of absent pulmonary arterial and venous flow on the pulmonary parenchyma depends on a host of factors. These include location of the occlusive insult, the speed at which the occlusion develops and the ability of the normal dual arterial supply to compensate through increased bronchial arterial flow. Pulmonary infarction occurs when oxygenation is cut off secondary to sudden occlusion with lack of recruitment of the dual supply arterial system. Thromboembolic disease is the commonest cause of such an insult but a whole range of disease processes intrinsic and extrinsic to the pulmonary arterial and venous lumen may also result in infarcts. Recognition of the presence of infarction can be challenging as imaging manifestations often differ from the classically described wedge shaped defect and a number of weighty causes need consideration. This review highlights aetiologies and imaging appearances of pulmonary infarction, utilising cases to illustrate the essential role of a multimodality imaging approach in order to arrive at the appropriate diagnosis. PMID:25241050

  15. [Pulmonary hamartoma].

    PubMed

    Briccoli, A; Farinetti, A; Del Prete, P; Rizzente, A G; Saviano, M S; Guernelli, N

    1993-08-01

    Pulmonary hamartoma is a rare benign tumor often found by chance. Only in 10% of cases are some calcifications like "pop corn". Fibrobroncho-scopy is help only in endobronchial forms; they don't reach 10% of cases. Computed Tomography and transparietal biopsy can be diagnostic. In the uncertain cases and in presence of symptoms, thoracotomy with exeresis of tumor is justified. PMID:8247291

  16. Pulmonary schistosomiasis.

    PubMed

    Hill, I R; Turk, E P

    1980-09-01

    Two cases are reported of the incidental finding of pulmonary schistosomiasis in the victims of a fatal aircraft accident. The presence of this disease had no bearing on the causation of the accident, but it gives insight into the potential hazards of dissemination of diseases by travellers. The finding also emphasises the value of routine postmortems and histology in all aircraft accident victims. PMID:7417181

  17. Pulmonary rehabilitation

    Microsoft Academic Search

    Annemie M. W. J. Schols; Emiel F. M. Wouters

    \\u000a Rehabilitation has been practised for several decades, but its application in respiratory disease is relatively recent. Although\\u000a by definition chronic obstructive pulmonary disease (COPD) is a disease state characterised by the presence of a progressive\\u000a and irreversible airflow obstruction, the primary treatment traditionally consists of pharmacological modulation of the airflow\\u000a limitation by bronchodilating and anti-inflammatory agents. Despite symptomatic relief after

  18. Types of Pulmonary Hypertension

    MedlinePLUS

    ... that group 1 is called pulmonary arterial hypertension (PAH) and groups 2 through 5 are called pulmonary ... hypertension.) Group 1 Pulmonary Arterial Hypertension Group 1 PAH includes: PAH that has no known cause. PAH ...

  19. 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

    PubMed Central

    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.

    2014-01-01

    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

  20. Interlaboratory and Interstudy Reproducibility of a Novel Lateral-Flow Device and Influence of Antifungal Therapy on Detection of Invasive Pulmonary Aspergillosis

    PubMed Central

    Najvar, Laura K.; Bocanegra, Rosie; Kirkpatrick, William R.; Patterson, Thomas F.; Thornton, Christopher R.

    2013-01-01

    Interest in lateral-flow devices (LFDs) as potential point-of-care assays for the diagnosis of infectious diseases has increased. Our objective was to evaluate the interlaboratory and interstudy reproducibility and the effects of antifungal therapy on an LFD developed for invasive pulmonary aspergillosis (IPA) detection. An established neutropenic guinea pig model of IPA caused by Aspergillus fumigatus was used. At predetermined time points (1 h and 3, 5, and 7 days postinoculation), blood and bronchoalveolar lavage (BAL) fluid were collected from infected and uninfected animals. In a separate experiment, guinea pigs were treated with posaconazole (10 mg/kg of body weight orally [p.o.] twice a day [BID]), voriconazole (10 mg/kg p.o. BID), liposomal amphotericin B (10 mg/kg intraperitoneally [i.p.] once a day [QD]), or caspofungin (2 mg/kg i.p. QD), and samples were collected on days 7 and 11. Each laboratory independently evaluated the IgG monoclonal antibody-based LFD. Galactomannan and (1?3)-?-d-glucan were also measured using commercially available kits. Good interlaboratory agreement was observed with the LFD, as the results for 97% (32/33) of the serum and 78.8% (26/33) of the BAL fluid samples from infected animals were in agreement. Good interstudy agreement was also observed. The serum sensitivity of each surrogate-marker assay was reduced in animals treated with antifungals. In contrast, these markers remained elevated within the BAL fluids of treated animals, which was consistent with the fungal burden and histopathology results. These results demonstrate that the LFD assay is reproducible between different laboratories and studies. However, the sensitivity of this assay and other markers of IPA may be reduced with serum in the presence of antifungal therapy. PMID:23175252

  1. Performance of lateral flow device and galactomannan for the detection of Aspergillus species in bronchoalveolar fluid of patients at risk for invasive pulmonary aspergillosis.

    PubMed

    Miceli, Marisa H; Goggins, Michael I; Chander, Pranay; Sekaran, Archana K; Kizy, Anne E; Samuel, Linoj; Jiang, Hui; Thornton, Christopher R; Ramesh, Mayur; Alangaden, George

    2015-06-01

    Early diagnosis of invasive pulmonary aspergillosis (IPA) remains difficult due to the variable performance of the tests used. We compared the performance characteristics of Aspergillus lateral flow device (LFD) in bronchoalveolar lavage (BAL) vs. BAL-galactomannan (GM), for the diagnosis of IPA. 311 BAL specimens were prospectively collected from patients who underwent bronchoscopy from January to May 2013. Patients at risk for IPA were divided into haematological malignancy (HEM) and non-HEM groups: solid organ transplants (SOT) (lung transplant (LT) and non-LT SOT); chronic steroid use (CSU); solid tumour (STU) and others. We identified 96 patients at risk for IPA; 89 patients (93%) were in the non-HEM groups: SOT 57 (LT, 46, non-LT SOT, 11); CSU 21; STU 6, other 5. Only three patients met criteria for IA (two probable; one possible). Overall sensitivity (SS) was 66% for both and specificity (SP) was 94% vs. 52% for LFD and GM respectively. LFD and GM performance was similar in the HEM group (SS 100% for both and SP 83% vs. 100% respectively). LFD performance was better than GM among non-HEM SOT patients (P = 0.02). Most false-positive GM results occurred in the SOT group (50.8%), especially among LT patients (56.5%). LFD performance was superior with an overall SP of 95.6% in SOT (P < 0.002) and 97% in LT patients (P = 0.0008). LFD is a rapid and simple test that can be performed on BAL to rule out IPA. PMID:25996144

  2. Transient changes in the pulmonary function of welders: a cross sectional study of Monday peak expiratory flow.

    PubMed Central

    Donoghue, A M; Glass, W I; Herbison, G P

    1994-01-01

    OBJECTIVES--The aim was to compare the peak expiratory flow (PEF) of welders and non-welders over a 12 hour period from the start of work on Monday. METHODS--The two study groups consisted of 20 welders and 20 non-welders, all men who had essentially never smoked, with no significant difference in age, height, ethnicity, or baseline spirometry between the groups. The PEF was measured for each welder before the start of work and 15 minutes, 30 minutes, and 1, 2, 4, 7, and 12 hours after the start of welding. The same method was applied to the non-welders, for whom a proxy time for the start of welding was used. RESULTS--The percentage change in baseline PEF was calculated for each subject at each of the recording times. The welder and non-welder group means for these results were significantly different at 15 minutes (p = 0.028). Also, the group mean for maximum fall in PEF (at any of the recording times during the 12 hour period) was significantly greater for the welders (p = 0.011). 50% of the welders (10/20), but only 5% of the non-welders (1/20), experienced a fall in PEF in excess of 5% (p = 0.0046). 25% of the welders (5/20) experienced drops of greater than 5% within the first 15 minutes. CONCLUSION--The results are suggestive of an immediate type reaction in welders, similar to that seen in some cases of occupational asthma, although not so severe. Studies to determine if these reactions reflect non-specific bronchial hyper-responsiveness would be useful. It is recommended that future studies also undertake breathing zone measurements to relate the response to particular constituents of the welding plume, especially the gases ozone and nitrogen dioxide. PMID:7951781

  3. Diffuse Interstitial Pulmonary Infiltrates in Malignant Melanoma.

    PubMed

    Bräunlich, Jens; Seyfarth, Hans-Jürgen; Frille, Armin; Wirtz, Hubert

    2015-07-01

    Only a few cases of sarcoidosis-like reaction to a pharmacologic compound have been reported in patients with melanoma in the literature. Long-term treatment with interferon alpha may be assumed. We report a case of a 25-y-old man who presented to our department with diffuse interstitial pulmonary infiltrates and slightly enlarged mediastinal lymph nodes as determined by computed tomography. He had a history of malignant melanoma with 18 months of interferon alpha-2 therapy. Histological analysis of a transbronchial biopsy revealed sarcoidosis-like reactions. PMID:25587168

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

    Microsoft Academic Search

    Tsvetomir Loukanov; Ralf Geiger; Rahul Agrawal

    2010-01-01

    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

  5. Lymph node staging in non-small cell lung cancer: evaluation by [18F]FDG positron emission tomography (PET)

    Microsoft Academic Search

    A. Guhlmann; M. Storck; J. Kotzerke; F. Moog; L. Sunder-Plassmann; S. N. Reske

    1997-01-01

    BACKGROUND: A study was undertaken to investigate the accuracy of positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) in the thoracic lymph node staging of non-small cell lung cancer (NSCLC). METHODS: Forty six patients with focal pulmonary tumours who underwent preoperative computed tomographic (CT) and FDG-PET scanning were evaluated retrospectively. Thirty two patients had NSCLC and 14 patients had a benign

  6. Pediatric Hodgkin lymphoma presenting with pulmonary nodules and leukemoid reaction.

    PubMed

    Kalra, Manas; Dinand, Veronique; Sachdeva, Anupam; Bhat, Sunil; Piplani, Tarun; Yadav, Satya Prakash

    2010-07-15

    An 8-year-old female presented with fever and severe pain in the hipbones and legs for 2(1/2) months. Investigations revealed a leukemoid reaction and bilateral diffuse nodular opacities on chest X-ray. Supraclavicular lymph node biopsy was diagnostic of Hodgkin lymphoma (HL), mixed cellularity. Both pulmonary nodules and leukemoid reaction being present in the same patient with HL has not been reported. PMID:20486186

  7. Pulmonary artery segmentation and quantification in sickle cell associated pulmonary hypertension

    NASA Astrophysics Data System (ADS)

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

    2008-03-01

    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.

  8. Chronic Thromboembolic Pulmonary Hypertension

    Microsoft Academic Search

    William R. Auger; Nick H. Kim; Terence K. Trow

    2010-01-01

    hronic thromboembolic pulmonary hypertension (CTEPH) has emerged as one of the leading causes of severe pulmonary hypertension. The disease is notoriously underdiagnosed, and the true prevalence is still unclear. CTEPH is characterized by intraluminal thrombus organiza- tion and fibrous stenosis or complete obliteration of pulmo- nary arteries.1 The consequence is an increased pulmonary vascular resistance resulting in pulmonary hypertension and

  9. Familial Blood and Lymph Node Cancers Study

    Cancer.gov

    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

  10. Sentinel lymph node mapping with GI cancer

    Microsoft Academic Search

    Takashi Aikou; Yuko Kitagawa; Masaki Kitajima; Yoshikazu Uenosono; Anton J. Bilchik; Steve R. Martinez; Sukamal Saha

    2006-01-01

    Precise evaluation of lymph node status is one of the most important factors in determining clinical outcome in treating gastro-intestinal\\u000a (GI) cancer. Sentinel lymph node (SLN) mapping clearly has become highly feasible and accurate in staging GI cancer. The lunchtime\\u000a symposium focused on the present status of SLN mapping for GI cancer. Dr. Kitigawa proposed a new strategy using sentinel

  11. Primary Neuroendocrine Carcinoma of Inguinal Lymph Node

    Microsoft Academic Search

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

    2005-01-01

    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

  12. Cervical lymph node diseases in children

    PubMed Central

    Lang, Stephan; Kansy, Benjamin

    2014-01-01

    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

  13. Aspergillus-Specific Lateral-Flow Device and Real-Time PCR Testing of Bronchoalveolar Lavage Fluid: a Combination Biomarker Approach for Clinical Diagnosis of Invasive Pulmonary Aspergillosis.

    PubMed

    Johnson, Gemma L; Sarker, Shah-Jalal; Nannini, Francesco; Ferrini, Arianna; Taylor, Emma; Lass-Flörl, Cornelia; Mutschlechner, Wolfgang; Bustin, Stephen A; Agrawal, Samir G

    2015-07-01

    Clinical experience with the impact of serum biomarkers for invasive fungal disease (IFD) varies markedly in hemato-oncology. Invasive pulmonary aspergillosis (IPA) is the most common manifestation, so we evaluated biomarkers in bronchoalveolar lavage (BAL) fluid. An Aspergillus-specific lateral-flow device (LFD), quantitative real-time PCR (qPCR), and the galactomannan (GM) test were used with 32 BAL fluid samples from 32 patients at risk of IPA. Eight patients had proven IPA, 3 had probable IPA, 6 had possible IPA, and 15 patients had no IPA by European Organization for Research and Treatment of Cancer Invasive Fungal Infections Cooperative Group/Mycoses Study Group of the National Institute of Allergy and Infectious Diseases (EORTC/MSG) criteria. The diagnostic accuracies of the tests were evaluated, and pairwise agreement between biomarkers was calculated. The diagnostic performance of the EORTC/MSG criteria was evaluated against the test(s) identified to be the most useful for IPA diagnosis. Using the EORTC/MSG criteria, the sensitivities of qPCR and LFD were 100% and the sensitivity of the GM test was 87.5% (GM test index cutoff, >0.8), with the tests having specificities of between 66.7 and 86.7%. The agreement between the results of qPCR and LFD was almost perfect (Cohen's kappa coefficient = 0.93, 95% confidence interval, 0.81 to 1.00). LFD and qPCR combined had a sensitivity of 100% and a specificity of 85.7%. Calcofluor staining and culture of all BAL fluid samples were negative for fungal infection. The median time from the start of mold-active antifungal therapy to the time of collection of BAL fluid was 6 days. Reversing roles and using dual testing by LFD and qPCR to classify cases, the EORTC/MSG criteria had a sensitivity of 83.3%. All three tests are useful for the diagnosis of IPA in BAL fluid samples. Despite the significant delays between the start of antifungal therapy and bronchoscopy, unlike microscopy and culture, the biomarkers remained informative. In particular, the combination of LFD and qPCR allows the sensitive and specific detection of IPA. PMID:25903568

  14. Detrimental effects of hydralazine in patients with chronic air-flow obstruction and pulmonary hypertension. A combined hemodynamic and radionuclide study

    SciTech Connect

    Tuxen, D.V.; Powles, A.C.; Mathur, P.N.; Pugsley, S.O.; Campbell, E.J.

    1984-03-01

    The acute effects of intravenously administered hydralazine on pulmonary hemodynamics and ejection radionuclide angiography were evaluated in 9 patients with chronic airflow obstruction (forced expiratory volume in one second, 1.2 +/- 0.8 L, mean +/- SD), pulmonary hypertension (mean pulmonary artery pressure (PAP), 29 +/- 13 mmHg), and sleep hypoxemia (maximal sleep desaturation, 20 +/- 16%). The effect of hydralazine was measured during both normoxia and hypoxia and compared with the effect of hyperoxia. Hydralazine increased cardiac index from 3.7 +/- 0.2 to 4.5 +/- 0.8 L/min/m2 (mean +/- SE, p less than 0.05, n . 9), but there were no significant changes in PAP (29 +/- 4 to 32 +/- 4 mmHg), mean pulmonary vascular resistance index (PVRI) (390 +/- 80 to 360 +/- 80 dyn.s.cm.-5.m2), mean right ventricular stroke work index (12.7 +/- 2.7 to 15.0 +/- 2.2 g.m/m2), and mean pulmonary capillary wedge pressure (12 +/- 1 to 12 +/- 2 mmHg). Mean right ventricular ejection fraction and mean right ventricular end diastolic volume also were not changed after treatment with hydralazine. Hyperoxia was used to assess the reversibility of pulmonary hypertension and to compare this with hydralazine. Hyperoxia increased arterial oxygen saturation (SaO2) from 91 +/- 1 to 96 +/- 1% and decreased the cardiac index from 3.8 +/- 0.1 to 3.1 +/- 0.2 L/min/m2 (p less than 0.02, n . 6) but, as with hydralazine, there was no significant change in PAP (28 +/- 6 to 25 +/- 6 mmHg) and PVRI (350 +/- 120 to 360 +/- 80 dyn.s.cm-5).m2).

  15. Lung volumes, ventricular function and pulmonary arterial flow in children operated on for left-sided congenital diaphragmatic hernia: long-term results

    Microsoft Academic Search

    Nasreddin Abolmaali; Arne Koch; Knut Götzelt; Gabriele Hahn; Guido Fitze; Christian Vogelberg

    2010-01-01

    Objectives  To compare MRI-based functional pulmonary and cardiac measurements in the long-term follow-up of children operated on for\\u000a left-sided congenital diaphragmatic hernia (CDH) with age- and body size-matched healthy controls.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Twelve children who received immediate postnatal surgery for closure of isolated left-sided CDH were included and received\\u000a basic medical examinations, pulmonary function testing and echocardiography. MRI included measurement of lung volume,

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

    PubMed

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

    2011-01-01

    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

  17. Pulmonary pathology.

    PubMed

    deMello, Daphne E

    2004-08-01

    Common causes of neonatal respiratory distress include meconium aspiration, pneumonia, persistent pulmonary hypertension of the newborn, pneumothorax and cystic adenomatoid malformation. Genomics and proteomics have enabled the recent recognition of several additional disorders that lead to neonatal death from respiratory disease. These are broadly classified as disorders of lung homeostasis and have pathological features of proteinosis, interstitial pneumonitis or lipidosis. These pathological changes result from inherited disorders of surfactant proteins or granulocyte-macrophage colony stimulating factor. Abnormal lung vascular development is the basis for another cause of fatal neonatal respiratory distress, alveolar capillary dysplasia with or without associated misalignment of veins. Diagnosis of these genetically transmitted disorders is important because of the serious implications for future siblings. There is also a critical need for establishing an archival tissue bank to permit future molecular biological studies. PMID:15251148

  18. Is the identification of in-transit sentinel lymph nodes in malignant melanoma patients really necessary?

    Microsoft Academic Search

    Sergi Vidal-Sicart; Francesca Pons; Silvia Fuertes; Antonio Vilalta; Ramón Rull; Susana Puig; Josep M. Palou; Marisa Ortega; Teresa Castel

    2004-01-01

    The sentinel lymph node (SLN) is the first node in a nodal basin to receive the direct lymphatic flow from a malignant melanoma. However, in some patients, lymphoscintigraphic study reveals the presence of lymphatic nodes in the area between the primary melanoma and the regional basin. These nodes are called “in-transit nodes” or “interval nodes” and, by definition, are also

  19. Pulmonary function after segmentectomy for small peripheral carcinoma of the lung

    Microsoft Academic Search

    Tsuneyo Takizawa; Manabu Haga; Nobuo Yagi; Masanori Terashima; Hiroko Uehara; Akira Yokoyama; Yuzo Kurita

    1999-01-01

    Objective: The aim of this study is to compare the pulmonary function after a segmentectomy with that after a lobectomy for small peripheral carcinoma of the lung. Patients And Methods: Between 1993 and 1996, segmentectomy and lobectomy were performed on 48 and 133 good-risk patients, respectively. Lymph node metastases were detected after the operation in 6 and 24 patients of

  20. The role of axillary lymph node dissection in breast cancer patients with sentinel lymph node micrometastases

    Microsoft Academic Search

    M. Gipponi; G. Canavese; R. Lionetto; A. Catturich; C. Vecchio; A. Sapino; D. Friedman; F. Cafiero

    2006-01-01

    AimTo identify by means of clinical and histopathological features a subset of breast cancer patients with sentinel lymph-node (sN) micrometastases and metastatic disease confined only to the sN in order to spare them an unnecessary axillary lymph node dissection (ALND).

  1. Intramammary lymph nodes and breast cancer: a marker for disease severity, or just another lymph node?

    Microsoft Academic Search

    Amber A. Guth; Cecilia Mercado; Daniel F. Roses; Karen Hiotis; Kristin Skinner; Thomas Diflo; Joan Cangiarella

    2006-01-01

    BackgroundAxillary lymph node status is still considered the most significant prognostic factor for breast cancer outcome, and treatment decisions are based on the presence or absence of nodal disease. Intramammary lymph nodes (IMLNs) can be a site of regional spread. Is this a marker for more aggressive disease?

  2. [Characteristics of liver circulation and the outflow of bile and lymph in acute carbon tetrachloride poisoning].

    PubMed

    Koval'skaia, K S; Gorin, A S

    1976-01-01

    In acute tests set up on 13 dogs the pressure and blood flow in the portal vein and hepatic artery, the pressure in the inferior vena cava along with lymph- and bile currents were registered following intraportal introduction of CCI4. Subject to determination were also the resistance of venous and arterial hepatic vessels and of the splachnic zone, as well as the summary blood flow. The rising pressure and diminished blood flow in the portal vein were found to be the result of the growing resistance of venous vessels in the liver. Falling pressure and reduced blood flow in the hepatic artery bore witness to the general toxic effect of CCl4 on the animal organism. Increased portal pressure and disturbed permeability of biological membranes was attended by a greater lymph outflow. The inhibition of bile secretion came as a result of hypoxic and toxic damage of the liver. PMID:1027571

  3. Bacteriologic studies of skin, tissue fluid, lymph, and lymph nodes in patients with filarial lymphedema.

    PubMed

    Olszewski, W L; Jamal, S; Manokaran, G; Pani, S; Kumaraswami, V; Kubicka, U; Lukomska, B; Dworczynski, A; Swoboda, E; Meisel-Mikolajczyk, F

    1997-07-01

    Filarial lymphedema is complicated by frequent episodes of dermatolymphangioadenitis (DLA). It is not certain whether DLA is of filarial or bacterial etiology. The frequency of episodic DLA does not depend on the presence or absence of microfilariae. Antibiotic therapy is effective in prevention and treatment of DLA. These observations point to the bacterial rather than filarial etiology of DLA. Skin and lymph node biopsies, tissue fluid, lymph, and blood from patients with chronic filarial lymphedema, and during acute episodes of DLA, were cultured for detection of bacteria. A high prevalence of bacterial isolates from the tissue fluid (64%), lymph (75%), and inguinal lymph nodes (66%) of limbs with filarial lymphedema was found. Bacillus cereus, Staphylococcus epidermidis, S. hominis, S. capitis, S. xylosus, and Micrococcus spp. were the most common isolates. Bacteria were also isolated from the blood of patients with recent episodes of DLA, with strains of the same phenotype and antibiotic sensitivity in all specimens from patients with DLA. Bacterial strains of the same phenotype and antibiotic sensitivity were documented on the toe web surface and in tissue fluid (25%), lymph (26%), or lymph nodes (41%). Increasing prevalence of bacterial isolates in tissue fluid, lymph, and lymph nodes was observed in advanced stages of lymphedema. Bacilli and cocci were sensitive to gentamicin, tetracyline, rifampicin, vancomycin, kanamycin and cotrimoxazole, and least sensitive to penicillin. Blood cultures of patients in the periods between DLA attacks were negative. In healthy controls without edema and episodes of DLA, tissue fluid did not contain bacteria. In lymph, only single colonies of Micrococcus and Acinetobacter were cultured in 12% of the cases. Impaired lymph drainage and lack of elimination of penetrating bacteria may be responsible for progression of lymphedema and recurrent attacks of DLA. PMID:9242310

  4. Exogenous normal lymph alleviates microcirculation disturbances and abnormal hemorheological properties in rats with disseminated intravascular coagulation

    PubMed Central

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

    2013-01-01

    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

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

    PubMed

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

    1993-05-01

    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

  6. Intraoperative sentinel lymph node mapping guides laparoscopic-assisted distal gastrectomy for distal gastric cancer

    PubMed Central

    Liu, Naiqing; Niu, Zhengchuan; Niu, Wei; Peng, Cheng; Zou, Xueqing; Sun, Shuxiang; Shinichi, Obo; Shahbaz, Muhammad; Sun, Qinli; Jun, Niu

    2015-01-01

    Aims: The aim of this retrospective study is to explore the effects of sentinel lymph node (SLN) mapping guided laparoscopic-assisted distal gastrectomy (LADG) for distal gastric cancer. Methods: Two hundred patients were enrolled in this study. One hundred and one patients undergoing SLN guided LADG were designated as the SLN group. Ninety-nine patients having conventional LADG with D1 or D2 lymph node dissection were designated as the control group. Intraoperative and postoperative indicators such as the number of lymph nodes dissected, intraoperative and postoperative conditions, flow cytometry analysis of T lymphocyte subsets and natural killer (NK) cells, survival rates, recurrence rates and postoperative complications were investigated between these two groups. Results: The number of lymph nodes dissected in the SLN group was significantly lesser than that in the control group. Furthermore, in the SLN group, the patients achieved better immunization status, improved intraoperative and postoperative conditions and decreased postoperative complications. There were no significant differences were found in the positive lymph nodes detected, the distance between proximal and distal cutting edge, postoperative survival or recurrence rates. Conclusions: SLN guided LADG for gastric cancer is a safe and effective method and could achieve an equal clinical effect as traditional laparoscopic D1 or D2 radical operation with less operation trauma and better recovery.

  7. Effects of prometryne on apoptosis and necrosis in thymus, lymph node and spleen in mice.

    PubMed

    Diki?, Domagoj; Zidovec-Lepej, Snježana; Remenar, Anica; Bendelja, Krešo; Benkovi?, Vesna; Horvat-Kneževi?, Anica; Brozovi?, Gordana; Oršoli?, Nada

    2009-03-01

    Prometryne is a methylthio-s-triazine herbicide. Significant traces are documented in environment, mainly waters, soil and plants used for nutrition. The aim of this study was to estimate prometryne immunotoxic properties through induction of apoptotic and/or necrotic changes in thymocytes, splenocytes and lymph node cells after repeated subchronical exposure. Three different doses of prometryne (185, 375, 555mgkg(-1)) were applied per os every 48h, over 28 days. Flow cytometry assay (annexinV-FITC and PI) was conducted to record apoptotic and necrotic damage. In the spleen significant changes in the percentage of apoptotic cells were not detected between treated and control groups respectively. In thymus and lymph node, within the lowest dose group (185mgkg(-)1), an increase in percentage of early apoptosis without any significant increase in necrosis was detected. Medium (375mgkg(-1)) as well as high dose triggered increase in late apoptosis in lymph node while in thymus; late apoptosis was increased only in animals exposed to the highest dose (555mgkg(-1)). The highest applied dose, in thymus and lymph node respectively, caused a general decrease in percentage of vital cells in favour of marked increase of percentages of all types of dying cells (apoptotic, late apoptotic/early necrotic and necrotic). Prometryne caused disbalance in major organs of immune system, markedly lymph nodes and thymus, by induction of early apoptotic changes in dose/time specific manner. PMID:21783937

  8. Coalition for Pulmonary Fibrosis

    MedlinePLUS

    ... Education Resources Accomplishments About Us Coalition for Pulmonary Fibrosis 10866 W. Washington Blvd #343 • Culver City, CA ... their respective owners. ©2001 – 2011 Coalition for Pulmonary Fibrosis Site Last Updated: June 3, 2015

  9. What Causes Pulmonary Embolism?

    MedlinePLUS

    ... What Causes Pulmonary Embolism? Major Causes Pulmonary embolism (PE) usually begins as a blood clot in a ... other tissue travels to the lungs and causes PE. Also, if a large bone in the body ( ...

  10. Living with Pulmonary Embolism

    MedlinePLUS

    ... on Twitter. Living With Pulmonary Embolism Pulmonary embolism (PE) usually is treated in a hospital. After leaving ... you're taking medicine. Medicines used to treat PE can thin your blood too much. This can ...

  11. Who Needs Pulmonary Rehabilitation?

    MedlinePLUS

    ... 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 ...

  12. Pulmonary Rehabilitation Program

    MedlinePLUS

    ... covered? Search Medicare.gov 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 ...

  13. Effect of external lymph drainage and of coumarin treatment on thermal injury in the rat hind leg

    PubMed Central

    Földi-Börcsök, Ethel

    1972-01-01

    1. External lymph drainage brings about a significant protective effect in thermal oedema of the rat hind leg. It is suggested that external lymph drainage prevents vasoactive substances drained from the site of injury from passing into the blood stream, which would further increase permeability of the injured blood capillaries. 2. Coumarin (5,6-benzo-alpha-pyron) brings about a significant protective effect against the same injury in sham-operated rats. 3. The strongest protective effect may be attained by combining external lymph drainage with the administration of coumarin. 4. The additional therapeutic effect brought about by coumarin treatment in rats with external lymph drainage is not mediated by an increased flow. The possible mechanisms are discussed. PMID:4651772

  14. Pulmonary arterial remodeling in chronic obstructive pulmonary disease is lobe dependent

    PubMed Central

    Wrobel, Jeremy P.; McLean, Catriona A.; Thompson, Bruce R.; Snell, Gregory I.

    2013-01-01

    Abstract Pulmonary arterial remodeling has been demonstrated in patients with severe chronic obstructive pulmonary disease (COPD), but it is not known whether lobar heterogeneity of remodeling occurs. Furthermore, the relationship between pulmonary hypertension (PH) and pulmonary arterial remodeling in COPD has not been established. Muscular pulmonary arterial remodeling in arteries 0.10–0.25 mm in diameter was assessed in COPD-explanted lungs and autopsy controls. Remodeling was quantified as the percentage wall thickness to vessel diameter (%WT) using digital image analysis. Repeat measures mixed-effects remodeling for %WT was performed according to lobar origin (upper and lower), muscular pulmonary arterial size (small, medium, and large), and echocardiography-based pulmonary arterial pressure (no PH, mild PH, and moderate-to-severe PH). Lobar perfusion and emphysema indices were determined from ventilation-perfusion and computed tomography scans, respectively. Overall, %WT was greater in 42 subjects with COPD than in 5 control subjects (). Within the COPD group, %WT was greater in the upper lobes () and in the small muscular pulmonary arteries (). Lobar differences were most pronounced in medium and large arteries. Lobar emphysema index was not associated with arterial remodeling. However, there was a significant positive relationship between the lobar perfusion index and pulmonary arterial remodeling (). The presence of PH on echocardiography showed only a trend to a small effect on lower lobe remodeling. The pattern of pulmonary arterial remodeling in COPD is complicated and lobe dependent. Differences in regional blood flow partially account for the lobar heterogeneity of pulmonary arterial remodeling in COPD. PMID:24618551

  15. Chronic Thromboembolic Pulmonary Hypertension

    Microsoft Academic Search

    Irene M. Lang; Walter Klepetko

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a poorly understood disorder. It is characterized by pulmonary hypertension\\u000a associated with an apparent failure to resolve extensive, typically major-vessel pulmonary thromboemboli. Although CTEPH is\\u000a believed to be a thromboembolic disease, the typical risk factors for venous thromboembolism are absent. According to the\\u000a 2003 Venice classification of pulmonary hypertension, CTEPH represents group IV of

  16. Extended Lymph Node Dissection for Rectal Cancer with Radiologically Diagnosed Extramesenteric Lymph Node Metastasis

    Microsoft Academic Search

    Byung Soh Min; Jin Soo Kim; Nam Kyu Kim; Joon-Seok Lim; Kang Young Lee; Chang Hwan Cho; Seung Kook Sohn

    2009-01-01

    Background  The purpose of this study is to review the clinical outcomes of patients who received extended lymph node dissection for radiologically\\u000a diagnosed extramesenteric lymph node metastasis.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods  The authors reviewed clinical characteristics, short-term operative outcomes, and long-term oncologic outcomes of 151 patients\\u000a who had received total mesorectal excision plus extended lymph node dissection for the treatment of radiologically diagnosed

  17. Sphincters of the pulmonary veins in man, and their significance

    Microsoft Academic Search

    L. L. Kapuller; M. Lo Shik

    1961-01-01

    Pressure curves in the pulmonary vein and in the left auricle were recorded in patients with stenosis of the left atrioventricular valve before and after mitral valvotomy. The curves showed that the sphincters of the pulmonary veins may fail when the mean pressure in the left auricle exceeds 20 mm Hg. Normally, by blocking the reverse flow, the sphincters protect

  18. Congenital pulmonary lymphangiectasis

    Microsoft Academic Search

    M. P. Shannon; E. B. Grantmyre; W. D. Reid; A. S. Wotherspoon

    1974-01-01

    Two cases of congenital pulmonary lymphangiectasis are described in neonates. One case represents an isolated form of the condition. The second example illustrates an association with complex cardiac disease, including total anomalous pulmonary venous drainage, and the asplenia syndrome. The radiological features of congenital pulmonary lymphangiectasis are discussed.

  19. Pulmonary calcifications: a review

    Microsoft Academic Search

    D. BENDAYAN; Y. BARZIV; M. R. KRAMER

    2000-01-01

    Pulmonary calcification is a common asymptomatic finding, usually discovered on routine chest X-ray or at autopsy.Pulmonary calcifications are caused mainly by two mechanisms: the dystrophic form and the metastatic form (1). Despite the different aetiologies, the pulmonary function and clinical manifestations are quite similar in both forms. We present a review of the clinical and radiology findings of the different

  20. Vascular malformations as underlying cause of chronic thromboembolism and pulmonary hypertension

    Microsoft Academic Search

    Charlene E. U. Oduber; Victor E. A. Gerdes; Chantal M. A. M. van der Horst; Paul Bresser

    2009-01-01

    We report four patients with chronic thromboembolic pulmonary hypertension (CTEPH) presumably due to recurrent pulmonary embolism from low-flow vascular malformations, and give a review of the literature. Venous malformations, such as those observed in Klippel- Trenaunay syndrome (KTS) can be associated with hypercoagulability, thrombosis and recurrent pulmonary embolism and ultimately CTEPH. Since many physicians appear unfamiliar with these potential complications,

  1. Sentinel lymph node navigation surgery for early stage gastric cancer

    PubMed Central

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

    2014-01-01

    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

  2. Hypoxia and pulmonary arterial pressure in the rabbit

    PubMed Central

    Owen-Thomas, J. B.; Reeves, J. T.

    1969-01-01

    1. The effect of hypoxia on pulmonary arterial pressure was studied in young and adult rabbits. 2. In isolated perfused lungs, hypoxia caused no rise in pulmonary arterial pressure in rabbits on the day of birth. The size of the hypoxic response increased progressively until 9-11 days of age, when the adult response of a 20% rise of pulmonary arterial pressure at constant flow was attained. 3. The intact adult rabbit responded to hypoxia with a 14-30% rise in pulmonary arterial pressure, attributed to vasoconstriction and independent of frequency or tidal volume during positive pressure ventilation. PMID:5767888

  3. Bronchogenic carcinoma: incidence of metastases to normal sized lymph nodes

    Microsoft Academic Search

    T Arita; T Kuramitsu; M Kawamura; T Matsumoto; N Matsunaga; K Sugi; K Esato

    1995-01-01

    BACKGROUND--The incidence of metastases to mediastinal lymph nodes was evaluated in patients with normal sized mediastinal nodes on the computed tomographic (CT) scan who underwent thoracotomy. The use of hilar lymph nodes in predicting mediastinal lymph node metastases was also assessed. METHODS--Ninety patients with non-small cell lung cancer who later underwent thoracotomy wer prospectively examined by CT scanning. Lymph nodes

  4. Is the Lateral Lymph Node Compartment Relevant?

    Microsoft Academic Search

    Moritz Koch; Peter Kienle; Dalibor Antolovic; Markus W. Büchler; Jürgen Weitz

    Lateral pelvic lymphadenectomy is routinely performed in advanced lower rectal cancers by Japanese surgeons, whereas in the western world it has not progressed to a frequently performed technique. Claimed benefit for this extensive surgery is an improved locoregional control; on the other hand, low positive lateral lymph node yields, questionable prognostic significance, and high morbidity (urinary and sexual dysfunction) are

  5. Noninvasive pulmonary artery wave intensity analysis in pulmonary hypertension.

    PubMed

    Quail, Michael A; Knight, Daniel S; Steeden, Jennifer A; Taelman, Liesbeth; Moledina, Shahin; Taylor, Andrew M; Segers, Patrick; Coghlan, Gerry J; Muthurangu, Vivek

    2015-06-15

    Pulmonary wave reflections are a potential hemodynamic biomarker for pulmonary hypertension (PH) and can be analyzed using wave intensity analysis (WIA). In this study we used pulmonary vessel area and flow obtained using cardiac magnetic resonance (CMR) to implement WIA noninvasively. We hypothesized that this method could detect differences in reflections in PH patients compared with healthy controls and could also differentiate certain PH subtypes. Twenty patients with PH (35% CTEPH and 75% female) and 10 healthy controls (60% female) were recruited. Right and left pulmonary artery (LPA and RPA) flow and area curves were acquired using self-gated golden-angle, spiral, phase-contrast CMR with a 10.5-ms temporal resolution. These data were used to perform WIA on patients and controls. The presence of a proximal clot in CTEPH patients was determined from contemporaneous computed tomography/angiographic data. A backwards-traveling compression wave (BCW) was present in both LPA and RPA of all PH patients but was absent in all controls (P = 6e(-8)). The area under the BCW was associated with a sensitivity of 100% [95% confidence interval (CI) 63-100%] and specificity of 91% (95% CI 75-98%) for the presence of a clot in the proximal PAs of patients with CTEPH. In conclusion, WIA metrics were significantly different between patients and controls; in particular, the presence of an early BCW was specifically associated with PH. The magnitude of the area under the BCW showed discriminatory capacity for the presence of proximal PA clot in patients with CTEPH. We believe that these results demonstrate that WIA could be used in the noninvasive assessment of PH. PMID:25659483

  6. Noninvasive pulmonary artery wave intensity analysis in pulmonary hypertension

    PubMed Central

    Quail, Michael A.; Knight, Daniel S.; Steeden, Jennifer A.; Taelman, Liesbeth; Moledina, Shahin; Taylor, Andrew M.; Segers, Patrick; Coghlan, Gerry J.

    2015-01-01

    Pulmonary wave reflections are a potential hemodynamic biomarker for pulmonary hypertension (PH) and can be analyzed using wave intensity analysis (WIA). In this study we used pulmonary vessel area and flow obtained using cardiac magnetic resonance (CMR) to implement WIA noninvasively. We hypothesized that this method could detect differences in reflections in PH patients compared with healthy controls and could also differentiate certain PH subtypes. Twenty patients with PH (35% CTEPH and 75% female) and 10 healthy controls (60% female) were recruited. Right and left pulmonary artery (LPA and RPA) flow and area curves were acquired using self-gated golden-angle, spiral, phase-contrast CMR with a 10.5-ms temporal resolution. These data were used to perform WIA on patients and controls. The presence of a proximal clot in CTEPH patients was determined from contemporaneous computed tomography/angiographic data. A backwards-traveling compression wave (BCW) was present in both LPA and RPA of all PH patients but was absent in all controls (P = 6e?8). The area under the BCW was associated with a sensitivity of 100% [95% confidence interval (CI) 63–100%] and specificity of 91% (95% CI 75–98%) for the presence of a clot in the proximal PAs of patients with CTEPH. In conclusion, WIA metrics were significantly different between patients and controls; in particular, the presence of an early BCW was specifically associated with PH. The magnitude of the area under the BCW showed discriminatory capacity for the presence of proximal PA clot in patients with CTEPH. We believe that these results demonstrate that WIA could be used in the noninvasive assessment of PH. PMID:25659483

  7. Percutaneous Pulmonary Valve Placement

    PubMed Central

    Prieto, Lourdes R.

    2015-01-01

    Patients with congenital heart disease and pulmonary valve disease need multiple procedures over their lifetimes to replace their pulmonary valves. Chronic pulmonary stenosis, regurgitation, or both have untoward effects on ventricular function and on the clinical status of these patients. To date, all right ventricle–pulmonary artery conduits have had relatively short lifespans. Percutaneous pulmonary valve implantation, although relatively new, will probably reduce the number of operative procedures that these patients will have to undergo over a lifetime. Refinement and further development of this procedure holds promise for the extension of this technology to other patient populations. PMID:26175629

  8. [Chronic thromboembolic pulmonary hypertension].

    PubMed

    Vavera, Zden?k

    2015-03-01

    In recent years, we have witnessed a growing interest in diseases of pulmonary circulation. It is due to the development of specific drug therapy for pulmonary hypertension (PH), improving the availability and performance of endarterectomy techniques of pulmonary artery. This technique has been established as method of choice for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, the crucial issue is early indication of treatment, right diagnosis and determination of exact type of pulmonary hypertension. Modern therapeutic approaches provide better prognosis, quality of life and even possibility to cure the patients, especially suffering from CTEPH. This article discusses the issue of CTEPH. PMID:25873119

  9. Lymphotrophic nanoparticle enhanced MR imaging (LNMRI) for lymph node imaging

    Microsoft Academic Search

    Anuradha Saokar; Marta Braschi; Mukesh G. Harisinghani

    The accurate staging of lymph nodes in various primary tumors continues to pose a major diagnostic challenge. Following the detection of lymph nodes, the next arduous task is the characterization of nodes into benign and malignant categories. Cross-sectional modalities like CT and MRI rely on nodal size as the primary yardstick for differentiating benign from malignant lymph nodes. Other parameters

  10. Sentinel lymph node biopsy progress in surgical treatment of cancer

    Microsoft Academic Search

    T. Schulze; A. Bembenek; P. M. Schlag

    2004-01-01

    Background Forty-three years after the first description of the sentinel lymph node technique in malignant tumours of the parotid by Gould, sentinel lymph node biopsy (SNLB) has become a precious tool in the treatment of solid tumours. Methods In the following review we give a synopsis of the fundamentals of the sentinel lymph node concept and then proceed to an

  11. 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 ...

  12. Introduction About 6070% of patients with lymph-node-negative

    E-print Network

    Tian, Qi

    Articles Introduction About 60­70% of patients with lymph-node-negative breast cancer are cured predictions on disease outcome for patients with lymph-node-negative breast cancer. Methods Patients' samples samples from patients with lymph-node- negative breast cancer who were treated during 1980­95, but who did

  13. Sentinel Lymph Node Biopsy in Patients with Previous Ipsilateral Complete Axillary Lymph Node Dissection

    Microsoft Academic Search

    Paramjeet Kaur; John V. Kiluk; Tammi Meade; Daniel Ramos; William Koeppel; Julia Jara; Jeff King; Charles E. Cox

    2011-01-01

    Background  Prior ipsilateral completion axillary lymph node dissection (CALND) may be considered a contraindication to performing a sentinel\\u000a lymph node (SLN) mapping in a patient with recurrent breast carcinoma. However, reoperative SLN biopsy following axillary\\u000a dissection would determine if alternative lymphatic drainage pathways exist. If nodes were found to contain metastatic disease,\\u000a staging and locoregional control of the disease could be

  14. Anomalous pulmonary venous connections.

    PubMed

    Katre, Rashmi; Burns, Stephanie K; Murillo, Horacio; Lane, Michael J; Restrepo, Carlos S

    2012-12-01

    Developmental lung anomalies are classified into 3 main categories: bronchopulmonary (lung bud) anomalies, vascular anomalies, and combined lung and vascular anomalies. These anomalies are uncommon, and patients are at times asymptomatic; hence, identifying a developmental lung anomaly in the adult can be a challenge. Pulmonary vascular anomalies include interruption or absence of the main pulmonary artery, anomalous origin of the left pulmonary artery from the right pulmonary artery, anomalous pulmonary venous drainage (partial or complete), and pulmonary arteriovenous malformations. Systemic vascular anomalies comprise persistent left superior vena cava, anomalies of azygos and hemiazygos systems, and anomalies of the thoracic aorta and its major branches. In this article, we present embryology, classification, epidemiology, clinical presentation, and imaging features of anomalous pulmonary venous connections, with special emphasis on multidetector computed tomography and magnetic resonance imaging. These state-of-art imaging techniques have facilitated accurate and prompt diagnosis of these anomalies. PMID:23168060

  15. Chronic thromboembolic pulmonary hypertension.

    PubMed

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

    2014-07-01

    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

  16. [Pulmonary hypertension: a review of current clinical practice].

    PubMed

    Satoh, Toru

    2014-06-01

    This short review illustrates current epidemiology, diagnosis and treatment of pulmonary hypertension. In the first part, classification, definition and prevalence of pulmonary hypertension (PH) are explained. According to recent reports, overall PH prevalence was 0.3% to 6.0% with left heart disease occupying the most proportion, followed by pulmonary disease, pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) constituting far less proportion of 10 to 50 per 1 million people. In diagnosis, flow of diagnosis of PH, differential diagnosis of PH and how to determine the severity of PH are explained including recent development of magnetic resonance imaging (MRI) and gene abnormality study on BMPRII. In treatment, newly-developed pulmonary vasodilators are shown as well as how to combine them in PAH, and in CTEPH treatment the drugs, operation and catheter therapy including our experience are demonstrated. PMID:25164213

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

    PubMed Central

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

    1997-01-01

    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

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

    PubMed

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

    1997-10-01

    Hemodynamic factors have profound influences on blood vessels. To test the hypothesis that hemodynamic conditions modify the pattern of remodeling in response to injury, monocrotaline (MCT) injury in Sprague-Dawley rats was followed 1 week later by left pneumonectomy to increase blood flow to the right lung. Right pulmonary artery remodeling in these MCT plus pneumonectomy animals was compared with animals receiving MCT or pneumonectomy alone. Neointimal changes developed in more than 90% of all right lung intra-acinar vessels 5 weeks after MCT injury (4 weeks after pneumonectomy). Neointimal lesions did not develop in untreated animals or in animals receiving MCT or pneumonectomy only. Animals with a neointimal pattern of remodeling developed severe right ventricular hypertrophy (RVH) whereas animals with a medial hypertrophy pattern of remodeling (MCT only) developed moderate RVH compared with control animals. Neointimal lesions and RVH were similar whether injury preceded pneumonectomy or vice versa. To exclude the possibility that neointimal lesions resulted from injury plus post-pneumonectomy compensatory lung growth, rather than injury plus increased flow, a left subclavian-pulmonary artery anastomosis was substituted for pneumonectomy. Neointimal lesions and severe RVH developed in these animals but were not seen in animals receiving either MCT or anastomosis only. These studies demonstrate an important role for hemodynamics in determining the pattern of pulmonary vascular remodeling after injury. PMID:9327735

  19. Metastasis of Right Upper Para-Esophageal Lymph Nodes in Central Compartment Lymph Node Dissection of Papillary Thyroid Cancer

    Microsoft Academic Search

    Byung-Joo Lee; Jin-Choon Lee; Soo-Geun Wang; Yong-Ki Kim; In-Ju Kim; Seok-Man Son

    2009-01-01

    Background  Although some lymph nodes (upper para-esophageal lymph nodes) that exist between the right recurrent laryngeal nerve and the\\u000a esophagus should be involved in central-compartment lymph node dissection (CLND) in patients with papillary thyroid cancer,\\u000a the procedure can cause some injury to the nerve. We set out to assess the incidence of right upper para-esophageal lymph\\u000a node metastasis after routine CLND.

  20. Aging-related anatomical and biochemical changes in lymphatic collectors impair lymph transport, fluid homeostasis, and pathogen clearance.

    PubMed

    Zolla, Valerio; Nizamutdinova, Irina Tsoy; Scharf, Brian; Clement, Cristina C; Maejima, Daisuke; Akl, Tony; Nagai, Takashi; Luciani, Paola; Leroux, Jean-Christophe; Halin, Cornelia; Stukes, Sabriya; Tiwari, Sangeeta; Casadevall, Arturo; Jacobs, William R; Entenberg, David; Zawieja, David C; Condeelis, John; Fooksman, David R; Gashev, Anatoliy A; Santambrogio, Laura

    2015-08-01

    The role of lymphatic vessels is to transport fluid, soluble molecules, and immune cells to the draining lymph nodes. Here, we analyze how the aging process affects the functionality of the lymphatic collectors and the dynamics of lymph flow. Ultrastructural, biochemical, and proteomic analysis indicates a loss of matrix proteins, and smooth muscle cells in aged collectors resulting in a decrease in contraction frequency, systolic lymph flow velocity, and pumping activity, as measured in vivo in lymphatic collectors. Functionally, this impairment also translated into a reduced ability for in vivo bacterial transport as determined by time-lapse microscopy. Ultrastructural and proteomic analysis also indicates a decrease in the thickness of the endothelial cell glycocalyx and loss of gap junction proteins in aged lymph collectors. Redox proteomic analysis mapped an aging-related increase in the glycation and carboxylation of lymphatic's endothelial cell and matrix proteins. Functionally, these modifications translate into apparent hyperpermeability of the lymphatics with pathogen escaping from the collectors into the surrounding tissue and a decreased ability to control tissue fluid homeostasis. Altogether, our data provide a mechanistic analysis of how the anatomical and biochemical changes, occurring in aged lymphatic vessels, compromise lymph flow, tissue fluid homeostasis, and pathogen transport. PMID:25982749

  1. Inhaled iloprost to control residual pulmonary hypertension following pulmonary endarterectomy

    Microsoft Academic Search

    Thorsten Kramm; Balthasar Eberle; Stefan Guth; Eckhard Mayer

    2005-01-01

    Objective: Pulmonary endarterectomy (PEA) is the standard therapy for patients with chronic thromboembolic pulmonary hypertension (CTEPH). In the immediate postoperative period, persistent pulmonary hypertension increases the risk of acute respiratory or right heart failure. In pulmonary arterial hypertension, prostanoid inhalation has been found to improve pulmonary hemodynamics, right ventricular function, gas exchange, and clinical outcome. We report the results of

  2. 200 Sentinel lymph node biopsies without axillary lymph node dissection – no axillary recurrences after a 3-year follow-up

    Microsoft Academic Search

    R Reitsamer; F Peintinger; E Prokop; L Rettenbacher; C Menzel

    2004-01-01

    The aim of this study is to evaluate the rate of axillary recurrences in sentinel lymph node (SLN)-negative breast cancer patients after sentinel lymph node biopsy (SLNB) alone without further axillary lymph node dissection (ALND). Between May 1999 and February 2002, 333 consecutive patients with primary invasive breast cancer up to 4 cm and clinically negative axillae were entered into

  3. Sentinel lymph node biopsy in breast cancer patients with previous breast augmentation surgery.

    PubMed

    Nagao, Tomoya; Hojo, Takashi; Kurihara, Hiroaki; Tsuda, Hitoshi; Tanaka-Akashi, Sadako; Kinoshita, Takayuki

    2014-09-01

    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

  4. Isolated retromammary lymph node metastasis of breast cancer without axillary lymph node involvement: a case report with a false-negative sentinel lymph node biopsy

    Microsoft Academic Search

    Nana Rokutanda; Jun Horiguchi; Yukio Koibuchi; Rin Nagaoka; Ayako Sato; Hiroki Odawara; Hideaki Tokiniwa; Yuichi Iino; Junko Hirato; Izumi Takeyoshi

    2009-01-01

    A 54-year-old woman visited our hospital with a palpable tumor in her left breast, which was diagnosed as invasive ductal\\u000a carcinoma. Breast-conserving surgery was performed, in association with a sentinel lymph node (SLN) biopsy and back-up dissection\\u000a of the axillary lymph nodes. One dyed axillary lymph node with high radioactivity was defined as an SLN, and intraoperative\\u000a frozen-section analysis of

  5. Surgical treatment of chronic thromboembolic pulmonary hypertension.

    PubMed

    Jenkins, David P; Madani, Michael; Mayer, Eckhard; Kerr, Kim; Kim, Nic; Klepetko, Walter; Morsolini, Marco; Dartevelle, Philippe

    2013-03-01

    It is likely that chronic thromboembolic pulmonary hypertension (CTEPH) is more prevalent than currently recognised. Imaging studies are fundamental to decision making with respect to operability. All patients with suspected CTEPH should be referred to an experienced surgical centre. Currently, there is no risk scoring stratification system to guide operability assessment and it is predominantly based on surgical experience. The aim of pulmonary endarterectomy (PEA) is the removal of obstructive material to immediately reduce pulmonary vascular resistance. PEA affords the best chance of cure, but is difficult to perfect. Recognition and clearance of distal segmental and subsegmental disease is the main problem. The basic surgical techniques include: median sternotomy incision, cardiopulmonary bypass, arteriotomy incisions within pericardium, and a true endarterectomy with meticulous full distal dissection. Deep hypothermic circulatory arrest is recommended as the best means of reducing blood flow in the pulmonary artery to allow a clear field for dissection. In the recent PEACOG (PEA and COGnition) trial there was no evidence of cognitive impairment post-PEA. Reperfusion pulmonary oedema and residual pulmonary hypertension are unique post-operative complications post-PEA and are associated with increased mortality. However, in-hospital mortality is now <5% in experienced centres. PMID:23143539

  6. Diffusion MRI on lymph node staging of gastric adenocarcinoma

    PubMed Central

    Akcakaya, Adem; Memmi, Naim; Turkmen, Ihsan; Cipe, Gokhan; Yildiz, Pelin; Arici, Dilek Sema; Muslumanoglu, Mahmut

    2015-01-01

    Objective The purpose of this study was to evaluate the accuracy of diffusion weighted magnetic resonance imaging (MRI) in preoperative assessment of metastatic lymph nodes of gastric cancer. Methods A total of 23 gastric cancer patients with a mean age of 59.4±10.9 years were analyzed. Lymph nodes were grouped as perigastric lesser curvature (Group Ia), perigastric greater curvature (Group Ib), D1+/D2 lymph nodes (Group II). Identification of histologically metastatic lymph nodes by diffusion weighted MRI was regarded as the main outcome. Results A total of 1,056 lymph nodes including 180 histologically proven metastatic lymph nodes were dissected. Although diffusion weighted MRI could identify the metastatic lymph nodes in 18 out of 23 patients (77.8%), only 69 of total 1,056 nodes (6.53%), either metastatic or non-metastatic, could be detected. There was no correlation between histopathology and diffusion weighted MRI with regard to lymph node groups (P>0.05 for all). Overall accuracy was calculated as 69.56, 65.21 and 52.17 for Groups II, Ib and Ia lymph nodes, respectively. Apparent diffusion coefficient (ADC) values could not be helpful to differentiate metastatic lymph nodes (P=0.673). Conclusions Diffusion weighted MRI has low accuracy to detect or to differentiate metastatic and non-metastatic lymph nodes based on their ADC values in gastric cancer.

  7. Pulmonary toxicity of Mount St. Helens volcanic ash

    SciTech Connect

    Sanders, C.L.; Conklin, A.W.; Gelman, R.A.; Adee, R.R.; Rhoads, K.

    1982-02-01

    The effects of Mount St. Helens volcanic ash, a sandy loam soil, and quartz particles on the lung and mediastinal lymph nodes of Fischer rats were studied at time intervals of up to 109 days after in tratracheal instillation of 40 mg ash, soil, or quartz in a single dose or after multiple doses of ash instilled in seven consecutive weekly doses for a total deposition of 77 mg. Quartz caused early granuloma formation, later fibrosis was also seen in lymph nodes. Volcanic ash caused an ill-defined inflammatory reaction with a few rats showing granuloma formulation, a very limited linear fibrosis, and a moderate lipoproteinosis, and lymph nodes were enlarged with numerous microgranulomas but without reticulin and collagen formation. Pulmonary reactions to soil particles were less intense but similar to those in ash- exposed animals; lymph nodes were not enlarged. No significant clearance of ash was found at 3 months after instillation. Volcanic ash produced a simple pneumoconiosis similar to what has been described for animals and humans living for prolonged periods of time in dusty desert areas of the United States.

  8. Pulmonary rehabilitation in chronic obstructive pulmonary disease

    Microsoft Academic Search

    Thierry Troosters; Rik Gosselink; Daniel Langer; Marc Decramer

    2007-01-01

    Pulmonary rehabilitation has become part of the evidence-based care in patients with COPD who remain symptomatic and have reduced participation in everyday life, after optimal medical treatment. Pulmonary rehabilitation is—by definition—a multidisciplinary intervention. By consequence the assessment of patients before entering a rehabilitation program includes both physiological and psychosocial assessment. In addition nutritional status and physical activity participation needs to

  9. The resistance-compliance product of the pulmonary circulation varies in health and pulmonary vascular disease

    PubMed Central

    Hadinnapola, Charaka; Li, Qiuju; Su, Li; Pepke-Zaba, Joanna; Toshner, Mark

    2015-01-01

    Pulmonary vascular resistance (PVR) is traditionally used to describe pulmonary hemodynamic characteristics. However, it does not take into account pulmonary artery compliance (Ca) or pulsatile flow. The product of PVR and Ca is known as RC time. Previous studies assert that the PVR-Ca relationship is fixed and RC time is constant between health and disease states. We hypothesized that RC time was not constant in health and pulmonary vascular disease. Right heart catheterizations performed in Papworth Hospital over a 6 year period were analyzed. Subjects were divided into those with normal pulmonary hemodynamics (NPH group; n = 156) and pulmonary arterial hypertension (PAH group; n = 717). RC time and the right ventricle (RV) oscillatory power fraction were calculated. RC time for the NPH group (0.47 ± 0.13 sec) is significantly lower than the PAH group (0.56 ± 0.16 sec; P < 0.0001). The RV oscillatory power fraction is lower in the NPH group (P < 0.0001). RC time correlates inversely with the RV oscillatory power fraction in each group. We conclude, there is an inverse relationship between PVR and Ca, however, this relationship is not always fixed. Consequently, RC time is significantly lower in health compared to disease with elevated pulmonary artery pressures. PAH leads to a decrease in cardiac efficiency. PMID:25902784

  10. Pulmonary hypertension caused by pulmonary venous hypertension

    PubMed Central

    2014-01-01

    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

  11. The Lymph Self-Antigen Repertoire

    PubMed Central

    Clement, Cristina C.; Santambrogio, Laura

    2013-01-01

    The lymphatic fluid originates from the interstitial fluid which bathes every parenchymal organ and reflects the “omic” composition of the tissue from which it originates in its physiological or pathological signature. Several recent proteomic analyses have mapped the proteome-degradome and peptidome of this immunologically relevant fluid pointing to the lymph as an important source of tissue-derived self-antigens. A vast array of lymph-circulating peptides have been mapped deriving from a variety of processing pathways including caspases, cathepsins, MMPs, ADAMs, kallikreins, calpains, and granzymes, among others. These self peptides can be directly loaded on circulatory dendritic cells and expand the self-antigenic repertoire available for central and peripheral tolerance. PMID:24379811

  12. Sentinel Lymph Node Biopsy in Colon Cancer

    PubMed Central

    Bembenek, Andreas E.; Rosenberg, Robert; Wagler, Elke; Gretschel, Stephan; Sendler, Andreas; Siewert, Joerg-Ruediger; Nährig, Jörg; Witzigmann, Helmut; Hauss, Johann; Knorr, Christian; Dimmler, Arno; Gröne, Jörn; Buhr, Heinz-Johannes; Haier, Jörg; Herbst, Hermann; Tepel, Juergen; Siphos, Bence; Kleespies, Axel; Koenigsrainer, Alfred; Stoecklein, Nikolas H.; Horstmann, Olaf; Grützmann, Robert; Imdahl, Andreas; Svoboda, Daniel; Wittekind, Christian; Schneider, Wolfgang; Wernecke, Klaus-Dieter; Schlag, Peter M.

    2007-01-01

    Introduction: The clinical impact of sentinel lymph node biopsy (SLNB) in colon cancer is still controversial. The purpose of this prospective multicenter trial was to evaluate its clinical value to predict the nodal status and identify factors that influence these results. Methods: Colon cancer patients without prior colorectal surgery or irradiation were eligible. The sentinel lymph node (SLN) was identified intraoperatively by subserosal blue dye injection around the tumor. The SLN underwent step sections and immunohistochemistry (IHC), if classified free of metastases after routine hematoxylin and eosin examination. Results: At least one SLN (median, n = 2) was identified in 268 of 315 enrolled patients (detection rate, 85%). Center experience, lymphovascular invasion, body mass index (BMI), and learning curve were positively associated with the detection rate. The false-negative rate to identify pN+ patients by SLNB was 46% (38 of 82). BMI showed a significant association to the false-negative rate (P < 0.0001), the number of tumor-involved lymph nodes was inversely associated. If only slim patients (BMI ?24) were investigated in experienced centers (>22 patients enrolled), the sensitivity increased to 88% (14 of 16). Moreover, 21% (30 of 141) of the patients, classified as pN0 by routine histopathology, revealed micrometastases or isolated tumor cells (MM/ITC) in the SLN. Conclusions: The contribution of SLNB to conventional nodal staging of colon cancer patients is still unspecified. Technical problems have to be resolved before a definite conclusion can be drawn in this regard. However, SLNB identifies about one fourth of stage II patients to reveal MM/ITC in lymph nodes. Further studies must clarify the clinical impact of these findings in terms of prognosis and the indication of adjuvant therapy. PMID:17522509

  13. Axillary lymph node metastasis in lung cancer

    Microsoft Academic Search

    Hiroaki Satoh; Hiroichi Ishikawa; Katsunori Kagohashi; Koichi Kurishima; Kiyohisa Sekizawa

    2009-01-01

    Study objectives Axillary lymph node metastasis (ALNM) from lung cancer is rare. Its prognosis and effective treatments remain unknown. To\\u000a evaluate clinicopatholgical characteristics of such lung cancer patients, we performed a retrospective study of them, who\\u000a had ALNM at the time of initial presentation or developed ALNM in their clinical courses. Methods We reviewed the medical records and pathological reports

  14. Chronic thromboembolic pulmonary hypertension

    Microsoft Academic Search

    P. Dartevelle; E. Fadel; S. Mussot; A. Chapelier; P. Herve; M. de Perrot; J. Cerrina; F. L. Ladurie; D. Lehouerou; M. Humbert; O. Sitbon; G. Simonneau

    2004-01-01

    ABSTRACT: Pulmonary arterial hypertension is a severe disease that has been ignored for a long time. However, over the past 20 yrs chest physicians, cardiologists and thoracic,surgeons,have,shown,increasing interest in this disease because,of the development of new therapies, that have improved both the outcome and quality of life of patients, including pulmonary transplantation and prostacyclin therapy. Chronic thromboembolic,pulmonary,arterial hypertension,(CTEPH) can be

  15. [Lymph node dissection: what for? From esophagus to rectum: surgical and lymph node related prognostic factors].

    PubMed

    Alline, Mathias; Bertrand, Martin Marie; Colombo, Pierre Emmanuel; Mourregot, Anne; Rouanet, Philippe

    2014-04-01

    Surgery has still a key role in curative treatment of digestive carcinomas, and for almost all localisations, lymph node status is a major prognostic factor. As far as oesophageal and gastric cancer are concerned, there is not yet any internationally standardized approach. Occidental guidelines recommend more limited lymph node dissections than Asiatic ones. Lymph node numbers requested during surgery of such cancers remain high, at least 23 lymph nodes for oesophageal cancer, and 25 for a D2 or D1.5 lymphadenectomy for gastric cancer. Generalisation of neo-adjuvant and adjuvant treatments has not yet modified these standards. On the other hand, rectal cancer surgery is well standardized since the global adoption of Total Mesorectal Excision (TME) for the late eighties. Development of mini-invasive techniques (laparoscopy and robot-assisted surgery) enabled an important decrease of surgery related morbidity as well as an enhanced post-operative recovery. However, rectal cancer surgery still has an important morbidity. Development of neo-adjuvant chemo-radiotherapy as well as in-depth knowledge of risk factor of lymph node invasion opened up the path for transanal full thickness resection without lymphadenectomy. The goal of such an approach is to avoid TME's morbidity without risking local recurrence rate increase. As a consequence, this technique might need to be completed with a TME case histological factors are not favorable. PMID:24793629

  16. Pulmonary rehabilitation: future directions.

    PubMed

    Nici, Linda; ZuWallack, Richard L

    2014-06-01

    Pulmonary rehabilitation is now an established standard of care for patients with chronic obstructive pulmonary disease (COPD). Although pulmonary rehabilitation has no appreciable direct effect on static measurements of lung function, it arguably provides the greatest benefit of any available therapy across multiple outcome areas important to the patient with respiratory disease, including dyspnea, exercise performance, and health-related quality of life. It also appears to be a potent intervention that reduces COPD hospitalizations, especially when given in the periexacerbation period. The role of pulmonary rehabilitation within the larger schema of integrated care represents a fruitful area for further research. PMID:24874138

  17. Selective Changes in the Immune Profile of Tumor-Draining Lymph Nodes After Different Neoadjuvant Chemoradiation Regimens for Locally Advanced Cervical Cancer

    Microsoft Academic Search

    Alessandra Battaglia; Alexia Buzzonetti; Enrica Martinelli; Mara Fanelli; Marco Petrillo; Gabriella Ferrandina; Giovanni Scambia; Andrea Fattorossi

    2010-01-01

    Purpose: To assess how neoadjuvant chemoradiation regimens modulate the immune system state in tumor-draining lymph nodes (TDLN), in the setting of advanced cervical cancer. Methods and Materials: Tumor-draining lymph nodes of patients undergoing chemotherapy only (nonirradiated, NI-TDLN) and chemoradiation with lower-dose (39.6 Gy, LD-TDLN) and higher-dose radiation (50 Gy, HD-TDLN) were analyzed by multicolor flow cytometry. Results: Enlarging our previous

  18. Pulmonary arterial hypertension in pregnancy.

    PubMed

    Obi?an, Sarah G; Cleary, Kirsten L

    2014-08-01

    Pulmonary hypertension is a medical condition characterized by elevated pulmonary arterial pressure and secondary right heart failure. Pulmonary arterial hypertension is a subset of pulmonary hypertension, which is characterized by an underlying disorder of the pulmonary arterial vasculature. Pulmonary hypertension can also occur secondarily to structural cardiac disease, autoimmune disorders, and toxic exposures. Although pregnancies affected by pulmonary hypertension and pulmonary arterial hypertension are rare, the pathophysiology exacerbated by pregnancy confers both high maternal and fetal mortality and morbidity. In light of new treatment modalities and the use of a multidisciplinary approach to care, maternal outcomes may be improving. PMID:25037519

  19. What Causes Idiopathic Pulmonary Fibrosis?

    MedlinePLUS

    ... the NHLBI on Twitter. What Causes Idiopathic Pulmonary Fibrosis? Sometimes doctors can find out what is causing pulmonary fibrosis (lung scarring). For example, exposure to environmental pollutants ...

  20. Solitary positive sentinel lymph node accompanied by negative sentinel lymph node(s) is predictive of a negative completion axillary lymph node dissection

    Microsoft Academic Search

    Weesam Alkhatib; Carol Connor; Fan Fang

    2007-01-01

    BackgroundMany patients with a positive sentinel lymph node (SLN) have a negative axillary lymph node dissection (ALND). We hypothesized that a solitary positive SLN associated with at least 1 negative SLN is predictive of a negative completion ALND. Omission of ALND may be possible in these patients.

  1. Diffuse pulmonary neuroendocrine cell hyperplasia involving the chest wall.

    PubMed

    Al-Ayoubi, Adnan M; Ralston, Jonathan S; Richardson, S Russ; Denlinger, Chadrick E

    2014-01-01

    Diffuse pulmonary neuroendocrine cell hyperplasia (DIPNECH) is characterized by a diffuse hypertrophy of neuroendocrine cells along the distal bronchioles. This condition is characterized by obstructive lung physiology and the development of small carcinoid tumors. We present a case of DIPNECH in a patient undergoing surgery for a primary lung adenocarcinoma. Interestingly, the chest wall also demonstrated involvement of DIPNECH indicated by the presence of small carcinoid tumors. The absence of any lung carcinoid tumor greater than 5 mm and the absence of lymph node metastases render the chest wall involvement unlikely to represent metastatic disease. PMID:24384190

  2. Predictors of Completion Axillary Lymph Node Dissection in Patients with Positive Sentinel Lymph Nodes

    Microsoft Academic Search

    Amer K. Karam; Meier Hsu; Sujata Patil; Michelle Stempel; Tiffany A. Traina; Alice Y. Ho; Hiram S. Cody; Elisa R. Port; Monica Morrow; Mary L. Gemignani

    2009-01-01

    Background  Completion axillary lymph node dissection (CALND) is routinely performed in breast cancer patients with positive sentinel\\u000a lymph nodes (SLN). We sought to determine the sociodemographic, pathologic, and therapeutic variables that were associated\\u000a with CALND.\\u000a \\u000a \\u000a \\u000a Methods  From 7\\/1997 to 7\\/2003, 1,470 patients with invasive breast cancer were SLN positive by intraoperative frozen section or final\\u000a pathologic exam by hematoxylin–eosin and\\/or immunohistochemistry (IHC).

  3. Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer

    Microsoft Academic Search

    Karen K. Swenson; Mary J. Nissen; Carolyn Ceronsky; Lindsey Swenson; Martin W. Lee; Todd M. Tuttle

    2002-01-01

    Background  Axillary lymph node dissection (ALND) is often associated with permanent arm side effects. Side effects after sentinel lymph\\u000a node dissection (SLND) should be less common, because the surgery is less extensive.\\u000a \\u000a \\u000a \\u000a Methods  The study compared side effects and interference with daily life between 169 women who underwent an SLND and 78 who underwent\\u000a an ALND for breast cancer. Patients rated symptom

  4. Predictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer

    PubMed Central

    Bao, Feichao; Yuan, Ping; Yuan, Xiaoshuai; Lv, Xiayi; Wang, Zhitian

    2014-01-01

    Background Accurate clinical staging of non-small cell lung cancer (NSCLC) is essential for developing an optimal treatment strategy. This study aimed to determine the predictive risk factors for lymph node metastasis, including both N1 and N2 metastases, in clinical T1aN0 NSCLC patients. Methods We retrospectively evaluated clinical T1aN0M0 NSCLC patients who showed no radiologic evidence of lymph node metastasis, and who had undergone surgical pulmonary resection with systematic mediastinal node dissection or sampling at the First Affiliated Hospital of Zhejiang University between January 2011 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify predictive factors for node metastasis. Results Pathologically positive lymph nodes were found in 16.2% (51/315) of the patients. Positive N1 nodes were found in 12.4% (39/315) of the patients, and positive N2 nodes were identified in 13.0% (41/315) of the patients. Some 9.2% (29/315) of the patients had both positive N1 and N2 nodes, and 3.8% (12/315) of the patients had nodal skip metastasis. Variables of preoperative radiographic tumor size, non-upper lobe located tumors, high carcinoembryonic antigen (CEA) levels and micropapillary predominant adenocarcinoma (AC) were identified as predictors for positive N1 or N2 node multivariate analysis. Conclusions Pathologically positive lymph nodes were common in small size NSCLC patients with clinical negative lymph nodes. Therefore, preoperative staging should be performed more thoroughly to increase accuracy, especially for patients who have the larger size, non-upper lobe located, high CEA level or micropapillary predominant ACs. PMID:25589962

  5. Pulmonary nuclear medicine

    SciTech Connect

    Loken, M.K.

    1987-01-01

    This book contains 19 chapters. Some of the titles are: Pulmonary Nuclear Medicine; Radionuclide Venography as an Adjunct to V-P Imaging in the Assessment of Thromboembolic Disease; Assessment of Mucous Transport in the Respiratory Tract by Radioisotopic Techniques; Radiolabeled Blood Cells and Tracers in the Study of Acute Pulmonary Injury and ARDS; and Magnetic Resonance Imaging of the Lungs.

  6. Pulmonary Rehabilitation in Emphysema

    Microsoft Academic Search

    Andrew L. Ries; Barry J. Make; John J. Reilly

    2008-01-01

    Pulmonary rehabilitation is an established treatment for patients with chronic lung disease. Benefits include improvement in exercise tolerance, symptoms, and quality of life, with a reduction in the use of health care resources. As an adjunct to surgical programs, such as lung volume reduction surgery, pulmonary rehabilitation plays an important role not just in preparing patients for surgery and faci-

  7. Severe Pulmonary Hypertension and Chronic Obstructive Pulmonary Disease

    Microsoft Academic Search

    Ari Chaouat; Anne-Sophie Bugnet; Nabila Kadaoui; Roland Schott; Irina Enache; Alain Ducolone; May Ehrhart; Romain Kessler; Emmanuel Weitzenblum

    Rationale: Severe pulmonary hypertension occurs occasionally in patients with chronic obstructive pulmonary disease (COPD), but no detailed description of these patients is available. Objectives: To identifyandcharacterizepatientswithCOPDandseverepulmonary hypertension. Methods: Retrospective study of 27 patients with COPD with severe pulmonary hypertension (pulmonary artery mean pressure (Ppa), 40 mm Hg) among 998 patients who underwent right heart catheterization between 1990 and 2002 as

  8. Changes in Large Pulmonary Arterial Viscoelasticity in Chronic Pulmonary Hypertension

    E-print Network

    Lakes, Roderic

    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

  9. Computerized tomography detects pulmonary lesions in children with normal radiographs diagnosed to have tuberculosis.

    PubMed

    Swaminathan, Soumya; Raghavan, Aarti; Datta, Manjula; Paramasivan, C N; Saravanan, K C

    2005-03-01

    This report is based on observations during the conduct of a larger study to develop diagnostic criteria for childhood tuberculosis (TB). Of 201 children confirmed to have pulmonary or lymph node TB, 84 had normal chest radiographs. Computerized tomography (CT) of the chest was performed in nine of them, seven of whom had normal chest radiographs while two had visible calcification. Eight of the nine children had definitive lesions detected by computerized tomography of the chest. While five children had primarily hilar lymph node enlargement, three had pulmonary parenchymal lesions. The use of more sensitive diagnostic tests like computed tomography helps to detect tuberculosis lesions not otherwise visualized on chest radiographs. This report highlights the difficulty in excluding active tuberculosis in children. More studies are required on the role of CT scans in the diagnosis of tuberculosis in children. PMID:15817975

  10. Pulmonary capillary haemangiomatosis: a rare cause of pulmonary hypertension.

    PubMed

    Babu, K Anand; Supraja, K; Singh, Raj B

    2014-01-01

    Pulmonary capillary haemangiomatosis (PCH) is a rare disorder of unknown aetiology, characterised by proliferating capillaries that invade the pulmonary interstitium, alveolar septae and the pulmonary vasculature. It is often mis-diagnosed as primary pulmonary hypertension and pulmonary veno-occlusive disease. Pulmonary capillary haemangiomatosis is a locally aggressive benign vascular neoplasm of the lung. We report the case of a 19-year-old female who was referred to us in the early post-partum period with severe pulmonary artery hypertension, which was diagnosed as PCH by open lung biopsy. PMID:25962202

  11. Morphological characteristics of lateral pelvic lymph nodes in rectal carcinoma

    Microsoft Academic Search

    Hiroyoshi Matsuoka; Tadahiko Masaki; Masanori Sugiyama; Yutaka Atomi; Yasuo Ohkura; Atsuhiko Sakamoto

    2007-01-01

    Aim  Macroscopic and imaging indicators for lymph node metastasis have been documented not in lateral pelvic lymph nodes but in\\u000a mesorectal lymph nodes in patients with rectal carcinoma. We conducted this study to uncover morphological characteristics\\u000a of lateral pelvic lymph nodes in patients with rectal carcinoma.\\u000a \\u000a \\u000a \\u000a Materials and methods  Fifty-eight patients with locally advanced rectal carcinoma who had total mesorectal excision and

  12. Lymph node size does not correlate with the presence of prostate cancer metastasis

    Microsoft Academic Search

    Rabi Tiguert; Edward L Gheiler; Marcos V Tefilli; Peter Oskanian; Mousumi Banerjee; David J Grignon; Wael Sakr; J. Edson Pontes; David P Wood

    1999-01-01

    Objectives. To determine whether lymph node size is a surrogate marker for lymph node metastasis.Methods. We reviewed 980 patients who underwent radical retropubic prostatectomy with bilateral pelvic lymph node dissection for clinically localized prostate cancer, of whom 63 had lymph node metastases. A comparable group of patients with prostate cancer undergoing radical prostatectomy who did not have lymph node involvement

  13. Black sentinel lymph node and 'scary stickers'.

    PubMed

    Yang, Arthur S; Creagh, Terrence A

    2013-04-01

    An unusual case is presented of a young adult patient with two black-stained, radio-nucleotide tracer-active sentinel lymph nodes biopsied following her primary cutaneous melanoma treatment. This was subsequently confirmed to be secondary to cutaneous tattoos, averting the need of an elective regional node dissection. History of tattooing and tattoo removal should therefore be obtained as a routine in all melanoma patients considered for sentinel node biopsy (SLN). SLN biopsy and any subsequent completion node dissection should be strictly staged so that proper histologic diagnosis of the sentinel node is available for correct decision making and treatment. PMID:23010587

  14. Predictors of positive axillary lymph nodes after sentinel lymph node biopsy in breast cancer

    Microsoft Academic Search

    Shahab F Abdessalam; Emmanuel E Zervos; Manju Prasad; William B Farrar; Lisa D Yee; Michael J Walker; William B Carson; William E Burak

    2001-01-01

    Objective: The purpose of this study was to determine the factors that predict the presence of metastasis in nonsentinel lymph nodes (SLN) when the SLN is positive.Methods: A prospective database was analyzed and included patients who underwent SLN biopsy for invasive breast cancer from July 1997 to August 2000 (n = 442). One hundred (22.6%) patients had one or more

  15. Reoperative sentinel lymph node biopsy for ipsilateral breast tumor recurrence after previous axillary lymph node dissection: Report of a case

    Microsoft Academic Search

    Masaya Hattori; Seiichiro Nishimura; Keiichiro Tada; Masamichi Koyama; Futoshi Akiyama; Yoshinori Ito; Takuji Iwase

    2011-01-01

    Sentinel lymph node biopsy has become a standard component of the evaluation of early-stage breast cancer, with a gradually\\u000a increasing number of indications in this patient population. This report presents the case of a patient who underwent reoperative\\u000a sentinel lymph node biopsy as part of an evaluation of ipsilateral breast tumor recurrence; she had previously undergone axillary\\u000a lymph node dissection.

  16. Sentinel lymph-node biopsy compared to axillary lymph-node dissection for axillary staging in breast cancer patients

    Microsoft Academic Search

    P Schrenk; A Shamiyeh; W Wayand

    2001-01-01

    Aims The purpose of this study was to evaluate the feasibility of sentinel lymph-node biopsy in breast cancer patients at our institution and to compare the results of sentinel node (SN) biopsy to standard axillary lymph-node dissection (ALND). Methods In a retrospective study the percentage of lymph-node positive patients and the number of micrometastases in 165 breast cancer patients following

  17. Sentinel lymph-node biopsy compared to axillary lymph-node dissection for axillary staging in breast cancer patients

    Microsoft Academic Search

    P. Schrenk; A. Shamiyeh; W. Wayand

    Aims: The purpose of this study was to evaluate the feasibility of sentinel lymph-node biopsy in breast cancer patients at our institution and to compare the results of sentinel node (SN) biopsy to standard axillary lymph-node dissection (ALND). Methods: In a retrospective study the percentage of lymph-node positive patients and the number of micrometastases in 165 breast cancer patients following

  18. Sentinel lymph node biopsy compared with axillary lymph node dissection in early breast cancer: a meta-analysis

    Microsoft Academic Search

    Zhen Wang; Liu-Cheng Wu; Jun-Qiang Chen

    Sentinel lymph node biopsy (SLNB) has been recommended as the standard performance for negative sentinel lymph node (SLN)\\u000a patients without axillary lymph node dissection (ALND) in the surgical management of early breast cancer; however, the efficiency\\u000a of SLNB for patients with positive SLNs is still unclear. We performed this meta-analysis to compare the effectiveness and\\u000a safety of SLNB with ALND.

  19. Cytokeratin Deposits in Lymph Nodes Show Distinct Clinical Significance from Lymph Node Micrometastasis in Human Esophageal Cancers

    Microsoft Academic Search

    Yuichiro Doki; Osamu Ishikawa; Masayuki Mano; Masahiro Hiratsuka; Yo Sasaki; Masao Kameyama; Hiroaki Ohigashi; Kohei Murata; Terumasa Yamada; Isao Miyashiro; Shigekazu Yokoyama; Shingo Ishiguro; Shingi Imaoka

    2002-01-01

    Background. Cytokeratin immunostaining is the most common method used to identify micrometastatic cancer cells from the lymph nodes. However, contamination with hyalinized cytokeratin particles, frequently observed in the lymph nodes of esophageal cancer patients, can lead to misinterpretation of cytokeratin immunostaining.Materials and methods. Cytokeratin immunostaining (AE1\\/AE3) of surgically removed lymph nodes was performed for 41 cases of node-negative, but locally

  20. The impact of lymph node metastases on the survival of breast cancer patients with ten or more positive lymph nodes

    Microsoft Academic Search

    Atsuo Tsuchiya; Masahiko Kanno; Rikiya Abe

    1997-01-01

    To investigate the impact of the number of involved lymph nodes on survival, we retrospectively reviewed the data for 37 patients\\u000a with breast cancer and metastases of ten or more lymph nodes who underwent treatment between 1987 and 1995. Based on the number\\u000a of positive lymph nodes, the patients were allocated to one of three groups. The 5-year disease-free and

  1. Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma

    Microsoft Academic Search

    Stephane Bardet; Elodie Malville; Jean-Pierre Rame; Emmanuel Babin; Guy Samama; Dominique De Raucourt; Jean-Jacques Michels; Yves Reznik; Michel Henry-Amar

    2008-01-01

    Objective: Whether lymph-node dissection (LND) influences the lymph-node recurrence (LNR) risk in patients with papillary thyroid cancer remains controversial. The prognostic impact of macroscopic and microscopic lymph-node involvement at diagnosis is also an unresolved issue. A retrospective study was conducted to assess the influence of various LND procedures and to search for LNR risk factors. Methods: Overall 545 patients without

  2. A mathematical model of axillary lymph node involvement considering lymph node size in patients with breast cancer

    Microsoft Academic Search

    Takaomi Suzuma; Takeo Sakurai; Goro Yoshimura; Teiji Umemura; Takeshi Tamaki; Yasuaki Naito

    2001-01-01

    Background  Surgical sampling for assessing axillary status has not been considered as a well defined surgical procedure. We have reported\\u000a that MRI is a good instrument for assessing lymph node size and identifying lymph node position. We also developed a mathematical\\u000a model that takes into consideration the size of axillary lymph nodes, and retrospectively determined the number and size of\\u000a the

  3. Chronic thromboembolic pulmonary hypertension.

    PubMed

    Kim, Nick H; Delcroix, Marion; Jenkins, David P; Channick, Richard; Dartevelle, Philippe; Jansa, Pavel; Lang, Irene; Madani, Michael M; Ogino, Hitoshi; Pengo, Vittorio; Mayer, Eckhard

    2013-12-24

    Since the last World Symposium on Pulmonary Hypertension in 2008, we have witnessed numerous and exciting developments in chronic thromboembolic pulmonary hypertension (CTEPH). Emerging clinical data and advances in technology have led to reinforcing and updated guidance on diagnostic approaches to pulmonary hypertension, guidelines that we hope will lead to better recognition and more timely diagnosis of CTEPH. We have new data on treatment practices across international boundaries as well as long-term outcomes for CTEPH patients treated with or without pulmonary endarterectomy. Furthermore, we have expanded data on alternative treatment options for select CTEPH patients, including data from multiple clinical trials of medical therapy, including 1 recent pivotal trial, and compelling case series of percutaneous pulmonary angioplasty. Lastly, we have garnered more experience, and on a larger international scale, with pulmonary endarterectomy, which is the treatment of choice for operable CTEPH. This report overviews and highlights these important interval developments as deliberated among our task force of CTEPH experts and presented at the 2013 World Symposium on Pulmonary Hypertension in Nice, France. PMID:24355646

  4. [Chronic thromboembolic pulmonary hypertension].

    PubMed

    Kim, Nick H; Delcroix, Marion; Jenkins, David P; Channick, Richard; Dartevelle, Philippe; Jansa, Pavel; Lang, Irene; Madani, Michael M; Ogino, Hitoshi; Pengo, Vittorio; Mayer, Eckhard

    2014-10-01

    Since the last World Symposium on Pulmonary Hypertension in 2008, we have witnessed numerous and exciting developments in chronic thromboembolic pulmonary hypertension (CTEPH). Emerging clinical data and advances in technology have led to reinforcing and updated guidance on diagnostic approaches to pulmonary hypertension, guidelines that we hope will lead to better recognition and more timely diagnosis of CTEPH. We have new data on treatment practices across international boundaries as well as long-term outcomes for CTEPH patients treated with or without pulmonary endarterectomy. Furthermore, we have expanded data on alternative treatment options for select CTEPH patients, including data from multiple clinical trials of medical therapy, including 1 recent pivotal trial, and compelling case series of percutaneous pulmonary angioplasty. Lastly, we have garnered more experience, and on a larger international scale, with pulmonary endarterectomy, which is the treatment of choice for operable CTEPH. This report overviews and highlights these important interval developments as deliberated among our task force of CTEPH experts and presented at the 2013 World Symposium on Pulmonary Hypertension in Nice, France. (J Am Coil Cardiol 2013;62:D92-9) ©2013 by the American College of Cardiology Foundation. PMID:25697039

  5. Ultrasound of malignant cervical lymph nodes

    PubMed Central

    Ying, M.; Ho, S.Y.; Antonio, G.; Lee, Y.P.; King, A.D.; Wong, K.T.

    2008-01-01

    Abstract Malignant lymph nodes in the neck include metastases and lymphoma. Cervical nodal metastases are common in patients with head and neck cancers, and their assessment is important as it affects treatment planning and prognosis. Neck nodes are also a common site of lymphomatous involvement and an accurate diagnosis is essential as its treatment differs from other causes of neck lymphadenopathy. On ultrasound, grey scale sonography helps to evaluate nodal morphology, whilst power Doppler sonography is used to assess the vascular pattern. Grey scale sonographic features that help to identify metastatic and lymphomatous lymph nodes include size, shape and internal architecture (loss of hilar architecture, presence of intranodal necrosis and calcification). Soft tissue oedema and nodal matting are additional grey scale features seen in tuberculous nodes or in nodes that have been previously irradiated. Power Doppler sonography evaluates the vascular pattern of nodes and helps to identify the malignant nodes. In addition, serial monitoring of nodal size and vascularity are useful features in the assessment of treatment response. PMID:18390388

  6. The local lymph node assay (LLNA).

    PubMed

    Rovida, Costanza; Ryan, Cindy; Cinelli, Serena; Basketter, David; Dearman, Rebecca; Kimber, Ian

    2012-02-01

    The murine local lymph node assay (LLNA) is a widely accepted method for assessing the skin sensitization potential of chemicals. Compared with other in vivo methods in guinea pig, the LLNA offers important advantages with respect to animal welfare, including a requirement for reduced animal numbers as well as reduced pain and trauma. In addition to hazard identification, the LLNA is used for determining the relative skin sensitizing potency of contact allergens as a pivotal contribution to the risk assessment process. The LLNA is the only in vivo method that has been subjected to a formal validation process. The original LLNA protocol is based on measurement of the proliferative activity of draining lymph node cells (LNC), as determined by incorporation of radiolabeled thymidine. Several variants to the original LLNA have been developed to eliminate the use of radioactive materials. One such alternative is considered here: the LLNA:BrdU-ELISA method, which uses 5-bromo-2-deoxyuridine (BrdU) in place of radiolabeled thymidine to measure LNC proliferation in draining nodes. PMID:22511117

  7. Diltiazem reduces pulmonary arterial pressures in recurrent pulmonary hypertension associated with pulmonary hypoplasia

    Microsoft Academic Search

    Saleem Islam; Peter Masiakos; Jay J Schnitzer; Daniel P Doody; Daniel P Ryan

    1999-01-01

    Background\\/Purpose: Recurrent pulmonary hypertension in the neonatal population is an unusual event with dire consequences. Pulmonary hypertension seen in association with pulmonary hypoplasia may be refractory to conventional medical management. The effect of the calcium channel antagonist diltiazem was studied in five patients with severe pulmonary hypertension.Methods: A retrospective review of the hospital records was performed to determine the efficacy

  8. Axillary lymph node ratio and total number of removed lymph nodes: predictors of survival in stage I and II breast cancer

    Microsoft Academic Search

    B. C. H van der Wal; R. M. J. M Butzelaar; S van der Meij; M. A Boermeester

    2002-01-01

    Aims: Presence of axillary lymph node metastases is considered the most important prognostic factor for breast cancer survival. In a period of increasing popularity for the sentinel node procedure, clarity about the possible relation between axillary dissection and survival is essential. This study investigated whether the total number of removed lymph nodes and the ratio of invaded\\/removed lymph nodes (lymph

  9. Management strategy of early-stage breast cancer patients with a positive sentinel lymph node: With or without axillary lymph node dissection

    Microsoft Academic Search

    Jia-Jian Chen; Jiong Wu

    2011-01-01

    Sentinel lymph node biopsy (SLNB) has been generally adopted as an alternative procedure to axillary lymph node dissection (ALND) for node staging. ALND remains the standard management of the axilla when a tumor-positive sentinel lymph node (SLN) is identified. However, further analysis has demonstrated that in 40–70% of cases with metastasis to the axillary lymph nodes, the SLN is the

  10. Studying the pulmonary circulation with positron emission tomography

    SciTech Connect

    Schuster, D.P.; Mintun, M.A.

    1988-01-01

    Positron emission tomography and appropriately labeled, short-lived radiopharmaceuticals can be used to study a variety of physiologic processes within the lung. Recently, methods have been developed to measure regional pulmonary blood flow and pulmonary vascular permeability to protein macromolecules. The advantages of these techniques include accurate quantitation, regional data available in an image format, noninvasiveness, and repeatability. These methods have recently been applied to studies of hypoxic vasoconstriction, pulmonary edema, and chronic obstructive lung disease in man and large experimental animals. Although the technology is complex and requires the integration of people from a variety of disciplines, these methods offer a unique opportunity to study in vivo lung physiology.

  11. The Cushing responses in the systemic and pulmonary circulation: the role of adrenal glands, bronchial circulation and pulmonary innervation.

    PubMed

    Chen, H I; Wang, Y C; Chai, C Y

    1987-01-01

    Systemic hypertension and increased total peripheral vascular resistance are the most consistent observations in the Cushing responses to an increase in intracranial pressure (ICP). In the present study, we evaluated the participation of adrenal glands, bronchial circulation and pulmonary innervation in the systemic and pulmonary hemodynamics following an intracranial hypertension (ICH). In a total of 18 anesthetized, vagotomized and open-chest dogs, total heart bypass was performed to perfuse the systemic and pulmonary circulation with constant flow. The venous outflows were diverted into reservoirs. The preparation allowed us to observe the simultaneous changes in the systemic vascular resistance (SVR) and capacity (SVC) as well as the pulmonary vascular resistance (PVR) and capacity (PVC). ICH was produced by inflation of an epidural balloon to elevate the ICP to a level of 165-175 mmHg for 1.5 min. Our data showed that ICH induced drastic increases in SVR and PVR accompanying decreases in SVC and PVC. Vascular occlusion of the adrenal glands (n = 6) did not affect the hemodynamic changes. Arrest of bronchial circulation (n = 6) or pulmonary denervation (n = 6) also did not affect the changes in systemic circulation (SVR and SVC), but greatly diminished the pulmonary hemodynamic changes (PVR and PVC). The results suggest that the adrenal glands are not involved in the systemic and pulmonary hemodynamic responses to this degree of ICH. The changes in the pulmonary vascular resistance and capacity require the integrity of bronchial blood supply and sympathetic innervation. PMID:3449323

  12. 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...

  13. Six Cases of Chylous Leakage after Axillary Lymph Node Dissection

    Microsoft Academic Search

    Ming-hua Cong; Qi Liu; Wen-hong Zhou; Jian Zhu; Chen-xin Song; Xing-song Tian

    2008-01-01

    Summary Background: Chylous leakage has been described after several surgical procedures, especially in the region of the neck and thorax. However, it has rarely been reported after axillary lymph node dissection. Patients and Methods: We encountered 6 cases of chylous leakage after axillary lymph node dissection out of a total of 882 breast cancer patients between July 2005 and June

  14. Radioguided Sentinel Lymph Node Biopsy in Breast Cancer Surgery

    Microsoft Academic Search

    Giuliano Mariani; Luciano Moresco; Giuseppe Viale; Giuseppe Villa; Marcello Bagnasco; Giuseppe Canavese; John Buscombe; H. William Strauss; Giovanni Paganelli

    The concept of sentinel lymph node biopsy in breast cancer surgery relates to the fact that the tumor drains in a logical way through the lymphatic system, from the first to upper levels. Therefore, the first lymph node met (the sentinel node) will most likely be the first to be affected by metastasis, and a negative sentinel node makes it

  15. Significance of Lymph Node Micrometastasis in Pancreatic Cancer Patients

    Microsoft Academic Search

    J. Bober

    2012-01-01

    Background \\/Aims: The present study deals with the significance of lymph node micrometastasis in the survival rate for pancreatic cancer patients. Methods: Between January 2006 and December 2010 at the First Department of Surgery in Košice, a prospective trial was done in which we investigated the survival rate after radical pancreatic resection. All negative lymph nodes removed during standard radical

  16. Tumour–induced immune modulation of sentinel lymph nodes

    Microsoft Academic Search

    Rong-Rong Huang; Jonathan Lee; Eijun Itakura; Stanley P. L. Leong; Richard Essner; Alistair J. Cochran

    2006-01-01

    Sentinel lymph nodes (SLNs), being the first nodes to receive lymph from a primary tumour and the preferential site of initial tumour metastases, are intensively exposed to the bioactive products of tumour cells and other associated cells. This makes them ideal for studies of the factors that determine selective tissue susceptibility to metastases. We postulate that tumour-induced immune modulation of

  17. THE ORIGIN AND SIGNIFICANCE OF MACROPHAGES IN THORACIC DUCT LYMPH

    Microsoft Academic Search

    Bruce J Roser

    1976-01-01

    Efferent lymph collected from a thoracic duct fistula initially contains no macrophages. However, the surgical procedures used to insert plastic cannulae into efferent lymphatics incite a vigorous foreign body reaction leading to the contamination of collected lymph with significant numbers of these cells. A sensitive and specific assay for the presence of macrophages in lymphocyte populations was used to quantitate

  18. Dissemination in cutaneous leishmaniasis. 3. Lymph node involvement.

    PubMed

    al-Gindan, Y; Kubba, R; el-Hassan, A M; Omer, A H; Kutty, M K; Saeed, M B

    1989-05-01

    In a study of zoonotic cutaneous leishmaniasis (CL) due to leishmania major in an endemic focus in Saudi Arabia, lymph node enlargement was observed in 66 of 643 patients (10.26%). The epitrochlear lymph nodes were most commonly involved (68%), but cervical (11%), axillary (15%), and inguinal (18%) lymph nodes were also involved. In eight patients (12%), two lymph node areas were involved. The affected lymph nodes were typically solitary, firm, mobile, nontender, only moderately enlarged, and appeared to persist beyond the clinical healing of the associated skin lesions. The results of pathologic and immunopathologic studies carried out on eight lymph nodes obtained from this group of patients supported the leishmanial etiology. Although amastigotes were only demonstrated in two lymph nodes, the leishmanial antigen was found in all eight specimens. The lymph node involvement is another manifestation of dissemination in infection with a dermotropic leishmania. It appears that in some cases, instead of the parasite, it may be the leishmanial antigen that disseminates and produces lymphadenitis. PMID:2722339

  19. Current status of sentinel lymph node biopsy in solid malignancies

    Microsoft Academic Search

    Amit Goyal; Robert E Mansel

    2004-01-01

    Lymphatic mapping and sentinel lymph node biopsy were first reported in 1977 by Cabanas for penile cancer. Since that time, the technique has become rapidly assimilated into clinical practice. The sentinel node concept has been validated in cutaneous melanoma and breast cancer. However, follow-up data of patients from randomised trials is needed to establish the clinical significance of sentinel lymph

  20. Genetic diagnosis of lymph-node metastasis in colorectal cancer

    Microsoft Academic Search

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

    1995-01-01

    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

  1. Absent pulmonary valve

    MedlinePLUS

    ... ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 424. Brown JW, Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW. Surgical treatment of absent pulmonary valve syndrome associated with bronchial obstruction. Ann Thoracic Surg , 2006; ...

  2. What Causes Pulmonary Hypertension?

    MedlinePLUS

    ... types of PH. Group 1 pulmonary arterial hypertension (PAH) may have no known cause, or the condition ... diseases and conditions also can cause group 1 PAH. Examples include HIV infection, congenital heart disease , and ...

  3. Pulmonary function tests

    MedlinePLUS

    ... measured to estimate the lung volume. To measure diffusion capacity , you breathe a harmless gas, called a ... on your report after pulmonary function tests include: Diffusion capacity to carbon monoxide (DLCO) Expiratory reserve volume ( ...

  4. Neonatal pulmonary artery thrombosis.

    PubMed

    Jadhav, Mangesh; Sapre, Ashish; Garekar, Swati; Kulkarni, Snehal

    2012-01-01

    Pulmonary artery thrombosis in neonates is a rare entity. We describe two neonates with this diagnosis; their presentation, evaluation, and management. These cases highlight the importance of this differential diagnosis when evaluating the cyanotic neonate. PMID:22529601

  5. Neonatal pulmonary artery thrombosis

    PubMed Central

    Jadhav, Mangesh; Sapre, Ashish; Garekar, Swati; Kulkarni, Snehal

    2012-01-01

    Pulmonary artery thrombosis in neonates is a rare entity. We describe two neonates with this diagnosis; their presentation, evaluation, and management. These cases highlight the importance of this differential diagnosis when evaluating the cyanotic neonate. PMID:22529601

  6. About Familial Pulmonary Fibrosis

    MedlinePLUS

    ... or sibling) have the diagnosis of an Idiopathic Interstitial Pneumonia (IIP) and at least one of the family members has the most common form of IIP, Idiopathic Pulmonary Fibrosis (IPF). However, family members can be second degree ...

  7. Lymph node dissection for lung cancer: past, present, and future.

    PubMed

    Watanabe, Shun-ichi

    2014-07-01

    In 1978, Naruke et al. proposed an anatomical map that included numbered lymph node stations, which then became widely used for nodal dissection. In 1997, Mountain and Dresler published a new map, which is now favored by the American Thoracic Society and the European Respiratory Society. Using these maps, regional nodal dissection has been universally performed in lung cancer surgery. Clear evidence regarding the survival benefit of lymph node dissection for lung cancer is lacking. However, lobectomy with lymph node dissection continues to be a standard surgical procedure for lung cancer because lymph node dissection is an important investigative process in staging patients. Over the last decade, the extent of nodal dissection for lung cancer has changed due to the increasing number of early detected lung cancers made possible by the recent development of the CT scanner. This manuscript describes the history, present strategy, and future perspectives of lymph node dissection for lung cancer. PMID:24823489

  8. High-altitude pulmonary edema.

    PubMed

    Swenson, Erik R; Bärtsch, Peter

    2012-10-01

    High-altitude pulmonary edema (HAPE), a not uncommon form of acute altitude illness, can occur within days of ascent above 2500 to 3000 m. Although life-threatening, it is avoidable by slow ascent to permit acclimatization or with drug prophylaxis. The critical pathophysiology is an excessive rise in pulmonary vascular resistance or hypoxic pulmonary vasoconstriction (HPV) leading to increased microvascular pressures. The resultant hydrostatic stress causes dynamic changes in the permeability of the alveolar capillary barrier and mechanical injurious damage leading to leakage of large proteins and erythrocytes into the alveolar space in the absence of inflammation. Bronchoalveolar lavage and hemodynamic pressure measurements in humans confirm that elevated capillary pressure induces a high-permeability noninflammatory lung edema. Reduced nitric oxide availability and increased endothelin in hypoxia are the major determinants of excessive HPV in HAPE-susceptible individuals. Other hypoxia-dependent differences in ventilatory control, sympathetic nervous system activation, endothelial function, and alveolar epithelial active fluid reabsorption likely contribute additionally to HAPE susceptibility. Recent studies strongly suggest nonuniform regional hypoxic arteriolar vasoconstriction as an explanation for how HPV occurring predominantly at the arteriolar level causes leakage. In areas of high blood flow due to lesser HPV, edema develops due to pressures that exceed the dynamic and structural capacity of the alveolar capillary barrier to maintain normal fluid balance. This article will review the pathophysiology of the vasculature, alveolar epithelium, innervation, immune response, and genetics of the lung at high altitude, as well as therapeutic and prophylactic strategies to reduce the morbidity and mortality of HAPE. PMID:23720264

  9. Pharmacotherapy of Pulmonary Hypertension

    PubMed Central

    Steinhorn, Robin H.

    2012-01-01

    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

  10. Recurrent amiodarone pulmonary toxicity.

    PubMed

    Chendrasekhar, A; Barke, R A; Druck, P

    1996-01-01

    Amiodarone, a widely used antiarrhythmic drug, is associated with pulmonary toxicity, with an estimated mortality of 1% to 33%. Standard treatment for amiodarone pulmonary toxicity (APT) has been discontinuance of the drug and steroid therapy. We report a case of APT that recurred after withdrawal of steroids and failed to respond to reinstatement of steroid therapy. Recurrent APT is a rare clinical entity that has been reported only twice in recent literature. PMID:8545700

  11. Chronic Thromboembolic Pulmonary Hypertension

    Microsoft Academic Search

    William R. Auger; Peter F. Fedullo

    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

  12. Chronic Thromboembolic Pulmonary Hypertension

    Microsoft Academic Search

    Lara M. Wittine; William R. Auger

    2010-01-01

    Opinion statement  The pulmonary hypertension (PH) and right heart dysfunction that results from chronic thromboembolic involvement of the pulmonary\\u000a vascular bed is potentially curable with surgical endarterectomy. Over the past several decades, growing clinical experience\\u000a has brought about increased recognition of this treatable form of PH. Moreover, advances in cardiothoracic surgical techniques\\u000a have given an increasing number of patients with chronic

  13. Arginase and pulmonary diseases

    Microsoft Academic Search

    Harm Maarsingh; Tonio Pera; Herman Meurs

    2008-01-01

    Recent studies have indicated that arginase, which converts l-arginine into l-ornithine and urea, may play an important role in the pathogenesis of various pulmonary disorders. In asthma, chronic obstructive\\u000a pulmonary disease (COPD) and cystic fibrosis, increased arginase activity in the airways may contribute to obstruction and\\u000a hyperresponsiveness of the airways by inducing a reduction in the production of bronchodilatory nitric

  14. Pulmonary mycosis in AIDS.

    PubMed

    Rizzi, E B; Schinina, V; Bellussi, A; De Santis, A; Mazzuoli, G; Giosué, S; Bibbolino, C

    2001-01-01

    We retrospectively reviewed our series of 35 pulmonary mycosis in patients with AIDS, observed from 1987 to 1999, to correlate the imaging and pathologic findings. We further evaluated the frequency of fungal pneumonia before and after the use of a highly active antiretroviral therapy (HAART). Early recognition of pulmonary mycosis is imperative in these patients and improved survival can be achieved with early CT detection and prompt institution of high-dose antifungal therapy. PMID:11274838

  15. Chronic thromboembolic pulmonary hypertension.

    PubMed

    Wittine, Lara M; Auger, William R

    2010-04-01

    The pulmonary hypertension (PH) and right heart dysfunction that results from chronic thromboembolic involvement of the pulmonary vascular bed is potentially curable with surgical endarterectomy. Over the past several decades, growing clinical experience has brought about increased recognition of this treatable form of PH. Moreover, advances in cardiothoracic surgical techniques have given an increasing number of patients with chronic thromboembolic PH (CTEPH) a surgical remedy with decreasing perioperative morbidity and mortality risks. The availability of pulmonary hypertensive-specific medical therapy for CTEPH patients with surgically inaccessible disease also has been a positive therapeutic advance over the past several years. However, despite this progress, chronic thromboembolic disease as a sequela of acute pulmonary emboli continues to be underappreciated. Furthermore, even if CTEPH has been appropriately diagnosed, misinterpretation of diagnostic information may lead to the inappropriate exclusion of patients from surgical consideration. This may result in the prescription of pulmonary hypertensive medical therapy in CTEPH patients with potentially surgically correctable disease. This difficulty arises from a lack of objective criteria as to what constitutes surgical chronic thromboembolic disease, which primarily is a result of the variability in surgical experience in specialty centers in the United States. Consequently, clinicians must be wary about using pulmonary hypertensive medications in CTEPH patients. Before prescription, it is important to exclude patients from surgical consideration by consulting a specialized center with expertise in this discipline. PMID:20376164

  16. Sentinel lymph node biopsy results in less postoperative morbidity compared with axillary lymph node dissection for breast cancer

    Microsoft Academic Search

    William E Burak; Scott T Hollenbeck; Emmanuel E Zervos; Karen L Hock; Lisa C Kemp; Donn C Young

    2002-01-01

    Background: This study was designed to compare the postoperative morbidity and socioeconomic impact of sentinel lymph node biopsy (SLNB) with axillary lymph node dissection (ALND) in patients with early stage breast cancer.Methods: A prospective, nonrandomized, controlled study was designed to include patients who underwent breast conservation surgery and SLNB ± ALND. Group A consisted of patients who had a negative

  17. Intraoperative Pathologic Evaluation of a Breast Cancer Sentinel Lymph Node Biopsy as a Determinant for Synchronous Axillary Lymph Node Dissection

    Microsoft Academic Search

    John M. Kane III; Stephen B. Edge; Janet S. Winston; Nancy Watroba; Thelma C. Hurd

    2001-01-01

    Background: Intraoperative pathologic evaluation of a breast cancer sentinel lymph node (SLN) biopsy permits synchronous axillary lymph node dissection (ALND), but frozen section is time consuming and potentially inaccurate. This study evaluated intraoperative gross examination and touch prep analysis (TPA) of a breast cancer SLN biopsy as determinants for synchronous ALND. Methods: Intraoperative gross examination\\/TPA were performed on the SLN

  18. Can Axillary Lymph Node Dissection Be Safely Omitted for Early-Stage Breast Cancer Patients with Sentinel Lymph Node Micrometastasis?

    Microsoft Academic Search

    Sameer Damle; Christine B. Teal

    2009-01-01

    This study presents data that we have been anxiously awaiting. It adds to a slowly growing body of evidence that axillary lymph node dissection (ALND) may be omitted in select groups of node-positive patients. Many of us prefer not to perform ALND when only micrometastases are identified in sentinel lymph nodes (SLNs), especially when it often involves returning to the

  19. Can Axillary Lymph Node Dissection Be Safely Omitted for Early-Stage Breast Cancer Patients with Sentinel Lymph Node Micrometastasis?

    Microsoft Academic Search

    Sameer Damle; Christine B. Teal

    2010-01-01

    This study presents data that we have been anxiously awaiting. It adds to a slowly growing body of evidence that axillary lymph node dissection (ALND) may be omitted in select groups of node-positive patients. Many of us prefer not to perform ALND when only micrometastases are identified in sentinel lymph nodes (SLNs), especially when it often involves returning to the

  20. Detection of Lymph Node Micrometastases and Isolated Tumor Cells in Sentinel and Nonsentinel Lymph Nodes of Colon Cancer Patients

    Microsoft Academic Search

    Andreas Bembenek; Ulrike Schneider; Stephan Gretschel; Joerg Fischer; Peter M. Schlag

    2005-01-01

    About 20% to 30% of colon cancer patients classified as node negative by routine hematoxylin-eosin (H&E) staining are found to have micrometastases (MM) or isolated tumor cells (ITC) in sentinel lymph nodes (SLNs) if analyzed by step sections and immunohistochemistry (IHC). Whether SLNs are in this respect representative for all lymph nodes was addressed in this study. SLNs were identified

  1. Chronic nitric oxide inhibition in utero produces persistent pulmonary hypertension in newborn lambs.

    PubMed Central

    Fineman, J R; Wong, J; Morin, F C; Wild, L M; Soifer, S J

    1994-01-01

    Persistent pulmonary hypertension of the newborn (PPHN) is associated with chronic intrauterine events. Acute nitric oxide (NO) inhibition attenuates the normal increase in pulmonary blood flow at birth. We investigated whether chronic NO inhibition in utero causes persistent pulmonary hypertension. 11 fetal lambs received either a continuous infusion of N omega-nitro-L-arginine (an NO synthesis inhibitor) or 0.9% saline. Before infusion, acetylcholine (dependent upon endogenous NO production) and sodium nitroprusside (which releases its own NO) produced potent pulmonary vasodilation. After 10.5 +/- 1.5 d of infusion, acetylcholine did not produce pulmonary vasodilation in N omega-nitric-L-arginine-treated fetal lambs, but did in saline-treated fetal lambs; sodium nitroprusside produced pulmonary vasodilation in both groups. Immediately after birth, at 140 d of gestation, during the 3-h study period, mean pulmonary arterial pressure did not decrease in N omega-nitro-L-arginine-treated lambs; the increase in pulmonary blood flow and decrease in pulmonary vascular resistance were markedly attenuated compared to saline-treated lambs. These hemodynamic derangements were reversed by L-arginine. There were no anatomic abnormalities in the pulmonary circulation. Chronic NO inhibition in utero reproduces many of the physiologic derangements of PPHN. Intrauterine events which result in endothelial dysfunction and inhibition of NO may produce the physiologic derrangements of PPHN. PMID:8201005

  2. CD169 mediates the capture of exosomes in spleen and lymph node

    PubMed Central

    Dunn, Amy C.; Crocker, Paul R.

    2014-01-01

    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

  3. Follicular lymphoma mimicking marginal zone lymphoma in lymph node: a case report

    PubMed Central

    Matsuda, Ikuo; Shimizu, Yoshifumi; Okamoto, Takahiro; Hirota, Seiichi

    2014-01-01

    Nodal follicular lymphoma (FL) is typically composed of follicular or nodular proliferation of small cleaved lymphoid cells, presumably derived from germinal center (GC) B cells. The hallmark of FL is t(14;18)(q32;q21) chromosomal translocation, which juxtaposes anti-apoptotic gene BCL2 to immunoglobulin heavy chain (IGH) promoter. Reflecting this background, FL cells are immunohistochemically positive for BCL2 as well as GC B cell markers CD10 and BCL6. It is known that low grade B-cell lymphomas, including FL, chronic lymphocytic leukemia/small lymphocytic lymphoma, and marginal zone lymphoma, are sometimes associated with marginal zone differentiation or plasmacytic differentiation. The marginal zone differentiation obscures the morphological differences among these, providing diagnostic challenges for histopathologists. In this paper, we present a case of FL, originally mimicking marginal zone lymphoma in the axillary lymph node. Subsequent bone marrow biopsy showed paratrabecular infiltration of small to medium-sized lymphoid cells. Immunohistochemical analysis of the bone marrow biopsy together with histopathology and flow cytometry of the axillary lymph node led to a final diagnosis of FL with marginal zone differentiation in the axillary lymph node and its bone marrow infiltration. Our case illustrates and reconfirms the importance of clinicopathological correlation which leads to a correct diagnosis. PMID:25400800

  4. Whole Proteome Analysis of Mouse Lymph Nodes in Cutaneous Anthrax

    PubMed Central

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

    2014-01-01

    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

  5. Plasmacytoid dendritic cells migrate in afferent skin lymph.

    PubMed

    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

    2008-05-01

    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

  6. Treatment of various secondary lymphedemas by microsurgical lymph vessel transplantation.

    PubMed

    Felmerer, Gunther; Sattler, Thorsten; Lohrmann, Christian; Tobbia, Dalia

    2012-03-01

    Chronic lymphedema is a debilitating complication of cancer diagnosis and therapy and poses many challenges for health care professionals. It remains a poorly understood condition that has the potential to occur after any intervention affecting lymph node drainage mechanism. Microsurgical lymph vessel transplantation is increasingly recognized as a promising method for bypassing the obstructed lymph pathways and promoting long-term reduction of edema in the affected limb. A detailed review of 14 patients with postoperative lymphedema treated with autologous lymph vessel transplantation between October 2005 and November 2009 was performed. In this report, the authors gave an account of their experience in utilizing this operative method to alleviate secondary lymphedema including upper limb, lower limb, genital, and facial edemas. Lymph vessel transplantation enhanced lymphatic drainage in patients with secondary lymphedema. In the upper and lower extremities, three patients had completed symptomatic recovery and another nine patients achieved reasonable reduction of lymphedema, four of these needed no further lymph drainage or compression garments and the remaining maintained their improvement with further decongestive therapy with or without compression garments. The patients with facial and genital edemas also experienced significant symptomatic improvement. The authors were able to establish long-term patency of the lymph vessel anastomosis by magnetic resonance lymphangiography. PMID:22113994

  7. Pulmonary artery endothelium resident endothelial colony-forming cells in pulmonary arterial hypertension.

    PubMed

    Duong, Heng T; Comhair, Suzy A; Aldred, Micheala A; Mavrakis, Lori; Savasky, Benjamin M; Erzurum, Serpil C; Asosingh, Kewal

    2011-01-01

    Proliferative pulmonary vascular remodeling is the pathologic hallmark of pulmonary arterial hypertension (PAH) that ultimately leads to right heart failure and death. Highly proliferative endothelial cells known as endothelial colony-forming cells (ECFC) participate in vascular homeostasis in health as well as in pathological angiogenic remodeling in disease. ECFC are distinguished by the capacity to clonally proliferate from a single cell. The presence of ECFC in the human pulmonary arteries and their role in PAH pathogenesis is largely unknown. In this study, we established a simple technique for isolating and growing ECFC from cultured pulmonary artery endothelial cells (PAEC) to test the hypothesis that ECFC reside in human pulmonary arteries and that the proliferative vasculopathy of PAH is related to greater numbers and/or more proliferative ECFC in the pulmonary vascular wall. Flow cytometric forward and side scatter properties and aggregate correction were utilized to sort unmanipulated, single PAEC to enumerate ECFC in primary PAEC cultures derived from PAH and healthy lungs. After 2 weeks, wells were assessed for ECFC formation. ECFC derived from PAH PAEC were more proliferative than control. A greater proportion of PAH ECFC formed colonies following subculturing, demonstrating the presence of more ECFC with high proliferative potential among PAH PAEC. Human androgen receptor assay showed clonality of progeny, confirming that proliferative colonies were single cell-derived. ECFC expressed CD31, von Willebrand factor, endothelial nitric oxide synthase, caveolin-1 and CD34, consistent with an endothelial cell phenotype. We established a simple flow cytometry method that allows ECFC quantification using unmanipulated cells. We conclude that ECFC reside among PAEC and that PAH PAEC contain ECFC that are more proliferative than ECFC in control cultures, which likely contributes to the proliferative angiopathic process in PAH. PMID:22530103

  8. Localised pulmonary metastatic calcification associated with pulmonary artery obstruction

    Microsoft Academic Search

    J Bloodworth; J F Tomashefski

    1992-01-01

    BACKGROUND: Metastatic pulmonary calcification, a complication of uraemia and disordered calcium metabolism, may be diffuse or localised. The factors that determine calcium precipitation are complex, but tissue alkalosis is thought to be important. As obstruction of the pulmonary artery theoretically causes local alkalosis a retrospective necropsy study was carried out to examine the relation between metastatic pulmonary calcification and vascular

  9. Use of a PEG-conjugated bright near-infrared dye for functional imaging of rerouting of tumor lymphatic drainage after sentinel lymph node metastasis

    PubMed Central

    Proulx, Steven T.; Luciani, Paola; Christiansen, Ailsa; Karaman, Sinem; Blum, Katrin S.; Rinderknecht, Matthias; Leroux, Jean-Christophe; Detmar, Michael

    2013-01-01

    Tumor lymphangiogenesis promotes metastatic cancer spread to lymph nodes and beyond. However, the potential remodeling and functionality of tumor-draining lymphatic vessels has remained unclear. Thus, we aimed to develop non-invasive imaging methods for repeated quantitative imaging of lymphatic drainage and of contractile collecting lymphatic vessel function in mice, with colloidal near-infrared (NIR) tracers and a custom fluorescence stereomicroscope specially adapted for NIR sensitive imaging. Using these tools, we quantitatively determined pulse rates and valvular function of collecting lymphatic vessels with high resolution. Unexpectedly, we found that tumor-draining lymphatic vessels in a melanoma footpad model initially were dilated but remained functional, despite lower pulse rates. In two independent tumor models, impaired lymphatic function was detected once metastases were present in draining lymph nodes. Importantly, we found that lymphatic dysfunction, induced by metastatic tumor spread to sentinel lymph nodes, can lead to a rerouting of lymphatic flow away from the metastatic lymph node, via collateral lymphatic vessels, to alternate lymph nodes. These findings might have important clinical implications for the procedure of sentinel lymph node mapping that represents the standard of care for determining prognosis and treatment of melanoma and breast cancer patients. PMID:23566803

  10. Distinct patterns of circulating endothelial cells in pulmonary hypertension.

    PubMed

    Smadja, D M; Mauge, L; Sanchez, O; Silvestre, J-S; Guerin, C; Godier, A; Henno, P; Gaussem, P; Israël-Biet, D

    2010-12-01

    The respective abundance of circulating endothelial cells and endothelial progenitor cells may reflect the balance between vascular injury and repair. As pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) can share features of pulmonary remodelling, we postulated that the two disorders might be associated with different types of pulmonary endothelial dysfunction. We studied 25 consecutive patients undergoing cardiac catheterisation for suspected pulmonary hypertension. Nine patients had PAH, nine had CTEPH, and seven had normal pulmonary arterial pressure and served as controls. Circulating endothelial cells were isolated with CD146-coated beads. CD34(+)CD133(+) cell and endothelial progenitor cell numbers were respectively determined by flow cytometry and cell culture, in peripheral vein and pulmonary artery blood. Plasma levels of soluble vascular endothelial growth factor (VEGF), soluble E-selectin and soluble vascular cell adhesion molecule (sVCAM) were measured by ELISA. No difference in progenitor counts or VEGF levels was found across the three groups. Compared to controls, circulating endothelial cell numbers were significantly increased in PAH but not in CTEPH, in keeping with the elevated soluble E-selectin and sVCAM levels found in PAH alone. In conclusion, PAH, in contrast to CTEPH, is associated with markers of vascular injury (circulating endothelial cells, soluble E-selectin and sVCAM) but not with markers of remodelling (endothelial progenitor cells, CD34(+)CD133(+) cells and VEGF). PMID:20413531

  11. Osteoporosis associated with pulmonary silicosis in an equine bone fragility syndrome.

    PubMed

    Arens, A M; Barr, B; Puchalski, S M; Poppenga, R; Kulin, R M; Anderson, J; Stover, S M

    2011-05-01

    California horses incur a bone fragility syndrome manifested by pathologic fractures. This study investigated gross, radiographic, and histologic features of the disorder as well as relationships with silicosis and levels of heavy metals and trace minerals through a postmortem study of 9 affected and 3 unaffected horses. Bones and soft tissues were evaluated grossly and histologically. Bones, lymph nodes, and lung tissue were evaluated radiographically. Tissues were evaluated for silicon levels, intracytoplasmic crystals, heavy metals, and trace minerals. All 9 affected horses had osteoporosis and clinical or subclinical pulmonary disease due to silicosis (8/9) or pneumoconiosis (1/9). All affected horses had radiographic findings consistent with osteopenia and histologic evidence of osteoporosis characterized by osteopenia, numerous resorption cavities, cement lines, and a mosaic lamellar pattern indicative of multiple remodeling events. Silicosis was characterized by widespread pulmonary granuloma formation with fibrosis; variable tracheobronchiolar and mediastinal granulomatous lymphadenitis; intracellular crystals within lung and lymph node macrophages; and pronounced lymph node fibrosis, focal necrosis, and dystrophic calcification. Crystals in lung (6/9) and lymph node (8/9) tissues were identified as cytotoxic silica dioxide polymorphs. Lung and liver tissue from affected horses had elevated levels of elemental silicon. Osteoporosis was highly correlated (r = 0.8, P < .01) with silicosis. No abnormalities in heavy metal or trace minerals were detected. This evaluation indicated that horses with bone fragility disorder have systemic osteoporosis associated with fibrosing pulmonary silicosis. The etiopathogenesis of the bone fragility syndrome is unknown; however, this study provides circumstantial evidence for a silicate associated osteoporosis. PMID:21097716

  12. A Longitudinal Comparison of Arm Morbidity in Stage I–II Breast Cancer Patients Treated with Sentinel Lymph Node Biopsy, Sentinel Lymph Node Biopsy Followed by Completion Lymph Node Dissection, or Axillary Lymph Node Dissection

    Microsoft Academic Search

    Jan J. Kootstra; Josette E. H. M. Hoekstra-Weebers; Johan S. Rietman; Jakob de Vries; Peter C. Baas; Jan H. B. Geertzen; Harald J. Hoekstra

    2010-01-01

    Background  Long-term shoulder and arm function following sentinel lymph node biopsy (SLNB) may surpass that following complete axillary\\u000a lymph node dissection (CLND) or axillary lymph node dissection (ALND). We objectively examined the morbidity and compared\\u000a outcomes after SLNB, SLNB + CLND, and ALND in stage I\\/II breast cancer patients.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and Methods  Breast cancer patients who had SLNB (n = 51), SLNB + CLND (n = 55), and ALND (n = 65)

  13. Current status of sentinel lymph node biopsy in solid malignancies

    PubMed Central

    Goyal, Amit; Mansel, Robert E

    2004-01-01

    Lymphatic mapping and sentinel lymph node biopsy were first reported in 1977 by Cabanas for penile cancer. Since that time, the technique has become rapidly assimilated into clinical practice. The sentinel node concept has been validated in cutaneous melanoma and breast cancer. However, follow-up data of patients from randomised trials is needed to establish the clinical significance of sentinel lymph node biopsy before accepting the procedure as a standard of care. This technique has the potential to be utilised in all solid tumours like colon, gastric, oesophageal, lung, gynaecologic, and head and neck cancer. This paper reviews the current status of sentinel lymph node biopsy in solid tumours. PMID:15107132

  14. How Is Pulmonary Embolism Diagnosed?

    MedlinePLUS

    ... Twitter. How Is Pulmonary Embolism Diagnosed? Pulmonary embolism (PE) is diagnosed based on your medical history, a ... emergency room often are the ones to diagnose PE with the help of a radiologist. A radiologist ...

  15. How Is Pulmonary Hypertension Treated?

    MedlinePLUS

    ... Pulmonary Arterial Hypertension Group 1 pulmonary arterial hypertension (PAH) includes PH that's inherited, that has no known ... certain drugs or conditions. Treatments for group 1 PAH include medicines and medical procedures. Medicines Your doctor ...

  16. Unusual cause of pulmonary emboli.

    PubMed

    Vitums, V C

    1984-10-01

    Pulmonary emboli resulted due to intravasation of iophendylate during myelography the previous day. Findings consistent with pulmonary emboli in nonambulatory patients after myelography should not always be diagnosed as thromboembolic disease from blood clots. PMID:6478908

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

    PubMed

    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

    2015-03-01

    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

  18. Percutaneous pulmonary valve replacement.

    PubMed

    Frigiola, Alessandra; Nordmeyer, Johannes; Bonhoeffer, Philipp

    2009-05-01

    Percutaneous pulmonary valve implantation helps in prolonging the lifespan of surgically placed right ventricle-to-pulmonary artery (RV-PA) conduits, and represents a less invasive alternative to repeat open-heart surgery. The clinical indications for treatment match those of surgery. As far as the suitability is concerned, the current ideal substrate is a degenerated RV-PA conduit, because of the presence of a certain degree of calcification that offers a safe anchoring point. So far, patients have been treated with low morbidity and mortality that were further improved with increasing experience. After percutaneous pulmonary valve implantation, patients experience a subjective improvement, mirrored by an objective increase of measured exercise capacity parameters and by reduced RV-PA gradient, regurgitant fraction, and RV volumes. New developments in the experimental field should result in an extension of indications in the future. PMID:19322077

  19. Trophoblastic pulmonary embolism.

    PubMed

    Smith, J C; Alsuleiman, S A; Bishop, H; Kassar, N S; Jonas, H S

    1981-08-01

    Trophoblastic embolism is subclinical in normal pregnancy, pronounced in eclampsia, and massive in hydatidiform mole. Self-limited acute respiratory distress arises in 3% to 10% of molar pregnancies at the time of uterine evacuation. Infrequently death occurs; the principal findings are trophoblastic emboli in the pulmonary arterioles, edema of the lungs, and dilatation of the right side of the heart. Hyperthyroidism may develop, and fibrin may line the alveolar walls. Pathogenetic mechanisms include heart failure, hyperthyroidism, dilutional anemia, and pulmonary arteriolar blockage. Infusions of fluid and whole blood tend to cause pulmonary overload, which may precipitate right-sided heart failure. Preferred therapy consists of diuresis and ventilatory support, especially with oxygen under positive end-expiratory pressure. PMID:6267719

  20. Pulmonary Nontuberculous Mycobacterial Disease Prospective Study of a Distinct Preexisting Syndrome

    Microsoft Academic Search

    Richard D. Kim; David E. Greenberg; Mary E. Ehrmantraut; Li Ding; Yvonne Shea; Margaret R. Brown; Milica Chernick; Wendy K. Steagall; Connie G. Glasgow; JingPing Lin; Clara Jolley; Lynn Sorbara; M ark Raffeld; Lisa A. Barnhart; L. Anderson; Reginald Claypool; Dianne M. Hilligoss; Mary Garofalo; Dirk Darnell; Rosamma DeCastro; Heather M. Menning; Kenneth N. Olivier; Joel Moss; Steven M. Holland

    Rationale: Pulmonary nontuberculous mycobacterial (PNTM) dis- ease is increasing, but predisposing features have been elusive. Objectives: To prospectively determine the morphotype, immuno- phenotype, and cystic fibrosis transmembrane conductance regula- tor genotype in a large cohort with PNTM. Methods: We prospectively enrolled 63 patients with PNTM infec- tion, each of whom had computerized tomography, echocardio- gram, pulmonary function, and flow cytometry

  1. Surgical outcome of pulmonary aspergilloma

    Microsoft Academic Search

    Alaa Brik; Abdel Meged Salem; Al Rady Kamal; Mohamed Abdel-Sadek; Mohamed Essa; Mamdoh El Sharawy; Ahmed Deebes; Khaled Abdel Bary

    2008-01-01

    Introduction: Surgical resection offers the only realistic chance of permanent cure for pulmonary aspergilloma. This prospective study was designed to evaluate our indications and surgical outcome of pulmonary aspergilloma with analysis of postoperative complications. Patients and methods: Between 2001 and 2008, 42 patients underwent surgical treatment for pulmonary aspergilloma at Zagazig University Hospital. The patients were divided into two groups,

  2. Surgical outcome of pulmonary aspergilloma

    Microsoft Academic Search

    Alaa Brik; Abdel Meged Salem; Rady Kamal; Mohamed Abdel-Sadek; Mohamed Essa; Mamdoh El Sharawy; Ahmed Deebes; Khaled Abdel Bary

    2010-01-01

    Introduction: Surgical resection offers the only realistic chance of permanent cure for pulmonary aspergilloma. This prospective study was designed to evaluate our indications and surgical outcome of pulmonary aspergilloma with analysis of postoperative complications. Patients and methods: Between 2001 and 2008, 42 patients underwent surgical treatment for pulmonary aspergilloma at Zagazig University Hospital. The patients were divided into two groups,

  3. Pulmonary talcosis: imaging findings.

    PubMed

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

    2010-04-01

    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

  4. S-Classification of Sentinel Lymph Node Predicts Axillary Nonsentinel Lymph Node Status in Patients with Breast Cancer

    Microsoft Academic Search

    Astrid Maria Fink; Harald Lass; Helmut Hartleb; Wolfgang Jurecka; Heinrich Salzer; Andreas Steiner

    2008-01-01

    Background  One-half of breast cancer patients with positive sentinel lymph node (SN) have no further metastases in the axillary lymph\\u000a node basin. The aim of the present study was to identify patients with positive SN who are unlikely to have further metastases\\u000a in the axillary lymph node basin, using a new classification of SN, namely the S-classification.\\u000a \\u000a \\u000a \\u000a Methods  Specimens of positive SN

  5. Handheld array-based photoacoustic probe for guiding needle biopsy of sentinel lymph nodes

    E-print Network

    Wang, Lihong

    lymph nodes for cancer staging and metastasis detection in humans. © 2010 Society of Photo cancer, replacing axillary lymph node dissection. Biopsy of the lymph nodes directly draining the tumorHandheld array-based photoacoustic probe for guiding needle biopsy of sentinel lymph nodes Chulhong

  6. Chronic thromboembolic pulmonary hypertension.

    PubMed

    Marshall, Peter S; Kerr, Kim M; Auger, William R

    2013-12-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease with high mortality and few treatment options. This article reviews the epidemiology of CTEPH and identifies risk factors for its development. The pathobiology and the progression from thromboembolic events to chronically increased right-sided pressures are discussed. The diagnosis and assessment of CTEPH requires several modalities and the role of these is detailed. The pre-operative evaluation assesses peri-operative risk and determines the likelihood of benefit from PTE. Pulmonary thromboendarterectomy (PTE) remains the treatment of choice in appropriate patients. Nonsurgical therapies for CTEPH may provide benefit in patients who cannot be offered surgery. PMID:24267304

  7. Ultrasound elastography for evaluation of cervical lymph nodes

    PubMed Central

    Choi, Young Jun; Lee, Jeong Hyun; Baek, Jung Hwan

    2015-01-01

    Ultrasound (US) elastography has been introduced as a noninvasive imaging technique for evaluating cervical lymph nodes. US elastography techniques include strain elastography and shear wave-based elastography. The application of this technique is based on the fact that stiff tissues tend to deform less and show less strain than compliant tissues when the same force is applied. In general, metastatic lymph nodes demonstrate higher stiffness than benign lymph nodes. Overall, preliminary studies suggest that US elastography may be useful in differentiating benign and malignant cervical lymph nodes, thereby informing decisions to perform a biopsy and facilitating follow-up. For US elastography to be accepted into clinical practice, however, its techniques, associated diagnostic criteria, and reliability need to be further refined. PMID:25827473

  8. Chronic Thromboembolic Pulmonary Hypertension: the End Result of Pulmonary Embolism.

    PubMed

    Witkin, Alison S; Channick, Richard N

    2015-08-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) occurs when a pulmonary embolism fails to undergo complete thrombolysis leading to vascular occlusion and pulmonary hypertension. Despite the fact that CTEPH is a potential consequence of pulmonary embolism, diagnosis requires a high degree of vigilance as many patients will not have a history of thromboembolic disease. The ventilation perfusion scan is used to evaluate for the possibility of CTEPH although right heart catheterization and pulmonary artery angiogram are needed to confirm the diagnosis. Pulmonary thromboendarterectomy is the first-line treatment for patients who are surgical candidates. Recently, riociguat has been approved for patients with nonsurgical disease or residual pulmonary hypertension despite surgical intervention. This review describes the pathophysiology, risk factors, diagnosis, and management of CTEPH. PMID:26099554

  9. Sentinel lymph node biopsy in Japan.

    PubMed

    Uhara, Hisashi; Takata, Minoru; Saida, Toshiaki

    2009-12-01

    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

  10. Apelin promotes lymphangiogenesis and lymph node metastasis.

    PubMed

    Berta, Judit; Hoda, Mir Alireza; 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

    2014-06-30

    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

  11. Apelin promotes lymphangiogenesis and lymph node metastasis

    PubMed Central

    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

    2014-01-01

    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

  12. Predictors of positive axillary lymph nodes in breast cancer patients with metastatic sentinel lymph node

    Microsoft Academic Search

    Isabel Peixoto Callejo; José Américo Brito; José Wheinholtz Bivar; Fernando Jesus Fernandes; João Leal Faria; María Saudade André; Carlos Santos Costa; M. Odette Almelda; J. Menesese Sousa

    2005-01-01

    Introduction  Breast cancer with metastatic sentinel lymph nodes (SLN) may have clinico-pathologic factors associated with the presence\\u000a of positive nonsentinel axillary nodes (NSLN). The aim of the present study was to determine factors that predict in-volvement\\u000a of NSLN in breast cancer patients with positive SLN.\\u000a \\u000a \\u000a \\u000a Material and methods  A prospective database search identified 80 patients who underwent SLN biopsy for invasive breast

  13. Sentinel lymph node biopsy in early-stage breast cancer

    Microsoft Academic Search

    Amit Goyal; Robert E. Mansel

    Sentinel lymph node biopsy (SLNB) is the current standard of care for nodal staging in early-stage breast cancer patients\\u000a who are clinically nodenegative. Data from three randomised controlled trials conclusively demonstrates that SLNB is associated\\u000a with less arm morbidity and better quality of life than axillary lymph node dissection (ALND). Large observational studies\\u000a have shown that SLNB is associated with

  14. Epitrochlear lymph node metastases from invasive ductal breast cancer.

    PubMed

    Kumar, Pavan; Singh, Shalini; Datta, N R; Tandon, Ashwani

    2009-01-01

    Metastasis to an epitrochlear lymph node from a primary invasive breast cancer has not been reported earlier. We report a case of epitrochlear lymph node metastasis that presented 10 years after the primary breast malignancy had been treated with radiotherapy, chemotherapy, and hormonal therapy. The patient was successfully treated and continues to remain asymptomatic more than 2 years after she presented with the metastasis. PMID:19841563

  15. Quality enhancement with adaptive edge preservation for lymph nodal images

    NASA Astrophysics Data System (ADS)

    Tian, Haiying; Cai, Hongmin; Cui, Chunyan; Li, Li

    2011-06-01

    Morphological information of lymph nodal metastasis is a critical prognostic factor in patients with cancer. However, the raw images of lymph node obtained by CT equipments are usually corrupted by noises. In this paper, we are proposing to use a revised nonlinear diffusion techniques to remove the noises while preserving edge information. Experiments on real data show that the method can be used to obtain accurate edge information and thus facilitate nodal morphological analysis.

  16. Sarcoid Reactions in Regional Lymph Nodes of Primary Lung Cancer

    Microsoft Academic Search

    Kenji Sugio; Takashi Inoue; Hideki Yokoyama; Teruyoshi Ishida; Shuji Nakano; Keizo Sugimachi

    1993-01-01

    A 66-year-old woman diagnosed as having primary lung cancer with an enlargement of the mediastinal, subcarinal and bilateral hilar lymph nodes underwent a thoracotomy after preoperative chemotherapy. The histological examination showed a moderately differentiated papillary adenocarcinoma in the left upper lobe without any metastases to the regional lymph nodes; however, non-caseous epithelioid granulomas without necrosis were observed in the nodes.

  17. Measurement of static and dynamic pulmonary work during pressure breathing.

    PubMed

    Morrison, J B; Taylor, N A

    1990-09-01

    Various environments alter static and flow-resistive pulmonary mechanics. Of interest to diving physiologists is the negative pressure breathing induced during upright immersions without appropriate modification of air supply pressure. This paper outlines methodologic considerations for determining static and flow-resistive pulmonary work under such exposures. Ten males performed inspiratory pressure-volume relaxation maneuvers and spontaneous breathing in air, and during upright immersion with mouth pressure air supply. The immersed lung centroid pressure (PLC) was +1.19 kPa relative to the hydrostatic pressure at the sternal notch. Immersion elevated inspiratory static work from 0.36 to 1.74 J.liter-1 (P less than 0.05). Pulmonary flow-resistive work was elevated from 0.20 to 0.75 J.liter-1 (P less than 0.05), whereas pulmonary resistance, determined at 0.5 liter.sec-1, increased from 0.18 to 0.44 kPa.liter-1.sec (P less than 0.05). No significant changes in the iso-volume compliance of the lung tissue, chest wall, or total respiratory system were observed (P greater than 0.05). Results indicate that increases in the work of breathing are due to a combination of hydrostatic pressure imbalance, increased pulmonary resistance, and reduced end-expiratory total respiratory compliance. PMID:2219553

  18. Clinico-pathological study of lymph node involvement in leprosy.

    PubMed

    Kar, H K; Mohanty, H C; Mohanty, G N; Nayak, U P

    1983-10-01

    One hundred and five leprosy patients including 37 cases of LL and LI, 22 cases of BL, 3 cases of BB, 17 cases of BT, 23 cases of TT and 3 cases of indeterminate type during the period of 1980-81 have been examined clinically. All the patients of LL, LI, BL and BB types, 94% of BT, 70% of TT and 66.6% of indeterminate type have showed clinical enlargement of lymph nodes. In order of frequency the enlarged nodes are inguinal (76.2%) cervical (69.5%), axillary (69.5%), epitrochlear (64.7%) and lastly pre-auricular (9.5%). Although both regional and distant groups of lymph node enlargement have been observed in all cases of LL, LI and BL, in majority of the non-lepromatous cases there is only involvement of regional lymph nodes. Biopsies of lymph nodes are made from 51 leprosy patients, 22 from LL and LI cases, 11 from BL cases, 2 from BB cases, 8 from BT cases, 6 from TT cases and 2 from indeterminate leprosy cases. Major histopathological changes have been studied in different types of leprosy. The humoral antibody response and the cellular immune response are well reflected on the histopathological finding of the lymph nodes belonging to different immunological spectrum of leprosy patients. The examination of lymph nodes is recommended as a useful adjunct for the diagnosis and classification of leprosy. PMID:6668933

  19. Predictors of tumour involvement in remaining axillary lymph nodes of breast cancer patients with positive sentinel lymph node

    Microsoft Academic Search

    N. Wada; S. Imoto; C. Yamauchi; T. Hasebe; A. Ochiai

    2006-01-01

    AimsTo characterize the various clinicopathologic features in cases of breast cancer with positive sentinel lymph nodes (SLNs), in order to determine factors that might help in predicting the involvement of the non-SLNs.

  20. Cardiac and Pulmonary Injury

    Microsoft Academic Search

    George C. Velmahos; Muhammad U. Butt

    2008-01-01

    Cardiac and pulmonary injuries present major chal- lenges in diagnosis and treatment. Distinct differences between penetrating and blunt trauma of these or- gans exist. Outcomes for severe injuries are still grave. Organized trauma systems can provide optimal care by minimizing prehospital time, allowing easy access to imaging modalities, and offering state-of-the-art treatment strategies. A multidisciplinary approach, including surgeons, intensivists, and

  1. Chronic obstructive pulmonary disease

    Microsoft Academic Search

    S Singh

    2003-01-01

    Chronic Obstructive Pulmonary disease (COPD), characterized by poorly reversible airflow limitation, and strongly associated with tobacco smoking, is estimated to cause >2.5 million deaths per year worldwide. Active smokers have more acute exacerbations, which correlate with long-term decline in lung function. The diagnosis, severity assessment and monitoring of COPD rely heavily but not exclusively on spirometry. Smoking cessation reduces exacerbation

  2. Immunoreactivity in pulmonary echinococcosis

    PubMed Central

    Todorov, T.; Dakov, I.; Kosturkova, M.; Tenev, S.; Dimitrov, A.

    1979-01-01

    A comparison was made of the diagnostic value of five immunological tests—complement fixation (CF), latex agglutination (LA), bentonite flocculation (BF), passive haemagglutination (PHA), and intradermal (ID)—in patients operated on for pulmonary echinococcosis. The sensitivity of all five tests was significantly lower in the patients with pulmonary echinococcosis than in a comparable group with liver echinococcosis. Some 252 patients with miscellaneous nonhydatid diseases and parasitic infections were also tested; nonspecific reactions were highest in the ID and CF tests and lowest in the LA and BF tests. None of the serological tests was significantly more sensitive than the others, although the CF test was somewhat less sensitive and therefore probably has the least diagnostic value in pulmonary echinococcosis. The ID test showed a significantly higher sensitivity than any of the serological tests. The difficulties encountered in the immunodiagnosis of pulmonary hydatid disease are discussed and it is recommended that at least two serological methods (PHA and either LA or BF) and the ID test should be used in each case. PMID:317251

  3. Axillary reverse mapping for preventing lymphedema in axillary lymph node dissection and\\/or sentinel lymph node biopsy

    Microsoft Academic Search

    Masakuni Noguchi

    2010-01-01

    The Japanese Breast Cancer Society 2009 Axillary lymph node dissection (ALND) is a standard surgical treatment in patients with involved axillary lymph nodes. Unfortunately, arm lymphedema develops in 2.7– 5.0% of patients treated by partial ALND (level I and II), in 3.1–9.6% of those undergoing total ALND, and in 26– 38% of patients treated with ALND and radiotherapy [1]. The

  4. Radioguided lymph node biopsy of a chemoresistant lymph node detected on interim FDG PET-CT in Hodgkin lymphoma

    Microsoft Academic Search

    Tamás Györke; Attila Kollár; Gyula Bottlik; Ágota Szepesi; Imre Bodó; Tamás Masszi; Viktor Bérczi; Ildikó Garai

    2011-01-01

    A 32-year-old male patient was diagnosed with nodular lymphocyte-predominant Hodgkin lymphoma. Staging FDG PET-CT detected\\u000a a large right axillary lymph node conglomerate and splenic manifestation. Interim PET-CT following two cycles of ABVD chemotherapy\\u000a revealed good metabolic response with the exception of a single axillary lymph node. A second “interim” PET-CT after two further\\u000a cycles showed a similar result. A biopsy

  5. The influence of sentinel lymph node tumour burden on additional lymph node involvement and disease-free survival in cutaneous melanoma – a retrospective analysis of 392 cases

    Microsoft Academic Search

    M Guggenheim; R Dummer; F J Jung; D Mihic-Probst; H Steinert; V Rousson; L E French; P Giovanoli

    2008-01-01

    Twenty per cent of sentinel lymph node (SLN)-positive melanoma patients have positive non-SLN lymph nodes in completion lymph node dissection (CLND). We investigated SLN tumour load, non-sentinel positivity and disease-free survival (DFS) to assess whether certain patients could be spared CLND. Sentinel lymph node biopsy was performed on 392 patients between 1999 and 2005. Median observation period was 38.8 months.

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

    PubMed

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

    2011-02-01

    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

  7. Pulmonary function testing in infants with tetralogy of Fallot and absent pulmonary valve syndrome

    PubMed Central

    Salazar, Adler M; Newth, Christopher CJL; Khemani, Robinder G; Jürg, Hammer; Ross, Patrick A

    2015-01-01

    Aim: Absent pulmonary valve syndrome (APVS) is found in 3-6% of patients with Tetralogy of Fallot (TOF). Along with findings of TOF, absence of pulmonary valve tissue results in aneurysmal dilatation of the main and branch pulmonary arteries compressing the trachea, main-stem, and intrapulmonary bronchi leading to obstructive airways disease. Our objective was to review pulmonary function tests (PFT) in TOF-APVS patients. Materials and Methods: Eight PFT were performed on five mechanically ventilated TOF-APVS patients in the intensive care unit. Tidal volume, forced vital capacity (FVC), maximal expiratory flow 25%, resistance and compliance of the respiratory system were measured. Results: Pre-operative PFTs showed markedly elevated airways resistance (RRS) (median 0.45 cmH2O/mL/sec, range 0.17-0.66) and marked variability of the static compliance of the respiratory system (CRS) (median 0.6 mL/cmH2O/kg, range 0.25-2.6). Flow-volume loops measured by forced deflation showed flow limitation within the medium to small airways. Post-operative FVC was reduced in four of the five patients (median 46 mL/kg, IQR 42.9 - 48.8 mL/kg). Patients studied with various levels of positive end expiratory pressure (PEEP) showed improvement in tidal volume and reduced obstruction with PEEP greater than 10 cmH2O. For three patients with pre-operative data available, surgical correction resulted in near-normal post-operative CRS and improved, but still elevated RRS (median 0.14 cmH2O/mL/sec, interquartile range [IQR] 0.11-0.31). Conclusion: For our patients with TOF-APVS, airway resistance was elevated. Flow limitation was seen in the medium to small airways with a mild reduction of FVC. PFTs may help guide management of mechanical ventilation for TOF-APVS patients.

  8. Regional pulmonary perfusion following human heart-lung transplantation

    SciTech Connect

    Lisbona, R.; Hakim, T.S.; Dean, G.W.; Langleben, D.; Guerraty, A.; Levy, R.D. (Royal Victoria Hospital, Montreal, Quebec (Canada))

    1989-08-01

    Ventilation and perfusion scans were obtained in six subjects who had undergone heart-lung transplantation with consequent denervation of the cardiopulmonary axis. Two of the subjects had developed obliterative bronchiolitis, which is believed to be a form of chronic rejection. Their pulmonary function tests demonstrated airflow obstruction and their scintigraphic studies were abnormal. In the remaining four subjects without obstructive airways disease, ventilation and planar perfusion scans were normal. Single photon emission computed tomography imaging of pulmonary perfusion in these patients revealed a layered distribution of blood flow indistinguishable from that of normal individuals. It is concluded that neurogenic mechanisms have little influence on the pattern of local pulmonary blood flow at rest.

  9. Pulmonary uptake of morphine (M)

    SciTech Connect

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

    1986-03-01

    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.

  10. Completion axillary lymph node dissection minimizes the likelihood of false negatives for patients with invasive breast carcinoma and cytokeratin positive only sentinel lymph nodes

    Microsoft Academic Search

    James W Jakub; Nils M Diaz; Mark D Ebert; Alan Cantor; Douglas S Reintgen; Elisabeth L Dupont; Alan R Shons; Charles E Cox

    2002-01-01

    Objective: To document the incidence of metastatic disease in complete axillary lymph node dissections (CALND) of patients with invasive carcinoma after a sentinel lymph node (SLN) biopsy, positive only by immunohistochemical staining for cytokeratin (CK-IHC).Methods: Sections of all SLNs, negative by routine histology, were immunostained and examined for cytokeratin positive cells. Sections of lymph nodes from CALND specimens were interpreted

  11. Angiotensin-converting enzyme inhibition delays pulmonary vascular neointimal formation.

    PubMed

    Okada, K; Bernstein, M L; Zhang, W; Schuster, D P; Botney, M D

    1998-09-01

    Primary pulmonary hypertension (PPH) is a disease characterized pathologically by pulmonary artery medial hypertrophy, adventitial thickening, and neointimal proliferation. Increasing recognition of the importance of remodeling to the pathogenesis of PPH suggests new therapeutic possibilities, but it will be necessary to (1) identify essential mediators of remodeling, and (2) demonstrate that inhibiting those mediators suppresses remodeling before new antiremodeling therapies can be considered feasible. The effect of angiotensin-converting enzyme (ACE) inhibition on pulmonary vascular remodeling was studied in a newly developed rat model in which neointimal lesions develop between 3 and 5 wk after monocrotaline injury is coupled with increased pulmonary artery blood flow after contralateral pneumonectomy. Neointimal formation was significantly suppressed at 5 wk by ACE inhibition whether it was started 10 d before or 3 wk after remodeling was initiated, although medial hypertrophy and adventitial thickening still developed. By 11 wk, the extent of neointimal formation in rats treated with ACE inhibition was similar to rats without ACE inhibition at 5 wk. Pulmonary artery pressures and right ventricular weights correlated with the extent of neointimal formation. Northern blot analysis and in situ hybridization demonstrated marked suppression of lung tropoelastin and type I procollagen gene expression in the presence of ACE inhibition. An angiotensin II type I receptor antagonist partially, but not completely, replicated the effects of ACE inhibition. These data suggest that the tissue angiotensin system may be a target for therapeutic efforts to suppress the vascular remodeling that is characteristic of primary pulmonary hypertension. PMID:9731029

  12. The Utility of Sentinel Lymph Node Biopsy in Papillary Thyroid Carcinoma with Occult Lymph Nodes

    PubMed Central

    Yan, Xingqiang; Zeng, Ruichao; Ma, Zhaosheng; Chen, Chengze; Chen, Endong; Zhang, Xiaohua; Cao, Feilin

    2015-01-01

    Background The sentinel lymph node (SLN) is defined as the first draining node from the primary lesion, and it has proven to be a good indicator of the metastatic status of regional lymph nodes in solid tumors. The aim of this study was to evaluate the clinical application of SLN biopsy (SLNB) in papillary thyroid carcinoma (PTC) with occult lymph nodes. Methods From April 2006 to October 2012, 212 consecutive PTC patients were treated with SLNB using carbon nanoparticle suspension (CNS). Then, the stained nodes defined as SLN were collected, and prophylactic central compartment neck dissection (CCND) followed by total thyroidectomy or subtotal thyroidectomy were performed. All the samples were sent for pathological examination. Results There were 78 (36.8%) SLN metastasis (SLNM)-positive cases and 134 (63.2%) SLNM-negative cases. The sensitivity, specificity, positive and negative predictive values, and false-positive and false-negative rates of SLNB were 78.8%, 100%, 100%, 84.3%, 0%, and 21.2%, respectively. The PTC patients with SLNM were more likely to be male (48.2% vs. 32.7%, p = 0.039) and exhibited multifocality (52.6% vs. 33.3%, p = 0.025) and extrathyroidal extension (56.7% vs. 33.5%, p = 0.015). A greater incidence of non-SLN metastases in the central compartment was found in patients with SLNM (41/78, 52.6%) than in those without SLNM (21/134, 15.7%; p < 0.05). However, the SLNM-negative PTC patients with non-SLN metastases were more likely to be male (37.9% vs. 9.5%, p < 0.05). Conclusions The application of SLNB using CNS is technically feasible, safe, and useful, especially for male patients with co-existing multifocality and extrathyroidal extension. However, the sensitivity of SLNB must be improved and its false-negative rate reduced before it can be a routine procedure and replace prophylactic CCND. More attention should be paid to PTC patients (especially males) without SLNM for signs of non-SLN metastases. PMID:26046782

  13. Autoimmune disease leading to pulmonary AL amyloidosis and pulmonary hypertension

    PubMed Central

    Ellender, Claire M; McLean, Catriona; Williams, Trevor J; Snell, Gregory I; Whitford, Helen M

    2015-01-01

    A 33-year-old woman with past history of Sjögren's syndrome and systemic lupus erythematosus presented with dyspnea and syncope secondary to pulmonary hypertension. After progressive symptoms over 4 years, she received bilateral lung transplantation. Histopathology of the explanted lungs showed isolated pulmonary amyloid light-chain amyloidosis and pulmonary cysts. No evidence of systemic amyloidosis was found at the time of transplantation. Seven years post lung transplantation, she remains well with no evidence of systemic amyloidosis recurrence. PMID:26090118

  14. Pulmonary effects of smoking.

    PubMed

    Patel, D R; Homnick, D N

    2000-10-01

    The problems of tobacco addiction have evolved over centuries. The possible relationship between smoking and oral cancer was recognized as early as the 19th century. The use of tobacco results in an estimated 4 million deaths each year worldwide. Approximately 3,000 adolescents start smoking every day; 4.5 million children and adolescents smoke cigarettes; 1 million use smokeless tobacco. This article reviews the effects of environmental tobacco smoke and primary smoking on lung health and maturation and the pathophysiology of smoking-related pulmonary disease. Smoking prevention and timely smoking cessation will significantly reduce the risk of not only lung diseases (chronic obstructive pulmonary disease, cancer, chronic bronchitis, asthma, etc.) but also suboptimal lung growth during preadolescent and adolescent years. PMID:11060554

  15. Pediatric pulmonary arterial hypertension.

    PubMed

    Wu, Dan-Chen; Zhang, Hong-Da; Jing, Zhi-Cheng

    2013-12-01

    Pulmonary arterial hypertension (PAH) can cause morbidity and mortality in children. Although adult and pediatric PAH share many similarities, many differences have been found in children. Thus, a new classification for pediatric pulmonary hypertensive vascular disease has been proposed. Both child and adult gene mutation carriers with PAH tend to have worse prognoses. Pediatric patients present with better preserved functional class, and parents should pay high attention to any children with unexplained shortness of breath, fatigue or syncope, as symptoms of PAH in children are often misleading. Right heart catheterization is necessary for diagnosis. Although there are few medications approved for pediatric PAH and evidence-based treatment algorithms for children are still lacking, the survival of pediatric patients has been improved significantly since targeted therapies approved for adults were introduced to pediatric patients. PAH in children is unique, and further studies are needed to have a better understanding of it. PMID:24163011

  16. [Primary and pulmonary tuberculosis].

    PubMed

    Toujani, S; Ben Salah, N; Cherif, J; Mjid, M; Ouahchy, Y; Zakhama, H; Daghfous, J; Beji, M; Mehiri-Ben Rhouma, N; Louzir, B

    2015-01-01

    Tuberculosis is a major public health problem worldwide. Indeed, a third of the world population is infected with Mycobacterium tuberculosis and more than 8 million new cases of tuberculosis each year. Pulmonary tuberculosis is the most common location. Its diagnosis is difficult and often established with a delay causing a spread of infection. The diagnosis of tuberculosis infection is mainly based on immunological tests represented by the tuberculin skin test and detection of gamma interferon, while the diagnosis of pulmonary tuberculosis is suspected on epidemiological context, lasting general and respiratory symptoms, contrasting usually with normal lung examination, and a chest radiography showing suggestive lesions. The radioclinical feature may be atypical in patients with extreme ages and in case of immunodeficiency. Confirmation of tuberculosis is bacteriological. Conventional bacteriological methods remain the reference. Innovative tests using the technique of molecular biology have improved the diagnosis of tuberculosis in terms of sensitivity and especially speed. However, those techniques are of limited use. PMID:25749628

  17. Inflammatory cytokines in pulmonary hypertension

    PubMed Central

    2014-01-01

    Pulmonary hypertension is an “umbrella term” used for a spectrum of entities resulting in an elevation of the pulmonary arterial pressure. Clinical symptoms include dyspnea and fatigue which in the absence of adequate therapeutic intervention may lead to progressive right heart failure and death. The pathogenesis of pulmonary hypertension is characterized by three major processes including vasoconstriction, vascular remodeling and microthrombotic events. In addition accumulating evidence point to a cytokine driven inflammatory process as a major contributor to the development of pulmonary hypertension. This review summarizes the latest clinical and experimental developments in inflammation associated with pulmonary hypertension with special focus on Interleukin-6, and its role in vascular remodeling in pulmonary hypertension. PMID:24739042

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

    PubMed

    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

    2014-01-01

    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

  19. Infant Pulmonary Function Testing

    PubMed Central

    Davis, Stephanie D.

    2011-01-01

    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

  20. Asthma Outcomes: Pulmonary Physiology

    PubMed Central

    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

    2014-01-01

    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

  1. [Case of pulmonary coccidioidomycosis presented with multiple infiltrative opacities].

    PubMed

    Kojima, Toru; Takase, Keiichirou; Nakaya, Junya; Igarashi, Kazunari; Yamaguchi, Wataru; Kaizaki, Yasuharu; Nakaya, Takakiyo

    2008-05-01

    A 54-year-old man was admitted to our hospital to be operated on for inguinal hernia, but complained of dry cough and cervical lymph nodes swelling after traveling to California in the United States. The chest X-ray films taken on admission showed consolidations in both lungs. The laboratory data revealed an increase in white blood cell counts with eosinophilia, and elevated ESR, IgE and beta-D-glucan. The biopsied lung specimen by VATS showed epithelioid granulomas consisting of giant cells and eosinophils. In addition, spherulitic forms filled with endopores were detected in the specimen. A diagnosis of primary pulmonary coccidioidomycosis was made. Eosinophilia and elevated in IgE and beta-D-glucan were closely related to the severity of the disease gravity after the treatment with fluconazole. PMID:18517016

  2. Nontuberculous mycobacterial pulmonary infections

    PubMed Central

    Odell, John A.

    2014-01-01

    Pulmonary infections due to nontuberculous mycobacteria (NTM) are increasingly recognized worldwide. Although over 150 different species of NTM have been described, pulmonary infections are most commonly due to Mycobacterium avium complex (MAC), Mycobacterium kansasii, and Mycobacterium abscessus. The identification of these organisms in pulmonary specimens does not always equate with active infection; supportive radiographic and clinical findings are needed to establish the diagnosis. It is difficult to eradicate NTM infections. A prolonged course of therapy with a combination of drugs is required. Unfortunately, recurrent infection with new strains of mycobacteria or a relapse of infection caused by the original organism is not uncommon. Surgical resection is appropriate in selected cases of localized disease or in cases in which the infecting organism is resistant to medical therapy. Additionally, surgery may be required for infections complicated by hemoptysis or abscess formation. This review will summarize the practical aspects of the diagnosis and management of NTM thoracic infections, with emphasis on the indications for surgery and the results of surgical intervention. The management of NTM disease in patients with human immunodeficiency virus (HIV) infections is beyond the scope of this article and, unless otherwise noted, comments apply to hosts without HIV infection PMID:24624285

  3. Nontuberculous mycobacterial pulmonary infections.

    PubMed

    Johnson, Margaret M; Odell, John A

    2014-03-01

    Pulmonary infections due to nontuberculous mycobacteria (NTM) are increasingly recognized worldwide. Although over 150 different species of NTM have been described, pulmonary infections are most commonly due to Mycobacterium avium complex (MAC), Mycobacterium kansasii, and Mycobacterium abscessus. The identification of these organisms in pulmonary specimens does not always equate with active infection; supportive radiographic and clinical findings are needed to establish the diagnosis. It is difficult to eradicate NTM infections. A prolonged course of therapy with a combination of drugs is required. Unfortunately, recurrent infection with new strains of mycobacteria or a relapse of infection caused by the original organism is not uncommon. Surgical resection is appropriate in selected cases of localized disease or in cases in which the infecting organism is resistant to medical therapy. Additionally, surgery may be required for infections complicated by hemoptysis or abscess formation. This review will summarize the practical aspects of the diagnosis and management of NTM thoracic infections, with emphasis on the indications for surgery and the results of surgical intervention. The management of NTM disease in patients with human immunodeficiency virus (HIV) infections is beyond the scope of this article and, unless otherwise noted, comments apply to hosts without HIV infection. PMID:24624285

  4. Nanomedicine in pulmonary delivery

    PubMed Central

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

    2009-01-01

    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

  5. Endothelial dysfunction in pulmonary hypertension

    Microsoft Academic Search

    Dominique Yelle; Lakshmi Kugathasan; Robin E. MacLaren; Duncan J. Stewart

    \\u000a Pulmonary arterial hypertension (PAH) is a rare disease caused by functional and structural abnormalities in distal pulmonary\\u000a arterioles that result in progressive increases in pulmonary vascular resistance, often leading to right heart failure and\\u000a death. Endothelial dysfunction, defined as a shift in the balance of production of endothelial vasodilator factors (i.e.,\\u000a nitric oxide and prostacyclin), and vasoconstrictor and proliferative factors

  6. What to Expect After Pulmonary Rehabilitation

    MedlinePLUS

    ... 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 ...

  7. Pulmonary function in children with idiopathic scoliosis

    PubMed Central

    2012-01-01

    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

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

    SciTech Connect

    Mitsudo, Kenji, E-mail: mitsudo@yokohama-cu.ac.jp [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)

    2012-08-01

    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.

  9. Microfocal angiography of the pulmonary vasculature

    NASA Astrophysics Data System (ADS)

    Clough, Anne V.; Haworth, Steven T.; Roerig, David T.; Linehan, John H.; Dawson, Christopher A.

    1998-07-01

    X-ray microfocal angiography provides a means of assessing regional microvascular perfusion parameters using residue detection of vascular indicators. As an application of this methodology, we studied the effects of alveolar hypoxia, a pulmonary vasoconstrictor, on the pulmonary microcirculation to determine changes in regional blood mean transit time, volume and flow between control and hypoxic conditions. Video x-ray images of a dog lung were acquired as a bolus of radiopaque contrast medium passed through the lobar vasculature. X-ray time-absorbance curves were acquired from arterial and microvascular regions-of-interest during both control and hypoxic alveolar gas conditions. A mathematical model based on indicator-dilution theory applied to image residue curves was applied to the data to determine changes in microvascular perfusion parameters. Sensitivity of the model parameters to the model assumptions was analyzed. Generally, the model parameter describing regional microvascular volume, corresponding to area under the microvascular absorbance curve, was the most robust. The results of the model analysis applied to the experimental data suggest a significant decrease in microvascular volume with hypoxia. However, additional model assumptions concerning the flow kinematics within the capillary bed may be required for assessing changes in regional microvascular flow and mean transit time from image residue data.

  10. Aggressive Digital Papillary Adenocarcinoma: Case Report of a Positive Sentinel Lymph Node and Discussion of Utility of Sentinel Lymph Node Biopsy.

    PubMed

    Kempton, Steve J; Navarrete, Andrew D; Salyapongse, A Neil

    2015-07-01

    Aggressive digital papillary adenocarcinoma (ADPA) is an uncommon eccrine sweat gland tumor of the distal extremities that is associated with a high rate of local recurrence and distant metastasis. Current opinion suggests that sentinel lymph node evaluation should be done for high-risk tumors where lymph node spread is a concern. Despite documented spread to regional lymph nodes, information on sentinel lymph node status in ADPA is reported infrequently, with only 1 documented case of positive findings. We report on a case of ADPA of the right long finger where sentinel lymph node biopsy was done and positive for metastases in the axilla, resulting in a subsequent completion lymphadenectomy. To determine the benefit of sentinel lymph node biopsy in ADPA, there is a need for more cases of sentinel lymph node evaluation along with data on local recurrence and distant metastasis in those with positive and negative findings. PMID:25954845

  11. A standardized surgical technique for mastoscopic axillary lymph node dissection.

    PubMed

    Chengyu, Luo; Yongqiao, Zhou; Hua, Lin; Xiaoxin, Ji; Chen, Guan; Jing, Li; Jian, Zhang

    2005-06-01

    To standardize the surgical technique for mastoscopic axillary lymph node dissection (MALND). Mastoscopic lymph node dissection was performed consistently by a group of surgeons in 316 cases of breast cancer. The mean operation time was 46.7 minutes with minimal bleeding, and the median number of lymph nodes dissected at each operation was 17.0. There were no operative complications in any case, nor did trocar implantation or tumor diffusion occurring during the mean follow-up time of 15.1 months. MALND is distinctive and practicable in operative anatomy as well as safe and convenient. The location of critical anatomy such as the intercostobrachial nerve, lateral thoracic artery, medial thoracic nerve, and thoracoepigastric vein should be clearly identified to avoid damage to them, so that is the great advantage of MALND. PMID:15956900

  12. Beyond conventional pathology: towards preoperative and intraoperative lymph node staging.

    PubMed

    Winter, Marnie; Gibson, Rachel; Ruszkiewicz, Andrew; Thompson, Sarah K; Thierry, Benjamin

    2015-02-15

    Accurate detection of lymph node metastases is critical for many solid tumours to guide treatment strategies and determine prognostic outcomes. The gold standard for detection of metastasis is by histological analysis of formalin-fixed paraffin-embedded (FFPE) sections of removed lymph nodes; this analysis method has remained largely unchanged for decades. Recent studies have highlighted limitations in the sensitivity of this approach, at least in its current clinical use, to detect very small metastatic deposits. Importantly, the poor prognostic outcomes associated with the presence of such small tumour deposits are now well established in a number of cancers. In addition, histological analysis of FFPE sections cannot be used practically for intraoperative node assessment. Novel lymph node staging technologies are therefore actively being developed. This review critically presents the main advances in this field and discusses why these technologies have not been able to provide a better alternative to the current gold standard diagnostic technique. PMID:24469881

  13. A case of idiopathic lymph leakage in the neck.

    PubMed

    Suzuki, Masanobu; Morita, Shinya; Iizuka, Keiji

    2010-08-01

    A 48-year-old female patient was seen in our institution complaining of sudden onset of swelling and tenderness in the left side of her neck. Computed tomography and magnetic resonance imaging revealed abundant effusions in this area. Since these narrowed the patient's airway, we performed incisional drainage and intra-operatively we observed a transparent, colorless lymph fluid that oozed from the operative field, which was mainly a fatty layer at the supraclavicular area. Dilated lymphatic ducts were seen along the carotid artery and internal jugular vein, but damaged lymphatic ducts and obvious causative disease structures like tumorous lesions were not seen. Idiopathic lymph leakage was diagnosed due to the serous discharge from the left side of the neck and no apparent causative disease. The patient was successfully treated with incisional drainage and dietary restriction. Lymph leakage in the neck is more common after trauma or surgery. To our knowledge, no similar cases have ever been reported. PMID:20031353

  14. Characteristics of magnetic probes for identifying sentinel lymph nodes.

    PubMed

    Ookubo, Tetsu; Inoue, Yusuke; Kim, Dongmin; Ohsaki, Hiroyuki; Mashiko, Yusuke; Kusakabe, Moriaki; Sekino, Masaki

    2013-01-01

    The identification of the sentinel lymph nodes that cause tumor metastasis is important in breast cancer therapy. The detection of magnetic fluid accumulating in the lymph nodes using a magnetic probe allows surgeons to identify the lymph nodes. In this study, we carried out numerical simulations and experiments to investigate the sensitivity and basic characteristics of a magnetic probe consisting of a permanent magnet and a small magnetic sensor. The measured magnetic flux density arising from the magnetic fluid agreed well with the numerical results. In addition, the results helped realize an appropriate probe configuration for achieving high sensitivity to magnetic fluid. A prototype probe detected magnetic fluid located 30 mm from the probe head. PMID:24110978

  15. Axillary lymph node dose with tangential breast irradiation

    SciTech Connect

    Reed, Daniel R. [Radiation Oncology, University of Washington Medical Center, Seattle, WA (United States)]. E-mail: drreed@u.washington.edu; Lindsley, Skyler Karen [Radiation Oncology, University of Washington Medical Center, Seattle, WA (United States); Mann, Gary N. [Department of Surgery, University of Washington Medical Center, Seattle, WA (United States); Austin-Seymour, Mary [Radiation Oncology, University of Washington Medical Center, Seattle, WA (United States); Korssjoen, Tammy [Radiation Oncology, University of Washington Medical Center, Seattle, WA (United States); Anderson, Benjamin O. [Department of Surgery, University of Washington Medical Center, Seattle, WA (United States); Moe, Roger [Department of Surgery, University of Washington Medical Center, Seattle, WA (United States)

    2005-02-01

    Purpose: The advent of sentinel lymph node mapping and biopsy in the staging of breast cancer has resulted in a significant decrease in the extent of axillary nodal surgery. As the extent of axillary surgery decreases, the radiation dose and distribution within the axilla becomes increasingly important for current therapy planning and future analysis of results. This analysis examined the radiation dose distribution delivered to the anatomically defined axillary level I and II lymph node volume and surgically placed axillary clips with conventional tangential breast fields and CT-based three-dimensional (3D) planning. Methods and materials: Fifty consecutive patients with early-stage breast cancer undergoing breast conservation therapy were evaluated. All patients underwent 3D CT-based planning with conventional breast tangential fields designed to encompass the entire breast parenchyma. Using CT-based 3D planning, the dose distribution of the standard tangential breast irradiation fields was examined in relationship to the axillary level I and II lymph node volumes. Axillary level I and II lymph node anatomic volumes were defined by CT and surgical clips placed during complete level I-II lymph node dissection. Axillary level I-II lymph node volume doses were examined on the basis of the prescribed breast radiation dose and 3D dose distribution. Results: All defined breast volumes received {>=}95% of the prescribed dose. By contrast, the 95% isodose line encompassed only an average of 55% (range, 23-87%) of the axillary level I-II lymph node anatomic volume. No patient had complete coverage of the axillary level I-II lymph node region by the 95% isodose line. The mean anatomic axillary level I-II volume was 146.3 cm{sup 3} (range, 83.1-313.0 cm{sup 3}). The mean anatomic axillary level I-II volume encompassed by the 95% isodose line was 84.9 cm{sup 3} (range, 25.1-219.0 cm{sup 3}). The mean 95% isodose coverage of the surgical clip volume was 80%, and the median value was 81% (range, 58-98%). The mean volume deficit between the axillary level I-II volume and the surgical clip volume was 41.7 cm{sup 3} (median, 30.0 cc). Conclusion: In this study, standard tangential breast radiation fields failed to deliver a therapeutic dose adequately to the axillary level I-II lymph node anatomic volume. No patient received complete coverage of the axillary level I-II lymph node volume. Surgically placed axillary clips also failed to delineate the level I-II axilla adequately. Definitive irradiation of the level I and II axillary lymph node region requires significant modification of standard tangential fields, best accomplished with 3D treatment planning, with specific targeting of anatomically defined axillary lymph node volumes as described, in addition to the breast parenchymal volumes.

  16. Efficiency of Ultrasound and Ultrasound-Guided Fine Needle Aspiration Cytology in Preoperative Assessment of Axillary Lymph Node Metastases in Breast Cancer

    PubMed Central

    Demirkazik, Figen Basaran; Akpinar, Meltem Gulsun; Soygur, Is?l; Baykal, Atac; Onder, Sevgen Celik; Uner, Aysegul

    2012-01-01

    Purpose We performed this study to detect preoperative axillary metastases with ultrasound (US)-guided fine needle aspiration biopsy (FNAB), to eliminate the need for time-consuming and costly sentinel lymph node (SLN) scintigraphy and biopsy steps in the treatment of breast cancer patients, and in that of with suspicious US findings, and to evaluate the accuracy of preoperative US-guided FNAB for patients with suspicious lymph node metastases on US. Methods Patients with a suspicious breast lump or histopathologically proven breast cancer underwent breast-axillary US. Increase in lymph node size, cortical thickening, non-hilar cortical flow, and hilar changes were evaluated with gray scale-color Doppler US. FNAB was performed if US results were suspicious for malignancy. Results Thirty-eight axillary lymph nodes (ALN) underwent FNAB. ALN dissection, SLN scintigraphy, and biopsy steps were bypassed in 23 axillas with positive ALN FNAB (60.5%). The sensitivity of ALN FNAB was 88.46%; specificity and positive predictive value were 100%; and negative predictive value was 66.6% (inadequate cytology included; 76.7%, 100%, 100%, 53.3%, respectively). Asymmetrical cortical thickening, non-hilar cortical flow, and increase in hypoechogenity were only detected in metastatic nodes. Cortical thickening, and lymph node and breast mass size was higher in the metastatic group. Conclusion By performing FNAB on suspicious lymph nodes, the routine, high-cost SLN scintigraphy and intraoperative gamma probe steps may be skipped, and axilla dissection can be performed directly. This leads to the elimination of the need for SLN investigation in more than half of the patients. The assessment of ALN metastases with preoperative US-guided FNAB is a cost-effective method with high specificity, that eliminates the need for costly and time-consuming SLN scintigraphy and biopsy steps, and helps in preoperative staging. PMID:22807939

  17. Antioxidant defenses in rat intestine and mesenteric lymph.

    PubMed

    Mohr, D; Umeda, Y; Redgrave, T G; Stocker, R

    1999-01-01

    Dietary oxysterols can reach the circulation and this may contribute to atherosclerosis, where lipid oxidation is thought to be important. There is also evidence that, in rats, peroxidized lipids are absorbed and transported into lymph [Aw TY, Williams MW, Gray L. Absorption and lymphatic transport of peroxidized lipids by rat small intestine in vivo: role of mucosal GSH. Am J Physiol 1992; 262: G99-G106], although the method used to detect lipid peroxides lacked specificity. We tested whether intragastric administration of vegetable oils containing triglyceride hydroperoxides (TG-OOH) to rats resulted in detectable lipid hydroperoxides in mesenteric lymph. Using sensitive HPLC with postcolumn chemiluminescence detection, we were unable to detect hydroperoxides of triglycerides, cholesterylesters or phospholipids during the course of lipid absorption, and lymph levels of ascorbate, urate, alpha-tocopherol and ubiquinol-9 did not change significantly. By contrast, we observed a striking reducing activity judged by the efficient reduction of administered ubiquinones-9 and -10 to the corresponding ubiquinols. Exposure of rat lymph and isolated chylomicrons to aqueous peroxyl radicals revealed patterns of antioxidant consumption and lipid hydroperoxide formation similar to those described previously for human extravascular fluids and isolated lipoproteins, respectively. In particular, rates of TG-OOH formation in lymph and chylomicrons were very low to undetectable as long as ascorbate and/or ubiquinols were present, but subsequently proceeded in a chain reaction despite the presence of alpha-tocopherol. These studies demonstrate that rat intestine and mesenteric lymph possess efficient antioxidant defenses against preformed lipid hydroperoxides and (peroxyl) radical mediated lipid oxidation. We conclude that dietary lipid hydroperoxides or postprandial oxidation of lipids are not likely to contribute to these particular forms of oxidized lipids in circulation and aortic tissue. PMID:10496410

  18. Robust automated lymph node segmentation with random forests

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

    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.

  19. The migration of synthetic magnetic nanoparticle labeled dendritic cells into lymph nodes with optical imaging

    PubMed Central

    Su, Hang; Mou, Yongbin; An, Yanli; Han, Wei; Huang, Xiaofeng; Xia, Guohua; Ni, Yanhong; Zhang, Yu; Ma, Jianmin; Hu, Qingang

    2013-01-01

    Background The successful biotherapy of carcinoma with dendritic cell (DC) vaccines pivotally relies on DCs’ migratory capability into lymph tissues and activation of T cells. Accurate imaging and evaluation of DC migration in vivo have great significance during antitumor treatment with DC vaccine. We herein examined the behavior of DCs influenced by synthetic superparamagnetic iron oxide (SPIO) nanoparticle labeling. Methods ?-Fe2O3 nanoparticles were prepared and DCs, which were induced from bone marrow monocytes of enhanced green fluorescent protein (EGFP) transgenic mice, were labeled. The endocytosis of the SPIO, surface molecules, cell apoptosis and fluorescence intensity of EGFP-DCs were displayed by Prussian blue staining and flow cytometry (FCM), respectively. After EGFP-DCs, labeled with SPIO, were injected into footpads (n = 5) for 24 hours, the mice were examined in vivo by optical imaging (OPI). Meanwhile, confocal imaging and FCM were applied, respectively, to detect the migration of labeled DCs into draining lymph nodes. Results Nearly 100% of cells were labeled by the SPIO, in which the intracellular blue color gradually deepened and the iron contents rose with the increase of labeling iron concentrations. In addition, cell apoptosis and the surface molecules on DCs were at similar levels after SPIO labeling. After confirming that the fluorescence intensity of EGFP on DCs was not influenced by SPIO, the homing ability of EGFP-DCs labeled with SPIO displayed that the fluorescence intensity and the ratios of EGFP-DCs in draining lymph nodes were gradually decreased with the increase of labeling iron concentrations. Conclusion The synthetic SPIO nanoparticles possess perfect labeling ability and biocompatibility. Moreover, DCs labeled with a low dose of SPIO showed stronger migratory capability in vivo. PMID:24124362

  20. Surgical treatment of lymph node metastases from hepatocellular carcinoma

    Microsoft Academic Search

    Shin Kobayashi; Shinichiro Takahashi; Yuichiro Kato; Naoto Gotohda; Toshio Nakagohri; Masaru Konishi; Taira Kinoshita

    2011-01-01

    Background  No consensus has been reached on the feasibility and efficacy of surgery for lymph node metastases (LNM) from hepatocellular\\u000a carcinoma (HCC).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Of 2189 patients with HCC treated at our hospital between July 1992 and March 2008, we retrospectively reviewed the medical\\u000a dossiers of the 18 patients (0.8%) who underwent lymph node resection and were pathologically diagnosed to have LNM from

  1. Lymph nodes tuberculosis: a retrospective study on clinical and therapeutic features

    PubMed Central

    Benjelloun, Amine; Darouassi, Youssef; Zakaria, Yasser; Bouchentouf, Rachid; Errami, Noureddine

    2015-01-01

    Lymph nodes tuberculosis represents 30 percent of extra pulmonary tuberculosis in Morocco. We report here the experience of the pulmonology unit of the Avicenne Military Hospital in Marrakech for a period of 4 years. Our study interested 30 patients (15 males and 15 females) with an average age of 29 years old (10 to 62 years old). Tuberculosis has interested a single site in 28 patients, the other two patients had multiple but unilateral involvement. For the single sites, locations were jugulo-carotidian (20 patients), supra-calvicular (2 patients), axillary (2 patients), sub-mandibular (2 patients), spinal (2 patients) and mediastinal (2 patients). For the multiple locations, the involvement was jugulo-carotidian, sub-mandibular, spinal and sub-clavicular for one patient; and jugulo-carotidian and sub-clavicular for the other. Diagnosis was made by surgical biopsy and histology for all the patients. A six-month anti-tuberculous treatment was given afterward, with relapses in two patients. PMID:26090023

  2. Deep venous thromboembolism in patients undergoing inguinal lymph node dissection for melanoma.

    PubMed Central

    Arbeit, J M; Lowry, S F; Line, B R; Jones, D C; Brennan, M F

    1981-01-01

    Deep venous thromboembolism (DVT) was studied in 44 patients with clinical Stage I, II, and III melanoma undergoing staging and therapeutic inguinal lymph node dissection. The ability of two noninvasive methods of surveillance, the phleborheograph (PRG) and the 125I fibrinogen scan to detect deep venous thrombosis was determined by comparison with prospective bilateral lower extremity venograms. In addition, the therapeutic impact, both beneficial and detrimental, of low dose heparin, 5000 units administered subcutaneously two hours prior to and every eight hours after operation was determined in a double blind study. The sensitivity of the PRG and 125I fibrinogen scan were both 20%. There were five deep venous thrombi, and two pulmonary emboli for a combined incidence of DVT of 13.6% for the entire patient population. However, there was no significant difference in the incidence of DVT between the two groups. The heparin-treated patients had an increased total volume (796 +/- 516 versus 388 +/- 208 ml; p less than 0.05), and duration of wound drainage (9 +/- 4 versus 13 +/- 6 days; p less than 0.05). PMID:7294936

  3. Pulmonary Lymphangitis Carcinomatosa and Acute Pancreatitis: A Rare Presentation of Choledochal Cyst

    PubMed Central

    Kelly, D. M.; O'Donnell, P. J.

    1999-01-01

    Pulmonary lymphangitis carcinomatosa is an unusal cause of death in a young adult. This case describes an apparently healthy young woman who presented with severe acute pancreatitis, which is a recognized complication of a choledochal cyst. Autopsy examination revealed advanced malignancy with poorly differentiated adenocarcinoma penetrating the wall of the choledochal cyst and metastatic adenocarcinoma in the lymph nodes, lungs and kidneys. This case emphasises the unusual presentation of a choledochal cyst with acute pancreatitis and the aggressive nature of malignancy associated with this congenital anomaly. PMID:10371061

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

    PubMed Central

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

    2014-01-01

    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. PMID:25798364

  5. Chronic thromboembolic pulmonary hypertension after pulmonary embolism, thrombolysis, catheter fragmentation, and embolectomy.

    PubMed

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

    2014-12-01

    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. PMID:25798364

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

    PubMed

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

    2015-01-01

    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

  7. Predictors of Completion Axillary Lymph Node Dissection in Patients With Immunohistochemical Metastases to the Sentinel Lymph Node in Breast Cancer

    Microsoft Academic Search

    Matthew S. Pugliese; Amer K. Karam; Meier Hsu; Michelle M. Stempel; Sujata M. Patil; Alice Y. Ho; Tiffany A. Traina; Kimberly J. Van Zee; Hiram S. Cody III; Monica Morrow; Mary L. Gemignani

    2010-01-01

    Background  Axillary lymph node dissection (ALND) in patients with immunohistochemistry (IHC)-determined metastases to the sentinel lymph\\u000a node (SLN) is controversial. The goal of this study was to examine factors associated with ALND in IHC-only patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Retrospective review of an institutional SLN database from July 1997 to July 2003 was performed. We compared sociodemographic,\\u000a pathologic, and therapeutic variables between IHC-only patients who

  8. Eighteen Sensations After Breast Cancer Surgery: A 5Year Comparison of Sentinel Lymph Node Biopsy and Axillary Lymph Node Dissection

    Microsoft Academic Search

    Roberta H. Baron; Jane V. Fey; Patrick I. Borgen; Michelle M. Stempel; Kathleen R. Hardick; Kimberly J. Van Zee

    2007-01-01

    Background  The aim of this study is to evaluate prevalence, severity, and level of distress of 18 sensations at baseline (3–15 days)\\u000a and 5 years after breast cancer surgery, and compare sensations after sentinel lymph node biopsy (SLNB) with those after SLNB\\u000a plus immediate or delayed axillary lymph node dissection (ALND).\\u000a \\u000a \\u000a \\u000a Methods  A total of 187 patients with breast cancer completed the

  9. Fluoxetin-induced pulmonary granulomatosis.

    PubMed

    de Kerviler, E; Trédaniel, J; Revlon, G; Groussard, O; Zalcman, G; Ortoli, J M; Espié, M; Hirsch, A; Frija, J

    1996-03-01

    A patient treated with fluoxetin for a manic depressive disorder developed pulmonary inflammatory nodules with noncaseating giant cell granulomas, interstitial pneumonia and non-necrotizing vasculitis, whilst remaining asymptomatic. A progressive resolution of pulmonary nodules occurred after withdrawal of the offending agent, and the chest radiograph returned to normal in 9 months. The diagnosis was assessed by an open lung biopsy. PMID:8730028

  10. Pulmonary emphysema and proteolysis: 1986

    SciTech Connect

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

    1987-01-01

    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}.

  11. Pulmonary Arteriovenous Malformations

    PubMed Central

    2014-01-01

    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

  12. Pulmonary arteriovenous malformations.

    PubMed

    Shovlin, Claire L

    2014-12-01

    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

  13. Specific Migratory Dendritic Cells Rapidly Transport Antigen from the Airways to the Thoracic Lymph Nodes

    PubMed Central

    Vermaelen, Karim Y.; Carro-Muino, Ines; Lambrecht, Bart N.; Pauwels, Romain A.

    2001-01-01

    Antigen transport from the airway mucosa to the thoracic lymph nodes (TLNs) was studied in vivo by intratracheal instillation of fluorescein isothiocyanate (FITC)-conjugated macromolecules. After instillation, FITC+ cells with stellate morphology were found deep in the TLN T cell area. Using flow cytometry, an FITC signal was exclusively detected in CD11cmed-hi/major histocompatibility complex class II (MHCII)hi cells, representing migratory airway-derived lymph node dendritic cells (AW-LNDCs). No FITC signal accumulated in lymphocytes and in a CD11chiMHCIImed DC group containing a CD8?hi subset (non–airway-derived [NAW]-LNDCs). Sorted AW-LNDCs showed long MHCIIbright cytoplasmic processes and intracytoplasmatic FITC+ granules. The fraction of FITC+ AW-LNDCs peaked after 24 h and had reached baseline by day 7. AW-LNDCs were depleted by 7 d of ganciclovir treatment in thymidine kinase transgenic mice, resulting in a strong reduction of FITC-macromolecule transport into the TLNs. Compared with intrapulmonary DCs, AW-LNDCs had a mature phenotype and upregulated levels of MHCII, B7-2, CD40, and intracellular adhesion molecule (ICAM)-1. In addition, sorted AW-LNDCs from FITC-ovalbumin (OVA)–instilled animals strongly presented OVA to OVA-TCR transgenic T cells. These results validate the unique sentinel role of airway DCs, picking up antigen in the airways and delivering it in an immunogenic form to the T cells in the TLNs. PMID:11136820

  14. [Pulmonary-renal syndrome].

    PubMed

    Risso, Jorge A; Mazzocchi, Octavio; De All, Jorge; Gnocchi, César A

    2009-01-01

    The pulmonary-renal syndrome is defined as a combination of diffuse alveolar hemorrhage and glomerulonephritis. The coexistence of these two clinical conditions is due to diseases with different pathogenic mechanisms. Primary systemic vasculitis and Goodpasture syndrome are the most frequent etiologies. Systemic lupus erythematosus, connective tissue diseases, negative anti neutrophil cytoplasmic antibody vasculitis and those secondary to drugs are far less common causes. An early diagnosis based on clinical, radiologic, laboratory and histologic criteria enables early treatment, thus diminishing its high morbidity-mortality rate. Therapy is based on high doses of corticosteroids, immunosuppressants, tumor necrosis factor inhibitors and plasmapheresis. PMID:20053612

  15. [Infectious pulmonary diseases].

    PubMed

    Hager, T; Reis, H; Theegarten, D

    2014-11-01

    Infectious pulmonary diseases and pneumonias are important causes of death within the group of infectious diseases in Germany. Most cases are triggered by bacteria. The morphology of the inflammation is often determined by the agent involved but several histopathological types of reaction are possible. Histology alone is only rarely able to identify the causal agent; therefore additional microbiological diagnostics are necessary in most cases. Clinically cases are classified as community acquired and nosocomial pneumonia, pneumonia under immunosuppression and mycobacterial infections. Histologically, alveolar and interstitial as well as lobar and focal pneumonia can be differentiated. PMID:25319227

  16. Cytokines in mammary lymph and milk during endotoxin-induced bovine mastitis

    Microsoft Academic Search

    K. Persson Waller; I. G. Colditz; S. Lun; K. Östensson

    2003-01-01

    Cytokine kinetics were examined in milk and in afferent and efferent lymph of the supramammary lymph node after intramammary infusion of endotoxin from Escherichia coli. Cows were sampled 0, 2 and 4h after infusion (p.i.). Neutrophils appeared in afferent lymph 2h p.i., and in efferent lymph and milk 4h p.i. The milk contained high concentrations of interleukin-8 (IL-8) at 2

  17. Axillary lymph node dissection in early-stage invasive breast cancer: is it still standard today?

    Microsoft Academic Search

    Bernd Gerber; Kristin Heintze; Johannes Stubert; Max Dieterich; Steffi Hartmann; Angrit Stachs; Toralf Reimer

    2011-01-01

    Evaluation of axillary lymph node status by sentinel lymph node biopsy (SLNB) and complete axillary lymph node dissection\\u000a (ALND) are an inherent part of breast cancer treatment. Increased understanding of tumor biology has changed the prognostic\\u000a and therapeutic impact of lymph node status. Non-invasive imaging techniques like axillary ultrasound, FDG-PET, or MRI revealed\\u000a moderate sensitivity and high specificity in evaluation

  18. Assessment of right ventricular function in pulmonary hypertension.

    PubMed

    Naeije, Robert

    2015-05-01

    Right ventricular function is a major determinant of symptomatology and prognosis in severe pulmonary hypertension. The diagnosis of right heart failure rests on a clinical approach with invasive and noninvasive measurements. Magnetic resonance and echocardiographic imaging of the right ventricle is of prognostic relevance. The gold standard of right ventricular function is the ratio of end-systolic to arterial elastances determined from synchronized volume and pressure measurements. Pressure measurements can be obtained during a right heart catheterization and volume measurements by integration of Doppler pulmonary flow-velocity, magnetic resonance imaging, or, more recently, three-dimensional echocardiography. Imaging also informs about regional function and derived estimates of dyssynchrony and asynchrony. Modern imaging with 3D echocardiography and magnetic resonance aims at improved assessment of regional function and right ventriculo-arterial coupling to assist in the evaluation and prognostication of severe pulmonary hypertension. PMID:25833458

  19. Embolization itself stimulates thrombus propagation in pulmonary embolism.

    PubMed

    Morris, Timothy A; Marsh, James J; Chiles, Peter G; Pedersen, Craig A; Konopka, Ronald G; Gamst, Anthony C; Loza, Oralia

    2004-08-01

    The role of active thrombosis in the pathophysiology of pulmonary embolism is unclear. We tested the hypothesis that venous thrombi significantly increase their thrombotic activity once they embolize into the high-flow circulation of the pulmonary arteries. Thrombotic activity was measured using an immunoassay that measures both fibrinopeptide B (FPB) as well as its most abundant metabolite des-arginine FPB. Thrombi were formed in the femoral veins of adult dogs. In one group, the thrombi were embolized without anticoagulation. In the second group, heparin (300 U/kg bolus, then 90 U x kg(-1) x h(-1) infusion) was administered before embolization to prevent subsequent thrombotic activity. Plasma FPB concentrations were significantly suppressed in the heparinized group relative to the nonheparinized group for 1 h postembolization (P = 0.038). We conclude that pulmonary embolization itself causes preexisting venous thrombi to greatly intensify their thrombotic activity and that embolization-associated thrombus propagation can be prevented by heparin. PMID:15044200

  20. Nitric oxide and pulmonary hypertension

    PubMed Central

    2010-01-01

    Pulmonary hypertension is a serious complication of a number of lung and heart diseases that is characterized by peripheral vascular structural remodeling and loss of vascular tone. Nitric oxide can modulate vascular injury and interrupt elevation of pulmonary vascular resistance selectively; however, it can also produce cytotoxic oxygen radicals and exert cytotoxic and antiplatelet effects. The balance between the protective and adverse effects of nitric oxide is determined by the relative amount of nitric oxide and reactive radicals. Nitric oxide has been shown to be clinically effective in the treatment of congenital heart disease, mitrial valvular disease combined with pulmonary hypertension and in orthotropic cardiac transplantation patients. Additionally, new therapeutic modalities for the treatment of pulmonary hypertension, phosphodiesterase inhibitors, natriuretic peptides and aqueous nitric oxide are also effective for treatment of elevated pulmonary vascular resistance. PMID:20498805

  1. Partial anomalous pulmonary venous return.

    PubMed

    Broy, Charles; Bennett, Steven

    2008-06-01

    Partial anomalous pulmonary venous return (PAPVR) is an uncommon congenital abnormality that occurs in 0.4 to 0.7% of postmortem examinations. Ninety percent of these anomalies are associated with an atrial septal defect. Partial anomalous pulmonary venous return occurs more commonly on the right than the left and is manifested by abnormal return of the pulmonary veins to the central venous circulation. Most patients are asymptomatic, but when symptoms are present they are due to shunting of oxygenated blood to the venous circulation. We submit the case of a recently activated solider who presented with dyspnea on exertion refractory to inhaled corticosteroids and an 8.5-mm solitary pulmonary nodule. Further diagnostic imaging revealed PAPVR. Our case appears to be the first report of a solitary pulmonary nodule as the initial presentation of a right upper lobe PAPVR with return to the superior vena cava in the absence of associated atrial septal defect. PMID:18595412

  2. Diseases of pulmonary surfactant homeostasis.

    PubMed

    Whitsett, Jeffrey A; Wert, Susan E; Weaver, Timothy E

    2015-01-01

    Advances in physiology and biochemistry have provided fundamental insights into the role of pulmonary surfactant in the pathogenesis and treatment of preterm infants with respiratory distress syndrome. Identification of the surfactant proteins, lipid transporters, and transcriptional networks regulating their expression has provided the tools and insights needed to discern the molecular and cellular processes regulating the production and function of pulmonary surfactant prior to and after birth. Mutations in genes regulating surfactant homeostasis have been associated with severe lung disease in neonates and older infants. Biophysical and transgenic mouse models have provided insight into the mechanisms underlying surfactant protein and alveolar homeostasis. These studies have provided the framework for understanding the structure and function of pulmonary surfactant, which has informed understanding of the pathogenesis of diverse pulmonary disorders previously considered idiopathic. This review considers the pulmonary surfactant system and the genetic causes of acute and chronic lung disease caused by disruption of alveolar homeostasis. PMID:25621661

  3. Tattoo Pigment Mimics Positive Sentinel Lymph Node in Melanoma

    Microsoft Academic Search

    M. Moehrle; H. J. Blaheta; P. Ruck

    2001-01-01

    A 42-year-old man with metastasizing melanoma from an unknown primary is presented. Initially a subcutaneous metastasis in the scapular region and a single lung metastasis were resected. Thorough examinations did not show any evidence of a primary tumour. From the site of the metastasis on the right scapular region, lymphoscintigraphy with axillary sentinel lymph node biopsy was performed. One axillary

  4. Neurocristic Hamartoma With Lymph Node Involvement: A Diagnostic Dilemma.

    PubMed

    Goyal, Surbhi; Arora, Vinod K; Gupta, Lipy; Singal, Archana; Kaur, Navneet

    2015-07-01

    Neurocristic hamartoma (NH) is a rare dermal melanocytic lesion that is formed due to the aberrant development of neural crest-derived melanocytes during their course of migration through the dermis at the time of embryogenesis. Here, we describe a case of NH in a 6-year-old boy who clinically presented with diffuse plaque-type blue nevus on his scalp with a contiguous extension into the cervical region and lymph node involvement. A subcutaneous nodule displaying a marked histological heterogeneity with lymph node involvement is a very unusual and diagnostically challenging presentation of NH. The importance of an accurate diagnosis of NH lies in the fact that malignant transformation can rarely occur within these lesions over an unpredictable time course and remain undetected, rendering clinical management difficult. Although our child had a benign course after a follow-up of 5 years despite lymph node involvement, the possible risk of development of malignant melanoma in such a lesion warrants long-term surveillance. This case report highlights the unusual clinical presentation and histopathological features of this rare entity along with a relevant review of the literature. The present case also underscores the concept that sentinel lymph node involvement in certain melanocytic lesions in children must not be mistaken for malignant melanoma. PMID:26091517

  5. Adhesive mechanisms governing interferon- producing cell recruitment into lymph nodes

    Microsoft Academic Search

    Thomas G. Diacovo; Amanda L. Blasius; Tak W. Mak; Marina Cella; Marco Colonna

    Natural interferon-producing cells (IPCs) are found in peripheral lymph nodes (PLNs), where they support NK cell, T cell, and B cell responses to pathogens. However, their route of entry and the adhesive mechanisms used to gain access to PLNs remain poorly defined. We report that IPCs can enter PLNs via a hematogenous route, which involves a multistep adhesive process, and

  6. Staging lymph node metastases from lung cancer in the mediastinum

    PubMed Central

    Terán, Mario D.

    2014-01-01

    Background The presence of tumor metastases in the mediastinum is one of the most important elements in determining the optimal treatment strategy in patients with non-small cell lung cancer. This review is aimed at examining the current strategies for investigating lymph node metastases corresponding to an “N2” classification delineated by The International Staging Committee of the International Association for the Study of Lung Cancer (IASLC). Methods Extensive review of the existing scientific literature related to the investigation of mediastinal lymph node metastases was undertaken in order to summarize and report current best practices. Conclusions N2 disease is very heterogeneous requiring multiple modalities for thorough investigation. New research is now focusing on better identifying, defining, and classifying lymph node metastases in the mediastinum. Molecular staging and sub-classifying mediastinal lymph node metastases are being actively researched in order to provide better prognostic value and to optimize treatment strategies. Non-invasive imaging, such as PET/CT and minimally invasive techniques such as endobronchial and endoscopic ultrasound guided biopsy, are now the lead investigative methods in evaluating the mediastinum for metastatic presence. PMID:24624287

  7. Increased concentrations of lysophosphatidylcholine in cardiac lymph from ischemic zones

    SciTech Connect

    Corr, P.B.; Akita, H.; Creer, M.H.; Yamada, K.A.; Sobel, B.E.

    1986-03-01

    The authors have previously shown that lysophosphatidylcholine (LPC) elicits electrophysiological derangements in normoxic cells exposed to low concentrations of LPC with or without albumin in the extracellular fluid. To determine whether such exposure occurs in vivo, concentrations of phospholipids in cardiac lymph were assessed in 7 dogs subjected to myocardial ischemia. In each animal, a cannula was inserted into the supracardiac lymph vessel identified with Evans Blue dye injected into the left ventricular apex. Less than 4% of /sup 14/C-PC (phosphatidyl choline) or /sup 14/C-LPC incubated in cardiac lymph for 30 min at 4/sup 0/C or 90 min at 37/sup 0/C was catabolized (n = 5). Lymph was collected on ice at 15 min intervals throughout 2 hr of ischemia induced by LAD coronary ligation, extracted in CHCl/sub 3/:CH/sub 3/OH (2:1) and phospholipids separated by HPLC. Prior to ischemia, PC constituted the major phospholipid (79 +/- 2%). Substantial quantities of sphinogomeylin (11 +/- 2%) and LPC (6 +/- 1%) were present. With ischemia, LPC concentration increased 134% from 84 +/- 5 to 197 +/- 34 ..mu..M (n = 7, p < .01) judging from the measured concentration and dilution determined with constant infusion of dye into the LV apex. In contrast, PC concentration and efflux did not change. Thus with ischemia LPC increases in interstitial fluid to levels sufficient to induce electrophysiologic derangements in normoxic cells.

  8. Local lymph node assay — validation, conduct and use in practice

    Microsoft Academic Search

    D. A. Basketter; P. Evans; R. J. Fielder; G. F. Gerberick; R. J. Dearman; I. Kimber

    2002-01-01

    The validation of alternative methods is a relatively new activity in toxicology. The local lymph node assay (LLNA), a novel method for the identification of chemicals that have the potential to cause skin sensitization, was the first test to pass through the formal regulatory validation process established in the USA under the auspices of ICCVAM, the Interagency Coordinating Committee on

  9. Local lymph node assay: Validation assessment for regulatory purposes

    Microsoft Academic Search

    G. Frank Gerberick; Cindy A. Ryan; Ian Kimber; Rebecca J. Dearman; Linda J. Lea; David A. Basketter

    2000-01-01

    For the prediction of skin sensitization potential of substances, the murine local lymph node assay (LLNA) is an alternative to the widely used guinea pig tests. For more than 10 years, this method has undergone extensive development, evaluation, and validation. In this review, the validation status of the LLNA is considered, specifically with regard to its use for regulatory identification

  10. [Lymph node metastasis in superficial squamous carcinoma of the esophagus].

    PubMed

    Takubo, K; Makuuchi, H; Arima, M; Aida, J; Arai, T; Vieth, M

    2013-03-01

    The definition of early carcinoma of the esophagus has changed with time on the basis of new data. As from 2007 an early carcinoma is defined as an intramucosal carcinoma with or without metastasis. In the subclassification based on invasion depth, m1 and m2 squamous cell carcinomas have no metastasis and are considered curable by endoscopic resection alone, whereas less than 10% of m3 carcinomas and some 20% of sm1 squamous cell carcinomas have lymph node metastasis. In this article the relationship between various histopathological findings and the incidence of lymph node metastasis is reviewed. The m3 and sm1 superficial squamous cell carcinomas showing 0-I and 0-III types, large tumors over 50 mm in size or those showing vessel permeation have higher incidences of lymph node metastasis. In the field of gastrointestinal surgical pathology pathologists are now expected to not only diagnose the presence or absence of malignancy but also to investigate in detail many of the histological factors related to the prevalence of lymph node metastasis. PMID:23420516

  11. Prostanoid induces premetastatic niche in regional lymph nodes.

    PubMed

    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

    2014-11-01

    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

  12. Cervical Lymph Node Metastasis Model of Pyriform Sinus Carcinoma

    Microsoft Academic Search

    Na Shen; Haitao Wu; Xiuyin Xu; Jianzhong Wang; Matthew R. Hoffman; Adam L. Rieves; Liang Zhou

    2009-01-01

    Objective: To establish a cervical lymph node metastasis model of pyriform sinus VX2 carcinoma and investigate its metastatic features. Methods: VX2 tumor tissue suspension was transplanted into the pyriform sinus submucosa of 15 rabbits under direct laryngoscopy. Rabbits were randomly placed into 1 of 3 groups, each comprised of 5 rabbits. Health evaluation and histopathological analysis were performed on days

  13. Imaging of the pulmonary hilum: a prospective comparative study in patients with lung cancer

    SciTech Connect

    Glazer, G.M.; Gross, B.H.; Aisen, A.M.; Quint, L.E.; Francis, I.R.; Orringer, M.B.

    1985-08-01

    Using magnetic resonance imaging (MRI), dynamic computed tomography (CT), and 55/sup 0/ posterior oblique tomography, the authors prospectively evaluated the pulmonary hilum in 35 patients with lung cancer; 19 of these patients had surficial excision of ipsilateral hilar lymph nodes and formed the study group. Their results showed no significant differences between the three imaging methods in overall accuracy of hilar for diagnosing hilar metastasis, whereas oblique tomography had fair sensitivity and specificity. The calculated magnetic relaxation times, T1 and T2, were not useful in distinguishing between benign and malignant enlarged hilar nodes. The authors conclude that accurate staging of the pulmonary hilum in patients with lung cancer is not currently possible using MRI, CT, or oblique tomography.

  14. Acute Exercise Activates Pulmonary eNOS and Lowers Pulmonary Pressure in Rats with Pulmonary Arterial Hypertension

    E-print Network

    Zhou, Yaoqi

    Acute Exercise Activates Pulmonary eNOS and Lowers Pulmonary Pressure in Rats with Pulmonary is impaired in pulmonary arterial hypertension (PAH). Exercise may be beneficial in PAH, just and activity. However, exercise-induced cardiac stress in PAH could also promote detrimental RV inflammation

  15. Prevalence and Characterization of Salmonella in Bovine Lymph Nodes Potentially Destined for Use in Ground Beef

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A potential source of pathogenic bacteria in ground beef is the lymphatic system, specifically the lymph nodes. There are several reports of bacteria isolated from the lymph nodes of cattle at slaughter; however, most of the studies have dealt with mesenteric lymph nodes that are not normally incor...

  16. Some Women May Not Need More Extensive Lymph Node Surgery for Breast Cancer

    Cancer.gov

    Results from a randomized clinical trial published February 9, 2011, in the Journal of the American Medical Association demonstrate that axillary lymph node dissection provided no additional survival benefit when compared with sentinel lymph node biopsy in women with small breast tumors and minimal lymph node metastasis who were treated with lumpectomy, whole-breast radiotherapy, and adjuvant systemic therapy.

  17. Omission of Mediastinal Lymph Node Dissection in Lung Cancer: Its Techniques and Diagnostic Procedures

    Microsoft Academic Search

    Hiroaki Nomori; Kazunori Iwatani; Hironori Kobayashi; Atsushi Mori; Shouichi Yoshioka

    To reduce or omit a mediastinal lymph node dissection in the patients with clinical stage I non-small cell lung cancer (NSCLC), several authors examined the prevalence of metastatic sites of lymph nodes. Because lymphatic drainage usually heads for the upper mediastinum in upper lobe cancer and for the lower mediastinum in lower lobe cancer, upper and lower mediastinal lymph node

  18. Head and Neck Lymph Node Region Delineation with 3-D CT Image Registration

    E-print Network

    Shapiro, Linda

    Head and Neck Lymph Node Region Delineation with 3-D CT Image Registration Chia-Chi Teng , Mary M for automatically selecting and adapting standardized regions of tumor spread based on the location of lymph nodes the GTV plus the lymph node regions around it. Microscopic disease cannot currently be im- aged by any

  19. The Role of Interval Nodes in Sentinel Lymph Node Mapping and Dissection for Melanoma Patients

    Microsoft Academic Search

    Maurice Matter; Marie Nicod Lalonde; Mohamed Allaoua; Ariane Boubaker; Danielle Li ´ enard; Oliver Gugerli; Jean-Philippe Cerottini; Hanifa Bouzourene; Angelika Bischof Delaloye; Ferdinand Lejeune

    In sentinel node (SN) biopsy, an interval SN is defined as a lymph node or group of lymph nodes located between the primary melanoma and an anatomically well-defined lymph node group directly draining the skin. As shown in previous reports, these interval SNs seem to be at the same metastatic risk as are SNs in the usual, classic areas. This

  20. Prognostic significance of lymph node ratio in patients with Merkel cell carcinoma.

    PubMed

    Fochtmann, Alexandra; Haymerle, Georg; Kunstfeld, Rainer; Pammer, Johannes; Grasl, Matthaeus Ch; Erovic, Boban M

    2015-07-01

    Merkel cell carcinoma is a rare and aggressive metastasizing tumor of the skin. Lymph node metastasis is a significant clinical prognostic factor for overall and disease-free survival in patients with Merkel cell carcinoma. A retrospective medical chart review of 12 Merkel cell carcinoma patients was performed. All patients received treatment at the Medical University of Vienna and underwent lymph node dissection between 1994 and 2013. The lymph node ratio was determined by dividing the total number of positive lymph nodes by the entire number of dissected lymph nodes. A positive lymph node ratio was defined as a number >0 and the negative lymph node ratio was defined by zero. The median follow-up was 44 months (range 4-92). A positive lymph node ratio (range 1.00-0.04) was found in 7 (58 %) out of 12 patients of whom 5 (71 %) died of disease. A negative lymph node ratio was found in 5 (42 %) out of 12 patients of whom 2 (40 %) patients died of disease. The disease-specific death rate was higher in patients diagnosed with a positive lymph node ratio compared to patients diagnosed with a negative lymph node ratio. Based on these preliminary findings, there might be a prognostic impact of lymph node ratio in patients suffering from Merkel cell carcinoma. PMID:24906842

  1. Rationale for Central and Bilateral Lymph Node Dissection in Sporadic and Hereditary Medullary Thyroid Cancer

    Microsoft Academic Search

    CLAUDIA SCOLLO; ERIC BAUDIN; JEAN-PAUL TRAVAGLI; BERNARD CAILLOU; NICOLAS BELLON; SOPHIE LEBOULLEUX; MARTIN SCHLUMBERGER

    A retrospective study was performed on 101 consecutive med- ullary thyroid cancer (MTC) patients who underwent at In- stitut Gustave-Roussy (IGR) total thyroidectomy with central and bilateral lymph node dissection. At histology, lymph node metastases were found in 55% of patients. In sporadic MTC, lymph node metastases were observed in the central compart- ment in 50% of patients, in the

  2. Elastic scattering spectroscopy for intraoperative determination of sentinel lymph node status in the breast

    E-print Network

    Bigio, Irving J.

    depends on establishing whether or not the cancer has spread to the lymph nodes under the arm incidence of up to 1 in 8 women. The presence or absence of metastatic cancer in the axillary lymph nodesElastic scattering spectroscopy for intraoperative determination of sentinel lymph node status

  3. Three-dimensional quantitative ultrasound to guide pathologists towards metastatic foci in lymph nodes

    E-print Network

    Illinois at Urbana-Champaign, University of

    -excised lymph nodes from cancer patients during lymphadenectomy is critically important for cancer staging-excised lymph nodes from cancer patients undergoing a lymphadenectomy. Our group previously described the basis of our innovative 3D QUS methods to characterize lymph-node tissues from cancer patients [4]. Our methods

  4. Investigating mediastinal lymph node stations segmentation on thoracic CT following experts

    E-print Network

    Paris-Sud XI, Université de

    Introduction Mediastinal and hilar lymph node involvement often occurs in lung cancer. A reference definition of lymph node station anatomy was recently updated by the IASLC Lung Cancer Staging Project cancer on CT images. This atlas has been superseded by the new IASLC lymph node. Lynch et al [9] have

  5. In Vitro Investigation of Lymph Node Metastasis of Colorectal Cancer Using Ultrasonic Spectral Parameters

    Microsoft Academic Search

    Tomoaki Noritomi; Junji Machi; Ernest J Feleppa; Eugene Yanagihara; Kazuo Shirouzu

    1998-01-01

    Lymph node involvement is one of the major factors affecting the prognosis of colorectal cancer. Various imaging methods, including ultrasound and computed tomography, are not sufficiently sensitive or specific for reliably determining lymph node involvement. We investigated the feasibility of using ultrasonic tissue characterization (UTC) based on spectrum analysis of backscattered echo signals for diagnosing lymph node metastasis of colorectal

  6. Salvage Pelvic Lymph Node Dissection after Radical Prostatectomy for Biochemical and Lymph Node Recurrence.

    PubMed

    Peeters, Charlotte; Ponette, Diederik; van Poppel, Hendrik

    2014-09-01

    Prostate cancer is the most common male malignancy. Radiation therapy and radical prostatectomy are the main curative treatment options for organ confined disease. Despite the good long-term oncologic outcomes, roughly 40% of patients undergoing surgery develop biochemical recurrence, manifested as a rising prostate-specific antigen (PSA). Those patients are at higher risk of developing a local or distant recurrence. The diagnosis of a nodal recurrence is challenging. This report is about a 66-year-old male, who had a radical prostatectomy in 2006. Postoperatively, the PSA was never undetectable. Radiotherapy was delivered in 2007, but the PSA rose again. Anti-androgen therapy was started, but he developed painful mastodynia. A ((11)C) choline PET-CT showed an enlarged suspicious lymph node at the left common iliac and a salvage pelvic lymphadenectomy was performed. Postoperatively, the PSA remained undetectable for the last 5 years. The use of lesion - targeted therapy for oligometastatic disease is a new concept in urology, aiming at reducing the tumor burden. Therefore, even though this surgical approach might not be associated with a durable response over time, the tumor load is decreased and further cancer progression might be delayed, allowing to postpone the delivery of hormone therapy. © 2014 S. Karger AG, Basel. PMID:25228162

  7. Cryptococcosis, silicosis, and tuberculous pseudotumor in the same pulmonary lobe*

    PubMed Central

    da Silva, Geruza Alves; Brandão, Daniel Ferracioli; Vianna, Elcio Oliveira; de Sá, João Batista Carlos; Baddini-Martinez, José

    2013-01-01

    Tuberculosis and cryptococcosis are infectious diseases that can result in the formation of single or multiple nodules in immunocompetent patients. Exposure to silica is known to raise the risk of infection with Mycobacterium tuberculosis. We report the case of an elderly man with no history of opportunistic infections and no clinical evidence of immunodeficiency but with a six-month history of dry cough and nocturnal wheezing. A chest X-ray revealed a mass measuring 5.0 × 3.5 cm in the right upper lobe. The diagnostic approach of the mass revealed tuberculosis. The histopathological analysis of the surrounding parenchyma reveled silicosis and cryptococcosis. Cryptococcosis was also found in masses identified in the mediastinal lymph nodes. The surgical approach was indicated because of the degree of pleuropulmonary involvement, the inconclusive results obtained with the invasive and noninvasive methods applied, and the possibility of malignancy. This case illustrates the difficulty inherent to the assessment of infectious or inflammatory pulmonary pseudotumors, the differential diagnosis of which occasionally requires a radical surgical approach. Despite the presence of respiratory symptoms for six months, the first chest X-ray was performed only at the end of that period. We discuss the possible pathogenic mechanisms that might have led to the combination of three types of granulomatous lesions in the same lobe, and we emphasize the need for greater awareness of atypical presentations of pulmonary tuberculosis. PMID:24310636

  8. Pulse propagation in the pulmonary arteries

    NASA Astrophysics Data System (ADS)

    Hill, Nicholas; Vaughan, Gareth; Olufsen, Mette; Johnson, Martin; Sainsbury, Christopher

    2007-11-01

    The model of Olufsen [1,2] has been extended to study pulse propagation in the pulmonary circulation. The pulmonary arteries are treated as a bifurcating tree of compliant and tapering vessels. The model is divided into two coupled parts: the larger and smaller arteries. Blood flow and pressure in the larger arteries are predicted from a nonlinear 1D cross-sectional area-averaged model for a Newtonian fluid in an elastic tube. The initial cardiac output is obtained from magnetic resonance measurements. The smaller blood vessels are modelled as an asymmetric structured tree with specified area and asymmetry ratios between the parent and daughter arteries. Womersley's theory gives the wave equation in the frequency domain for the 1D flow in these smaller vessels, resulting in a linear system. The impedances of the smallest vessels are set to a constant and then back-calculation gives the required outflow boundary condition for the Navier-Stokes equations in the larger vessels. The number of generations of blood vessels, and the compliance of the arterial wall are shown to affect both the systolic and diastolic pressures. [1] Olufsen MS et al. Ann Biomed Eng. 2000;28:1281-99. [2] Olufsen MS. Am J Physiol. 1999;276:H257-68.

  9. GELSOLIN IS DEPLETED IN POST-SHOCK MESENTERIC LYMPH

    PubMed Central

    Jordan, Janeen R.; Moore, Ernest E.; Damle, Sagar S.; Eckels, Phillip; Johnson, Jeffrey L.; Roach, Jonathan P.; Redzic, Jasmina S.; Hansen, Kirk C.; Banerjee, Anirban

    2009-01-01

    Background Gelsolin is a plasma protein that functions to depolymerize actin filaments preventing capillary plug formation following tissue injury. It also functions to mediate the inflammatory response by binding proinflammatory lipids such as lysophosphatidic acid, sphingosine-1-phosphate and phosphoinositides. Clinically, reduced gelsolin concentrations have been associated with increased mortality in critically ill, trauma and burn patients. We have previously shown that following hemorrhagic shock with splanchnic hypoperfusion, mesenteric lymph contains lipid components that cause neutrophil and EC activation and that protein concentrations are severely diluted due to resuscitation. We hypothesized that lipid binding proteins such as gelsolin may be depleted after trauma/hemorrhagic shock leading to increased lipid bioactivity. Methods Shock was induced in SD rats by controlled hemorrhage and the mesenteric duct cannulated for lymph collection. Resuscitation was performed by infusing 2x SB volume in NS over 30min, followed by ½ SB volume over 30min, then 2x SB volume in NS over 60min. Pre and post-shock lymph was loaded at equal protein concentrations on 2D-gels, followed by trypsin digestion and identification with mass spectrometry (MS-MS). Proteomics data was confirmed with Western blotting then quantitated by densitometry. ANOVA was used evaluate statistical data. Results Gelsolin decreased in mesenteric lymph following hemorrhagic shock. Conclusion Gelsolin is found at high levels (comparable to plasma) in mesenteric lymph. Following hemorrhagic shock, gelsolin levels decrease significantly possibly due to consumption by the actin scavenging system. The magnitude of this change in concentration could release lipid bioactivity and predispose the lung and other organs to capillary injury. PMID:17950082

  10. The unusual symmetric reopening effect induced by pulmonary surfactant

    PubMed Central

    Yamaguchi, Eiichiro; Giannetti, Matthew J.; Van Houten, Matthew J.; Forouzan, Omid; Shevkoplyas, Sergey S.

    2014-01-01

    This study investigates the stability of a finger of air as it propagates into a liquid-filled model of a liquid-filled model of a pulmonary bifurcation. We seek to elucidate the stability characteristics of the reopening of daughter airways, an event that may be important to the treatment of acute lung disease. To do so, we investigated the symmetry of reopening under conditions of nearly constant surface tension with 1) purified H2O or 2) an anionic surfactant (sodium dodecyl sulfate). Dynamic surface tension was investigated using pulmonary surfactant (Infasurf) with and without the presence of albumin. Flow visualization was accomplished using a microparticle image velocimetry (?-PIV)/shadowgraph system through which we measured 1) the propagation velocity of the finger of air that reopens each daughter branch, and 2) the instantaneous and averaged velocity field of liquid phase surrounding the tip of the propagating bubble. Only pulmonary surfactant demonstrated the ability of maintaining a nearly symmetric propagation in the daughter channels, which is likely to lead to homogeneous airway reopening. In contrast, when pulmonary surfactant was inactivated by albumin or when the system was held at a nearly constant surface tension, reopening occurred asymmetrically. Our analysis suggests that Infasurf's dynamic surface tension qualities are important to stabilize the removal of liquid obstructions. This demonstrates a new important function of pulmonary surfactant for airway reopening of a multibranched network. PMID:24458752

  11. Pulmonary venous hypertension or pulmonary hypertension due to left heart disease

    Microsoft Academic Search

    Ian Adatia; Tom Kulik; Mary Mullen

    2009-01-01

    Pulmonary venous hypertension may be caused by increased pressure anywhere between the intraparenchymal pulmonary veins and the left ventricle. Pulmonary venous hypertension has different causes in children compared with adults. In adults the most common cause of pulmonary venous hypertension is left ventricular diastolic disease. In children, congenital heart diseases, acquired and congenital cardiomyopathies are the usual causes of pulmonary

  12. Immunoreactivity in pulmonary echinococcosis

    PubMed Central

    Todorov, T.; Rai?ev, I.; Tenev, S.; Kosturkova, M.; Dakov, I.; Dimitrov, A.

    1979-01-01

    The part played by certain factors in determining the antibody response in pulmonary echinococcosis has been studied. Five immunodiagnostic procedures were used—complement fixation, latex agglutination, bentonite flocculation, passive haemagglutination, and intradermal tests—and parasitological and pathological examinations were carried out. The number of hydatid cysts had only a small influence on the qualitative nature of the immune response while the quantitative effect was considerable. The immune response did not vary significantly in relation to the size of hydatid cysts but it was affected by changes within the cysts and the surrounding lung tissue. In patients with cysts full of clear hydatid fluid the proportions with negative results and relatively low antibody titres were highest. In these patients the size of hydatid cyst appeared to be significant—the smaller the size, the lower the antibody level. The immune response is weak or completely absent when the hydatid cyst has a thick fibrous capsule. When suppurative changes are present in the hydatid fluid and/or in the fibrous capsule, and when there is inflammatory involvement of the surrounding lung tissue an easily detectable immune response may be seen at an early stage, sometimes even with a high antibody level, but later it usually decreases and may disappear completely. A hypothesis for the explanation of immunological reactivity in pulmonary hydatid disease is discussed. ImagesFig. 7Fig. 3Fig. 4Fig. 5Fig. 6Fig. 1Fig. 2 PMID:317252

  13. Transcatheter Arterial Embolization With Spherical Embolic Agent for Pulmonary Metastases From Renal Cell Carcinoma

    SciTech Connect

    Seki, Akihiko, E-mail: sekia@igtc.jp; Hori, Shinichi, E-mail: horishin@igtc.jp; Sueyoshi, Satoru, E-mail: sueyoshis@igtc.jp; Hori, Atsushi, E-mail: horiat@igtc.jp; Kono, Michihiko, E-mail: konom@igtc.jp; Murata, Shinichi, E-mail: muratas@igtc.jp; Maeda, Masahiko, E-mail: maedam@igtc.jp [Gate Tower Institute for Image Guided Therapy, Department of Radiology (Japan)] [Gate Tower Institute for Image Guided Therapy, Department of Radiology (Japan)

    2013-12-15

    Purpose: This retrospective study aimed to evaluate the safety and local efficacy of transcatheter arterial embolization (TAE) with superabsorbent polymer microspheres (SAP-MS) in patients with pulmonary metastases from renal cell carcinoma (RCC). Methods: Sixteen patients with unresectable pulmonary metastases from RCC refractory to standard therapy were enrolled to undergo TAE with the purpose of mass reduction and/or palliation. The prepared SAP-MS swell to approximately two times larger than their dry-state size (100-150 {mu}m [n = 14], 50-100 {mu}m [n = 2]). Forty-nine pulmonary nodules (lung n = 22, mediastinal lymph node n = 17, and hilar lymph node n = 10) were selected as target lesions for evaluation. Local tumor response was evaluated 3 months after TAE according to Response Evaluation Criteria in Solid Tumors (RECIST; version 1.1). The relationship between tumor enhancement ratio by CT during selective angiography and local tumor response was evaluated. Results: The number of TAE sessions per patient ranged from 1 to 5 (median 2.9). Embolized arteries at initial TAE were bronchial arteries in 14 patients (87.5 %) and nonbronchial systemic arteries in 11 patients (68.8 %). Nodule-based evaluation showed that 5 (10.2 %) nodules had complete response, 17 (34.7 %) had partial response, 15 (30.6 %) had stable disease, and 12 (24.5 %) had progressive disease. The response rate was significantly greater in 22 lesions that had a high tumor enhancement ratio than in 27 lesions that had a slight or moderate ratio (90.9 vs. 7.4 %, p = 0.01). Severe TAE-related adverse events did not occur. Conclusion: TAE with SAP-MS might be a well-tolerated and locally efficacious palliative option for patients with pulmonary metastases from RCC.

  14. Pulmonary Hypertension in Advanced Heart Failure

    Microsoft Academic Search

    Stefano Ghio

    2005-01-01

    The diagnosis of pulmonary hypertension is easy during routine evaluation of patients with chronic heart failure by means of Doppler echocardiography. However, one must remember that an accurate hemodynamic characterization of the pulmonary circulation requires right heart catheterization to measure pulmonary vascular resistance and, if necessary, to test the reversibility of pulmonary hypertension. In addition, the importance of combining the

  15. Pulmonary fibrosis: pathogenesis, etiology and regulation

    Microsoft Academic Search

    M S Wilson; T A Wynn

    2009-01-01

    Pulmonary fibrosis and architectural remodeling of tissues can severely disrupt lung function, often with fatal consequences. The etiology of pulmonary fibrotic diseases is varied, with an array of triggers including allergens, chemicals, radiation and environmental particles. However, the cause of one of the most common pulmonary fibrotic conditions, idiopathic pulmonary fibrosis (IPF), is still unclear. This review examines common mechanisms

  16. Discordance of Intraoperative Frozen Section Analysis with Definitive Histology of Sentinel Lymph Nodes in Breast Cancer Surgery: Complementary Axillary Lymph Node Dissection is Irrelevant for Subsequent Systemic Therapy

    Microsoft Academic Search

    D. Geertsema; P. D. Gobardhan; E. V. E. Madsen; M. Albregts; J. van Gorp; P. de Hooge; Th. van Dalen

    2010-01-01

    Background  In breast cancer surgery, intraoperative frozen section (FS) analysis of sentinel lymph nodes (SLNs) enables axillary lymph\\u000a node dissection (ALND) during the same operative procedure. In case of discordance between a “negative” FS analysis and definitive\\u000a histology, an ALND as a second operation is advocated since additional lymph node metastases may be present. The clinical\\u000a implications of the subsequent ALND

  17. Touch Imprint Cytology of the Sentinel Lymph Nodes Might Not Be Indicated in Early Breast Cancer Patients with Ultrasonically Uninvolved Axillary Lymph Nodes

    Microsoft Academic Search

    Andraž Perhavec; Nikola Besi?; Marko Ho?evar; Janez Žgajnar

    2008-01-01

    Background  Touch imprint cytology (TIC) is a fast, cheap and specific intraoperative examination of the sentinel lymph nodes (SLNs) in\\u000a early breast cancer patients. The results of TIC in patients with ultrasonically (US) uninvolved axillary lymph nodes are\\u000a not known. The objective of our study was to compare the results of TIC in the patients with US uninvolved axillary lymph\\u000a nodes

  18. Combination of Ex Vivo Sentinel Lymph Node Mapping and Methylene Blue-Assisted Lymph Node Dissection in Gastric Cancer: A Prospective and Randomized Study

    Microsoft Academic Search

    Bruno Märkl; Alexandra I. Moldovan; Hendrik Jähnig; Claudio Cacchi; Hanno Spatz; Matthias Anthuber; Daniel V. Oruzio; Hallie Kretsinger; Hans M. Arnholdt

    2011-01-01

    Background  Exact lymph node (LN) staging is crucial for prognosis estimation and treatment stratification in gastric cancer. Recently,\\u000a a new concept for improving LN harvest and the accuracy of LN staging was introduced. It combines methylene blue-assisted\\u000a lymph node dissection (MBLND) with a new ex vivo sentinel lymph node (evSLN) mapping technique. The purpose of this study\\u000a was to investigate these

  19. Immunomorphologic study of regional lymph nodes in cancer: Response of regional lymph node cells from gastric and colorectal cancer to PHA stimulation

    Microsoft Academic Search

    Osamu Kojima; Yoshihiro Fujita; Akimune Oh; Masakazu Sakita; Bunzo Nishioka; Susumu Majima

    1980-01-01

    To obtain information regarding the immunologic capacity of uninvolved regional lymph nodes (RLNs) draining tumor, the in\\u000a vitro response of regional lymph node cells (RLNCs) to PHA was investigated in lymph nodes from 55 patients with gastric or\\u000a colorectal cancer, and gastric ulcer. Evaluation of data relative to cancer progress demonstrated that, in gastric cancer\\u000a patients, the response of stimulated

  20. Dyspnea due to pulmonary vessel arteritis

    PubMed Central

    Gilmour, Suzana M; Dominelli, Giulio S; Leipsic, Jonathon A; Levy, Robert D

    2014-01-01

    Pulmonary arteritis is a rare cause of pulmonary hypertension. Causes of pulmonary arteritis can be divided into primary and secondary, as well as classified according to vessel size. Only large vessel vasculitis is associated with pulmonary hypertension; primary forms include Takayasu arteritis and giant cell arteritis. The diagnosis of pulmonary arteritis can be challenging and the associated morbidity is serious without prompt, directed treatment. The authors present a case involving a 48-year-old First Nations man presenting with a six-month history of exertional dyspnea and severe stenosis of the left pulmonary artery, who was ultimately diagnosed with pulmonary arteritis related to large vessel vasculitis. PMID:24524110

  1. Lymph node staging of oral and maxillofacial neoplasms in 31 dogs and cats.

    PubMed

    Herring, Erin S; Smith, Mark M; Robertson, John L

    2002-09-01

    A retrospective study was performed to report the histologic examination results of regional lymph nodes of dogs and cats with oral or maxillofacial neoplasms. Twenty-eight dogs and 3 cats were evaluated. Histologic examination results of standard and serial tissue sectioning of regional lymph nodes were recorded. When available, other clinical parameters including mandibular lymph node palpation, thoracic radiographs, and pre- and postoperative fine needle aspiration of lymph nodes were compared with the histologic results. Squamous cell carcinoma, fibrosarcoma, and melanoma were the most common neoplasms diagnosed in dogs. Squamous cell carcinoma and fibrosarcoma were diagnosed in cats. Of the palpably enlarged mandibular lymph nodes, 17.0% had metastatic disease histologically. Radiographically evident thoracic metastatic disease was present in 7.4% of cases. Preoperative cytologic evaluation of the mandibular lymph node based on fine needle aspiration concurred with the histologic results in 90.5% of lymph nodes examined. Postoperative cytologic evaluation of fine needle aspirates of regional lymph nodes concurred with the histologic results in 80.6% of lymph nodes examined. Only 54.5% of cases with metastatic disease to regional lymph nodes had metastasis that included the mandibular lymph node. Serial lymph node sectioning provided additional information or metastasis detection. Cytologic evaluation of the mandibular lymph node correlates positively with histology, however results may fail to indicate the presence of regional metastasis. Assessment of all regional lymph nodes in dogs and cats with oral or maxillofacial neoplasms will detect more metastatic disease than assessing the mandibular lymph node only. PMID:12382529

  2. Extended lymph node dissection in robot-assisted radical prostatectomy: lymph node yield and distribution of metastases

    PubMed Central

    Kim, Kwang Hyun; Lim, Sey Kiat; Koo, Kyo Chul; Han, Woong Kyu; Hong, Sung Joon; Rha, Koon Ho

    2014-01-01

    In this study, we reported our experience performing robotic extended lymph node dissection (eLND) in patients with prostate cancer. A total of 147 patients with intermediate and high-risk prostate cancer who underwent robotic eLND from May 2008 to December 2011 were included in this analysis. The dissection template extended to the ureter crossing the iliac vessels. We assessed lymph node yield, lymph node positivity, and perioperative outcomes. Lymph node positivity was also evaluated according to the number of lymph nodes (LNs) removed (<22 vs ?22). The median number of LNs removed was 22 (11–51), and 97 positive LNs were found in 24 patients (16.3%). While the obturator fossa was the most common site for LN metastases (42.3%, 41/97), the internal iliac area was the most common area for a single positive LN packet (20.8%, 5/24). Eight patients (33.3%, 8/24) had positive LNs at the common iliac area. The incidence of positive LNs did not differ according to the number of LNs removed. Complications associated with eLND occurred in 21 patients (14.3%) and symptomatic lymphocele was found in five patients (3.4%). In conclusion, robotic eLND can be performed with minimal morbidity. Furthermore, LN yield and the node positive rate achieved using this robotic technique are comparable to those of open series. In addition, the extent of dissection is more important than the absolute number of LNs removed in eLND, and the robotic technique is not a prohibitive factor for performing eLND. PMID:25038184

  3. Primary Pulmonary NUT Midline Carcinoma: Clinical, Radiographic, and Pathologic Characterizations.

    PubMed

    Sholl, Lynette M; Nishino, Mizuki; Pokharel, Saraswati; Mino-Kenudson, Mari; French, Christopher A; Janne, Pasi A; Lathan, Christopher

    2015-06-01

    NUT midline carcinoma (NMC) is a poorly differentiated tumor typically driven by a t(15;19) rearrangement leading to a NUT fusion event. This rare and uniformly fatal tumor arises in multiple organ sites; however the clinical, radiographic, and pathologic characteristics of primary pulmonary NMC are poorly defined. We identified eight cases of primary pulmonary NMC in our consult practice over 4 years and, using a NUT immunohistochemistry screen, retrospectively identified one additional case from 166 (0.6%) consecutive in-house biopsies of lung carcinomas lacking glandular differentiation. Eight cases had available clinical and radiographic data and shared a remarkable degree of similarity. The median age at presentation was 30 (range 21-68). Six patients had little or no smoking history. All complained of 1 to 3 months of cough at presentation. Computed tomography scans showed a large, centrally located primary mass with confluent involvement of mediastinal lymph nodes, pleural disease, and sparing of the contralateral lung. Lytic bone metastases were common but brain metastases were absent in all cases. Pathologically, all cases showed primitive-appearing round to epitheloid cells growing in nests and sheets. All tumors expressed keratin, p63 or p40, and NUT protein. Eight cases had a fluorescence in situ hybridization-proven BRD4-NUT or BRD3-NUT rearrangement; one case was presumed to have a NUT-variant fusion event. Median overall survival was 2.2 months. Despite the rarity of primary pulmonary NMC, it is important to recognize this entity to counsel patients regarding outcome and to identify candidates for targeted BRD inhibitors currently in clinical trials. PMID:26001144

  4. Current Status and Scope of Lymph Node Micrometastasis in Gastric Cancer

    PubMed Central

    Lee, Chang Min; Park, Sung-Soo

    2015-01-01

    Recently, lymph node micrometastasis has been evaluated for its prognostic value in gastric cancer. Lymph node micrometastasis cannot be detected via a usual pathologic examination, but it can be detected by using some other techniques including immunohistochemistry and reverse transcription-polymerase chain reaction assay. With the development of such diagnostic techniques, the detection rate of lymph node micrometastasis is constantly increasing. Although the prognostic value of lymph node micrometastasis remains debatable, its clinical impact is apparently remarkable in both early and advanced gastric cancer. At present, studies on the prognostic value of lymph node micrometastasis are evolving to overcome its current limitations and extend the scope of its application. PMID:25861517

  5. Intradermal administration of fluorescent contrast agents for delivery to axillary lymph nodes

    NASA Astrophysics Data System (ADS)

    Rasmussen, John C.; Meric-Berstam, Funda; Krishnamurthy, Savitri; Tan, I.-Chih; Zhu, Banghe; Wagner, Jamie L.; Babiera, Gildy V.; Mittendorf, Elizabeth A.; Sevick-Muraca, Eva M.

    2014-05-01

    In this proof-of-concept study we seek to demonstrate the delivery of fluorescent contrast agent to the tumor-draining lymph node basin following intraparenchymal breast injections and intradermal arm injection of micrograms of indocyanine green in 20 breast cancer patients undergoing complete axillary lymph node dissection. Individual lymph nodes were assessed ex vivo for presence of fluorescent signal. In all, 88% of tumor-negative lymph nodes and 81% of tumor-positive lymph nodes were fluorescent. These results indicate that future studies utilizing targeted fluorescent contrast agents may demonstrate improved surgical and therapeutic intervention.

  6. A dual beam study with isotopic X- and gamma-rays for in vivo lymph pool assay

    NASA Astrophysics Data System (ADS)

    Bolin, F. P.; Preuss, L. E.; Jedlenski, D. E.; Beninson, J.

    1986-01-01

    Dual beam absorptiometry utilizes differential absorption of X- and gamma rays of differing energy to determine an absorber's component ratio. This principle has been applied to diverse physical and biological problems. Our method, using the 22 and 88 keV emissions from 109Cd, resolves the lean and non-lean mammalian tissue fractions. Accuracy of 1%, and reproducibility of 1-2% is attainable in in vitro measurements. Techniques have been developed to apply this system to the more complicated applications involved in human studies. A scanning device capable of measuring limbs has been developed. Mathematical treatment provides an integrated value of lean fraction over the scanned area. Lymphedema is a painful malady in which blockage of lymph flow causes swelling and distension of the extremities. Compressive therapy is the preferred medical treatment. There has been no accurate quantitative index of the efficacy of this therapy. Our research program uses dual beam analysis as a unique quantitative measure of the lymph transport. Lymph pool change is equated to change in the lean. Five measurements are made on subjects undergoing a two week regimen of compressive therapy. These absorptiometric results are analyzed for correlation to other indices of treatment effect. Data shows a progressive decrease in the lean tissue component over the treatment period. Changes seen vary with the individual and the severity of involvement. This study showed that the largest transport rate occurs in the first treatment days. Absorptiometry accurately monitors total adipose mass, total non-adipose mass, extremely cross section, and change in lymph pooling.

  7. Tuberous sclerosis with pulmonary involvement.

    PubMed Central

    Liberman, B. A.; Chamberlain, D. W.; Goldstein, R. S.

    1984-01-01

    Pulmonary tuberous sclerosis produced interstitial disease in a woman with normal-sized lungs; numerous hemosiderin-laden macrophages were found in the fluid obtained through bronchoalveolar lavage. The pathological changes seen in the lungs were identical to those of pulmonary lymphangiomyomatosis, in which the constellation of clinical signs usually found in tuberous sclerosis is absent. The two conditions are sufficiently similar in clinical presentation, pathological changes and prognosis to be considered variants of the same disease. The recent findings of progestin receptors in lung tissue from patients with pulmonary lymphangiomyomatosis will likely direct future management towards hormonal manipulation. Images FIG. 1 FIG. 2 FIG. 3 PMID:6692213

  8. Interstitial fluid pressure and associated lymph node metastasis revealed in tumors by dynamic contrast-enhanced MRI.

    PubMed

    Hompland, Tord; Ellingsen, Christine; Øvrebø, Kirsti Marie; Rofstad, Einar K

    2012-10-01

    Elevated interstitial fluid pressure (IFP) in tumors can cause metastatic dissemination and treatment resistance, but its study poses a challenge because of a paucity of noninvasive imaging strategies. In this study, we address this issue by reporting the development of a noninvasive tool to assess tumor IFP and interstitial hypertension-induced lymph node metastasis. Using mouse xenograft models of several types of human cancer, we used gadolinium diethylene-triamine penta-acetic acid (Gd-DTPA) as a contrast agent for dynamic contrast-enhanced MRI (DCE-MRI). Immediately after Gd-DTPA administration, a high-signal-intensity rim was observed in the tumor periphery, which moved outward with time. Assuming the velocity of Gd-DTPA to be equal to the fluid flow velocity, we used a simple model of peritumoral interstitial fluid flow to calculate the fluid flow velocity at the tumor surface (v(0)) based on the rim movement. Significant positive correlations were found between v(0) and IFP in all tumor xenografts. Moreover, the primary tumors of metastasis-positive mice displayed higher IFP and v(0) than the primary tumors of metastasis-negative mice. Findings were confirmed in cervical cancer patients with pelvic lymph node metastases, where we found v(0) to be higher compared with patients without lymph node involvement (P < 0.00001). Together, these findings establish that Gd-DTPA-based DCE-MRI can noninvasively visualize tumor IFP, and they reveal the potential for v(0) determined by this method to serve as a novel general biomarker of tumor aggressiveness. PMID:23027087

  9. Chronic obstructive pulmonary disease in blacks and whites: pulmonary function norms and risk factors.

    PubMed Central

    Gillum, R. F.

    1991-01-01

    Chronic obstructive pulmonary disease (COPD) and asthma are significant causes of illness and death in blacks. Racial differences in normal values of pulmonary function tests must be considered in both patient care and research. Assessment of risk factors is an important part of COPD management and prevention. An extensive review of data from the National Center for Health Statistics and from other population-based studies confirmed lower lung volumes in blacks compared to whites. However, the ratio of forced expiratory volume in 1 second to forced vital capacity was not lower in blacks; racial differences in flow rates were inconsistently reported. Thoracic dimensions were smaller in blacks than in whites in healthy populations. The cause and the physiologic and pathophysiologic significance of these racial differences are unknown. Population-based studies in blacks have firmly established only age and cigarette smoking as risk factors for COPD other than asthma. In 1987, 43% of black men aged 45 and older smoked cigarettes compared to only 30% of white men. Further research is needed on racial differences in pulmonary function and the effects of multiple risk factors to enhance understanding of COPD etiology and prevention. More vigorous smoking prevention and cessation efforts should be targeted for blacks by physicians and public health organizations. PMID:1875419

  10. Technical advances of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension

    Microsoft Academic Search

    Christian Hagl; Nawid Khaladj; Tina Peters; Marius M. Hoeper; Frank Logemann; Axel Haverich; Paolo Macchiarini

    2003-01-01

    Objective: To minimize the side-effects of circulatory arrest times and profound hypothermia in patients undergoing pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Between March 2000 and June 2002, 30 patients (in New York Heart Association (NYHA) class III or IV) were operated for CTEPH using our modified technique. It includes moderate hypothermic (28–32°C), total cardiopulmonary bypass (CPB)

  11. Molecular and Functional Imaging for Detection of Lymph Node Metastases in Prostate Cancer

    PubMed Central

    Fortuin, Ansje; de Rooij, Maarten; Zamecnik, Patrik; Haberkorn, Uwe; Barentsz, Jelle

    2013-01-01

    Knowledge on lymph node metastases is crucial for the prognosis and treatment of prostate cancer patients. Conventional anatomic imaging often fails to differentiate benign from metastatic lymph nodes. Pelvic lymph node dissection is an invasive technique and underestimates the extent of lymph node metastases. Therefore, there is a need for more accurate non-invasive diagnostic techniques. Molecular and functional imaging has been subject of research for the last decades, in this respect. Therefore, in this article the value of imaging techniques to detect lymph node metastases is reviewed. These techniques include scintigraphy, sentinel node imaging, positron emission tomography/computed tomography (PET/CT), diffusion weighted magnetic resonance imaging (DWI MRI) and magnetic resonance lymphography (MRL). Knowledge on pathway and size of lymph node metastases has increased with molecular and functional imaging. Furthermore, improved detection and localization of lymph node metastases will enable (focal) treatment of the positive nodes only. PMID:23823804

  12. [Idiopathic pulmonary fibrosis].

    PubMed

    Cottin, Vincent

    2014-09-01

    Idiopathic pulmonary fibrosis is a chronic disease, which affects more frequently subjects older than 60 years, males, and smokers or ex-smokers. The diagnosis is based on a pattern of usual interstitial pneumonia at high resolution computed tomography of the chest and/or at the video- assisted thoracic surgical lung biopsy, and by multidisciplinary discussion in a specialized center, after ruling out possible causes and specific contexts (as connective tissue disease). The disease progresses inexorably to chronic respiratory insufficiency, occasionally with episodes of acute exacerbation, and death after a median of 3 years. Treatment with pirfenidone in patients with mild to moderate disease slows the progression of disease, and reduces the risk of death at one year, with skin and gastro-intestinal adverse events. Drug therapy should be part of a global care management. Several approaches are considered for an earlier diagnosis and treatment. PMID:25362769

  13. Postoperative pulmonary complications updating.

    PubMed

    Langeron, O; Carreira, S; le Saché, F; Raux, M

    2014-01-01

    Postoperative pulmonary complications (PPCs) are a major contributor to the overall risk of surgery. PPCs affect the length of hospital stay and are associated with a higher in-hospital mortality. PPCs are even the leading cause of death either in cardiothoracic surgery but also in non-cardiothoracic surgery. Thus, reliable PPCs risk stratification tools are the key issue of clinical decision making in the perioperative period. When the risk is clearly identified related to the patient according the ARISCAT score and/or the type of surgery (mainly thoracic and abdominal), low-cost preemptive interventions improve outcomes and new strategies can be developed to prevent this risk. The EuSOS, PERISCOPE and IMPROVE studies demonstrated this care optimization by risk identification first, then risk stratification and new care (multifaceted) strategies implementation allowing a decrease in PPCs mortality by optimizing the clinical path of the patient and the care resources. PMID:25168300

  14. Effects of pulmonary blood volume on vascular reactivity in the lung

    Microsoft Academic Search

    Z. P. Ding; T. W. L. Scheeren; J. O. Arndt

    1999-01-01

    Objective: Pulmonary flow resistance is mainly determined by vessel calibres, resulting from the interaction of volume-passive distension\\u000a and active vasomotion. However, quantitative information on the interplay between these counteracting forces in the lung is\\u000a lacking. Therefore, we aimed at quantifying (1) the effects of vasomotor tone on pulmonary blood volume (Qp) and (2) the influence\\u000a of Qp on vascular reactivity.

  15. Effect of Heimlich valve and underwater seal on lung expansion after pulmonary resection

    Microsoft Academic Search

    Ilan Bar; Michael Papiashvilli; Boris Kurtzer; Murat Bahar

    2009-01-01

    Background  A study was undertaken to compare the physiologic and clinical effects of Under Water Seal (UWS) versus Heimlich Valve (HV)\\u000a pleural drainage systems in the treatment of patients following pulmonary resection.\\u000a \\u000a \\u000a \\u000a Methods  Twenty patients post pulmonary resection (lobectomy - 13, wedge resections - 6, bullectomy - 1) were studied. The relative\\u000a intrapleural pressures were measured by a flow meter that was

  16. Nurse-led preoperative screening and targeted optimization of pulmonary dysfunction in patients undergoing cardiac surgery.

    PubMed

    Sivalingam, Sivakumar; Rathinam, Sridhar; Ajis, Adam; Satur, Christopher M R

    2007-08-01

    Postoperative pulmonary dysfunction prolonging intensive care treatment after cardiac surgery most commonly occurs in patients with a background of pre-existing pulmonary dysfunction. However, many patients have occult dysfunction and present primarily after surgery. We describe and discuss the results of a respiratory optimization program utilizing a peak expiratory flow rate below 400 L/min as a screening test to identify patients in a nurse-directed preoperative clinic. PMID:17643671

  17. Bosentan in pulmonary arterial hypertension: a comparison between congenital heart disease and chronic pulmonary embolism

    Microsoft Academic Search

    M. G. J. Duffels; M. N. van der Plas; S. Surie; M. M. Winter; B. J. Bouma; M. Groenink; A. P. J. van Dijk; E. S. Hoendermis; R. M. F. Berger; P. Bresser; B. J. M. Mulder

    2009-01-01

    Background. In patients with pulmonary hypertension, it is unknown whether the treatment effect of bosentan is dependent on the duration\\u000a of pulmonary vessel changes. Therefore, we studied the response to bosentan in patients with life-long pulmonary vessel changes\\u000a (pulmonary arterial hypertension (PAH) due to congenital heart disease (CHD)) and in patients with subacutely induced pulmonary\\u000a vessel changes (chronic thromboembolic pulmonary

  18. Pulmonary segmentectomy: results and complications

    Microsoft Academic Search

    David R Jones; Brendon M Stiles; Chadrick E Denlinger; Philip Antippa; Thomas M Daniel

    2003-01-01

    BackgroundSegmentectomy is an anatomic pulmonary parenchymal-sparing resection performed for certain benign lesions and on selected patients with lung cancer. We reviewed our experience with segmentectomy in this highly select group of patients.

  19. Schistosomiasis-associated pulmonary hypertension

    PubMed Central

    Mocumbi, Ana Olga H.; Kim, Nick H.; Mandel, Jess

    2014-01-01

    Abstract Schistosomiasis, a parasite-borne disease, is highly prevalent in Africa and Asia; it is estimated that close to 20 million people worldwide have a severe form of the disease. The chronic form can affect the gastrointestinal system and lead to hepatosplenic disease, and it may cause cardiopulmonary complications, including pulmonary hypertension. The exact pathogenesis of schistosomiasis-associated pulmonary hypertension (Sch-PH) remains unclear, although several mechanisms, including parasitic arterial embolization, pulmonary arteriopathy, and portopulmonary hypertension–like pathophysiology, have been suggested. The immunopathology of the disease is also unclear, although there are similarities with the immunology of idiopathic pulmonary arterial hypertension (PAH). Finally, the treatment of Sch-PH has not been well studied. There is some evidence on treating the underlying infection, with unclear effect on Sch-PH, and advanced PAH therapies are now being suggested, but more studies are needed to confirm their efficacy. PMID:25610596

  20. Peritoneal malignant mesothelioma metastatic to supraclavicular lymph nodes.

    PubMed

    Zannella, Stefano; Testi, Maria Adele; Cattoretti, Giorgio; Pelosi, Giuseppe; Zucchini, Nicola

    2014-09-01

    Distinguishing between malignant mesothelioma and reactive mesothelial hyperplasia is often inestimable, but may be a challenging gauntlet for pathologists. A 62-year-old man underwent appendectomy after the identification of a peritoneal mass and the histological examination showed mesothelial proliferation along the appendix surface with no clear images of infiltration. After a few months the patient developed mediastinal and supraclavicular lymphadenopathies, and a nodal biopsy showed mesothelial cell proliferation invading lymphatic sinuses, consistent with the cells seen in the abdominal cavity. Since overt morphologic criteria for malignancy were lacking and reactive mesothelial cell deposits have been documented in lymph nodes, a molecular investigation of the CDKN2A (henceforth simply p16) gene status via fluorescence in situ hybridization was performed, which showed homozygous deletion in 100% tumor cells. These data ruled out the hypothesis of reactive mesothelial cells inclusion in lymph nodes, thus confirming the diagnosis of epithelioid malignant mesothelioma. PMID:24474244

  1. The local lymph node assay and skin sensitization testing.

    PubMed

    Kimber, Ian; Dearman, Rebecca J

    2010-01-01

    The mouse local lymph node assay (LLNA) is a method for the identification and characterization of skin sensitization hazards. In this context the method can be used both to identify contact allergens, and also determine the relative skin sensitizing potency as a basis for derivation of effective risk assessments.The assay is based on measurement of proliferative responses by draining lymph node cells induced following topical exposure of mice to test chemicals. Such responses are known to be causally and quantitatively associated with the acquisition of skin sensitization and therefore provide a relevant marker for characterization of contact allergic potential.The LLNA has been the subject of exhaustive evaluation and validation exercises and has been assigned Organization for Economic Cooperation and Development (OECD) test guideline 429. Herein we describe the conduct and interpretation of the LLNA. PMID:19967517

  2. Photoacoustic image-guided needle biopsy of sentinel lymph nodes

    NASA Astrophysics Data System (ADS)

    Kim, Chulhong; Erpelding, Todd N.; Akers, Walter J.; Maslov, Konstantin; Song, Liang; Jankovic, Ladislav; Margenthaler, Julie A.; Achilefu, Samuel; Wang, Lihong V.

    2011-03-01

    We have implemented a hand-held photoacoustic and ultrasound probe for image-guided needle biopsy using a modified clinical ultrasound array system. Pulsed laser light was delivered via bifurcated optical fiber bundles integrated with the hand-held ultrasound probe. We photoacoustically guided needle insertion into rat sentinel lymph nodes (SLNs) following accumulation of indocyanine green (ICG). Strong photoacoustic image contrast of the needle was achieved. After intradermal injection of ICG in the left forepaw, deeply positioned SLNs (beneath 2-cm thick chicken breast) were easily indentified in vivo and in real time. Further, we confirmed ICG uptake in axillary lymph nodes with in vivo and ex vivo fluorescence imaging. These results demonstrate the clinical potential of this hand-held photoacoustic system for facile identification and needle biopsy of SLNs for cancer staging and metastasis detection in humans.

  3. What next? Managing lymph nodes in men with penile cancer

    PubMed Central

    Leveridge, Michael; Siemens, D. Robert; Morash, Christopher

    2008-01-01

    The management of patients with squamous cell carcinoma of the penis is often daunting given its rarity and subsequent lack of high-level evidence to support our decision-making. This culminates in the complex surgical issues involving the management of the regional lymph nodes, which is of critical importance to both quantity and quality of life for these patients. This review aims to highlight the decisive issues surrounding the management of the pelvic and inguinal lymph nodes in the setting of squamous cell carcinoma of the penis, and to spotlight recently published information that adds credence to accepted management strategies of both the clinically positive and negative groin after successful management of the primary lesion. PMID:18953451

  4. Sudden Death from Pulmonary Causes

    Microsoft Academic Search

    Kris S. Cunningham; Michael S. Pollanen

    \\u000a This chapter seeks to survey many of the common pathological entities identified in the lungs at autopsy and the potential\\u000a role of pulmonary disease in formulating an opinion regarding the cause of death. Appreciation of pulmonary pathology in the\\u000a medicolegal context is important as it frequently contributes to the immediate or underlying mechanisms of death. The primacy\\u000a of the lungs

  5. Liposomes for Pulmonary Drug Delivery

    Microsoft Academic Search

    Janani Swaminathan; Carsten Ehrhardt

    \\u000a Liposomes have been widely used in pulmonary drug delivery for ­multiple applications including solubilization, sustained\\u000a release, cellular and intracellular ­targeting, minimization of toxicity, and facilitation of absorption. In this chapter,\\u000a formulation aspects, aerosolization, and an extensive overview of the use of pulmonary drug delivery of liposomes for disease\\u000a and drug classes are provided. Specifically, this chapter examines liposomes from in

  6. Total anomalous pulmonary venous connection

    Microsoft Academic Search

    Roger W. Byard; John D. Gilbert

    2005-01-01

    Total anomalous pulmonary venous connection (TAPVC), where the pulmonary venous circulation drains into the systemic venous\\u000a circulation rather than into the left atrium, may present a number of problems at autopsy. A 5-week-old infant is reported\\u000a who died suddenly and unexpectedly who was found at autopsy to have infradiaphragmatic TAPVC into the portal vein. The only\\u000a associated anomalies were a

  7. Animal model of para-aortic lymph node metastasis

    Microsoft Academic Search

    Souichi Tsutsumi; Hiroyuki Kuwano; Nobuhiro Morinaga; Tatsuo Shimura; Takayuki Asao

    2001-01-01

    The purpose of this study was to establish a model of experimental lymph node metastasis by intra-rectal implantation of human cancer cells in nude mice. Four types of human cancer cell lines (TE-1, MKN-45, HT-29, and MIAPaca-2) were investigated. Tumor cells suspended in MatrigelTM were injected into the submucosal layer of the rectum. All cancer cell lines produced locally aggressive

  8. Factors influencing lymph node harvest in colorectal surgery

    Microsoft Academic Search

    M. Gelos; J. Gelhaus; P. Mehnert; G. Bonhag; M. Sand; S. Philippou; B. Mann

    2008-01-01

    Background and aims  Lymphadenectomy in colorectal cancer is a critical component concerning prognosis and survival of patients. Several variables\\u000a influence the number of harvested lymph nodes (LN). However, results of studies are contradictory, and influencing factors\\u000a remain to be identified. The aim of the present study was to identify factors that have a significant influence on the number\\u000a of assessed LN

  9. Epitrochlear lymph nodes as a site of melanoma metastasis

    Microsoft Academic Search

    Jeremy A. Hunt; John F. Thompson; Roger F. Uren; Robert Howman-Giles; C. Richard Harman

    1998-01-01

    Background: The incidence of epitrochlear lymph node metastasis for patients with melanomas on the hand or forearm is disputed, and management guidelines for these nodes are unclear.\\u000aMethods: The records of 13,139 consecutive melanoma patients were reviewed to document the incidence of metastatic disease in epitrochlear nodes. The frequency of direct lymphatic drainage to epitrochlear nodes was determined for 109

  10. Lymph Node Metastasis In Small Peripheral Adenocarcinoma Of The Lung

    Microsoft Academic Search

    Tsuneyo Takizawa; Masanori Terashima; Teruaki Koike; Takehiro Watanabe; Yuzo Kurita; Akira Yokoyama; Keiichi Honma

    1998-01-01

    Objective: Our aim in this study is to clarify the clinical and pathologic features of small peripheral adenocarcinoma of the lung with special emphasis on intraoperative identification of lymph node metastasis. Patients and methods: Between 1980 and 1996, 157 patients underwent lobectomy and complete hilar\\/mediastinal lymphadenectomy for small (1.1 to 2.0 cm in diameter) peripheral adenocarcinoma of the lung. The

  11. High definition infrared spectroscopic imaging for lymph node histopathology.

    PubMed

    Leslie, L Suzanne; Wrobel, Tomasz P; Mayerich, David; Bindra, Snehal; Emmadi, Rajyasree; Bhargava, Rohit

    2015-01-01

    Chemical imaging is a rapidly emerging field in which molecular information within samples can be used to predict biological function and recognize disease without the use of stains or manual identification. In Fourier transform infrared (FT-IR) spectroscopic imaging, molecular absorption contrast provides a large signal relative to noise. Due to the long mid-IR wavelengths and sub-optimal instrument design, however, pixel sizes have historically been much larger than cells. This limits both the accuracy of the technique in identifying small regions, as well as the ability to visualize single cells. Here we obtain data with micron-sized sampling using a tabletop FT-IR instrument, and demonstrate that the high-definition (HD) data lead to accurate identification of multiple cells in lymph nodes that was not previously possible. Highly accurate recognition of eight distinct classes - naïve and memory B cells, T cells, erythrocytes, connective tissue, fibrovascular network, smooth muscle, and light and dark zone activated B cells was achieved in healthy, reactive, and malignant lymph node biopsies using a random forest classifier. The results demonstrate that cells currently identifiable only through immunohistochemical stains and cumbersome manual recognition of optical microscopy images can now be distinguished to a similar level through a single IR spectroscopic image from a lymph node biopsy. PMID:26039216

  12. Epitrochlear sentinel lymph nodes in melanoma: interval or independent?

    PubMed

    Kidner, Travis B; Yoon, Jeong L; Faries, Mark B; Morton, Donald L

    2012-06-01

    Most primary melanomas on the distal upper extremity metastasize to a sentinel lymph node (SLN) in the axillary basin, but occasionally a primary melanoma will drain to the epitrochlear basin. The relationship between tumor-draining axillary and epitrochlear SLNs is unclear. We hypothesize that the epitrochlear SLN functions in an interval manner with the axillary lymph node basin. We queried our melanoma database to identify patients who underwent SLN biopsy for a distal upper-extremity melanoma. Patient demographics, tumor characteristics, patterns of nodal drainage, and incidence of SLN metastasis were analyzed. Of 255 patients identified, 38 (14.9%) had an epitrochlear SLN. Mean Breslow thickness was 2.26 mm. All patients with epitrochlear drainage had concurrent axillary drainage and underwent axillary and epitrochlear SLN biopsies. Of these 38 patients, two (5.2%) had epitrochlear and axillary SLN metastasis, four (10.5%) had epitrochlear metastasis only, four (10.5%) had axillary metastasis only, and the remaining 28 (73.7%) had tumor-free SLNs. The invariable association of epitrochlear and axillary drainage in this study suggests that epitrochlear nodes function in an interval role with the axillary lymph node basin. Therefore we recommend that all patients with a positive epitrochlear SLN undergo completion axillary dissection. PMID:22643268

  13. High Definition Infrared Spectroscopic Imaging for Lymph Node Histopathology

    PubMed Central

    Leslie, L. Suzanne; Wrobel, Tomasz P.; Mayerich, David; Bindra, Snehal; Emmadi, Rajyasree; Bhargava, Rohit

    2015-01-01

    Chemical imaging is a rapidly emerging field in which molecular information within samples can be used to predict biological function and recognize disease without the use of stains or manual identification. In Fourier transform infrared (FT-IR) spectroscopic imaging, molecular absorption contrast provides a large signal relative to noise. Due to the long mid-IR wavelengths and sub-optimal instrument design, however, pixel sizes have historically been much larger than cells. This limits both the accuracy of the technique in identifying small regions, as well as the ability to visualize single cells. Here we obtain data with micron-sized sampling using a tabletop FT-IR instrument, and demonstrate that the high-definition (HD) data lead to accurate identification of multiple cells in lymph nodes that was not previously possible. Highly accurate recognition of eight distinct classes - naïve and memory B cells, T cells, erythrocytes, connective tissue, fibrovascular network, smooth muscle, and light and dark zone activated B cells was achieved in healthy, reactive, and malignant lymph node biopsies using a random forest classifier. The results demonstrate that cells currently identifiable only through immunohistochemical stains and cumbersome manual recognition of optical microscopy images can now be distinguished to a similar level through a single IR spectroscopic image from a lymph node biopsy. PMID:26039216

  14. Interoperative detection of cancer metastasis to the axillary lymph nodes

    NASA Astrophysics Data System (ADS)

    Derakhshan, Jamal

    2002-03-01

    Sentinel lymph node biopsy utilizing Technetium-99m-labeled sulfur colloid is becoming a standard part of the surgical treatment of breast cancer. However, the non-tumor-specific nature of colloids necessitates removal of the node(s) for analysis. Tumor-specific radiotracers, such as positron-emitting Fluorine-18-labeled Fluorodeoxyglucose (FDG), are used with positron emission tomography (PET) to successfully stage breast cancer. Thus, the use of FDG with a handheld probe optimized for detection of beta particles could perhaps identify cancer-infiltrated nodes. In this study the ability of a new solid-state beta-sensitive probe to identify tumor-infiltrated lymph nodes was investigated in a phantom study. A PET image of the phantom was also acquired. The results demonstrated that the probe was capable of identifying nodes containing as little as 10ml of tumor, an amount too small to be detected by the PET scanner. This method, therefore, may be useful in intraoperatively identifying some tumor-infiltrated lymph nodes not detected with PET.

  15. Immunoscintigraphic evaluation of lymph node involvement in prostatic carcinoma

    SciTech Connect

    Vihko, P.; Kontturi, M.; Lukkarinen, O.; Martikainen, P.; Pelliniemi, L.; Heikkilae, J.V.; Vihko, R.

    1987-01-01

    Five patients who were candidates for radical prostatectomy were investigated. One milligram of diethylene triamine pentaacetic acid derivatives of purified F(ab')2 fragments of monoclonal antibodies against prostatic acid phosphatase, labeled with /sup 99m/Tc, were bilaterally injected into the periprostatic space. The amount of radioactivity injected varied between 3 and 7 mCi. Imaging took place dynamically for the first hour following injection, then at 6 and 24 hr. In one patient, lymph node metastases were detected in the left paraaortic, iliac, and obturator lymph nodes by this technique. The lesions incorporating radioactivity were confirmed to be metastases of prostatic cancer following staging pelvic lymphadenectomy. Immunolabeling electron microscopy studies revealed internalized antibody in prostatic cancer cells. In the four other patients, radioimaging did not show any lymph node metastases, and this negative finding was confirmed at surgery. These early data indicate the possibility of preoperative staging of prostatic cancer using radiolabeled derivatives of monoclonal antibodies raised against prostatic acid phosphatase and injected into the periprostatic area.

  16. Epitrochlear Sentinel Lymph Nodes in Melanoma: Interval or Independent?

    PubMed Central

    Kidner, Travis; Yoon, Jeong; Faries, Mark; Morton, Donald

    2012-01-01

    Most primary melanomas on the distal upper extremity metastasize to a sentinel lymph node (SLN) in the axillary basin, but occasionally a primary melanoma will drain to the epitrochlear basin. The relationship between tumor-draining axillary and epitrochlear SLNs is unclear. We hypothesize that the epitrochlear SLN functions in an interval manner with the axillary lymph node basin. We queried our melanoma database to identify patients who underwent SLN biopsy for a distal upper-extremity melanoma. Patient demographics, tumor characteristics, patterns of nodal drainage and incidence of SLN metastasis were analyzed. Of 255 patients identified, 38 (14.9%) had an epitrochlear SLN. Mean Breslow thickness was 2.26 mm. All patients with epitrochlear drainage had concurrent axillary drainage and underwent axillary and epitrochlear SLN biopsies. Of these 38 patients, two (5.2%) had epitrochlear and axillary SLN metastasis, four (10.5%) had epitrochlear metastasis only, four (10.5%) had axillary metastasis only, and the remaining 28 (73.7%) had tumor-free SLNs. The invariable association of epitrochlear and axillary drainage in this study suggests that epitrochlear nodes function in an interval role with the axillary lymph node basin. Therefore we recommend that all patients with a positive epitrochlear SLN undergo completion axillary dissection. PMID:22643268

  17. Popliteal lymph node dissection for metastases of cutaneous malignant melanoma

    PubMed Central

    2014-01-01

    Popliteal lymph node dissection is performed when grossly metastatic nodal disease is encountered in the popliteal fossa or after microscopic metastasis is found in interval sentinel nodes during clinical staging of cutaneous malignant melanoma. Initially, an S-shaped incision is made to gain access to the popliteal fossa. A careful en bloc removal of fat tissue and lymph nodes is made to preserve and avoid the injury of peroneal and tibial nerves as well as popliteal vessels, following the previous recommendations. This rare surgical procedure was successfully employed in a patient with cutaneous malignant melanoma and nodal metastases at the popliteal fossa. The technique described by Karakousis was reproduced in a step-by-step fashion to allow anatomical identification of the neurovascular structures and radical resection with no post-operative morbidity and prompt recovery. Popliteal lymph node dissection is a rarely performed operative procedure. Following a lymphoscintigraphic examination of the popliteal nodal station, surgeons can be asked to explore the popliteal fossa. Detailed familiarity of the operative procedure is necessary, however, to avoid complications. PMID:24886058

  18. Morbidity of Sentinel Lymph Node Biopsy (SLN) Alone Versus SLN and Completion Axillary Lymph Node Dissection After Breast Cancer Surgery A Prospective Swiss Multicenter Study on 659 Patients

    Microsoft Academic Search

    Igor Langer; Ulrich Guller; Gilles Berclaz; Ossi R. Koechli; Gabriel Schaer; Mathias K. Fehr; Thomas Hess; Daniel Oertli; Lucio Bronz; Beate Schnarwyler; Edward Wight; Urs Uehlinger; Eduard Infanger; Daniel Burger; Markus Zuber

    Objective: To assess the morbidity after sentinel lymph node (SLN) biopsy compared with SLN and completion level I and II axillary lymph node dissection (ALND) in a prospective multicenter study. Summary Background Data: ALND after breast cancer surgery is associated with considerable morbidity. We hypothesized: 1) that the morbidity in patients undergoing SLN biopsy only is signifi- cantly lower compared

  19. The Influence of Serial Sections, Immunohistochemistry, and Extension of Pelvic Lymph Node Dissection on the Lymph Node Status in Clinically Localized Prostate Cancer

    Microsoft Academic Search

    Friedhelm Wawroschek; Theodor Wagner; Michael Hamm; Dorothea Weckermann; Harry Vogt; Bruno Märkl; Ronald Gordijn; Rolf Harzmann

    2003-01-01

    Objectives: Pelvic lymph node metastases indicate a poor prognosis for patients with clinically localized prostate cancer. The aim of the study was to investigate the value of extended histopathological techniques considering the extent of pelvic lymphadenectomy and preoperative risk factors.Methods: Total of 194 patients with prostate cancer were examined. At first all patients had a sampling of the sentinel lymph

  20. Real-time rapid reverse transcriptase-polymerase chain reaction for intraoperative diagnosis of lymph node micrometastasis: Clinical application for cervical lymph node dissection in esophageal cancers

    Microsoft Academic Search

    Setsuko Yoshioka; Yoshiyuki Fujiwara; Yurika Sugita; Yoshihiro Okada; Masahiko Yano; Shigeyuki Tamura; Takushi Yasuda; Shuji Takiguchi; Hitoshi Shiozaki; Morito Monden

    2002-01-01

    Background. New molecular techniques have been designed to detect cancer micrometastases that are otherwise missed by conventional histologic examination. The aim of this study was to establish a sensitive and rapid genetic assay to detect lymph node micrometastasis and to assess its usefulness clinically for cervical lymphadenectomy in esophageal cancer. We have recently shown that metastasis in the lymph node

  1. Assessment of the performance of the Stanford Online Calculator for the prediction of nonsentinel lymph node metastasis in sentinel lymph node-positive breast cancer patients

    Microsoft Academic Search

    Jeffrey S. Scow; Amy C. Degnim; Tanya L. Hoskin; Carol Reynolds; Judy C. Boughey

    2009-01-01

    BACKGROUND: Several models for the prediction of nonsentinel lymph node (NSLN) metastasis in sentinel lymph node (SLN)-positive breast cancer patients have been proposed. In this study, the authors evaluate the Stanford Online Calculator (SOC), which was designed to predict the likelihood of NSLN metastasis using only 3 variables: primary tumor size, SLN metastasis size, and angiolymphatic invasion status. They compared

  2. Vascular stiffening in pulmonary hypertension: cause or consequence? (2013 Grover Conference series)

    PubMed Central

    Tan, Wei; Madhavan, Krishna; Hunter, Kendall S.; Park, Daewon

    2014-01-01

    Abstract Recent studies have indicated that systemic arterial stiffening is a precursor to hypertension and that hypertension, in turn, can perpetuate arterial stiffening. Pulmonary artery (PA) stiffening is also well documented to occur in pulmonary hypertension (PH), and there is evidence that pulmonary vascular stiffness (PVS) may be a better predictor of outcome than pulmonary vascular resistance (PVR). We have hypothesized that the decreased flow-damping function of elastic PAs in PH likely initiates and/or perpetuates dysfunction of pulmonary microvasculature. Recent studies have shown that large-vessel stiffening increases flow pulsatility in the distal pulmonary vasculature, leading to endothelial dysfunction within a proinflammatory, vasoconstricting, and profibrogenic environment. The intricate role of stiffening-stimulated high pulsatile flow in endothelial cell dysfunction includes stepwise molecular events underlying PA hypertrophy, inflammation, endothelial-mesenchymal transition, and fibrosis. In addition to contributing to microenvironmental alterations of the distal vasculature, disordered proximal-distal PA coupling likely also plays a role in increasing ventricular afterload, ultimately causing right ventricle (RV) dysfunction and death. Current therapeutic treatments do not provide a realistic approach to destiffening arteries and, thus, to potentially abrogating the effects of high pulsatile flow on the distal pulmonary vasculature or the increased work imposed by stiffening on the RV. Scrutinizing the effect of PA stiffening on high pulsatile flow–induced cellular and molecular changes, and vice versa, might lead to important new therapeutic options that abrogate PA remodeling and PH development. With a clear understanding that PA stiffening may contribute to the progression of PH to an irreversible state by contributing to chronic microvascular damage in lungs, future studies should be aimed first at defining the underlying mechanisms leading to PA stiffening and then at improved treatment approaches based on these findings. PMID:25610594

  3. Pulmonary functional impairment from years of arc welding

    SciTech Connect

    Kilburn, K.H.; Warshaw, R.H.

    1989-07-01

    The adverse effects of arc welding on pulmonary function have been previously documented. However, in many of these studies, the effects of welding exposure and smoking were not separated. Also, some studies did not adjust for or ignored the effects of asbestosis on pulmonary function. We assessed the long-term effects of welding on pulmonary function in welders who had no evidence of asbestosis on chest radiographs, and adjusted each individual value for height, age, and years of cigarette smoking. The study consisted of 226 male construction welders who had never worked in shipyards. Forced vital capacity (FVC) and flows were measured by spirometry, chest radiographs were obtained and examined for evidence of asbestosis using, and thoracic gas volume (TGV) was determined by planimetry. The subjects were also administered an occupational and respiratory questionnaire. Data on workers with asbestosis (ILO profusion 1/0 or greater) and pleural abnormalities were excluded. The mean age for the 226 subjects without asbestosis was 45 years, mean height was 175.7 cm, and mean duration of welding was 21.3 years. Pulmonary function measurements are presented as mean percentage of predicted (pop) and adjusted for height, age, and years of smoking. In 151 current cigarette smokers, mean midflows and terminal flows were decreased, FEF25-75 to 93.2 pop and FEF75-85 to 91.2 pop, but FVC, forced expiratory volume in one second (FEV1) and TGV were normal. The 43 nonsmokers also had reductions in flows but normal FVC and TGV. Flows in both groups were significantly (p less than 0.05) below those of the referent group. The regression coefficient was -0.0031 for years of welding and FVC pop, -0.0035 for FEV1 pop, and -0.0080 for midflow pop (FEF25-75) (all significant at p less than 0.05), but the coefficient for FEF75-85 pop was not significant.

  4. In-vitro Strain and Modulus Measurements in Porcine Cervical Lymph Nodes

    PubMed Central

    Wing-Han Yuen, Queeny; Zheng, Yong-Ping; Huang, Yan-Ping; He, Jun-Feng; Chung-Wai Cheung, James; Ying, Michael

    2011-01-01

    Cervical lymph nodes are common sites of metastatic involvement in head and neck cancers. These lymph nodes are superficially located and palpation is a common practice for assessing nodal hardness and staging cancer which is, however, too subjective and with limited accuracy. In this study, the mechanical properties of pig lymph node tissues were investigated using ultrasound elastography and indentation test. Lymph nodes were excised from fresh pork pieces and embedded in an agar-gelatin phantom for strain imaging by elastography. A strain ratio reflecting the strain contrast of lymph node over agar-gelatin phantom was used to assess the elasticity of the lymph node. A cutting device was then custom-designed to slice the phantom into uniform slices for indentation test. The measurements revealed that there were significant differences in both the strain ratio and Young’s modulus between the peripheral and middle regions of the lymph nodes (both p < 0.05); however, the results appeared contradictory. Correlation between the results of the two measurements (modulus ratio vs. inversed strain ratio) showed their association was moderate for both the peripheral and middle regions (R2 = 0.437 and 0.424 respectively). As the tests were only performed on normal lymph nodes, comparison in stiffness between healthy and abnormal lymph nodes could not be made. Future studies should be conducted to quantify the stiffness change in abnormal lymph nodes. PMID:21643424

  5. Intercostobrachial Nerves as a Novel Anatomic Landmark for Dividing the Axillary Space in Lymph Node Dissection

    PubMed Central

    Li, Jianyi; Zhang, Yang; Zhang, Wenhai; Jia, Shi; Gu, Xi; Ma, Yan; Li, Dan

    2013-01-01

    Purpose. Our aim was to assess the feasibility of using the intercostobrachial nerves (ICBNs) as a possible new anatomic landmark for axillaries lymph node dissection in breast cancer patients. Background Data Summary. The preservation of ICBN is now an accepted procedure in this type of dissection; however, it could be improved further to reduce the number of postoperative complications. The axillary space is divided into lower and upper parts by the ICBN—a thorough investigation of the metastasis patterns in lymph nodes found in this area could supply new information leading to such improvements. Methods. Seventy-two breast cancer patients, all about to undergo lymph node dissection and with sentinel lymph nodes identified, were included in this trial. The lymph nodes were collected in two groups, from lower and upper axillary spaces, relative to the intercostobrachial nerves. The first group was further subdivided into sentinel (SLN) and nonsentinel (non-SLN) nodes. All lymph nodes were tested to detect macro- and micrometastasis. Results. All the sentinel lymph nodes were found under the intercostobrachial nerves; more than 10 lymph nodes were located in that space. Moreover, when lymph nodes macrometastasize or micrometastasize above the intercostobrachial nerves, we also observe metastasis-positive nodes under the nerves; when the lower group nodes show no metastasis, the upper group is also metastasis free. Conclusions. Our results show that the intercostobrachial nerves are good candidates for a new anatomic landmark to be used in lymph node dissection procedure. PMID:23401796

  6. The prognostic significance of total lymph node number in patients with axillary lymph node-negative breast cancer

    Microsoft Academic Search

    H Mersin; E Y?ld?r?m; H Bulut; U Berbero?lu

    2003-01-01

    Aim: In node-negative breast cancer patients, several factors for survival have been evaluated and currently, some of them are accepted for their prognostic and\\/or predictive values after validation in the separate data sets. The prognostic significance of increases in the number of pathologically detectable axillary lymph nodes in the node-negative patients could not been established clearly. To address this question,

  7. Lymph Node Recovery from Colorectal Tumor Specimens:Recommendation for a Minimum Number of Lymph Nodes to be Examined

    Microsoft Academic Search

    Fabio Cianchi; Annarita Palomba; Vieri Boddi; Luca Messerini; Filippo Pucciani; Giuliano Perigli; Paolo Bechi; Camillo Cortesini

    2002-01-01

      Lymph node involvement is the mostimportant prognostic factor for patients who have undergone radicalsurgery for colorectal\\u000a carcinoma. An accurate examination of thesurgical specimens is mandatory for the correct assessment of the lymphnode status\\u000a of the tumor. The risk of understaging is particularly highfor patients with tumors classified as Dukes B (TNM stage II).\\u000a The aimof this study was to determine

  8. The local lymph node assay: an interlaboratory evaluation of interleukin 6 (IL-6) production by draining lymph node cells.

    PubMed

    Dearman, R J; Scholes, E W; Ramdin, L S; Basketter, D A; Kimber, I

    1994-01-01

    The murine local lymph node assay is a predictive method for the identification of skin-sensitizing chemicals in which activity is measured as a function of proliferative activity induced in lymph nodes draining the site of exposure. In the present study, the induction by topically applied chemicals of draining lymph node cell (LNC) production of the cytokine interleukin 6 (IL-6) has been evaluated as an alternative endpoint for the local lymph node assay. In addition, results derived from studies of IL-6 production by LNC performed independently in two separate collaborating laboratories have been compared. Of the nine skin sensitizing chemicals examined, six provoked detectable levels (> 150 pg ml-1) of IL-6 production by draining LNCs (as measured by enzyme-linked immunosorbent assay) following exposure of mice to at least one test concentration of the material in both of the laboratories. Three other sensitizing chemicals failed to induce measurable IL-6 production at any test concentration in either one or both of the participating laboratories. Both of the non-sensitizing chemicals evaluated (sodium lauryl sulphate and methyl salicylate) also failed to result in detectable IL-6 synthesis. There was a high level of agreement between the two laboratories. The rank order of chemicals with respect to IL-6 production by LNCs was identical in both cases, as was the dose-response relationship observed with each test material. These data reveal that, although inducible IL-6 production by draining LNCs provides a robust approach to the measurement of strong sensitizing activity, as performed here the method is of insufficient sensitivity for the routine identification of skin allergens. PMID:7963242

  9. Changes in pulmonary artery size before and after total cavopulmonary connection

    PubMed Central

    Buheitel, G.; Hofbeck, M.; Tenbrink, U.; Leipold, G.; von der Emde, J.; Singer, H.

    1997-01-01

    Objective—To assess changes in size of the central pulmonary arteries following a total cavopulmonary connection (TCPC).?Design—A retrospective analysis of the angiographic diameters of the central pulmonary arteries, expressed as z scores, in infancy before the TCPC and 3.5 (0.9) years (mean (SD)) later. Analysis of the relation between the pulmonary arteriolar resistance and the z scores at follow up.?Setting—Tertiary referral centre.?Patients—32 patients who had TCPC from February 1990 to July 1993.?Results—The patients were divided into two groups (n = 16) depending on their preoperative flow ratio: group I, Qp/Qs ? 1; group II, Qp/Qs > 1. At the initial study in infancy the mean z scores in group I were ?6.0 for the right pulmonary artery (RPA) and ?9.6 for the left pulmonary artery (LPA); in group II the respective values were ?2.7 and ?3.0. Before the TCPC the values increased to 0.5 (RPA) and ?0.5 (LPA) in group I, and to 8.8 (RPA) and 8.2 (LPA) in group II. At follow up the z scores decreased to ?2.4 (RPA) and ?4.9 (LPA) in group I, and to 2.2 (RPA) and ?0.7 (LPA) in group II. The changes in pulmonary artery diameters were significant for both groups (p < 0.02). Following the TCPC, no significant difference in pulmonary arteriolar resistance index was found between patients with relatively small pulmonary arteries (z score RPA+LPA ? 0) and those with relatively large pulmonary arteries (z score RPA+LPA > 0).?Conclusions—Creation of a TCPC results in a significant reduction in size of the central pulmonary arteries. At a mean interval of 3.5 years following the TCPC, however, there was no significant difference in pulmonary arteriolar resistance index between patients with smaller and larger central pulmonary arteries.?? Keywords: total cavopulmonary connection;  congenital heart disease;  pulmonary artery size;  pulmonary arteriolar resistance PMID:9415009

  10. Pulmonary arterial compliance and exercise capacity after pulmonary endarterectomy.

    PubMed

    Ghio, Stefano; Morsolini, Marco; Corsico, Angelo; Klersy, Catherine; Mattiucci, Gabriella; Raineri, Claudia; Scelsi, Laura; Vistarini, Nicola; Oltrona Visconti, Luigi; D'Armini, Andrea Maria

    2014-05-01

    Patients with chronic thromboembolic pulmonary hypertension (CTEPH), despite successful pulmonary endarterectomy (PEA), can continue to suffer from a limitation in exercise capacity. The objective of this study was to assess whether pulmonary arterial compliance is a predictor of exercise capacity after PEA. Right heart haemodynamics, treadmill incremental exercise test, spirometry, carbon monoxide transfer factor, arterial blood gas and echocardiographic examinations were retrospectively analysed in a population of CTEPH patients who underwent PEA at a single centre. Baseline and 3-month haemodynamic data were available in 296 patients; 5-year follow-up data were available in 68 patients. In a multivariable model the following parameters were found to be independent predictors of exercise capacity after surgery: age, sex, pulmonary arterial compliance, tricuspid annular plane excursion, arterial oxygen tension and carbon monoxide transfer factor (p<0.0001); the model showed good discrimination (Harrell's c=0.84) and calibration (shrinkage coefficient=0.91). Poor exercise capacity at 3 months was loosely associated with higher death rate during subsequent survival (Harrell's c=0.61). In conclusion, after successful PEA, reduced pulmonary arterial compliance is an important determinant of exercise capacity in association with the age and sex of the patients, and the extent of recovery of both cardiac and respiratory function. However, exercise capacity does not explain a large proportion of the effect of surgery on subsequent survival. PMID:24435007

  11. Assessment of the intrapulmonary ventilation-perfusion distribution after the Fontan procedure for complex cardiac anomalies: Relation to pulmonary hemodynamics

    SciTech Connect

    Matsushita, T.; Matsuda, H.; Ogawa, M.; Ohno, K.; Sano, T.; Nakano, S.; Shimazaki, Y.; Nakahara, K.; Arisawa, J.; Kozuka, T. (Osaka Univ. Medical School (Japan))

    1990-03-15

    In 12 patients who underwent the Fontan procedure for complex cardiac anomalies, lung scanning with xenon-133 was performed to assess the intrapulmonary ventilation-perfusion distribution, and comparison was made with a control group. All data were then analyzed in relation to either pre- or postoperative pulmonary hemodynamic data. In ventilation scans, the intrapulmonary distribution in the right lung was almost normal. In perfusion scans, an abnormal increased upper to lower lobe perfusion ratio greater than the normal value found in the control group was noted in seven patients (58.3%). There was a significant correlation (p less than 0.02) between the upper to lower lobe perfusion ratio and postoperative pulmonary vascular resistance. Furthermore, this perfusion ratio correlated inversely with the preoperative (p less than 0.005) and postoperative (p less than 0.02) right pulmonary artery area index, defined as the ratio of cross-sectional area to the normal value. Of five patients with less than 90% arterial oxygen saturation, four showed an abnormal distribution of pulmonary blood flow greater than the normal perfusion ratio. No patient had evidence of a pulmonary arteriovenous fistula by the echocardiographic contrast study. These results suggest that abnormal distribution of pulmonary blood flow to the upper lung segment may develop in patients after the Fontan procedure, and that insufficient size of the pulmonary artery before operation and the consequent postoperative elevation of pulmonary vascular resistance may be responsible for this perfusion abnormality.

  12. [Postpartum pulmonary hypertension].

    PubMed

    Escalante, Juan Pablo; Diez, Ana; Figueroa Casas, Marcelo; Lasave, Alejandro; Cursack, Guillermo; Poy, Carlos; Rodríguez, María Soledad; Galuppo, Marcela; Zapata, Gerardo

    2015-01-01

    Pulmonary hypertension (PH) in pregnancy is a rare disorder that carries a high risk to mother and child, and as such, it is considered a contraindication to becoming pregnant. However, there are few published reports related to the diagnosis of this condition after delivery. We describe three PH cases diagnosed after their normal pregnancies and deliveries. Although the causes are unknown, several mechanisms such as hypercoagulation, placental hypoxia or amniotic fluid embolism have been considered as possible causes. It is difficult to define whether a PH diagnosed in the postpartum period, relates to an earlier asymptomatic PH period that was triggered by the physiological stress of labor or if it is a recently acquired condition. Despite the lack of data to support the absence of PH previous to pregnancy in our three patients, lack of events during this period, asymptomatic and normal deliveries, lead us to believe that they did not suffer this disease prior to pregnancy; considering that high hemodynamic demands impair a ventricle with little reserve, and its subsequent appearance at time of delivery. PMID:25637900

  13. Asymmetric Dimethylarginine is increased in Chronic Thromboembolic Pulmonary Hypertension

    Microsoft Academic Search

    Nika Skoro-Sajer; Friedrich Mittermayer; Adelheid Panzenboeck; Diana Bonderman; Roela Sadushi; Robert Hitsch; Johannes Jakowitsch; Walter Klepetko; Meinhard P Kneussl; Michael Wolzt; Irene M Lang

    2007-01-01

    Rationale: Asymmetric dimethylarginine (ADMA), a potent endoge- nous nitric oxide synthase (NOS) inhibitor, is increased in idiopathic pulmonary arterial hypertension and associated with unfavorable outcome. Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH), although principally amenable to surgical removal of ma- jor pulmonary arterial obstructions by pulmonary endarterectomy, may show a small-vessel pulmonary arteriopathy similar to idio- pathic pulmonary arterial hypertension. We

  14. Managing chronic thromboembolic pulmonary hypertension: pharmacological treatment options

    Microsoft Academic Search

    I. M. Lang

    2009-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening condition in which organised thrombi obstruct the pulmonary vessels, causing increased pulmonary vascular resistance, progressive pulmonary hypertension (PH) and right heart failure. The treatment of choice is pulmonary endarterectomy, which restores pulmonary haemodynamics with acceptable periprocedural mortality rates in the majority of suitable patients. However, CTEPH may be inoperable owing to surgically

  15. An Automated Preschool Pulmonary Function Test

    PubMed Central

    Budd, Jeffrey R.; Finkelstein, Stanley M.; Warwick, Warren J.

    1981-01-01

    A non-invasive, non-effort dependent pulmonary function test has been created which can be used on preschool subjects. The integration of a mini-computer system with the test procedure allows extensive analysis of flow and gas concentration data. This analysis not only supplies lung volume measurements but also gas mixing efficiency which quantifies the evenness of gas distribution and alveolar efficiency which indicates the extent of ventilation-perfusion inequalities and diffusion abnormalities. The test has been performed on a sample of control subjects and cystic fibrosis patients aged 1 to 23 years old. The results indicate that the measurements are not only sensitive and specific to lung disease but also that they should prove useful for following the extent of lung disease over time.

  16. Exposure to formaldehyde: effects of pulmonary function

    SciTech Connect

    Alexandersson, R. (Karolinska Hospital, Stockholm, Sweden); Kolmodin-Hedman, B.; Hedenstierna, G.

    1982-09-01

    Forty-seven subjects exposed to formaldehyde (mean air concentration 0.45 mg/m/sup 3/) and 20 unexposed subjects, all of whom were employed at a carpentry shop, were studied with regard to symptoms and pulmonary function. Symptoms involving eyes and throat as well as chest oppression were significantly more common in the exposed subjects than in the unexposed controls. Spirometry and single breath nitrogen washout were normal Monday morning before exposure to formaldehyde. A reduction in forced expiratory volume in 1 sec by an average of 0.2 L (P = .002), percent forced expiratory volume by 2% (P = .04), maximum midexpiratory flow by 0.3 L/sec (P = .04) and an increase in closing volume in percentage of vital capacity by 3.4% (P = .002) were seen after a day of work and exposure to formaldehyde, suggesting bronchoconstriction. Smokers and nonsmokers displayed similar changes in spirometry and nitrogen washout.

  17. Duodenal gangliocytic paraganglioma with regional lymph node metastasis and a glandular component.

    PubMed

    Ogata, Sho; Horio, Takuya; Sugiura, Yoshiaki; Aiko, Satoshi; Aida, Shinsuke

    2011-02-01

    Gangliocytic paraganglioma (GP) is generally considered to be a benign periampullary lesion, although it is unclear whether it should be classified as a hamartoma or as a neoplasm. Here, we present a GP case with lymph node metastasis. A 16-year-old boy complained of exertional dyspnea. Upper endoscopy and imaging studies revealed a polypoid ampullary tumor. Pancreaticoduodenectomy with lymph node dissection was performed due to swelling of peripancreatic lymph nodes. Histologically, the tumor consisted of three cell types: epithelioid; spindle; and ganglion cells. In addition to these typical components of GP, a distinct glandular component was also present. There was substantial invasion of tumor cells into the lymphovascular vessels, associated with lymph node metastases. These lymph node metastases were histologically similar to the primary tumor. To judge from these findings GP may be a true neoplasm with metastatic capacity. Pre- and intraoperative investigations for lymph node or distant metastases are required for adequate resection of this kind of tumor. PMID:21255188

  18. Inhaled iloprost in patients with chronic thromboembolic pulmonary hypertension: effects before and after pulmonary thromboendarterectomy

    Microsoft Academic Search

    Thorsten Kramm; Balthasar Eberle; Frank Krummenauer; Stefan Guth; Hellmut Oelert; Eckhard Mayer

    2003-01-01

    BackgroundIn primary pulmonary hypertension, aerosolized prostanoids selectively reduce pulmonary vascular resistance and improve right ventricular function. In this study, hemodynamic effects of inhaled iloprost, a stable prostacyclin analogue, were evaluated in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and early after pulmonary thromboendarterctomy (PTE).

  19. Pulmonary veno-occlusive disease as a cause of pulmonary arterial hypertension

    PubMed Central

    Al-Bayati, Ihsan; Porres-Muñoz, Mateo; Padilla, Osvaldo; Syed, Saad H.; Lowder, Kevin; Azimova, Komola; Fan, Jerry; Mukherjee, Debabrata; Abbas, Aamer

    2015-01-01

    Pulmonary veno-occlusive disease (PVOD) represents a rare form of precapillary pulmonary arterial hypertension. We present a young patient hospitalized with progressive dyspnea, with initial workup suggestive of pulmonary hypertension and unexplained noncardiogenic pulmonary edema. His subsequent clinical course was consistent with the diagnosis of PVOD.

  20. Pulmonary veno-occlusive disease as a cause of pulmonary arterial hypertension.

    PubMed

    Porres-Aguilar, Mateo; Al-Bayati, Ihsan; Porres-Muñoz, Mateo; Padilla, Osvaldo; Syed, Saad H; Lowder, Kevin; Azimova, Komola; Fan, Jerry; Mukherjee, Debabrata; Abbas, Aamer

    2015-07-01

    Pulmonary veno-occlusive disease (PVOD) represents a rare form of precapillary pulmonary arterial hypertension. We present a young patient hospitalized with progressive dyspnea, with initial workup suggestive of pulmonary hypertension and unexplained noncardiogenic pulmonary edema. His subsequent clinical course was consistent with the diagnosis of PVOD. PMID:26130886

  1. [Pulmonary hypertension in liver diseases].

    PubMed

    Savale, Laurent; Sattler, Caroline; Sitbon, Olivier

    2014-09-01

    Portopulmonary hypertension (PoPH) is defined by the combination of portal hypertension and precapillary pulmonary hypertension (mPAP ? 25 mmHg, PCWP < 15 mmHg and PVR > 3 Wood units). PoPH is characterised by pathobiological mechanisms that are similar to other forms of pulmonary arterial hypertension. Prevalence of PoPH is estimated at 0.5-5% among patients with portal hypertension with or without cirrhosis. Treatment strategies most commonly employed for PoPH patients are based on recommendations for idiopathic PAH management. Indeed, the choice of specific PAH treatment must take account the severity of the underlying liver disease. Prognosis of PoPH patients is dependent on both the severity of PAH and of the underlying liver disease. PoPH may be a contraindication for orthotopic liver transplantation (OLT) if mean pulmonary arterial pressure is > 35 mmHg associated with severe right ventricular dysfunction or high level of pulmonary vascular resistance (> 3-4 Wood units). Bridge therapy with specific PAH therapies should be considered in those patients in an attempt to improve pulmonary hemodynamic and thereby allow OLT with acceptable risk. Recent data suggest that stabilize, improve or cure PoPH seems to be possible by combining specific PAH therapies and liver transplantation in selected patients. Clinical and experimental evidences suggest that IFN therapy may be a possible risk factor for PAH. PMID:25148949

  2. Pulmonary Vascular Angioscopy - Current Results

    NASA Astrophysics Data System (ADS)

    Shure, Deborah; Buchbinder, Maurice; Peterson, Kirk

    1988-06-01

    We performed angioscopy on 31 patients with suspected chronic pulmonary arterial ob-struction using three prototype angioscopes. The instruments varied in length (80, 90, and 120 cm), outside diameter (3.2 and 4 mm), and distal tip deflection (70, 90, and 180 degrees). All had a distal viewing balloon. Conventional diagnostic studies were performed and decisions about diagnosis and operability were made prior to angioscopy. An independent assessment of diagnosis and operability was then made based on the results of angioscopy. Surgical confirmation was obtained in most cases and clinical or autopsy data were obtained in the remainder. Angioscopy led to a change in the diagnosis of 6 patients (19%). Four of 25 patients with chronic pulmonary emboli were felt to be inoperable based on the angioscopic findings. Two of these 4 underwent surgery and were found to be inoperable. 21 of the remaining 25 patients were felt to have operable disease and 19 underwent surgery. In 14 of these 19 (74%), the conventional studies were either negative or equivocal with respect to operability and the decision to operate was based on angioscopic data. We conclude that good visualization of the central pulmonary arteries can be achieved with the optical balloon technique; that the procedure can be performed safely in patients with severe pulmonary hypertension; and that the information obtained by angioscopy can significantly affect clinical decisions in patients with chronic pulmonary artery obstruction.

  3. Pulmonary manifestations of ankylosing spondylitis.

    PubMed

    Kanathur, Naveen; Lee-Chiong, Teofilo

    2010-09-01

    Ankylosing spondylitis, a chronic multisystem inflammatory disorder, can present with articular and extra-articular features. It can affect the tracheobronchial tree and the lung parenchyma, and respiratory complications include chest wall restriction, apical fibrobullous disease with or without secondary pulmonary superinfection, spontaneous pneumothorax, and obstructive sleep apnea. Ankylosing spondylitis is a common cause of pulmonary apical fibrocystic disease; early involvement may be unilateral or asymmetrical, but most cases eventually consist of bilateral apical fibrobullous lesions, many of which are progressive with coalescence of the nodules, formation of cysts and cavities, fibrosis, and bronchiectasis. Mycobacterial or fungal superinfection of the upper lobe cysts and cavities occurs commonly. Aspergillus fumigatus is the most common pathogen isolated, followed by various species of mycobacteria. Prognosis of patients with fibrobullous apical lesions is mainly determined by the presence, extent, and severity of superinfection. Pulmonary function test results are nonspecific and generally parallel the severity of parenchymal involvement. A restrictive ventilatory impairment can develop in patients with ankylosing spondylitis because of either fusion of the costovertebral joints and ankylosis of the thoracic spine or anterior chest wall involvement. Chest radiographic findings may mirror the severity of clinical involvement. Pulmonary parenchymal disease is typically progressive, and cyst formation, cavitation, and fibrosis are seen in advanced cases. No treatment has been shown to alter the clinical course of apical fibrobullous disease. Although several antiinflammatory agents, such as infliximab, etanercept, and adalimumab, are being used to treat ankylosing spondylitis, their effects on pulmonary manifestations are unclear. PMID:20692546

  4. Monocyte and macrophage regulation of pulmonary fibrosis 

    E-print Network

    Gibbons, Michael A.

    2010-01-01

    In this thesis I examined the role of circulating monocytes and lung macrophages in the pathogenesis of the early fibrotic, progressive fibrotic and resolution phases of pulmonary fibrosis. Pulmonary fibrosis with ...

  5. Chronic thromboembolic pulmonary hypertension: animal models.

    PubMed

    Mercier, Olaf; Fadel, Elie

    2013-05-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening disease due to pulmonary artery obstruction by persistent organised clots related to one or more episodes of acute pulmonary embolism. To date, the pathogenesis of CTEPH remains unexplained. Pulmonary endarterectomy removes obstruction from pulmonary vessels and can cure patients. However, some unreachable distal pulmonary obstruction and/or associated distal pulmonary vasculopathy could induce persistent pulmonary hypertension, the main postoperative complication. The pathophysiology of CTEPH is not fully understood and improving knowledge of this disease could improve our future surgical and medical management. Many attempts, conducted over several decades, have failed to reproduce this chronic disease in animals. However, several animal models have provided insights into the pathophysiology and pathogenesis of CTEPH. Here, we review all the animal models that have improved the comprehension of CTEPH and hold promise for further investigations. This short review analyses strengths and weaknesses of all animal models available to study the pathophysiology of CTEPH. PMID:23314897

  6. How Is Idiopathic Pulmonary Fibrosis Treated?

    MedlinePLUS

    ... to the Health Topics Oxygen Therapy article. Pulmonary Rehabilitation PR is now a standard treatment for people ... more information, go to the Health Topics Pulmonary Rehabilitation article. Lung Transplant Your doctor may recommend a ...

  7. Lymph Node Micrometastases in Early Gastric Cancer and Their Impact on Prognosis

    Microsoft Academic Search

    Paolo Morgagni; Luca Saragoni; Emanuela Scarpi; Pier Sante Zattini; Alberto Zaccaroni; Diana Morgagni; Francesca Bazzocchi

    2003-01-01

      Abstract\\u000a \\u000a While the presence of lymph node metastases in early gastric cancer (EGC) is the most significant prognostic factor, the relevance\\u000a of lymph node micrometastases remains uncertain. The authors studied 5400 lymph nodes dissected from 300 patients treated\\u000a surgically for EGC between 1976 and 1999, all of whom were histologically pN0. Micrometastases were defined as single or small\\u000a clusters of

  8. A preliminary study on sentinel lymph node biopsy: feasibility and predictive ability in oral cavity cancer

    Microsoft Academic Search

    Kazuaki Chikamatsu; Hideo Kamada; Hiroshi Ninomiya; Katsumasa Takahashi; Tsutomu Sakurai; Noboru Oriuchi; Nobuhiko Furuya

    2004-01-01

    The main factor that affects the prognosis of patients with head and neck cancer (HNC) is regional lymph node metastases.\\u000a For this reason, the accurate evaluation of neck metastases is required for neck management. This study investigates the sentinel\\u000a lymph node identification and the accuracy of the histopathology of the sentinel lymph node in patients with HNC. Eleven patients\\u000a with

  9. A clinicopathological study of mediastinal lymph node metastasis of lung cancer

    Microsoft Academic Search

    Jin-liang Xu; Qing-kai Yu; Sen Wu; Zong-ren Gao; Zhi-qiang Long; Si-jie Qiao

    2000-01-01

    Objective: To investigate pathologically the characteristics of lung cancer metastasis by mediastinal lymph node ways (N2). Methods: Of 398 lung cancer patients who underwent radical pulmonectomy and extensive lymph node dissection, 160 patients\\u000a were diagnosed as with N2 metastasis, their 352 groups of mediastinal lymph nodes invaded were subject to the pathological\\u000a study. Results: Evidences showed that the N2 metastasis

  10. Sensitization to 2,4-dinitrochlorobenzene: influence of vehicle on absorption and lymph node activation

    Microsoft Academic Search

    J. R. Heylings; H. M. Clowes; M. Cumberbatch; R. J. Dearman; I. Fielding; J. Hilton; I. Kimber

    1996-01-01

    Effective skin sensitization is dependent upon immune activation of lymph nodes draining the site of exposure. The influence of vehicle formulation on the vigour of lymph node cell proliferative responses to 2,4-dinitrochlorobenzene (DNCB) has been examined. Mice (BALB\\/c strain) were exposed topically to 0.5% DNCB dissolved in either acetone or propylene glycol (PG). A significantly greater lymph node cell proliferative

  11. Posterior lymph heart function in two species of anurans: analysis based on both in vivo pressure-volume relationships by conductance manometry and ultrasound.

    PubMed

    Crossley, Dane A; Hillman, Stanley S

    2010-11-01

    Rhinella marina and Lithobates catesbeianus have known differences in the capacity to mobilize lymph to stabilize blood volume following dehydration and hemorrhage. The purpose of these experiments was to assess whether there are interspecific differences in basic lymph heart functions. The end diastolic volumes of posterior lymph hearts averaged 10.8 ?l kg?¹ in R. marina and 7.9-10.8 ?l kg?¹ in L. catesbeianus by conductance manometry, and 9-32 ?l kg?¹ in R. marina by ultrasound techniques, which correlated with body mass. Stroke volumes were approximately 20% of end diastolic volumes in both species. Peak systolic pressures and stroke work were correlated with the index of contractility (dP/dt(max)) in both species. Stroke volume was correlated to stroke work but not peak systolic pressure, end diastolic volume or end diastolic pressure indicating the preload variables do not seem to determine stroke volume as would be predicted from Starling considerations of the blood heart. Renal portal elastance (end systolic pressure/stroke volume) an afterload index did not differ interspecifically, and was equivalent to values for systemic flow indices from mice of equivalent ventricular volume. These data, taken together with predictions derived from mammalian models on the effect of high resistance indicate afterload (renal portal pressure), may be important determinants of posterior lymph heart stroke volume. The shape of the pressure-volume loop is different from an idealized version previously reported, and is influenced by end diastolic volume. Our data indicate that increasing end diastolic pressure and volume can influence the loop shape but not the stroke volume. This indicates that lymph hearts do not behave in a Starling Law manner with increased preload volume. PMID:20952620

  12. Posterior lymph heart function in two species of anurans: analysis based on both in vivo pressure–volume relationships by conductance manometry and ultrasound

    PubMed Central

    Crossley, Dane A.; Hillman, Stanley S.

    2010-01-01

    Rhinella marina and Lithobates catesbeianus have known differences in the capacity to mobilize lymph to stabilize blood volume following dehydration and hemorrhage. The purpose of these experiments was to assess whether there are interspecific differences in basic lymph heart functions. The end diastolic volumes of posterior lymph hearts averaged 10.8 ?l kg–1 in R. marina and 7.9–10.8 ?l kg–1 in L. catesbeianus by conductance manometry, and 9–32 ?l kg–1 in R. marina by ultasound techniques, which correlated with body mass. Stroke volumes were approximately 20% of end diastolic volumes in both species. Peak systolic pressures and stroke work were correlated with the index of contractility (dP/dtmax) in both species. Stroke volume was correlated to stroke work but not peak systolic pressure, end diastolic volume or end diastolic pressure indicating the preload variables do not seem to determine stroke volume as would be predicted from Starling considerations of the blood heart. Renal portal elastance (end systolic pressure/stroke volume) an afterload index did not differ interspecifically, and was equivalent to values for systemic flow indices from mice of equivalent ventricular volume. These data, taken together with predictions derived from mammalian models on the effect of high resistance indicate afterload (renal portal pressure), may be important determinants of posterior lymph heart stroke volume. The shape of the pressure–volume loop is different from an idealized version previously reported, and is influenced by end diastolic volume. Our data indicate that increasing end diastolic pressure and volume can influence the loop shape but not the stroke volume. This indicates that lymph hearts do not behave in a Starling Law manner with increased preload volume. PMID:20952620

  13. CCR5 Expression Is Reduced in Lymph Nodes of HIV Type 1–Infected Women, Compared With Men, But Does Not Mediate Sex-Based Differences in Viral Loads

    PubMed Central

    Meditz, Amie L.; Folkvord, Joy M.; Lyle, Ngan H.; Searls, Kristina; Lie, Yolanda S.; Coakley, Eoin P.; McCarter, Martin; MaWhinney, Samantha; Connick, Elizabeth

    2014-01-01

    Background.?Human immunodeficiency virus type 1 (HIV-1)–infected women have lower viral loads than men but similar rates of disease progression. We hypothesized that sex-based differences in CCR5 expression mediate viral load differences. Methods.?CCR5 was analyzed by flow cytometry in disaggregated lymph node cells from untreated HIV-1–infected women (n = 28) and men (n = 27). The frequencies of HIV-1 RNA–producing cells in the lymph node were determined by in situ hybridization. Linear and generalized linear regression models were used. Results.?The percentage of CCR5+CD3+CD4+ cells was lower in women (mean, 12%) than men (mean, 16%; P = .034). Neither the percentage of CCR5+CD3+CD4+ cells nor the CCR5 density predicted viral load or HIV-1 RNA–producing lymph node cells (P ? .24), after adjusting for CD4+ T-cell count, race, and age. Women had marginally fewer HIV-1 RNA–producing cells (mean, 0.21 cells/mm2) than men (mean, 0.44 cells/mm2; P = .046). After adjusting for the frequency of HIV-1 RNA–producing cells and potential confounders, the viral load in women were 0.46 log10 copies/mL lower than that in men (P = .018). Conclusions.?Reduced lymph node CCR5 expression in women did not account for the viral load difference between sexes. CCR5 expression did not predict viral load or frequencies of HIV-1 RNA–producing cells, indicating that physiologic levels of CCR5 do not limit HIV-1 replication in lymph node. Less plasma virus was associated with each HIV-1 RNA–producing cell in women as compared to men, suggesting that women may either produce fewer virions per productively infected cell or more effectively clear extracellular virus. PMID:24179109

  14. Chronic amiodarone ingestion induces pulmonary toxicity in rats.

    PubMed

    Carvalho, C R; Kairalla, R A; Capelozzi, V L; Amato, M B; Saldiva, P H

    1996-06-01

    Patients who receive amiodarone may develop interstitial pulmonary disease. The objective of the present study was to develop an experimental model of interstitial pulmonary disease in rats based on the chronic oral administration of amiodarone diluted in water ad libitum. A total of 97 three-month old male Wistar rats weighing 133-167 g (control and intoxicated) were studied after daily administration of amiodarone (about 50 mg/kg) for 3 weeks and 3, 6, and 13 months. We carried out conventional histopathologic evaluation, morphometric studies of the alveolar wall, transmission electron microscopy, measurement of pulmonary volumes and forced expiratory flows, and computed respiratory system resistance and elastance during spontaneous breath cycles. Chronic ingestion of amiodarone by rats produced pulmonary disease that started as a phospholipidosis, as early as 3 weeks after the use of the drug. After 6, and mainly after 13 months, a focal inflammatory reaction with reactive alveolar epithelium was observed. Signals of a concomitant repair process were also present, but fibrosis was visible only by electron microscopy. The physiologic dysfunction could be identified after 13 months; expiratory flow (ml/sec) limitation and an increased respiratory system elastance (cmH2O/ml) were the main functional changes, respectively 10.8 (forced expiratory mean flow between 0-25% of forced vital capacity) and 5.36 in treated animals vs 13.3 and 3.65 in controls, reported as mean +/- SD for 6 animals in each group. A body of evidence suggests that amiodarone may cause changes in lung phospholipid metabolism that may be responsible for a part of the functional derangement observed in this study. PMID:9070391

  15. Statins for Treatment of Pulmonary Hypertension

    Microsoft Academic Search

    John L. Faul; Peter N. Kao; Toshihiko Nishimura; Arthur Sung; Hong Hu; Ronald G. Pearl

    By virtue of their multiple actions, including anti-inflammatory, antiproliferative, and pro-apoptotic traits and the ability\\u000a to restore endothelial vasoactive mediator production, statins have been proposed as potential therapies for pulmonary hypertension.\\u000a In experimental studies in rats with pulmonary hypertension induced either by either monocrotaline or hypoxia, statins have\\u000a blunted the severity of pulmonary hypertension, right ventricular hypertrophy, and pulmonary vascular

  16. Group B streptococcal phospholipid causes pulmonary hypertension

    NASA Astrophysics Data System (ADS)

    Curtis, Jerri; Kim, Geumsoo; Wehr, Nancy B.; Levine, Rodney L.

    2003-04-01

    Group B Streptococcus is the most common cause of bacterial infection in the newborn. Infection in many cases causes persistent pulmonary hypertension, which impairs gas exchange in the lung. We purified the bacterial components causing pulmonary hypertension and identified them as cardiolipin and phosphatidylglycerol. Synthetic cardiolipin or phosphatidylglycerol also induced pulmonary hypertension in lambs. The recognition that bacterial phospholipids may cause pulmonary hypertension in newborns with Group B streptococcal infection opens new avenues for therapeutic intervention.

  17. Sleep in Patients With Pulmonary Disease

    Microsoft Academic Search

    Susan M. Harding

    Sleep complaints are very prevalent in the patients with pulmonary disease. This review will examine sleep effects on respiration,\\u000a explore ventilatory responses during sleep in normal individuals, and examine mechanisms of hypoxemia in patients with pulmonary\\u000a disease. Sleep disorders in patients with obstructive pulmonary diseases, including chronic obstructive pulmonary disease\\u000a (COPD), cystic fibrosis (CF), asthma, and restrictive parenchymal disease will

  18. Sentinel lymph node biopsy in head and neck melanoma*

    PubMed Central

    GIUDICE, G.; LEUZZI, S.; ROBUSTO, F.; RONGHI, V.; NACCHIERO, E.; GIARDINELLI, G.; DI GIOIA, G.; RAGUSA, L.; PASCONE, M.

    2014-01-01

    Aim The purpose of this study is to evaluate prognosis and surgical management of head and neck melanoma (HNM) and the accuracy of sentinel lymph node biopsy (SLNB). Patients and Methods All patients with a primary cutaneous melanoma treated starting from 01/07/1994 to 31/12/2012 in the department of Plastic and Reconstructive Surgery of Bari are included in a electronic clinical medical registry. Within the 90th day from excision of the primary lesion all patients with adverse prognostic features underwent SLNB. All patients with positive findings underwent lymphadenectomy. Results out of 680 patients affected by melanoma, 84 (12.35%) had HNM. In the HNM cohort lymphoscintigraphy was performed in 57 patients, 15 of which (26.3%) were positive. The percentage of unfound sentinel lymph node was similar both to the HNM group (5,26%) and to patients with melanoma of different sites (OMS 4,92%). There was a recurrence of disease after negative SLNB (false negatives) only in 4 cases. Recurrence-free period and survival rate at 5 years were worse in HNM cohort. Conclusion SLNB of HNM has been for a long time contested due to its complex lymphatic anatomy, but recent studies agreed with this technique. Our experience showed that identification of sentinel lymph node in HNM cohort was possible in 98.25% of cases. Frequency of interval nodes is significantly higher in HNM group. The prognosis of HNM cohort is significantly shorter than OMS one. Finally, this procedure requires a multidisciplinary team in referral centers. PMID:24979109

  19. Methylation signature of lymph node metastases in breast cancer patients

    PubMed Central

    2012-01-01

    Background Invasion and metastasis are two important hallmarks of malignant tumors caused by complex genetic and epigenetic alterations. The present study investigated the contribution of aberrant methylation profiles of cancer related genes, APC, BIN1, BMP6, BRCA1, CST6, ESR-b, GSTP1, P14 (ARF), P16 (CDKN2A), P21 (CDKN1A), PTEN, and TIMP3, in the matched axillary lymph node metastasis in comparison to the primary tumor tissue and the adjacent normal tissue from the same breast cancer patients to identify the potential of candidate genes methylation as metastatic markers. Methods The quantitative methylation analysis was performed using the SEQUENOM’s EpiTYPER™ assay which relies on matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Results The quantitative DNA methylation analysis of the candidate genes showed higher methylation proportion in the primary tumor tissue than that of the matched normal tissue and the differences were significant for the APC, BIN1, BMP6, BRCA1, CST6, ESR-b, P16, PTEN and TIMP3 promoter regions (P<0.05). Among those candidate methylated genes, APC, BMP6, BRCA1 and P16 displayed higher methylation proportion in the matched lymph node metastasis than that found in the normal tissue (P<0.05). The pathway analysis revealed that BMP6, BRCA1 and P16 have a role in prevention of neoplasm metastasis. Conclusions The results of the present study showed methylation heterogeneity between primary tumors and metastatic lesion. The contribution of aberrant methylation alterations of BMP6, BRCA1 and P16 genes in lymph node metastasis might provide a further clue to establish useful biomarkers for screening metastasis. PMID:22695536

  20. Consensus on the regional lymph nodes irradiation in breast cancer.

    PubMed

    Bayo, E; Herruzo, I; Arenas, M; Algara, M

    2013-10-01

    Standard locoregional treatment of early-stage breast cancer currently consists of the conservative surgery and sentinel lymph node biopsy. In the event of positive sentinel node biopsy, an axillary level I-II lymphadenectomy should be carried out. However, recent publications have increasingly supported a tendency not to apply the surgical lymphadenectomy, but simultaneously, it has been developed a new role of regional radiotherapy, even if there is only 1-3 axillary lymph nodes involved. Given these new trends, radiation oncologists are facing the dilemma with regard to deciding about regional irradiation of breast cancer. For such purpose, The Spanish Group of Breast Cancer Radiation Oncology (GEORM as per its Spanish acronym) decided to reach a consensus to issue the respective guidelines for such types of cases. GEORM Managing Commission, gathering 13 members of different Spanish regional communities, issued a questionnaire including different clinical situations. These questions were set as key questions seeking responses, which were answered by 66 % out of the 75 members of the group. Following the response, the guidelines were drafted based on the replies to the mentioned questionnaire. All the respective issues were discussed by means of a virtual platform. In this article, we show the levels of consensus for different clinical situations, depending on the number of nodes involved and the type of surgical procedure performed on the axillary lymph nodes. The ongoing evolution of the oncological treatments obliges the radiation oncologists to take decisions without any existing clarifying evidence, and therefore, the consensus is necessary, which can assist in the decision-making process by the practitioners in such kinds of clinical situations. PMID:23519538