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Sample records for pulmonary lymph flow

  1. Mechanobiological oscillators control lymph flow

    PubMed Central

    Kunert, Christian; Baish, James W.; Liao, Shan; Padera, Timothy P.; Munn, Lance L.

    2015-01-01

    The ability of cells to sense and respond to physical forces has been recognized for decades, but researchers are only beginning to appreciate the fundamental importance of mechanical signals in biology. At the larger scale, there has been increased interest in the collective organization of cells and their ability to produce complex, “emergent” behaviors. Often, these complex behaviors result in tissue-level control mechanisms that manifest as biological oscillators, such as observed in fireflies, heartbeats, and circadian rhythms. In many cases, these complex, collective behaviors are controlled—at least in part—by physical forces imposed on the tissue or created by the cells. Here, we use mathematical simulations to show that two complementary mechanobiological oscillators are sufficient to control fluid transport in the lymphatic system: Ca2+-mediated contractions can be triggered by vessel stretch, whereas nitric oxide produced in response to the resulting fluid shear stress causes the lymphatic vessel to relax locally. Our model predicts that the Ca2+ and NO levels alternate spatiotemporally, establishing complementary feedback loops, and that the resulting phasic contractions drive lymph flow. We show that this mechanism is self-regulating and robust over a range of fluid pressure environments, allowing the lymphatic vessels to provide pumping when needed but remain open when flow can be driven by tissue pressure or gravity. Our simulations accurately reproduce the responses to pressure challenges and signaling pathway manipulations observed experimentally, providing an integrated conceptual framework for lymphatic function. PMID:26283382

  2. Mechanobiological oscillators control lymph flow.

    PubMed

    Kunert, Christian; Baish, James W; Liao, Shan; Padera, Timothy P; Munn, Lance L

    2015-09-01

    The ability of cells to sense and respond to physical forces has been recognized for decades, but researchers are only beginning to appreciate the fundamental importance of mechanical signals in biology. At the larger scale, there has been increased interest in the collective organization of cells and their ability to produce complex, "emergent" behaviors. Often, these complex behaviors result in tissue-level control mechanisms that manifest as biological oscillators, such as observed in fireflies, heartbeats, and circadian rhythms. In many cases, these complex, collective behaviors are controlled--at least in part--by physical forces imposed on the tissue or created by the cells. Here, we use mathematical simulations to show that two complementary mechanobiological oscillators are sufficient to control fluid transport in the lymphatic system: Ca(2+)-mediated contractions can be triggered by vessel stretch, whereas nitric oxide produced in response to the resulting fluid shear stress causes the lymphatic vessel to relax locally. Our model predicts that the Ca(2+) and NO levels alternate spatiotemporally, establishing complementary feedback loops, and that the resulting phasic contractions drive lymph flow. We show that this mechanism is self-regulating and robust over a range of fluid pressure environments, allowing the lymphatic vessels to provide pumping when needed but remain open when flow can be driven by tissue pressure or gravity. Our simulations accurately reproduce the responses to pressure challenges and signaling pathway manipulations observed experimentally, providing an integrated conceptual framework for lymphatic function. PMID:26283382

  3. Peculiarities of lymph flow in microvessels

    NASA Astrophysics Data System (ADS)

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

    2000-05-01

    In the present study the characteristics of lymph flow in microvessels are investigated in vivo by the speckle- interferometrical and biomicroscopic methods. Two parameters of the lymph flow velocity are determined. The first frequency-weighted spectral moment of Doppler signal (M1) was calculated. This parameter is proportional to lymph flow velocity. In the same regions of lymphatics the velocity of translational motion of the signal lymphocytes in the flow is assessed. The value of velocity and the parameter M1 essentially varied. The temporary dynamics of M1 indicated that the lymph flow had the alternating- translational character. Simultaneously the diameter of lymph microvessel, the amplitude and the rate of phasic contraction and the rate of valve functioning are registered. NG-nitro-L-arginine (L-NNA, 10-4 M), an inhibitor of nitric oxide synthase, is topically applied during 15 min. The application of L-NNA provoked the modulation of alternating-translational motion of lymph flow, the changes of diameters and rate of valve function and the stimulating of phasic contractions and the correlation between parameters of lymph microcirculation.

  4. Lymph-flow diagnostics using speckle microscopy

    NASA Astrophysics Data System (ADS)

    Bednov, Andrey A.; Tuchin, Valery V.; Ulyanov, Sergey S.; Brill, Gregory E.; Galanzha, Ekateryna I.

    1996-01-01

    In the present paper speckle-interferometrical technique utilizing strongly focused Gaussian beam (SFGB) diffraction has been proposed for the analysis of microcirculatory parameters. The method has been applied for the investigation of lymph motion characteristics in microvessels in vivo. Spectra of scattered intensity fluctuations in the statistically inhomogeneous speckles formed at the diffraction in lymph microvessels have been presented. It has been shown that the alterations of the spectra envelope depend on peculiarities of lymph motion in microvessels. Physical parameters of determination both of temporal changes of a mean velocity and of spatial-temporal velocity distribution in lymph microvessels have been proposed. An application of lymphotropic drug on the lymph microvessels has been studied. Temporal changes of lymph flow parameters have been analyzed in the paper.

  5. Splenic regulation of the murine pulmonary lymph node response.

    PubMed Central

    Allen, E M; Abramoff, P; Fink, J N; Calvanico, N J

    1987-01-01

    Exposure to intratracheal immunization and aerosolization with soluble antigen plus murmayl-dipeptide (MDP) induces the development of plaque-forming cells in the pulmonary draining lymph nodes of two of three inbred mouse strains. Splenectomy before immunization led to a heightened plaque-forming cell response in the two responder mouse strains. Adoptive transfer of spleen cells from one strain exposed to sperm whale myoglobin via the respiratory tract revealed the presence of antigen-specific suppressor cells. These observations suggest that the spleen may play a role in the down-regulation of an immune response elicited in the pulmonary draining lymph nodes by exposure of the respiratory tract to soluble antigens plus MDP. PMID:3308230

  6. Reduction of lymph tissue false positives in pulmonary embolism detection

    NASA Astrophysics Data System (ADS)

    Ghanem, Bernard; Liang, Jianming; Bi, Jinbo; Salganicoff, Marcos; Krishnan, Arun

    2008-03-01

    Pulmonary embolism (PE) is a serious medical condition, characterized by the partial/complete blockage of an artery within the lungs. We have previously developed a fast yet effective approach for computer aided detection of PE in computed topographic pulmonary angiography (CTPA),1 which is capable of detecting both acute and chronic PEs, achieving a benchmark performance of 78% sensitivity at 4 false positives (FPs) per volume. By reviewing the FPs generated by this system, we found the most dominant type of FP, roughly one third of all FPs, to be lymph/connective tissue. In this paper, we propose a novel approach that specifically aims at reducing this FP type. Our idea is to explicitly exploit the anatomical context configuration of PE and lymph tissue in the lungs: a lymph FP connects to the airway and is located outside the artery, while a true PE should not connect to the airway and must be inside the artery. To realize this idea, given a detected candidate (i.e. a cluster of suspicious voxels), we compute a set of contextual features, including its distance to the airway based on local distance transform and its relative position to the artery based on fast tensor voting and Hessian "vesselness" scores. Our tests on unseen cases show that these features can reduce the lymph FPs by 59%, while improving the overall sensitivity by 3.4%.

  7. High-sensitivity optical lymph flow-meter.

    PubMed

    Sorensen, O; Engeset, A; Olszewski, W I; Lindmo, T

    1982-03-01

    An optical flow-meter is described which allows precise and continuous registration of the flow of lymph from cannulated human lymph vessels. The cannula from the lymph vessel is connected to the measurement tubing of the instrument where the flow is measured by automatically monitoring the movement of an air bubble introduced into the flow at the beginning of the measurement. The limit of sensitivity of the instrument is about 0.1 microliter, allowing reliable registration of stroke volumes of about 1 microliter which typically occur in human leg lymphatics. The size and capacity of the instrument were chosen to be suitable for clinical use. A technical description of the instrument is given. Application of the instrument is illustrated with recording of lymph flow and lateral intralymphatic pressure in a prenodal lymph vessel of the human leg. PMID:6461802

  8. Laser speckle technique for monitoring of blood and lymph flow

    NASA Astrophysics Data System (ADS)

    Fedosov, Ivan V.; Tuchin, Valery V.

    2004-07-01

    Laser speckle technique developed for monitoring of micro scale blood and lymph flows is described and discussed. It is based on the space-time correlation properties of dynamic speckle field formed by coherent light scattered by capillary flow of blood or lymph. As it was proved experimentally, the estimating of cross-correlation of speckle-field intensity fluctuations recorded in two different point allows for measurement of flow velocity and flow direction discrimination. Developed technique was applied for investigation of push-pull dynamics of lymph flow in rat mesentery. The results of experiments with models of bioflows and in vivo measurements are presented.

  9. Investigation of lymph flow dynamics using methods of speckle interferometry

    NASA Astrophysics Data System (ADS)

    Bednov, Andrey A.; Ulyanov, Sergey S.; Tuchin, Valery V.; Brill, Gregory E.; Galanzha, Ekateryna I.

    1997-06-01

    For some human diseases both the blood and lymph microcirculation parameters change. These parameters are of great importance in diagnostics. As distinct from blood flow from the lymph motion is more complicated and diverse. Lymph flow in microvessels is non-stationary and randomly varies in time. At present, the existing measuring methods of these flows are not fully developed and are mostly of qualitative character. In this paper the blood and the lymph motion have been considered from the viewpoint of nonlinear dynamics. The speckle-interferometric method has been proposed for the investigation of the dynamic characteristics of biofluids. The method has been applied in the investigation of blood and lymph flows in microvessels. Using the method of the focused Gaussian beam diffraction, the following parameters were defined: V that is the value characterizing the time- averaged velocity of biofluid and (Sigma) V that is the parameter indicating the deviation degree of the spectral envelope from the Gaussian curve. The value of (Sigma) V contains an information about the velocity range in the flow and, besides, indicates the spatial-temporal velocity changes in region being investigated. Investigations of the lymph flow dynamics also have been carried out under the influence of the lymphotropic agent. It has been shown that lymph vessels may act at different stages when both the structure of the lymph flow and its temporal dynamics change qualitatively.

  10. Lymph flow pattern in the intact thoracic duct in sheep.

    PubMed Central

    Onizuka, M; Flateb, T; Nicolaysen, G

    1997-01-01

    1. To study the lymph flow dynamics in the intact thoracic duct, we applied an ultrasound transit-time flow probe in seven anaesthetized and four unanaesthetized adult sheep (approximately 60 kg). In unanaesthetized non-fasting animals we found that lymph flow in the thoracic duct was always regular pulsatile (pulsation frequency, 5.2 +/- 0.8 min-1) with no relation to heart or respiratory activity. At baseline the peak level of the thoracic duct pulse flow was 11.6-20.7 ml min-1 with a nadir of 0-3.6 ml min-1. Mean lymph flow was 5.4 +/- 3.1 ml min-1. The flow pattern of lymph in the thoracic duct was essentially the same in the anaesthetized animals. 2. In both the anaesthetized and unanaesthetized animals, the lymph flow response to a stepwise increase in the outflow venous pressure showed interindividual variation. Some were sensitive to any increase in outflow venous pressure, but others were resistant in that lymph flow did not decrease until outflow venous pressure was increased to higher levels. This resistance was also observed in the high lymph flow condition produced by fluid infusion in the anaesthetized animal and mechanical constriction of the caudal vena cava in the unaesthetized animals. Pulsation frequency of the thoracic duct flow initially increased and then decreased with a stepwise increase in the outflow venous pressure. This initial increase might be a compensatory response to maintain lymph flow against elevated outflow venous pressure. 3. To test the effect of long-term outflow venous pressure elevation in unanaesthetized sheep, outflow venous pressure was increased by inflation of a cuff around the cranial vena cava for 1, 5 or 25 h. The cuff was inflated to a level where lymph flow was reduced. Lymph flow remained low or decreased further during the entire cuff-inflation period. We calculated the lymph debt caused by the outflow venous pressure elevation and the amount 'repaid' when venous pressure returned to normal. Lymph debt for 25 h was 6400 ml but only 200 ml was repaid. Since we observed no visible oedema formation in the lower body of the sheep, the non-colloidal components of the lymph must have been reabsorbed into the bloodstream, most likely in the lymph nodes. PMID:9288690

  11. Imaging of lymph flow in single microvessels in vivo

    NASA Astrophysics Data System (ADS)

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

    2000-10-01

    In this study parameters of lymph microcirculation are investigated. The microcirculation was studied on small intestine mesentery in norm and during Dimethyl sulfoxide (DMSO) application. The direct measurement of lymph flow velocity (parameter V) in individual microvessels was based on the technique of light intravital videomicroscopy. The first spectral moments of Doppler signal, characterizing the mean velocities of lymph flow in microvessels (parameter M1), were measured by speckle-interferometrical method. Simultaneously, diameters of lymph microvessels as well as parameters of phasic contractions and valve function of lymphatics were registered. The value of V was very changeable; the mean V was equal to 270+/- 24micrometers /s. The M1 was the varying characteristic of the lymph flow too. The temporal dynamic of M1 was reflected alternating- translation motion of lymph flow. DMSO application during 15 min caused the constriction in a majority of lymphatics and the phasic contractions. DMSO induced lymphostatis in 20% of cases. But the other microvessels responded to the rise of lymph flow velocity. These changes led to the stimulation of drainage function of lymph microcirculation function.

  12. Investigation of lymph flow characteristics using speckle-interferometrical method

    NASA Astrophysics Data System (ADS)

    Bednov, A. A.; Tuchin, Valery V.; Brill, Gregory E.; Galanzha, Ekateryna I.; Ulyanov, Sergey S.

    2001-07-01

    The measuring method of microcirculatory parameters using strongly focused Gaussain beam (SFGB) diffraction phenomenon has been proposed in this paper. The method has been applied for the investigation of lymph flow characteristics in microvessels in vivo. Intensity, fluctuation spectra of a scattered field which are the result of laser beam diffraction in lymph vessels have been presented in the paper. It has been shown that the alterations of spectra shape depend on peculiarities of lymph motion in microvessels. Physical parameters of determination both of temporal changes of mean velocity and of spatial-temporal velocity distribution in lymph microvessels have been proposed. An action of lymphotropic drug on the lymph flow parameters have been studied.

  13. Speckle diagnostics and biomicroscopy of lymph flow in microvessels

    NASA Astrophysics Data System (ADS)

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

    2001-08-01

    In the present study speckle-interferometry and TV intravital biomicroscopy techniques has been proposed for the analysis of microcirculatory parameters. The power spectra of fluctuation of intensity, scattered by these vessels, have a complicated shape. The mean value of first spectral movement M1 (which is assumed to be directly proportional to average velocity) in lymphatics with spontaneous contractions differ from vessels without phasic activity. We register two types of histogram of M1 in contracting and non-contracting vessels. The phasic contractions may be caused by the modification of lymph flow in microvessels and/or by the changes of the speckle signal values. An application of lymphotropic drugs (staphylococcal toxin, N-nitro-L-arginine and dimethyl sufoxide) on the lymph microvessels has been investigated. The study of lymph flow by two methods (intravital TV biomicroscopy and speckle-interferometry) allows to determine the ways of the action of vasoactive drugs on lymph flow.

  14. Effects of NO/sub 2/ on immune responses in pulmonary lymph of sheep

    SciTech Connect

    Joel, D.D.; Chandra, P.; Chanana, A.D.

    1982-08-01

    Sheep in which the efferent duct of the caudal mediastinal lymph node was cannulated were exposed to 5 ppm NO/sub 2/, 1.5 h/d for 10 or 11 d. Immune responses were assessed by measuring the daily output of hemolytic plaque-forming cells (PFC) in pulmonary lymph, following intrabronchial immunization with horse red blood cells (HRBC) and phytohemagglutinin- (PHA) induced transformation of blood and pulmonary lymph lymphocytes. Sheep immunized 2 d after termination of NO/sub 2/ exposure had reduced outputs of PFC as compared to those seen in sheep challenged 4 d after NO/sub 2/ exposure. Animals immunized 4 d after NO/sub 2/ exposure had outputs similar to those of air control sheep.A reduction of 38-87% in the transformation index of both blood and pulmonary lymph lymphocytes was observed in sheep exposed to NO/sub 2/. These results suggest that intermittent, short-term exposure to 5 ppm NO/sub 2/ may temporarily alter pulmonary immune responsiveness.

  15. Analysis of lymph flow in microvessels by biomicroscopic and coherent optical methods

    NASA Astrophysics Data System (ADS)

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

    2000-04-01

    The lymph flow velocity in microvessels of rat mesentery was investigated by using biomicroscopic manual frame-by-frame technique with image processing system and speckle- interferometrical method. Lymph flow was observed in the majority of lymphatics. Lymph flow was registered in microvessels with phasic contractions and functioning valves. The lymphocytes motion in flow was measured. It was established that mean lymph flow velocity increased in vessels with phasic contractions and moderate concentration of lymphocytes in flow. The application of speckle- interferometry allowed us to estimate lymph flow on the whole with all stops, the increases and decreases of flow velocity. The parameters both of changes of a mean velocity and of spatial-temporal velocity distribution in lymph flow were calculated. Temporal changes of the parameter V showed a shuttle-type character of lymph flow velocity.

  16. Optical properties of lymph flow in single microvessels: biomicroscopic, speckle-interferometric, and spectroscopic measurements

    NASA Astrophysics Data System (ADS)

    Galanzha, Ekateryna I.; Tuchin, Valery V.; Ulyanov, Sergey S.; Solov'eva, Anastasiya V.; Luo, Qingming; Cheng, Haiying

    2001-10-01

    The lymph flow diagnostics in microvessels of rat mesentery were performed using light biomicroscopy, speckle- interferometry and spectroscopy. By light microscopy method we have got the dynamic of microvessels images in real time and registered phasic contractions and valve function of lymphatics, lymph and blood flow. The mean velocity of lymph flow was the highest at the moderate number of lymphocytes in flow. We had found the close links between phasic contractions, valve activity and lymph flow intensity. The high-resolution speckle-microscopy quickly gives much information about average lymph flow velocity, but only the relative value of velocity can be estimated. The phasic contractions cause the changes of the speckle signals and led to the modification of lymph flow in microvessels. The reflectance spectra characterize functional state of lymphatics and lymph flow in microvessels.

  17. A rare case of pulmonary sclerosing hemagioma with lymph node metastasis and review of the literature

    PubMed Central

    Xu, Hai-Miao; Zhang, Gu

    2015-01-01

    Pulmonary sclerosing hemagioma (SH) is an uncommon tumor with malignance potential. Clinically this disease is regarded as benign but extremely rare cases can have lymph node metastasis. Up to date, there have been only very few reports concerning SH with lymph node metastasis. In this paper we reported one pulmonary SH case with lymph node metastasis and additionally overviewed the clinical and pathological features of SH. A young-aged female was found incidentally to have a nodule in the right upper lung. This patient presented no cough, no hemoptysis and chest pain. Computed tomography (CT) scan indicated a large mass in the right upper lung and enlarged lymph nodes in the right hilum. The patient underwent lobectomy of the right upper lung. Histologically, the tumor demonstrated typical features of SH and was consisted of angiomatoid areas, sclerosis, papillary structures lined with cuboidal cells and sheets of round to polygonal cells. Polygonal cells in some solid areas presented abnormal enlarged nuclei and increased karyoplasmic ratio; tumor giant cells were noted; whereas mitosis was not observed. One peribronchial lymph node was noted for SH metastasis and the metastatic tissue were consisted of polygonal cells. Immunohistochemistry (IHC) revealed that both surface-lining cuboidal and polygonal cells expressed EMA and thyroid transcription factor 1 (TTF-1), but were negative for CD34, VIII factor, CD68 and Claratinin. The polygonal cells showed relatively higher expression of Ki-67 and p53 than the surface-lining cells. Postoperatively, the patient received no chemotherapy or radiotherapy and no recurrence 2 years after surgery was noted. PMID:26339444

  18. Thymus and pulmonary lymph node response to acute and subchronic ozone inhalation in the mouse

    SciTech Connect

    Dziedzic, D.; White, H.J.

    1985-12-01

    Ozone is an oxidant gas which primarily injures the centroacinar portion of the lung. While the classical lesion of oxidant-mediated lung damage is relatively well described, the effect of this form of injury on the lymphocytic arm of the pulmonary defense system is less clear. In the present experiments Cd-1 female mice were exposed to ozone at a level of 0.7 ppm for 20 hr per day for 1-28 days and the lymphocyte response was observed in the pulmonary lymph nodes and the thymus. In the mediastinal lymph nodes a marked hyperplastic response was observed that was prominent in the paracortex and was characterized by the presence of blastic forms. In contrast, the thymus underwent an atrophic response characterized by cellular loss in the cortical region. Prior surgical adrenalectomy of ozone-exposed animals eliminated part, but not all of the thymic atrophy response, indicating that adrenal-mediated stress alone did not account for all the observed effect. Thymectomy of animals prior to ozone exposure produced a 40% reduction in the mediastinal lymph node response, suggesting that a part of the node hyperplasia is thymus dependent. The results of these experiments indicate that lymphoid organs are altered following oxidant-mediated lung damage in the mouse. The changes are observed in the absence of exogenous antigenic stimulation and suggest that lymphoid cells are in integral aspect of the host response to high-level ozone inhalation.

  19. Lymph flow regulates collecting lymphatic vessel maturation in vivo

    PubMed Central

    Sweet, Daniel T.; Jiménez, Juan M.; Chang, Jeremy; Hess, Paul R.; Mericko-Ishizuka, Patricia; Fu, Jianxin; Xia, Lijun; Davies, Peter F.; Kahn, Mark L.

    2015-01-01

    Fluid shear forces have established roles in blood vascular development and function, but whether such forces similarly influence the low-flow lymphatic system is unknown. It has been difficult to test the contribution of fluid forces in vivo because mechanical or genetic perturbations that alter flow often have direct effects on vessel growth. Here, we investigated the functional role of flow in lymphatic vessel development using mice deficient for the platelet-specific receptor C-type lectin–like receptor 2 (CLEC2) as blood backfills the lymphatic network and blocks lymph flow in these animals. CLEC2-deficient animals exhibited normal growth of the primary mesenteric lymphatic plexus but failed to form valves in these vessels or remodel them into a structured, hierarchical network. Smooth muscle cell coverage (SMC coverage) of CLEC2-deficient lymphatic vessels was both premature and excessive, a phenotype identical to that observed with loss of the lymphatic endothelial transcription factor FOXC2. In vitro evaluation of lymphatic endothelial cells (LECs) revealed that low, reversing shear stress is sufficient to induce expression of genes required for lymphatic valve development and identified GATA2 as an upstream transcriptional regulator of FOXC2 and the lymphatic valve genetic program. These studies reveal that lymph flow initiates and regulates many of the key steps in collecting lymphatic vessel maturation and development. PMID:26214523

  20. Lymph flow regulates collecting lymphatic vessel maturation in vivo.

    PubMed

    Sweet, Daniel T; Jimnez, Juan M; Chang, Jeremy; Hess, Paul R; Mericko-Ishizuka, Patricia; Fu, Jianxin; Xia, Lijun; Davies, Peter F; Kahn, Mark L

    2015-08-01

    Fluid shear forces have established roles in blood vascular development and function, but whether such forces similarly influence the low-flow lymphatic system is unknown. It has been difficult to test the contribution of fluid forces in vivo because mechanical or genetic perturbations that alter flow often have direct effects on vessel growth. Here, we investigated the functional role of flow in lymphatic vessel development using mice deficient for the platelet-specific receptor C-type lectin-like receptor 2 (CLEC2) as blood backfills the lymphatic network and blocks lymph flow in these animals. CLEC2-deficient animals exhibited normal growth of the primary mesenteric lymphatic plexus but failed to form valves in these vessels or remodel them into a structured, hierarchical network. Smooth muscle cell coverage (SMC coverage) of CLEC2-deficient lymphatic vessels was both premature and excessive, a phenotype identical to that observed with loss of the lymphatic endothelial transcription factor FOXC2. In vitro evaluation of lymphatic endothelial cells (LECs) revealed that low, reversing shear stress is sufficient to induce expression of genes required for lymphatic valve development and identified GATA2 as an upstream transcriptional regulator of FOXC2 and the lymphatic valve genetic program. These studies reveal that lymph flow initiates and regulates many of the key steps in collecting lymphatic vessel maturation and development. PMID:26214523

  1. Pulmonary Langerhans cell histiocytosis with cervical lymph node involvement, and coexistence with pulmonary tuberculosis and right pneumothorax: a case report and review of literature

    PubMed Central

    Gao, Limin; Li, Huifang; Li, Gandi; Liu, Weiping; Li, Jinnan; Zhang, Wenyan

    2015-01-01

    We report an uncommon 22-year-old male Pulmonary Langerhans Cell Histiocytosis (PLCH) case which co-existed with pulmonary tuberculosis (TB). Unlike the common PLCH cases, this PLCH case has cervical lymph node involvement and right pneumothorax. The diagnosis was established by the imaging of lung and the biopsies of the lung and left neck lymph node. Imaging of the chest showed characteristic small nodules and thin-walled cysts and right pneumothorax. The LCH cells in the lung and left neck lymph node were characterized by large convoluted nuclei with cerebriform indentations of the nuclear envelope and longitudinal grooves. The nuclei contained small eosinophilic nucleoli and moderate amount cytoplasm. Immunohistochemically, the histiocytoid cells were positive for Langerin, CD1a and S-100. Acid-fast bacilli were found in sputum and lung biopsy tissue. To the best of our knowledge, this is the first case of PLCH with cervical lymph node involvement, and coexisted with pulmonary tuberculosis, right pneumothorax. A contribution of this case and review three of the five cases of PLCH with extrapulmonary involvement to lymph nodes resolved spontaneously after smoking cessation constitute a novel addition that it is inappropriate to regard pulmonary/nodal LCH as multi-organ or disseminated disease, and the treatment methods are the same whether the PLCH patient with lymph node involvement or not. PMID:25973117

  2. Mesenteric lymph flow in adult and aged rats.

    PubMed

    Akl, Tony J; Nagai, Takashi; Coté, Gerard L; Gashev, Anatoliy A

    2011-11-01

    The objective of study was to evaluate the aging-associated changes, contractile characteristics of mesenteric lymphatic vessels (MLV), and lymph flow in vivo in male 9- and 24-mo-old Fischer-344 rats. Lymphatic diameter, contraction amplitude, contraction frequency, and fractional pump flow, lymph flow velocity, wall shear stress, and minute active wall shear stress load were determined in MLV in vivo before and after N(ω)-nitro-L-arginine methyl ester hydrochloride (L-NAME) application at 100 μM. The active pumping of the aged rat MLV in vivo was found to be severely depleted, predominantly through the aging-associated decrease in lymphatic contractile frequency. Such changes correlate with enlargement of aged MLV, which experienced much lower minute active shear stress load than adult vessels. At the same time, pumping in aged MLV in vivo may be rapidly increased back to levels of adult vessels predominantly through the increase in contraction frequency induced by nitric oxide (NO) elimination. Findings support the idea that in aged tissues surrounding the aged MLV, the additional source of some yet unlinked lymphatic contraction-stimulatory metabolites is counterbalanced or blocked by NO release. The comparative analysis of the control data obtained from experiments with both adult and aged MLV in vivo and from isolated vessel-based studies clearly demonstrated that ex vivo isolated lymphatic vessels exhibit identical contractile characteristics to lymphatic vessels in vivo. PMID:21873496

  3. Pulmonary blood flow distribution after banding of pulmonary artery.

    PubMed Central

    Samnek, M; Fiser, B; Ruth, C; T?ma, S; Hucn, B

    1975-01-01

    Radioisotope lung scanning was used to investigate the distribution of pulmonary blood flow after banding of the pulmonary artery in children with a left-to-right shunt and pulmonary hypertension. An abnormal distribution of blood flow in the lung on the side of the operation approach was observed in all patients in the first three weeks following surgery. Abnormalities were still observed in 17 of 21 children 10 months to more than 8 years after the banding operation. There was no significant relation between the occurrence of these abnormalities and time after surgery. Diminished flow to the zones of the right lung was observed less frequently. The incidence of abnormalities in flow distribution was also high preoperatively. Respiratory complications in infants with large left-to-right shunts were considered to be responsible for most of the abnormal blood flow distributions observed. Radioactive lung scanning was found to be a valuable diagnostic method in the early and late postoperative period in infants and small children. It was more sensitive than the other techniques used in revealing deviation of blood flow from one lung in those cases with shifting of the applied band. Images PMID:1111558

  4. Biomedical applications of coherent-optical methods for the analysis of lymph flow in microvessels

    NASA Astrophysics Data System (ADS)

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

    2001-10-01

    In the present study the characteristics of lymph microcirculation are investigated. The lymph microcirculation was studied on small intestine mesentery during NG=nitro=L-arginine (L-NNA) application on intact microvessels and after stress. The direct measurement of lymph flow velocity (parameter V) in individual microvessels was based on the technique of light intravital videomicroscopy. The first spectral moments of Doppler signal characterizing the mean velocities of lymph flow in microvessels (parameters M1) were measured by the laser- speckle method. Simultaneously, diameters of lymph microvessels as well as parameters of phasic contractions and valve functioning were registered.

  5. Speckle diagnostics of shuttle-stream lymph and blood flows

    NASA Astrophysics Data System (ADS)

    Bednov, Andrey A.; Ulyanov, Sergey S.; Tuchin, Valery V.; Brill, Gregory E.; Galanzha, Ekateryna I.

    1996-05-01

    The theoretical and experimental investigations of the focused Gaussian beam (FGB) diffraction both in blood and lymph microvessels have been carried out. Speckle- interferometrical technique with the spectral analysis of scattered light intensity fluctuations has been applied for the investigation of lymph circulation in native microvessels. The measuring errors of bioflow velocity has been analyzed. Alterations caused by the drug influence on lymph vessels have been studied. Doppler method using FGB scattering is considered theoretically and experimentally.

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

    SciTech Connect

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

    1984-01-01

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

  7. Investigation of statistical properties of lymph-flow dynamics using speckle microscopy

    NASA Astrophysics Data System (ADS)

    Bednov, Andrey A.; Galanzha, Ekateryna I.; Tuchin, Valery V.; Ulyanov, Sergey S.; Brill, Gregory E.

    1997-05-01

    At different pathological stages, the changes both of blood and lymph microcirculation parameters are observed. These parameters are of great importance in diagnostics. The type of these changes may indicate both the kind and the degree of disease. Investigation of the behavior of dynamic characteristics of these flows at different stages is of special interest. In this paper the peculiarities both of blood and lymph motion have been considered. The further development of speckle-interferometrical method has been carried out for the investigation of the dynamic characteristics of blood and lymph flows in microvessels. Analysis of two dynamic parameters which had been introduced in previous papers concerning this problem, is made in this paper. The influence of lymphotropic agent both on lymph flow and its dynamic characteristics is also discussed.

  8. 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.

  9. 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

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

    NASA Astrophysics Data System (ADS)

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

    2000-11-01

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

  11. An Image-Based Model of Fluid Flow Through Lymph Nodes.

    PubMed

    Cooper, Laura J; Heppell, James P; Clough, Geraldine F; Ganapathisubramani, Bharathram; Roose, Tiina

    2016-01-01

    The lymphatic system returns fluid to the bloodstream from the tissues to maintain tissue fluid homeostasis. Lymph nodes distributed throughout the system filter the lymphatic fluid. The afferent and efferent lymph flow conditions of lymph nodes can be measured in experiments; however, it is difficult to measure the flow within the nodes. In this paper, we present an image-based modelling approach to investigating how the internal structure of the node affects the fluid flow pathways within the node. Selective plane illumination microscopy images of murine lymph nodes are used to identify the geometry and structure of the tissue within the node and to determine the permeability of the lymph node interstitium to lymphatic fluid. Experimental data are used to determine boundary conditions and optimise the parameters for the model. The numerical simulations conducted within the model are implemented in COMSOL Multiphysics, a commercial finite element analysis software. The parameter fitting resulted in the estimate that the average permeability for lymph node tissue is of the order of magnitude of [Formula: see text]. Our modelling shows that the flow predominantly takes a direct path between the afferent and efferent lymphatics and that fluid is both filtered and absorbed across the blood vessel boundaries. The amount that is absorbed or extravasated in the model is dependent on the efferent lymphatic lumen fluid pressure. PMID:26690921

  12. Inhibition of the active lymph pump by flow in rat mesenteric lymphatics and thoracic duct

    NASA Technical Reports Server (NTRS)

    Gashev, Anatoliy A.; Davis, Michael J.; Zawieja, David C.; Delp, M. D. (Principal Investigator)

    2002-01-01

    There are only a few reports of the influence of imposed flow on an active lymph pump under conditions of controlled intraluminal pressure. Thus, the mechanisms are not clearly defined. Rat mesenteric lymphatics and thoracic ducts were isolated, cannulated and pressurized. Input and output pressures were adjusted to impose various flows. Lymphatic systolic and diastolic diameters were measured and used to determine contraction frequency and pump flow indices. Imposed flow inhibited the active lymph pump in both mesenteric lymphatics and in the thoracic duct. The active pump of the thoracic duct appeared more sensitive to flow than did the active pump of the mesenteric lymphatics. Imposed flow reduced the frequency and amplitude of the contractions and accordingly the active pump flow. Flow-induced inhibition of the active lymph pump followed two temporal patterns. The first pattern was a rapidly developing inhibition of contraction frequency. Upon imposition of flow, the contraction frequency immediately fell and then partially recovered over time during continued flow. This effect was dependent on the magnitude of imposed flow, but did not depend on the direction of flow. The effect also depended upon the rate of change in the direction of flow. The second pattern was a slowly developing reduction of the amplitude of the lymphatic contractions, which increased over time during continued flow. The inhibition of contraction amplitude was dependent on the direction of the imposed flow, but independent of the magnitude of flow. Nitric oxide was partly but not completely responsible for the influence of flow on the mesenteric lymph pump. Exposure to NO mimicked the effects of flow, and inhibition of the NO synthase by N (G)-monomethyl-L-arginine attenuated but did not completely abolish the effects of flow.

  13. [Management of Pulmonary Blood Flow for a Patient with Congenital Pulmonary Vein Stenosis Undergoing Pulmonary Venous Obstruction Release and Pulmonary Artery Banding].

    PubMed

    Ideno, Satoshi; Yamamoto, Shinichi; Oda, Fujiko; Wakamiya, Rie; Ozawa, Kana; Kaneko, Haruka; Matsuoka, Taku; Shinto, Atsushi; Mikasa, Hiromi; Miyazawa, Noriko

    2015-02-01

    Congenital pulmonary vein stenosis (CPVS) is a rare fetal congenital heart disease with a prevalence of 1.7 per 100,000 children younger than two years of age. Because of the difficulty of maintaining the pulmonary blood flow, CPVS is associated with a 50% survival rate within five years of diagnosis. We describe a successful management of pulmonary blood flow for a 4-month-old-girl with CPVS, combined with atrial septal defect and ventricular septal defect, undergoing pulmonary vein obstruction release (PVOR). In this case, CPVS was the only cause for pulmonary hypertension because there was no significant pressure gradient between each pulmonary capillary wedge pressure and the paired pulmonary vein pressure, indicating the normal pulmonary vascular structure prior to pulmonary vein stenosis. As pulmonary blood flow was estimated to be high after PVOR, pulmonary artery banding was also performed. Management of pulmonary blood flow is the most important issue for anesthesia of this surgery, especially in postcardiopulmonary bypass period, when the pulmonary vasoconstriction is induced by endothelial dysfuncion. PMID:26121811

  14. Uniportal complete video-assisted thoracoscopic surgery lobectomy with partial pulmonary arterioplasty for lung cancer with calcified lymph node

    PubMed Central

    Wang, Guang-Suo; Wang, Jian; Rao, Zhan-Peng; Ding, Guang-Gui

    2015-01-01

    Now, more and more complete video-assisted thoracoscopic surgery (cVATS) surgeons are capable of performing lobectomy by uniportal approach. However, concerns regarding the safety of uniportal procedures for complex cases such as neoadjuvant chemotherapy, bronchial sleeves or vascular reconstructions still remains. As experience with uniportal VATS has increased, its application toward more technically demanding operations has also expanded. This article describes a uniportal cVATS left upper lobectomy with partial pulmonary arterioplasty for lung cancer with calcified lymph nodes. In order to reduce the risk of bleeding, we looped the left main pulmonary artery and applied two-stage maneuvering for left upper lobe (LUL) bronchus, cut the bronchus at the distal end and close the stump using a stapler at the end, which are conducive to maximal safety.

  15. Lagrangian transport properties of pulmonary interfacial flows

    PubMed Central

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

    2012-01-01

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

  16. Pulmonary blood flow and pulmonary hypertension: Is the pulmonary circulation flowophobic or flowophilic?

    PubMed Central

    Kulik, Thomas J.

    2012-01-01

    Increased pulmonary blood flow (PBF) is widely thought to provoke pulmonary vascular obstructive disease (PVO), but the impact of wall shear stress in the lung is actually poorly defined. We examined information from patients having cardiac lesions which impact the pulmonary circulation in distinct ways, as well as experimental studies, asking how altered hemodynamics impact the risk of developing PVO. Our results are as follows: (1) with atrial septal defect (ASD; increased PBF but low PAP), shear stress may be increased but there is little tendency to develop PVO; (2) with normal PBF but increased pulmonary vascular resistance (PVR; mitral valve disease) shear stress may also be increased but risk of PVO still low; (3) with high PVR and PBF (e.g., large ventricular septal defect), wall shear stress is markedly increased and the likelihood of developing PVO is much higher than with high PBF or PAP only; and (4) with ASD, experimental and clinical observations suggest that increased PBF plus another stimulus (e.g., endothelial inflammation) may be required for PVO. We conclude that modestly increased wall shear stress (e.g., ASD) infrequently provokes PVO, and likely requires other factors to be harmful. Likewise, increased PAP seldom causes PVO. Markedly increased wall shear stress may greatly increase the likelihood of PVO, but we cannot discriminate its effect from the combined effects of increased PAP and PBF. Finally, the age of onset of increased PAP may critically impact the risk of PVO. Some implications of these observations for future investigations are discussed. PMID:23130101

  17. 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.

  18. 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

  19. Recording of lymph flow dynamics in microvessels using correlation properties of scattered coherent radiation

    SciTech Connect

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

    2002-11-30

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

  20. [Detection of lymph node involvement and surgical treatment of pulmonary neoplastic processes. Current state of diagnostic and therapeutic procedures].

    PubMed

    Garca-Yuste, Mariano; Matilla, Jos Mara; Gonzlez-Aragoneses, Federico; Heras, Flix

    2010-03-01

    An analysis is made of different publications associated with the surgical staging and treatment of primary and metastasic pulmonary neoplastic processes. A suitable treatment program is essential to determine lymph node involvement in patients with bronchogenic carcinoma. The indication and sequence of the procedure to use (CT-PET, transbronchial puncture, videomediastinoscopic ultrasound guided transbronchial needle aspiration) is evaluated in accordance to the sensitivity, specificity and positive and negative predictive value of the different methods. Another interesting challenge is to define the criteria for indicating a sublobar resection in certain tumours and patients. Different factors, age, lung function, tumour location and type of sublobar resection, are analysed. Levels of evidence and recommendations of the procedure are also considered. Surgical resection is an accepted therapeutic option in the treatment of colorectal cancer lung metastases. Its indication is based on acceptable survival rates and knowledge of the impact of various factors (interval free of disease, number of metastases, presence of liver metastasis, presence of lymph node involvement, or increased pre-operative levels of carcinoembryonic antigen), is analysed in detail. PMID:20353850

  1. The measurement of skin lymph flow by isotope clearance--reliability, reproducibility, injection dynamics, and the effect of massage

    SciTech Connect

    Mortimer, P.S.; Simmonds, R.; Rezvani, M.; Robbins, M.; Hopewell, J.W.; Ryan, T.J. )

    1990-12-01

    The measurement of skin lymph flow was investigated using an isotope clearance technique (ICT). Multiple lymph flow determinations were undertaken in the skin of anaesthetized large white pigs to test for reproducibility, ascertain the most suitable tracer, study the influence of injection dynamics, and observe the effect of massage as a stimulus to lymph flow. Blood clearance of tracer was also investigated. Results demonstrated that lymphatic clearance is a monoexponential function with good reproducibility under controlled laboratory conditions. 99mTc-colloid (TCK17 Cis) compared favorably with 131I-human serum albumin as a tracer and both performed better than colloid gold (198Au). Lymph flow was significantly faster in one pig than in the other. No difference existed between left and right sides or between caudal and rostral sites on each flank, but clearance was significantly slower in thigh than flank skin. Sub-epidermal injections cleared faster and more consistently than either deep or subcutaneous injections. Neither injection volume nor needle tract backflow of tracer influenced results, but local massage significantly enhanced clearance. Escape of 99mTc-colloid by the blood was negligible. These results indicate that skin lymph flow can be reliably measured when conditions are controlled. Extrinsic factors such as massage strongly influence lymph flow. Greater sensitivity in detecting degrees of lymphatic insufficiency may be achieved if a standardized stimulus to lymph flow is administered during isotope clearance measurement.

  2. 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

  3. 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

  4. Cerebral blood flow during treatment for pulmonary hypertension

    PubMed Central

    Kusuda, S.; Shishida, N.; Miyagi, N.; Hirabayashi, M.; Kim, T.

    1999-01-01

    AIMTo determine if the haemodynamics of systemic and cerebral circulation are changed during treatment for persistent pulmonary hypertension of the newborn (PPHN).?METHODSFifteen term newborn piglets with hypoxia induced pulmonary hypertension were randomly assigned either tolazoline infusion (Tz), hyperventilation alkalosis (HAT), and inhaled nitric oxide (iNO). Mean pulmonary arterial pressure (PAP), mean systemic arterial pressure (SAP), and cerebral blood flow volume (CBF) were measured.? RESULTSDuring hypoxic breathing, PAP increased significantly in all groups. After treatment PAP decreased significantly in all groups, but no significant difference was observed between groups. SAP decreased significantly only in the Tz group, and CBF reduced significantly only in the HAT group. On the other hand, iNO did not change SAP or CBF.?CONCLUSIONInhaled NO might be ideal for the resolution of pulmonary hypertension.?? PMID:10325808

  5. Photothermal imaging of moving cells in lymph and blood flow in vivo

    NASA Astrophysics Data System (ADS)

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

    2004-07-01

    The in vivo capabilities of a new, integrated optical system for studying lymph and blood flow were explored, including imaging of moving red and white blood cells. This system combined transmission microscopy with different dual-beam photothermal (PT) techniques, such as PT imaging, PT thermolens method, and PT deflection velocimetry. All of these PT techniques are based on irradiation of rat mesenteric microvessels with a short laser pulse and on detection of temperature-dependent variations of the refractive index with a second, probe laser beam. In general, the concept of in vivo PT flow cytometry was developed, with a focus on real-time monitoring of moving blood cells in their natural states without labeling (e.g., fluorescent), including obtaining PT images of the cells and determining their flow velocity and response to different interventions. Preliminary experiments revealed many potential applications of this integrated system: (1) quantitation of lymph and blood flow without probes; (2) imaging of moving red and white blood cells; (3) visualization and tracking of PT nanoprobes and sensitizers; (4) comparison of laser-tissue interactions in vivo and in vitro, especially optimization of laser treatment of vascular lesions (port-wine stains, lymphatic malformations, etc.); and (5) determination of the link between in vitro and in vivo cytotoxicity studies.

  6. New type of manifestation of the Doppler effect: an application to blood and lymph flow measurements

    NASA Astrophysics Data System (ADS)

    Ul'yanov, Sergey S.

    1995-10-01

    Based on theoretical and experimental analyses, it is shown that the spectrum of intensity fluctuations contains a high-frequency peak in the absence of a subsidiary reference wave at nonsmall angles of speckle observation. This phenomenon, interpreted as a new type of manifestation of the Doppler effect, is usual only for the case of strongly focused coherent beam sucattering. The possibilities for using the observed effect in the measurements of blood and lymph flows in narrow native capillaries are discussed. The traditional Doppler method using strongly focused Gaussian beam scattering is also considered. It is shown that the frequency position of the Doppler peak in the spectrum of intensity fluctuations is defined not only by the angle of speckle observation but also by the relation between the waist beam diameter and the average size of flow inhomogeneities. This result was experimentally verified. It is concluded that the Doppler method of blood flow measurement using strongly focused Gaussian beam diffraction should be revised.

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

    NASA Astrophysics Data System (ADS)

    Tuchin, Valery V.

    2004-05-01

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

  8. Flow cytometry can diagnose classical hodgkin lymphoma in lymph nodes with high sensitivity and specificity.

    PubMed

    Fromm, Jonathan R; Thomas, Anju; Wood, Brent L

    2009-03-01

    The diagnosis of classical Hodgkin lymphoma (CHL) has been made in tissue sections as attempts to identify neoplastic Hodgkin and Reed Sternberg (HRS) cells in lymph nodes by flow cytometry (FC) have been unsuccessful. However, we have recently demonstrated that HRS cells can be identified by FC, often present as T-cell-HRS-cell rosettes. In this study, we examined the usefulness of a novel 9-color (CD95-Pacific blue/CD64-fluorescein isothiocyanate/CD30-phycoerythrin [PE]/CD45-PE-Texas red/CD40-PE cyanine [Cy]5.5/CD20-PECy7/CD15-allophycocyanin [APC]/CD71-APC-AlexaFluor A700/CD5-APC-Cy7), single tube FC assay to diagnose CHL in lymph nodes. We used the FC assay to determine diagnostic sensitivity and specificity in 279 blindly identified and 141 selected (for specimen type or cytopreparation morphologic features suggesting CHL) tissues. Of the 53 morphologically defined CHL cases identified (10 in the unselected group; 43 in the selected group), the FC assay diagnostic sensitivity and specificity were 88.7% and 100%, respectively. With the current availability of 8 (or more) color clinical flow cytometers, this assay can now be applied to routinely immunophenotype and confirm a diagnosis of CHL or as an adjunct to immunohistochemical analysis. PMID:19228638

  9. 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

  10. [External respiratory function and pulmonary capillary blood flow in patients with postoperative recurrent pulmonary tuberculosis].

    PubMed

    El'kin, A V; Savin, I B

    1999-01-01

    To clarify criteria for functional operability, external respiratory function (ERF) and pulmonary capillary blood flow (PCBF) were studied in 116 patients with postoperative recurrent pulmonary tuberculosis who had been admitted to the resurgery unit. Moderate ERF impairments (stages I and II) were identified in 65% of cases, 23% had stage III ventilation disorders (VD), and 11% were found to have stages IV and V VD. In focal recurrences, overall PCBF ranged 19 to 36% of the total pulmonary blood flow with is decrease from 11 to 0.3% in the total number of recurrences. Preoperative preparation improved ERF in 54% of patients. Contraindications for surgery were found in 9% due their low functional reserves. A total of 105 patients were operated on, postoperative mortality was 11.4%. Cardiopulmonary insufficiency was a cause of death in 4 cases, of them 3 patients underwent repeated resection of the lung as pneumonectomy in baseline stage III VD, which allows these patients to refer to as a high surgical risk group. PMID:10420759

  11. Dynamics of statistically inhomogeneous speckles: an application to blood and lymph flow measurements

    NASA Astrophysics Data System (ADS)

    Ul'yanov, Sergey S.

    1995-11-01

    In the paper on the basis of theoretical and experimental analyses it is shown that the spectrum of intensity fluctuations contains the high frequency peak in the absence of subsidiary reference wave at non-small angles of speckles observation. Such phenomenon, interpreted as a new type of manifestation of Doppler effect, is habitual only for the case of strongly focused coherent beam scattering. In the paper the possibilities of the usage of the observed effect in the measurements of blood and lymph flows in narrow native capillaries are discussed. Traditional Doppler method utilizing the strongly focused Gaussian beam scattering is considered. It is shown that the frequency position of Doppler peak in the spectrum of intensity fluctuations of measurements is defined not only by the angle of speckles observation but also by the relation between the waist beam diameter and the average size of flow inhomogeneities. Such result was experimentally verified. In the paper it is concluded that the Doppler method of blood flow measurements utilizing strongly focused Gaussian beam diffraction has to be revised.

  12. 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.

  13. Changes in pulmonary blood flow do not affect gas exchange during intermittent ventilation in resting turtles.

    PubMed

    Wang, Tobias; Hicks, James W

    2008-12-01

    The breathing pattern of many different air-breathing vertebrates, including lungfish, anuran amphibians, turtles, crocodiles and snakes, is characterized by brief periods of lung ventilation interspersed among apnoeas of variable duration. These intermittent ventilatory cycles are associated with characteristic increases in pulmonary blood flow and tachycardia. In animals with central vascular shunts, the rise in pulmonary blood flow during ventilation is associated with the development of left-to-right (L-R) cardiac shunt (pulmonary recirculation of oxygenated blood returning from the lungs). By contrast, a large net right-to-left (R-L) shunt (pulmonary bypass) normally prevails during apnoea. The cardio-respiratory interaction and the changes in cardiac shunting have been suggested to improve pulmonary gas exchange but the benefits of L-R shunting on pulmonary gas transport have not been studied experimentally. The present study measured pulmonary gas exchange in fully recovered, freely diving turtles, where changes in pulmonary blood flow were prevented by partial occlusion of the pulmonary artery. Prevention of L-R shunt during ventilation did not impair CO2 excretion and overall, oxygen uptake and CO2 excretion did not correlate with changes in pulmonary blood flow. We conclude that increases in pulmonary blood flow associated with ventilation are not required to maintain resting rates of oxygen uptake and CO2 excretion in resting animals. PMID:19011217

  14. Blood and lymph flow measurements in microvessels using focused laser beam diffraction phenomenon

    NASA Astrophysics Data System (ADS)

    Bednov, Andrey A.; Brill, Gregory E.; Tuchin, Valery V.; Ulyanov, Sergey S.; Galanzha, Ekateryna I.

    1995-01-01

    In the present paper speckle-interferometric technique utilizing focused Gaussian beam diffraction was applied for the analysis of lymph circulation in narrow native capillaries. The spectrum of scattered intensity fluctuations of the statistically inhomogeneous speckles formed with the diffraction in such capillaries are presented. The alterations of the spectra envelope caused by drug administration to the lymph vessel have been studied.

  15. Factors affecting regional pulmonary blood flow in chronic ischemic heart disease

    SciTech Connect

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

    1988-07-01

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

  16. 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. PMID:26175785

  17. Pulmonary Fluid Flow Challenges for Experimental and Mathematical Modeling

    PubMed Central

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

    2014-01-01

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

  18. Antegrade flow in Anomalous Left Coronary Artery from Pulmonary Artery: Clinical implications

    PubMed Central

    Sedky, Yasser; Hosny, Hatem; Donya, Mohamed; AbdElsalam, Sherin; Yacoub, Magdi

    2014-01-01

    Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly that usually presents in childhood. It results in left ventricular (LV) ischemia with resulting LV dysfunction. This ischemia results from retrograde flow into the pulmonary artery which can act as a coronary steal. We here report antegrade flow detected in ALCAPA caused by severe pulmonary hypertension. Anatomic correction of ALCAPA is the preferred surgical option and should be performed as early as possible. PMID:25763380

  19. Antegrade flow in Anomalous Left Coronary Artery from Pulmonary Artery: Clinical implications.

    PubMed

    Sedky, Yasser; Hosny, Hatem; Donya, Mohamed; AbdElsalam, Sherin; Yacoub, Magdi

    2014-01-01

    Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly that usually presents in childhood. It results in left ventricular (LV) ischemia with resulting LV dysfunction. This ischemia results from retrograde flow into the pulmonary artery which can act as a coronary steal. We here report antegrade flow detected in ALCAPA caused by severe pulmonary hypertension. Anatomic correction of ALCAPA is the preferred surgical option and should be performed as early as possible. PMID:25763380

  20. Catheter closure of accessory pulmonary blood flow after bidirectional Glenn anastomosis using Amplatzer duct occluder.

    PubMed

    Ebeid, Makram R; Gaymes, Charles H; Joransen, James A

    2002-09-01

    Additional source of pulmonary blood flow in patients with bidirectional cavopulmonary anastomosis (Glenn shunt) may cause elevation of the pulmonary artery pressure precluding safe completion of the Fontan operation. A case is presented with single-ventricle bidirectional cavopulmonary anastomosis and additional flow from the ventricle to the pulmonary artery resulting in elevated Glenn pressure. The communication was successfully occluded using Amplatzer duct occluder with satisfactory reduction in the Glenn pressure. PMID:12203939

  1. Niflumic Acid Attenuated Pulmonary Artery Tone and Vascular Structural Remodeling of Pulmonary Arterial Hypertension Induced by High Pulmonary Blood Flow In Vivo.

    PubMed

    Wang, Kai; Ma, Jianfa; Pang, Yusheng; Lao, Jinquan; Pan, Xuanren; Tang, Qiaoyun; Zhang, Feng; Su, Danyan; Qin, Suyuan; Shrestha, Arnav Prasad

    2015-10-01

    Calcium-activated chloride channels (CaCCs) play a vital role in regulating pulmonary artery tone during pulmonary arterial hypertension (PAH) induced by high blood flow. The role of CaCCs inhibitor niflumic acid (NFA) in vivo during this process requires further investigation. We established the PAH model by abdominal shunt surgery and treated with NFA in vivo. Fifty rats were randomly divided into normal, sham, shunt, NFA group 1 (0.2 mg/kg), and NFA group 2 (0.4 mg/kg). Pathological changes, right ventricle hypertrophy index, arterial wall area/vessel area, and arterial wall thickness/vessel external diameter were analyzed. Then contraction reactions of pulmonary arteries were measured. Finally, the electrophysiological characteristics of pulmonary arterial smooth muscle cells were investigated using patch-clamp technology. After 11 weeks of shunting, PAH developed, accompanied with increased right ventricle hypertrophy index, arterial wall area/vessel area, and arterial wall thickness/vessel external diameter. In the NFA treatment groups, the pressure and pathological changes were alleviated. The pulmonary artery tone in the shunt group increased, whereas it decreased after NFA treatment. The current density of CaCC was higher in the shunt group, and it was decreased in the NFA treatment groups. In conclusion, NFA attenuated pulmonary artery tone and structural remodeling in PAH induced by high pulmonary blood flow in vivo. CaCCs were involved and the augmented current density was alleviated by NFA treatment. PMID:26132368

  2. SPECT imaging of pulmonary blood flow in a rat

    NASA Astrophysics Data System (ADS)

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

    2003-05-01

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

  3. Correlation between nuclear factor ?B activity and pulmonary artery pressure in a rat high pulmonary blood flow model

    PubMed Central

    YANG, JIE; YU, XIAO-XIAO; ABULAITI, ABDUHAER; FEI, JIAN-CHUN

    2015-01-01

    The aim of the present study was to investigate the correlation between nuclear factor-?B (NF-?B) activity and pulmonary artery pressure in the pulmonary artery endothelial cells of high pulmonary blood flow rat models. A total of 50 four-week-old male Wistar rats were randomly divided into four groups: Surgery shunt group (Tn, n=15); surgery + pyrollidine dithiocarbamate (PDTC) administration group (Ti, n=15); sham control group (Co, n=10) and negative control group (Cn, n=10). The 30 rats of the Ti and Tn groups underwent carotid artery-external jugular vein anastomosis; the 15 rats in the Ti group were injected with PDTC intraperitoneally 1 h prior to surgery for a two-week continuous infusion. After 12 weeks of feeding ad libitum, right ventricular systolic pressure and NF-?B activity in the pulmonary artery endothelial cells of the rats were measured. The NF-?B activity of the Tn group was significantly higher than that of the Cn group (P<0.01) and the NF-?B activity of the Ti group was lower than that of the Cn group (P<0.01); however, no significant difference was observed between the Co and Cn groups. The increased activity of NF-?B was an important factor in the pulmonary vasoconstriction and structural remodeling of rats with high pulmonary blood flow. PMID:25574231

  4. Pulmonary blood flow distribution in sheep: effects of anesthesia, mechanical ventilation, and change in posture

    NASA Technical Reports Server (NTRS)

    Walther, S. M.; Domino, K. B.; Glenny, R. W.; Hlastala, M. P.

    1997-01-01

    BACKGROUND: Recent studies providing high-resolution images of pulmonary perfusion have questioned the classical zone model of pulmonary perfusion. Hence the present work was undertaken to provide detailed maps of regional pulmonary perfusion to examine the influence of anesthesia, mechanical ventilation, and posture. METHODS: Pulmonary perfusion was analyzed with intravenous fluorescent microspheres (15 microm) in six sheep studied in four conditions: prone and awake, prone with pentobarbital-anesthesia and breathing spontaneously, prone with anesthesia and mechanical ventilation, and supine with anesthesia and mechanical ventilation. Lungs were air dried at total lung capacity and sectioned into approximately 1,100 pieces (about 2 cm3) per animal. The pieces were weighed and assigned spatial coordinates. Fluorescence was read on a spectrophotometer, and signals were corrected for piece weight and normalized to mean flow. Pulmonary blood flow heterogeneity was assessed using the coefficient of variation of flow data. RESULTS: Pentobarbital anesthesia and mechanical ventilation did not influence perfusion heterogeneity, but heterogeneity increased when the animals were in the supine posture (P < 0.01). Gravitational flow gradients were absent in the prone position but present in the supine (P < 0.001 compared with zero). Pulmonary perfusion was distributed with a hilar-to-peripheral gradient in animals breathing spontaneously (P < 0.05). CONCLUSIONS: The influence of pentobarbital anesthesia and mechanical ventilation on pulmonary perfusion heterogeneity is small compared with the effect of changes in posture. Analysis of flow gradients indicate that gravity plays a small role in determining pulmonary blood flow distribution.

  5. Pulmonary blood flow redistribution by increased gravitational force.

    PubMed

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

    1998-04-01

    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. PMID:9516194

  6. 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.

  7. 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.

  8. Control of the pulmonary arterial resistance by the use of the oscillated assist flow.

    PubMed

    Yambe, T; Izutsu, K; Hashimoto, H; Yoshizawa, M; Tanaka, A; Abe, K; Fukuju, T; Miura, M; Tabayashi, K; Takeda, H; Shizuka, K; Sonobe, T; Naganuma, S; Kobayashi, S; Nanka, S; Nitta, S

    1998-05-01

    In the clinical application of supporting circulation, the treatment of a patient with pulmonary hypertension is very important. We developed the electromagnetically driven vibrating flow pump (VFP) as a totally implantable type ventricular assist system. The artificial heart driven by electromagnetic forces creates high speed oscillation flow around 10-50 Hz. Assistance by high-speed oscillation flow has an interesting influence on the cardiovascular system. In this study, we carried out research on the influence such oscillation flow had on the pulmonary arterial vessels, and the supporting flow wave-form that controlled pulmonary vascular resistance was considered. Six healthy adult goats of both sexes were used in the experiments. We carried out inhalation anesthesia and performed intubation. The thorax was opened through left fourth rib resection. Right heart bypass was performed from the right atrium to the pulmonary artery. The flow of right heart assistance was maintained within 20-25% of total flow. Our purpose was to add flow of a specific high frequency to the right heart circulation. The hemodynamic parameters were recorded on a magnetic tape data recorder and input into a computer through an A-D converter. A result identified was that the pulmonary vascular resistance changed according to the alteration of the driving frequency of the VFP even during the same flow assistance. The resistance of the pulmonary arterial vessels became smaller when the driving of the VFP of 30 Hz was added to the right heart circulation. This was significant even when compared with continuous flow right heart assist. The characteristics of impedance appeared to have interesting alterations as well. Control of pulmonary vascular resistance by right heart assistance becomes possible if these results are applied. Accordingly, it may become one of the choices for treatment of a patient with pulmonary hypertension. PMID:9609354

  9. 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

  10. Palatine tonsillar metastasis of a small pulmonary adenocarcinoma showing an invasive micropapillary carcinoma pattern and Pagetoid spread at the tonsil: a case suggesting retrograde lymphatic metastasis from bulky lymph node metastases of the neck

    PubMed Central

    Tajima, Shogo; Koda, Kenji

    2015-01-01

    Metastasis rarely occurs in the palatine tonsils. Among primary pulmonary carcinoma subtypes, small cell carcinoma more frequently metastasizes to this site. Herein, we present an exceedingly rare case of a small pulmonary adenocarcinoma that metastasized to the cervical lymph nodes and the right palatine tonsil in a 62-year-old man. In spite of the small size of the primary site, such extensive metastasis may have occurred because of the invasive micropapillary carcinoma pattern seen in the metastatic sites. The manner of metastasis to the palatine tonsil was considered retrograde lymphatic metastasis originating from carcinoma cells in the cervical lymph nodes. Furthermore, Pagetoid spread was observed at the palatine tonsil. Although there have been only a few cases showing retrograde lymphatic metastasis and Pagetoid spread at the metastatic site, we should be careful when speculating about the primary site based on such metastatic sites, especially when dealing with a biopsy sample exhibiting Pagetoid spread. PMID:26722582

  11. Effect of complement activation with cobra venom factor on pulmonary vascular permeability.

    PubMed

    Johnson, A; Cooper, J A; Malik, A B

    1986-12-01

    We examined the effect of acute complement activation on lung vascular permeability to proteins in awake sheep prepared with lung lymph fistulas. Complement was activated by cobra venom factor (CVF) infusion (400 U/kg for 1 h iv). Studies were made in two groups of sheep: 1) infusion of CVF containing the endogenous phospholipase A2 (PLA2) (n = 6); and 2) infusion of CVF pretreated with bromophenacyl bromide to inhibit PLA2 activity (n = 5). Intravascular complement activation transiently increased mean pulmonary arterial pressure (Ppa) and pulmonary vascular resistance (PVR) in both groups. Pulmonary lymph flow (Qlym) and lymph protein clearance (Qlym X lymph-to-plasma protein concentration ratio) were also transiently increased in both groups. Pulmonary vascular permeability to proteins was assessed by raising left atrial pressure and determining the lymph-to-plasma protein concentration ratio (L/P) at maximal Qlym. In both groups the L/P at maximal Qlym was not different from normal. In a separate group (n = 4), CVF-induced complement activation was associated with 111In-oxine granulocyte sequestration in the lungs. In vitro plasma from CVF-treated animals aggregated neutrophils but did not stimulate neutrophils to produce superoxide anion generation. Therefore, CVF-induced complement activation results in pulmonary neutrophil sequestration and in increases in PVR and lymph protein clearance. The increase in lymph protein clearance is due to increased pulmonary microvascular pressure and not increased vascular permeability to proteins. PMID:3027023

  12. Lymph nodes

    MedlinePLUS Videos and Cool Tools

    ... a complex network of thin vessels, valves, ducts, nodes, and organs. It helps to protect and maintain ... lymph and by producing various blood cells. Lymph nodes play an important part in the body's defense ...

  13. Doppler flow velocity waveforms of human fetal ductus arteriosus and branch pulmonary artery.

    PubMed

    Choi, J Y; Park, J D; Jung, M J; Kim, H S

    1997-10-01

    Doppler waveforms of the human fetal ductus arteriosus and the branch pulmonary artery are distinct in their shape and might reflect fetal cardiovascular hemodynamics and vessel wall characteristics. The waveform of ductus arteriosus had two peaks, a higher one in systole and a lower one in diastole. Both peaks had slow acceleration and deceleration and looked like two narrow base isosceles triangles. This unique waveform might be due to vessel wall characteristics and an instantaneous pressure gradient between the main pulmonary artery and descending aorta. The waveform of the branch pulmonary artery showed very steep acceleration with the onset of ejection followed by steep decline, then low velocity flow during diastole. The characteristic shape of the branch pulmonary artery might be related to high vascular resistance, decreased capacitance and the earlier reflection wave of pulmonary vessels. PMID:9364298

  14. Simulated Flow Pattern in Massive Pulmonary Embolism: Significance for Selective Intrapulmonary Thrombolysis

    SciTech Connect

    Schmitz-Rode, Thomas; Kilbinger, Markus; Guenther, Rolf W.

    1998-05-15

    Purpose: The flow pattern in the central pulmonary arteries proximal to large pulmonary emboli was studied experimentally. The currents to which thrombolytic agents are exposed when administered via an intrapulmonary catheter were visualized in order to explain the lack of benefit of local versus systemic administration. Methods: By illumination of suspended microspheres, the flow pattern proximal to an obstructing embolus was visualized in an in vitro pulmonary arterial flow model. In six dogs massive pulmonary embolism was created. A pigtail catheter was positioned in the pulmonary artery immediately proximal to the central edge of the occluding embolus. To allow visualization of the local flow pattern, a small amount of contrast material (4 ml) was injected through the catheter at a high flow rate (25 ml/sec). The course of the radiopaque spot that emerged from the catheter tip within 160 msec was monitored with digital subtraction angiography at a frame rate of 12.5 frames/sec. In two dogs, the study was repeated after embolus fragmentation with the same catheter position. Results: The flow model study revealed formation of a vortex proximal to the occluding embolus. In vivo experiments showed that the radiopaque spot was whirled by the vortex proximal to the embolus and made only evanescent contact with the edge of the embolus. Regardless of the embolus location, the contrast spot was washed into the non-occluded ipsilateral and contralateral pulmonary arteries within 0.40-0.64 sec. After embolus fragmentation, the contrast spot was carried completely into the formerly occluded artery. Conclusion: Flow studies explain why thrombolytic agents administered via a catheter positioned adjacent to the embolus may have no more effect than systemically administered agents. An enhanced local effect is precluded by the rapid washout into the non-occluded pulmonary arteries and subsequent systemic dilution. These results support the practice of direct intrathrombic injection of thrombolytics or local thrombolysis as an adjunct to embolus fragmentation.

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

    NASA Astrophysics Data System (ADS)

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

    2009-03-01

    Nanoparticles are intensively being explored as contrast agents for medical diagnostics and therapies using various optical methods. We present the first demonstration of the use of time-resolved Raman spectroscopy for in vivo real-time detection of circulating carbon nanotubes (CNTs) or cancer cells labeled with CNTs in the lymph, blood, and tissues of live animals with fast spectral acquisition times of down to few milliseconds. After intravenously administering CNTs in the tail vein of the rat, this technique provides the ability to detect the circulation of CNTs in the blood microvessels of the intact rat ear. The capability of Raman spectroscopy is also demonstrated to monitor, identify, and image the CNTs during their transportation by lymphatics in the rat ear and mesentery. The strong and specific Raman scattering properties of CNTs make it possible to detect in vitro and in vivo single cancer cells (HeLa) tagged with CNTs. In vivo Raman flow cytometry opens a new avenue for multiparameter analysis of circulating nanoparticles with strong Raman scattering properties and their pharmokinetics in blood and lymph systems. Moreover, this technology has the potential for molecular detection and identification of circulating tumor cells, and infections labeled with CNTs.

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

    PubMed Central

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

    2016-01-01

    Nanoparticles are intensively being explored as contrast agents for medical diagnostics and therapies using various optical methods. We present the first demonstration of the use of time-resolved Raman spectroscopy for in vivo real-time detection of circulating carbon nanotubes (CNTs) or cancer cells labeled with CNTs in the lymph, blood, and tissues of live animals with fast spectral acquisition times of down to few milliseconds. After intravenously administering CNTs in the tail vein of the rat, this technique provides the ability to detect the circulation of CNTs in the blood microvessels of the intact rat ear. The capability of Raman spectroscopy is also demonstrated to monitor, identify, and image the CNTs during their transportation by lymphatics in the rat ear and mesentery. The strong and specific Raman scattering properties of CNTs make it possible to detect in vitro and in vivo single cancer cells (HeLa) tagged with CNTs. In vivo Raman flow cytometry opens a new avenue for multiparameter analysis of circulating nanoparticles with strong Raman scattering properties and their pharmokinetics in blood and lymph systems. Moreover, this technology has the potential for molecular detection and identification of circulating tumor cells, and infections labeled with CNTs. PMID:19405719

  17. Effects of inertial load and countermeasures on the distribution of pulmonary blood flow.

    PubMed

    Chornuk, M A; Bernard, S L; Burns, J W; Glenny, R W; Sheriff, D D; Sinclair, S E; Polissar, N L; Hlastala, M P

    2000-08-01

    We assessed the influence of cranial-to-caudal inertial force (+G(z)) and the countermeasures of anti-G suit and positive pressure breathing during G (PBG), specifically during +G(z), on regional pulmonary blood flow distribution. Unanesthetized swine were exposed randomly to 0 G(z) (resting), +3 G(z), +6 G(z), and +9 G(z), with and without anti-G suit and PBG with the use of the Air Force Research Laboratory centrifuge at Brooks Air Force Base (the gravitational force of the Earth, that is, the dorsal-to-ventral inertial force, was present for all runs). Fluorescent microspheres were injected into the pulmonary vasculature as a marker of regional pulmonary blood flow. Lungs were excised, dried, and diced into approximately 2-cm(3) pieces, and the fluorescence of each piece was measured. As +G(z) was increased from 0 to +3 G(z), blood flow shifted from cranial and hilar regions toward caudal and peripheral regions of the lung. This redistribution shifted back toward cranial and hilar regions as anti-G suit inflation pressure increased at +6 and +9 G(z). Perfusion heterogeneity increased with +G(z) stress and decreased at the higher anti-G suit pressures. The distribution of pulmonary blood flow was not affected by PBG. ANOVA indicated anatomic structure as the major determinant of pulmonary blood flow. PMID:10926625

  18. Effect of furosemide on pulmonary blood flow distribution in resting and exercising horses

    NASA Technical Reports Server (NTRS)

    Erickson, H. H.; Bernard, S. L.; Glenny, R. W.; Fedde, M. R.; Polissar, N. L.; Basaraba, R. J.; Walther, S. M.; Gaughan, E. M.; McMurphy, R.; Hlastala, M. P.

    1999-01-01

    We determined the spatial distribution of pulmonary blood flow (PBF) with 15-micron fluorescent-labeled microspheres during rest and exercise in five Thoroughbred horses before and 4 h after furosemide administration (0.5 mg/kg iv). The primary finding of this study was that PBF redistribution occurred from rest to exercise, both with and without furosemide. However, there was less blood flow to the dorsal portion of the lung during exercise postfurosemide compared with prefurosemide. Furosemide did alter the resting perfusion distribution by increasing the flow to the ventral regions of the lung; however, that increase in flow was abated with exercise. Other findings included 1) unchanged gas exchange and cardiac output during rest and exercise after vs. before furosemide, 2) a decrease in pulmonary arterial pressure after furosemide, 3) an increase in the slope of the relationship of PBF vs. vertical height up the lung during exercise, both with and without furosemide, and 4) a decrease in blood flow to the dorsal region of the lung at rest after furosemide. Pulmonary perfusion variability within the lung may be a function of the anatomy of the pulmonary vessels that results in a predominantly fixed spatial pattern of flow distribution.

  19. Analysis of blood flow in pulmonary hypertension with the pulsed Doppler flowmeter combined with cross sectional echocardiography.

    PubMed Central

    Okamoto, M; Miyatake, K; Kinoshita, N; Sakakibara, H; Nimura, Y

    1984-01-01

    Blood flow patterns were analysed at nine points in the pulmonary area using the pulsed Doppler technique combined with cross-sectional echocardiography in 53 patients with heart disease and 10 healthy subjects. In subjects with a normal pulmonary artery pressure the blood flow pattern in systole showed a gradual acceleration and deceleration with a rounded summit in mid systole, designated the round type. In patients with pulmonary hypertension it showed a rapid acceleration and early deceleration with a sharp peak in early systole, designated the triangular type. The acceleration time index, defined as the ratio of the time interval from the beginning to the peak of ejection to the ejection time, showed a significant inverse correlation with mean pulmonary artery pressure. In pulmonary hypertension a prominent reverse flow occurred in the right posterior part of the pulmonary trunk during mid-systole and early diastole, indicating the presence of a vortex. Similar flow patterns were also seen in patients with idiopathic pulmonary artery dilatation. The factors responsible for the triangular type were principally the reduced capacitance and increased impedance of the pulmonary vascular tree. Those responsible for the reverse flow were the curved path of the blood flow and dilatation of the pulmonary artery. Images PMID:6231042

  20. 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.

  1. The adjustable systemic-pulmonary artery shunt provides precise control of flow in vivo.

    PubMed

    Douglas, William I; Moore, Karabeth B; Resig, Phillip P; Mohiuddin, M Waqar

    2010-01-01

    The ratio of pulmonary:systemic blood flow (Qp:Qs) remains problematic after single ventricle reconstruction. The adjustable systemic-pulmonary artery shunt (AS) was created as a solution for this problem. Prototype ASs were created using a screw-plunger mechanism as a variable resistor. A stepper motor controls plunger displacement. Six adult dogs underwent placement of a 4-mm AS in the femoral position to test its ability to control flow. Shunts were placed as arteriovenous fistulae to simulate the continuous flow of systemic-pulmonary AS. The 3.5-mm control shunts (CS) were placed on the contralateral side. The stepper motor was rotated from fully open to 3.4 mm of plunger depression for six complete cycles. Flow in the fully open AS was 687.9 +/- 28.7 cc/min* vs. 578.7 +/- 26.8 cc/min in the CS (flow +/- standard error, *p < 0.005 vs. CS). Standard deviation of flow was similar between the AS and CS, implying hysteresis in resistor function did not contribute to flow variability. Peak torque requirement to turn the resistor was 2.4 mNm. The AS offers excellent control of flow in vivo. Control of Qp:Qs may lead to improved outcomes for single ventricle reconstructions. PMID:20051834

  2. 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.

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

    NASA Technical Reports Server (NTRS)

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

    1978-01-01

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

  4. Echocardiographic evaluation of pulmonary venous blood flow and cardiac function changes during one-lung ventilation

    PubMed Central

    Lee, Su Hyun; Kim, Namo; Kim, Hyun IL; Oh, Young Jun

    2015-01-01

    Objectives: The intra-pulmonary shunt induced by one-lung ventilation (OLV), is alleviated by increased pulmonary blood flow by gravitational redistribution and hypoxic pulmonary vasoconstriction. We investigated the changes of pulmonary venous blood flow (PVBF) and biventricular function during OLV with echocardiography. And the correlation between PVBF and intra-pulmonary shunt fraction (Qs/Qt) was evaluated. Methods: PVBF of the left upper pulmonary vein and cardiac function were measured with echocardiography in twenty-five patients who underwent elective thoracic surgery in left lateral decubitus. Qs/Qt and PaO2 were measured with blood gas analysis. Data was obtained at 10 min after two-lung ventilation in supine (TLV-S) and lateral decubitus position (TLV-L), and at 10, 20 and 30 min after OLV in lateral decubitus position (OLV-10, -20 and -30). Results: There were significant changes in PVBF among TLV-S, TLV-L and OLV-10 (959.5280.8, 1416.9489.7 and 1999.9670.5 ml/min; P<0.05, respectively). There were not differences in PVBF, Qs/Qt and PaO2 among OLV-10, -20 and -30. There were an inverse correlation between percent change of PVBF and change of Qs/Qt (r2 = 0.5; P<0.0001) and positive correlations between the percent change of PVBF and change of PaO2 (r2 = 0.4; P<0.0001) during OLV over TLV-L. No significant changes in biventricular systolic and diastolic function were observed during positional change and OLV. Conclusions: A remarkable change of PVBF relevant to gravitational distribution and hypoxic pulmonary vasoconstriction was proved by echocardiography. And PVBF changes could represent the changes of Qs/Qt and PaO2 during OLV. However, biventricular function was not impaired during OLV. PMID:26550232

  5. 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

  6. Flow cytometric detection and isolation of human tonsil or lymph node T follicular helper cells.

    PubMed

    Misiak, Jan; Tarte, Karin; Amé-Thomas, Patricia

    2015-01-01

    T-follicular helper (Tfh) cells have emerged as an independent CD4(+) helper T-cell lineage required for antigen-selected germinal center B-cell survival, class switch recombination, and differentiation into long-lived plasma cells. The quantification and function of Tfh subsets are currently extensively explored in humans with infectious diseases, cancer, or autoimmune disorders. Reliable methods to identify and isolate human Tfh cells in patients and healthy donors are necessary to perform these studies. Here, we propose a classical and robust flow cytometric method to detect and isolate Tfh cells from human secondary lymphoid organs based on the expression of CXCR5, PD-1, and CD25 in the CD4(+) T-cell population. An alternative protocol using anti-ICOS and anti-Bcl-6 antibodies and requiring fixation and permeabilization steps without a decrease of detection of membrane markers is also described. PMID:25836310

  7. Non-invasive pulmonary blood flow analysis and blood pressure mapping derived from 4D flow MRI

    NASA Astrophysics Data System (ADS)

    Delles, Michael; Rengier, Fabian; Azad, Yoo-Jin; Bodenstedt, Sebastian; von Tengg-Kobligk, Hendrik; Ley, Sebastian; Unterhinninghofen, Roland; Kauczor, Hans-Ulrich; Dillmann, Rüdiger

    2015-03-01

    In diagnostics and therapy control of cardiovascular diseases, detailed knowledge about the patient-specific behavior of blood flow and pressure can be essential. The only method capable of measuring complete time-resolved three-dimensional vector fields of the blood flow velocities is velocity-encoded magnetic resonance imaging (MRI), often denoted as 4D flow MRI. Furthermore, relative pressure maps can be computed from this data source, as presented by different groups in recent years. Hence, analysis of blood flow and pressure using 4D flow MRI can be a valuable technique in management of cardiovascular diseases. In order to perform these tasks, all necessary steps in the corresponding process chain can be carried out in our in-house developed software framework MEDIFRAME. In this article, we apply MEDIFRAME for a study of hemodynamics in the pulmonary arteries of five healthy volunteers. The study included measuring vector fields of blood flow velocities by phase-contrast MRI and subsequently computing relative blood pressure maps. We visualized blood flow by streamline depictions and computed characteristic values for the left and the right pulmonary artery (LPA and RPA). In all volunteers, we observed a lower amount of blood flow in the LPA compared to the RPA. Furthermore, we visualized blood pressure maps using volume rendering and generated graphs of pressure differences between the LPA, the RPA and the main pulmonary artery. In most volunteers, blood pressure was increased near to the bifurcation and in the proximal LPA, leading to higher average pressure values in the LPA compared to the RPA.

  8. 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.

  9. The spatial-temporal redistribution of pulmonary blood flow with postnatal growth.

    PubMed

    Glenny, Robb W; Bernard, Susan L; Luchtel, Daniel L; Neradilek, Blazej; Polissar, Nayak L

    2007-03-01

    The pulmonary vascular tree undergoes remarkable postnatal development and remodeling. While a number of studies have characterized longitudinal changes in vascular function with growth, none have explored regional patterns of vascular remodeling. We therefore studied six neonatal pigs to see how regional blood flow changes with growth. We selected pigs because of their rapid growth and their similarities to human development with respect to the pulmonary vascular tree. Fluorescent microspheres of varying colors were injected into the pulmonary circulation to mark regional blood on days 3, 12, 27, 43, and 71 after birth. The animals were awake and in the prone posture for all injections. The lungs were subsequently removed, air dried, and sectioned into approximately 2-cm(3) pieces. Flow on each injection day was determined for each piece. Despite the increase in the hydrostatic gradient in the lung with growth, there was a strong correlation between blood flow to the same lung piece when compared on days 3 and 71 (0.73 +/- 0.12). Although a dorsal-ventral gradient of perfusion did not exist on day 3, blood flow increased more in the dorsal region by day 12 and then gradually became more uniform by day 71. Although most of the lung pieces did not show any discernable pattern of blood flow redistribution, there were spatial patterns of blood flow redistribution that were similar across animals. Our findings suggest that local mechanisms, shared across animals, guide regional changes in vascular resistance or vasoregulation during postnatal development. In the pig, these mechanisms act to produce more uniform flow in the normal posture for an ambulating quadruped. The stimuli for these changes have not yet been identified. PMID:17095640

  10. Effects of antihistamines on the lung vascular response to histamine in unanesthetized sheep. Diphenhydramine prevention of pulmonary edema and increased permeability.

    PubMed Central

    Brigham, K L; Bowers, R E; Owen, P J

    1976-01-01

    To see whether antihistamines could prevent and reverse histamine-induced pulmonary edema and increased lung vascular permeability, we compared the effects of a 4-h intravenous infusion of 4 mug/kg per min histamine phosphate on pulmonary hemodynamics, lung lymph flow, lymph and plasma protein content, arterial blood gases, hematocrit, and lung water with the effects of an identical histamine infusion given during an infusion of diphenhydramine or metiamide on the same variables in unanesthetized sheep. Histamine caused lymph flow to increase from 6.0+/-0.5 to 27.0+/-5.5 (SEM) ml/h (P less than 0.05), lymph; plasma globulin concentration ratio to increase from 0.62+/-0.01 to 0.67+/-0.02 (P less than 0.05), left atrial pressure to fall from 1+/-1 to -3+/-1 cm H2O (P less than 0.05), and lung lymph clearance of eight protein fractions ranging from 36 to 96 A molecular radius to increase significantly. Histamine also caused increases in lung water, pulmonary vascular resistance, arterial PCO2, pH, and hematocrit, and decreases in cardiac output and arterial PO2. Diphenhydramine (3 mg/kg before histamine followed by 1.5 mg/kg per h intravenous infusion) completely prevented the histamine effect on hematocrit, lung lymph flow, lymph protein clearance, and lung water content, and reduced histamine effects on arterial blood gases and pH. 6 mg/kg diphenhydramine given at the peak histamine response caused lymph flow and lymph: plasma protein concentration ratios to fall. Metiamide (10 mg/kg per h) did not affect the histamine lymph response. We conclude that diphenhydramine can prevent histamine-induced pulmonary edema and can prevent and reverse increased lung vascular permeability caused by histamine, and that histamine effects on lung vascular permeability are H1 actions. PMID:956373

  11. Lymph node biopsy

    MedlinePLUS

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

  12. Biodegradable radiopaque microspheres for the evaluation of regional pulmonary blood flow distribution using electron-beam computed tomography

    NASA Astrophysics Data System (ADS)

    Workman, Michael J.; Tajik, Jehangir K.; Robinson, Miguel T.; Hoffman, Eric A.

    1994-05-01

    Accurate measurement of regional pulmonary blood flow distribution is of interest both as a research and diagnostic tool. Measurements of regional pulmonary perfusion via x-ray CT offer the possibility of detecting perfusion deficits due to pulmonary embolus while maintaining a high degree of anatomic detail. Use of bolus injection of conventional radiopaque contrast with associated short mean transit times (5 - 7 seconds), requires a high degree of temporal resolution offered clinically only by electron beam x-ray CT (Imatron). The present study was intended to characterize biodegradable radiopaque microspheres as an alternative contrast agent which would allow for measurement of regional pulmonary blood flow with scanning times associated with conventional or spiral thin slice, volumetric x-ray CT protocols. To test this, a dog was scanned at 6 slice levels and 13 time points with image acquisition gated to the cardiac cycle. Lung volumes were maintained at functional residual capacity.

  13. 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.

  14. Hypoxia, not pulmonary vascular pressure, induces blood flow through intrapulmonary arteriovenous anastomoses

    PubMed Central

    Tremblay, Joshua C; Lovering, Andrew T; Ainslie, Philip N; Stembridge, Mike; Burgess, Keith R; Bakker, Akke; Donnelly, Joseph; Lucas, Samuel JE; Lewis, Nia CS; Dominelli, Paolo B; Henderson, William R; Dominelli, Giulio S; Sheel, A William; Foster, Glen E

    2015-01-01

    Blood flow through intrapulmonary arteriovenous anastomoses (IPAVA) is increased with exposure to acute hypoxia and has been associated with pulmonary artery systolic pressure (PASP). We aimed to determine the direct relationship between blood flow through IPAVA and PASP in 10 participants with no detectable intracardiac shunt by comparing: (1) isocapnic hypoxia (control); (2) isocapnic hypoxia with oral administration of acetazolamide (AZ; 250mg, three times a day for 48h) to prevent increases in PASP; and (3) isocapnic hypoxia with AZ and 8.4% NaHCO3 infusion (AZ+HCO3) to control for AZ-induced acidosis. Isocapnic hypoxia (20min) was maintained by end-tidal forcing, blood flow through IPAVA was determined by agitated saline contrast echocardiography and PASP was estimated by Doppler ultrasound. Arterial blood samples were collected at rest before each isocapnichypoxia condition to determine pH, [HCO3] and . AZ decreased pH (0.080.01), [HCO3] (?7.10.7mmoll?1) and (?4.51.4mmHg; P<0.01), while intravenous NaHCO3 restored arterial blood gas parameters to control levels. Although PASP increased from baseline in all three hypoxic conditions (P<0.05), a main effect of condition expressed an 112% reduction in PASP from control (P<0.001) following AZ administration while intravenous NaHCO3 partially restored the PASP response to isocapnic hypoxia. Blood flow through IPAVA increased during exposure to isocapnic hypoxia (P<0.01) and was unrelated to PASP, cardiac output and pulmonary vascular resistance for all conditions. In conclusion, isocapnic hypoxia induces blood flow through IPAVA independent of changes in PASP and the influence of AZ on the PASP response to isocapnic hypoxia is dependent upon the H+ concentration or . PMID:25416621

  15. Drug detection in breath: effects of pulmonary blood flow and cardiac output on propofol exhalation.

    PubMed

    Kamysek, Svend; Fuchs, Patricia; Schwoebel, Henny; Roesner, Jan P; Kischkel, Sabine; Wolter, Kathi; Loeseken, Christian; Schubert, Jochen K; Miekisch, Wolfram

    2011-10-01

    Breath analysis could offer a non-invasive means of intravenous drug monitoring if robust correlations between drug concentrations in breath and blood can be established. In this study, propofol blood and breath concentrations were determined in an animal model under varying physiological conditions. Propofol concentrations in breath were determined by means of two independently calibrated analytical methods: continuous, real-time proton transfer reaction mass spectrometry (PTR-MS) and discontinuous solid-phase micro-extraction coupled with gas chromatography mass spectrometry (SPME-GC-MS). Blood concentrations were determined by means of SPME-GC-MS. Effects of changes in pulmonary blood flow resulting in a decreased cardiac output (CO) and effects of dobutamine administration resulting in an increased CO on propofol breath concentrations and on the correlation between propofol blood and breath concentrations were investigated in seven acutely instrumented pigs. Discontinuous propofol determination in breath by means of alveolar sampling and SPME-GC-MS showed good agreement (R(2)=0.959) with continuous alveolar real-time measurement by means of PTR-MS. In all investigated animals, increasing cardiac output led to a deterioration of the relationship between breath and blood propofol concentrations (R(2)=0.783 for gas chromatography-mass spectrometry and R(2)=0.795 for PTR-MS). Decreasing pulmonary blood flow and cardiac output through banding of the pulmonary artery did not significantly affect the relationship between propofol breath and blood concentrations (R(2)>0.90). Estimation of propofol blood concentrations from exhaled alveolar concentrations seems possible by means of different analytical methods even when cardiac output is decreased. Increases in cardiac output preclude prediction of blood propofol concentration from exhaled concentrations. PMID:21643859

  16. 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.

  17. 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

  18. 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.

  19. 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.

  20. Pandiastolic antegrade flow in patient with severe right ventricle to pulmonary artery conduit stenosis: An interesting phenomenon

    PubMed Central

    Awasthy, Neeraj; Bhatt, Chintan; Iyer, Krishna Subramony

    2016-01-01

    In a post operative tetralogy of fallot (TOF) physiology patient, abnormal right ventricular (RV) function remains the greatest matter of concern. Due to restrictive RV diastolic dysfunction, there is detectable antegrade diastolic flow in the pulmonary artery during atrial systole. We report a case of 21 year old male patient with total correction done in infancy using right ventricle to pulmonary artery conduit. He was relatively asymptomatic with a unique pattern of antegrade diastolic flow in both early and late diastolic phases (pan diastolic). This physiology was supportive and made him relatively asymptomatic. We discuss the physiology and clinical implication of the same.

  1. [Lymphatic afferents and efferents of lymph nodes of the Barety's space. Anatomic review in adults].

    PubMed

    Riquet, M; Debesse, B; Zouaoui, A; Hidden, G

    1990-06-01

    Lymph nodes of the Barety's space (LNLB) often involved in lung diseases are known under various names for a long time ago by pathologists. Our study involves 360 cadavers of adult subjects. The injection of a dye was performed by direct catheterization of a pulmonary segment. L.N.L.B. were directly or indirectly coloured (inter connected ganglionary network) more often from the lobes of the right lung, but from the lobes of the left lung too. From L.N.L.B. the lymphatic flow discharges in the venous confluent of the neck in the right side; in 1/4 of the cases a mediastinal efferent joints the left venous confluent too. From the lower lymph nodes of the space efferents can go to lymph nodes which are located right along the arch of the azygos vein (and then to the thoracic duct) and in the left side the group of left suprabronchial lymph nodes (then either to the thoracic duct in the mediastinum, or to the recurrent chain to the neck). At last, it seems that inside the lymph nodes themselves, lymphatic flows exist, the topography and the nature of which change according to the area interested by the injection. PMID:2289035

  2. Swollen lymph nodes

    MedlinePLUS

    Swollen glands; Glands - swollen; Lymph nodes - swollen; Lymphadenopathy ... Common areas where the lymph nodes can be felt (with the fingers) include: Groin Armpit Neck (there is a chain of lymph nodes on either side of ...

  3. Effect of pulmonary blood flow on measurements of respiratory mechanics using the interrupter technique.

    PubMed

    Freezer, N J; Lanteri, C J; Sly, P D

    1993-03-01

    The relationship between respiratory mechanics, changes in pulmonary blood flow (PBF), pulmonary arterial pressure, and left atrial pressure is unclear. Conventional methods for the measurement of respiratory mechanics model the respiratory system as a single compartment, which may not adequately represent the respiratory system in a diseased state. The interrupter technique models the respiratory system as two compartments, with the "flow resistance" of the conducting airways and chest wall (Raw) considered separately from Pdif, a measure of the viscoelastic properties of the lung and chest wall, together with any pendelluft present. The respiratory mechanics of 15 infants in the first year of life were studied during cardiac catheterization with the use of conventional methods and the interrupter technique. The infants had a PBF-to-systemic blood flow ratio ranging from 0.6 to 4.0:1. The specific dynamic compliance of the respiratory system was not related to the PBF; however, there was a significant relationship between PBF and the total resistance of the respiratory system (Rrs) [analysis of variance (ANOVA) F = 5.69, P < 0.05], Raw (ANOVA, F = 12.30, P < 0.01), and Pdif (ANOVA, F = 3.79, P < 0.05). Rrs increased significantly with an increase in mean left atrial pressure (ANOVA, F = 6.92, P < 0.05); however, dynamic compliance, Raw, and Pdif did not. These results suggest that the relationship between Rrs and PBF is due an increase in the resistive properties of the conducting airways and tissue components. PMID:8482646

  4. Smoke aldehyde component influences pulmonary edema

    SciTech Connect

    Hales, C.A.; Musto, S.W.; Janssens, S.; Jung, W.; Quinn, D.A.; Witten, M. , Massachusetts General Hospital, Boston )

    1992-02-01

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

  5. Measurement of effective pulmonary blood flow by soluble gas uptake in patients with chronic airflow obstruction.

    PubMed Central

    Pierce, R J; McDonald, C F; Thuys, C A; Rochford, P D; Barter, C E

    1987-01-01

    A study was designed to assess the accuracy and reproducibility of rebreathing and single breath soluble gas uptake measurements of effective pulmonary blood flow (Q) in patients with airways obstruction. Both rebreathing (RB) and single breath (SB) estimates of Q were compared with direct Fick and thermodilution (TD) measurements of cardiac output at rest and during exercise in eight patients with chronic, poorly reversible airflow obstruction with mean FEV1 65% predicted and mean FEV1/FVC 53%. The mean (SD) resting values obtained were QRB 3.47 (0.46), QSB 4.75 (1.15), QFick 4.77 (0.97), and QTD 5.15 (0.98). QRB was significantly lower than the other three estimates, which did not differ significantly from each other. Exercise produced significant increases in all four estimates for the group. The mean exercise values were QRB 6.23 (1.19), QSB 7.62 (1.97), QFick 8.97 (1.96), and QTD 9.09 (1.00), both QRB and QSB being significantly less than QFick and QTD. Analysis of variance of the rest, exercise, and combined data showed highly significant relationships with the TD and Fick measurements for both QRB and QSB over the range of values studied. In addition, the reproducibility of QRB and QSB was assessed in 15 other patients with chronic airflow obstruction (mean FEV1 42% predicted, FEV1/FVC 43%) and in 10 normal subjects. The coefficients of intrasubject variability for a single measurement for QRB were 8.7% in normal subjects and 10.2% in patients and for QSB were 11.7% in normal subjects and 16.1% in patients. The group differences from morning to afternoon, between days, and over a month were not significant in the normal subjects. In the patients QRB was slightly higher in the afternoon than in the morning of the same day, but the differences between days and over a month were not significant for either test. Although both tests detected the increase in pulmonary blood flow during exercise, the single breath test was more accurate at rest. Some underestimation was present for rebreathing at rest and for both tests during exercise, but this can be allowed for. In patients with mild airflow obstruction the reproducibility of the soluble gas uptake methods was similar to that of invasive catheter methods of cardiac output estimation. The single breath test in particular was, however, less reproducible in patients with more severe airflow obstruction, and the rebreathing method may be more useful for detecting increases in pulmonary blood flow in these patients. PMID:3660313

  6. On-line determination of pulmonary blood flow using respiratory inert gas analysis.

    PubMed

    Gan, K; Nishi, I; Chin, I; Slutsky, A S

    1993-12-01

    An inert gas analysis method has been developed to perform on-line real time determination of pulmonary blood flow using a nonrebreathing approach. This technique is based on a mathematical model describing mass balance of two inert gases which are breathed using an open gas circuit. The measurements using this method are noninvasive, easy to peform, and do not disturb normal physiological processes. As well, since data are collected on a breath-by-breath basis, it is possible to estimate other respiratory, cardiopulmonary, and metabolic parameters simultaneously in a breath-by-breath manner. Special consideration was given to developing effective data processing algorithms to minimize the influence of measurement noise and respiratory variations. Experimental studies to compare this method with other accepted techniques were conducted to validate the present technique. PMID:8125501

  7. Pulmonary Hypertension

    PubMed Central

    Newman, John H.

    2005-01-01

    The modern era in cardiopulmonary medicine began in the 1940s, when Cournand and Richards pioneered right-heart catheterization. Until that time, no direct measurement of central vascular pressure had been performed in humans. Right-heart catheterization ignited an explosion of insights into function and dysfunction of the pulmonary circulation, cardiac performance, ventilationperfusion relationships, lungheart interactions, valvular function, and congenital heart disease. It marked the beginnings of angiocardiography with its diagnostic implications for diseases of the left heart and peripheral circulation. Pulmonary hypertension was discovered to be the consequence of a large variety of diseases that either raised pressure downstream of the pulmonary capillaries, induced vasoconstriction, increased blood flow to the lung, or obstructed the pulmonary vessels, either by embolism or in situ fibrosis. Hypoxic vasoconstriction was found to be a major cause of acute and chronic pulmonary hypertension, and surprising vasoreactivity of the pulmonary vascular bed was discovered to be present in many cases of severe pulmonary hypertension, initially in mitral stenosis. Diseases as disparate as scleroderma, cystic fibrosis, kyphoscoliosis, sleep apnea, and sickle cell disease were found to have shared consequences in the pulmonary circulation. Some of the achievements of Cournand and Richards and their scientific descendents are discussed in this article, including success in the diagnosis and treatment of idiopathic pulmonary arterial hypertension, chronic thromboembolic pulmonary hypertension, and management of hypoxic pulmonary hypertension. PMID:15994464

  8. 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

  9. Lung ventilation contributes to vertical lymph movement in anurans.

    PubMed

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

    2007-11-01

    Anurans (frogs and toads) generate lymphatic fluid at 10 times the rate in mammals, largely as a consequence of their very 'leaky' vasculature and high interstitial compliance. Lymph is ultimately pumped into the venous system by paired, dorsally located lymph hearts. At present, it is unclear how lymphatic fluid that accumulates in central body subcutaneous lymph sacs is moved to the anterior and posterior lymph hearts in the axillary regions and how lymph is moved, against gravity, to the dorsally located lymph hearts. In this study, we tested the hypothesis that lung ventilation, through its consequent effects on lymph sac pressure, contributes to the vertical movement of lymphatic fluid in the cane toad (Chaunus marinus) and the North American bullfrog (Lithobates catesbeiana). We measured pressure in the dorsal, lateral and subvertebral lymph sacs of anesthetized cane toads and bullfrogs during artificial lung inflation and deflation. We also measured pressure in the subvertebral lymph sac, which adheres to the dorsal surface of the lungs, simultaneously with brachial (forelimb) and pubic (posterior) sac pressure during ventilation in freely behaving animals. There were highly significant (P<0.001) relationships between lung pressure and lymph sac pressures (r(2)=0.19-0.72), indicating that pulmonary pressure is transmitted to the highly compliant lymph sacs that surround the lungs. Subvertebral sac pressure of resting animals was not significantly different between L. catesbeiana (518+/-282 Pa) and C. marinus (459+/-111 Pa). Brachial sac compliance (ml kPa(-1) kg(-1)) also did not differ between the two species (33.6+/-5.0 in L. catesbeiana and 37.0+/-9.4 in C. marinus). During expiration (lung deflation), reductions in expanding subvertebral sac pressure are communicated to the brachial lymph sac. Changes in brachial and pubic lymph sac pressures were correlated almost entirely during expiration rather than inspiration. The change in brachial sac pressure during expiration was 235+/-43 Pa for C. marinus and 215+/-50 Pa for L. catesbeiana, which is of sufficient magnitude to move lymph the estimated 0.5-1.0 cm vertical distance from the forelimb to the vicinity of the anterior lymph hearts. We suggest that lymph is moved during expiration to the subvertebral sac from anterior and posterior lymph sacs. During lung inflation, increased lymph sac pressure moves lymph to axillary regions, where lymph hearts can return lymph to the vascular space. Consequently, pulmonary ventilation has an important role for lymph movement and, hence, blood volume regulation in anurans. PMID:17981861

  10. Pulmonary hypertension

    MedlinePLUS

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

  11. Predictive capacity of a non-radioisotopic local lymph node assay using flow cytometry, LLNA:BrdU-FCM: Comparison of a cutoff approach and inferential statistics.

    PubMed

    Kim, Da-Eun; Yang, Hyeri; Jang, Won-Hee; Jung, Kyoung-Mi; Park, Miyoung; Choi, Jin Kyu; Jung, Mi-Sook; Jeon, Eun-Young; Heo, Yong; Yeo, Kyung-Wook; Jo, Ji-Hoon; Park, Jung Eun; Sohn, Soo Jung; Kim, Tae Sung; Ahn, Il Young; Jeong, Tae-Cheon; Lim, Kyung-Min; Bae, SeungJin

    2016-01-01

    In order for a novel test method to be applied for regulatory purposes, its reliability and relevance, i.e., reproducibility and predictive capacity, must be demonstrated. Here, we examine the predictive capacity of a novel non-radioisotopic local lymph node assay, LLNA:BrdU-FCM (5-bromo-2'-deoxyuridine-flow cytometry), with a cutoff approach and inferential statistics as a prediction model. 22 reference substances in OECD TG429 were tested with a concurrent positive control, hexylcinnamaldehyde 25%(PC), and the stimulation index (SI) representing the fold increase in lymph node cells over the vehicle control was obtained. The optimal cutoff SI (2.7≤cutoff <3.5), with respect to predictive capacity, was obtained by a receiver operating characteristic curve, which produced 90.9% accuracy for the 22 substances. To address the inter-test variability in responsiveness, SI values standardized with PC were employed to obtain the optimal percentage cutoff (42.6≤cutoff <57.3% of PC), which produced 86.4% accuracy. A test substance may be diagnosed as a sensitizer if a statistically significant increase in SI is elicited. The parametric one-sided t-test and non-parametric Wilcoxon rank-sum test produced 77.3% accuracy. Similarly, a test substance could be defined as a sensitizer if the SI means of the vehicle control, and of the low, middle, and high concentrations were statistically significantly different, which was tested using ANOVA or Kruskal-Wallis, with post hoc analysis, Dunnett, or DSCF (Dwass-Steel-Critchlow-Fligner), respectively, depending on the equal variance test, producing 81.8% accuracy. The absolute SI-based cutoff approach produced the best predictive capacity, however the discordant decisions between prediction models need to be examined further. PMID:26654807

  12. Effect of Supine Posture on Airway Blood Flow and Pulmonary Function in Stable Heart Failure

    PubMed Central

    Ceridon, Maile L.; Morris, Norman R.; Olson, Thomas P.; Lalande, Sophie; Johnson, Bruce D.

    2014-01-01

    Background The aim of this study was to determine the relationship between body position, pulmonary function (PF) and bronchial blood flow (Qaw) in a group of heart failure (HF) and control subjects. Methods Thirty-six subjects were studied: 24 stable, ambulatory HF patients (HF: LVEF=276%, age=659yr) and 12 age- and sex-matched controls (CTRL: LVEF=607%, age=628yr). Measures of Q?aw (soluble gas method) and PF were collected upright and following 30 min in the supine position. Results Q?aw was similar between groups and remained unchanged with body position. Declines in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) with the supine position were observed in both groups; declines in forced expiratory flow 2575% (FEF2575) and FEF 75% (FEF75) with the supine position were observed in the HF group only. Changes in Q?aw were related to changes in PF only in the HF patient groups (?FVC, %predicted, r=?0.45, p<0.04, ?FEV1 r=?0.61, p<0.01, ?FEV1 %predicted, r=?0.45, p<0.04). Conclusion These data demonstrate that relationships between postural changes in Q?aw and PF exist only in the HF population and that the bronchial circulation may contribute to postural PF decline in HF. PMID:21741500

  13. Dexamethasone Suppression FDG PET/CT for Differentiating between True- and False-Positive Pulmonary and Mediastinal Lymph Node Metastases in Non-Small Cell Lung Cancer: A Pilot Study of FDG PET/CT after Oral Administration of Dexamethasone.

    PubMed

    Nakajo, Masatoyo; Nakajo, Masayuki; Nakayama, Hirofumi; Jinguji, Megumi; Nakabeppu, Yoshiaki; Higashi, Michiyo; Nakamura, Yoshihiro; Sato, Masami; Yoshiura, Takashi

    2016-04-01

    Purpose To examine whether dexamethasone suppression can reduce fluorine 18 fluorodeoxyglucose (FDG) uptake in false-positive (FP) findings in pulmonary and mediastinal lymph nodes in non-small cell lung cancer (NSCLC). Materials and Methods Institutional ethics review board approved this prospective study with written informed consent. The study population was composed of 17 patients with NSCLC who underwent both baseline and dexamethasone suppression (24 hours after oral administration of 8 mg dexamethasone) FDG positron emission tomography/computed tomography and surgery. FDG uptake was evaluated by using a five-point visual scoring system (negative findings, score of 0-1; positive findings, score of 2-4) and maximum standardized uptake value (SUVmax). The Mann-Whitney U, Wilcoxon signed-rank, Kruskal-Wallis, or Spearman rank correlation tests were used as necessary for statistical evaluations. Results In 17 primary lesions, no significant difference was noted in visual score between baseline (mean, 3.4 ± 1.2) and dexamethasone suppression scans (mean, 3.3 ± 1.2; P = .16), although SUVmax was significantly lower on dexamethasone suppression scans (mean, 7.1 ± 5.2) than on baseline scans (mean, 8.6 ± 6.6; P = .005). In eight nodes with true-positive (TP) findings, there were no significant differences in visual score (mean for both, 3.8 ± 0.5) and SUVmax (mean, 5.3 ± 2.3 vs 5.5 ± 2.5, respectively; P = .81) between baseline and dexamethasone suppression scans. In 19 nodes with FP findings at baseline, dexamethasone suppression resulted in significantly lowered visual score (mean, 3.4 ± 0.6 vs 2.4 ± 0.8, respectively; P < .001) and SUVmax (mean, 3.5 ± 0.8 vs 2.7 ± 0.7, respectively; P < .001), and four nodes with FP findings were rated as true-negative findings on dexamethasone suppression scans, which resulted in a significant difference in SUVmax between nodal lesions with TP and FP findings (P = .014). Conclusion Oral dexamethasone has the potential to reduce FDG uptake in pulmonary and mediastinal nodes with FP findings in NSCLC. (©) RSNA, 2015 Online supplemental material is available for this article. PMID:26579562

  14. Axillary lymph node tuberculosis masquerading as inflammatory breast carcinoma in an immune-compromised patient.

    PubMed

    Chikkannaiah, Panduranga; Vani, B R; Benachinmardi, Kirtilaxmi; Murthy, V Srinivasa

    2016-02-01

    While tuberculosis is still the leading opportunistic infection among human immunodeficiency virus-seropositive patients, extra-pulmonary tuberculosis is more common than pulmonary tuberculosis, with lymph nodes being a common site. Axillary lymph node pathology such as tuberculosis and lymphoma rarely mimics inflammatory breast carcinoma by producing lymphatic obstruction. We report a case of axillary lymph node tuberculosis in a 40-year-old immune-compromised woman, clinically presenting as inflammatory breast carcinoma. PMID:25681261

  15. 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. PMID:25854923

  16. In situ lymph dynamic characterization through lymph nodes in rabbit hind leg: special reference to nodal inflammation.

    PubMed

    Nagai, Takashi; Ikomi, Fumitaka; Suzuki, Shigeru; Ohhashi, Toshio

    2008-04-01

    In some lymph nodes, water and water-soluble substances of smaller molecular weight are known to be absorbed into blood vessels, and consequently the protein concentration of lymph within the nodes increases. In this study, we examined pressure-flow relationships of lymph nodes in situ and exchange properties of water and water-soluble substances through the nodes with special reference to inflamed lymph nodes. A lymph perfusion model through the lymph node in situ was constructed by cannulating one of the afferent lymphatics and an efferent lymphatic. Increasing infusion pressure (0 to 150 cmH(2)O) or decreasing outflow pressure (10 to -5 cmH(2)O) in the model caused a significant increase of the lymph outflow rate through the node. This rate was also increased significantly with increases in both intranodal venous pressure (range: control, 20, 30, and 40 mmHg) and prenodal lymph albumin concentration (range: 0%, 2.6%, and 10%). When formyl-Met-Leu-Phe-OH (fMLP)-mediated acute inflammation was produced in the lymph nodes, the lymph outflow rate through the node was significantly decreased. These results indicate that colloid osmotic pressure and hydrostatic pressure within the lymph node may play important roles in the transport of water and water-soluble substances through the node. Acute fMLP-mediated inflammation of lymph nodes also produced a significant decrease of the lymph flow rate through lymph nodes. PMID:18325146

  17. 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.

  18. Incidentally proven pulmonary "ALKoma".

    PubMed

    Osoegawa, Atsushi; Nosaki, Kaname; Miyamoto, Hitoshi; Kometani, Takuro; Hirai, Fumihiko; Ondo, Kaoru; Seto, Takashi; Sugio, Kenji; Choi, Young Lim; Soda, Manabu; Mano, Hiroyuki; Ichinose, Yukito

    2010-01-01

    Genetic alterations of echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) inversion were recently found in lung cancer. A 39-year-old woman with multiple brain metastases and bulky mediastinal lymph node metastases was admitted. Biopsy from her supraclavicular lymph nodes was performed to differentiate the diagnosis between lymphoma and lung cancer. Pathologically, the lymph nodes had a feature of adenocarcinoma. On the other hand, the commercially available chromosomal fluorescent in situ hybridization (FISH) analysis showed split signals of ALK, which was confirmed to be the EML4-ALK inversion. The commercial-based ALK FISH is useful for screening pulmonary ALKoma. PMID:20228600

  19. Assessment of diastolic function by tissue Doppler echocardiography: comparison with standard transmitral and pulmonary venous flow

    NASA Technical Reports Server (NTRS)

    Farias, C. A.; Rodriguez, L.; Garcia, M. J.; Sun, J. P.; Klein, A. L.; Thomas, J. D.

    1999-01-01

    The objective of this study was to determine the utility of Doppler tissue echocardiography in the evaluation of diastolic filling and in discriminating between normal subjects and those with various stages of diastolic dysfunction. We measured myocardial velocities in 51 patients with various stages of diastolic dysfunction and in 27 normal volunteers. The discriminating power of each of the standard Doppler indexes of left ventricular filling, pulmonary venous flow, and myocardial velocities was determined with the use of Spearman rank correlation and analysis of variance F statistics. Early diastolic myocardial velocity (E(m)) was higher in normal subjects (16.0 +/- 3.8 cm/s) than in patients with either delayed relaxation (n = 15, 7.5 +/- 2.2 cm/s), pseudonormal filling (n = 26, 7.6 +/- 2.3 cm/s), or restrictive filling (n = 10, 7.4 +/- 2.4 cm/s, P <.0001). E(m ) was the best single discriminator between control subjects and patients with diastolic dysfunction (P =.7, F = 64.5). Myocardial velocities assessed by Doppler tissue echocardiography are useful in differentiating patients with normal from those with abnormal diastolic function. Myocardial velocity remains reduced even in those stages of diastolic dysfunction characterized by increased preload compensation.

  20. 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.

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

    PubMed Central

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

    2015-01-01

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

  2. Oral antioxidants improve leg blood flow during exercise in patients with chronic obstructive pulmonary disease.

    PubMed

    Rossman, Matthew J; Trinity, Joel D; Garten, Ryan S; Ives, Stephen J; Conklin, Jamie D; Barrett-O'Keefe, Zachary; Witman, Melissa A H; Bledsoe, Amber D; Morgan, David E; Runnels, Sean; Reese, Van R; Zhao, Jia; Amann, Markus; Wray, D Walter; Richardson, Russell S

    2015-09-01

    The consequence of elevated oxidative stress on exercising skeletal muscle blood flow as well as the transport and utilization of O2 in patients with chronic obstructive pulmonary disease (COPD) is not well understood. The present study examined the impact of an oral antioxidant cocktail (AOC) on leg blood flow (LBF) and O2 consumption during dynamic exercise in 16 patients with COPD and 16 healthy subjects. Subjects performed submaximal (3, 6, and 9 W) single-leg knee extensor exercise while LBF (Doppler ultrasound), mean arterial blood pressure, leg vascular conductance, arterial O2 saturation, leg arterial-venous O2 difference, and leg O2 consumption (direct Fick) were evaluated under control conditions and after AOC administration. AOC administration increased LBF (3 W: 1,604 100 vs. 1,798 128 ml/min, 6 W: 1,832 109 vs. 1,992 120 ml/min, and 9W: 2,035 114 vs. 2,187 136 ml/min, P < 0.05, control vs. AOC, respectively), leg vascular conductance, and leg O2 consumption (3 W: 173 12 vs. 210 15 ml O2/min, 6 W: 217 14 vs. 237 15 ml O2/min, and 9 W: 244 16 vs 260 18 ml O2/min, P < 0.05, control vs. AOC, respectively) during exercise in COPD, whereas no effect was observed in healthy subjects. In addition, the AOC afforded a small, but significant, improvement in arterial O2 saturation only in patients with COPD. Thus, these data demonstrate a novel beneficial role of AOC administration on exercising LBF, O2 consumption, and arterial O2 saturation in patients with COPD, implicating oxidative stress as a potential therapeutic target for impaired exercise capacity in this population. PMID:26188020

  3. Swollen lymph node (image)

    MedlinePLUS

    Lymph nodes play an important part in the body's defense against infection. Swelling might occur even if the infection is trivial or not apparent. Swelling of lymph nodes generally results from localized or systemic infection, abscess ...

  4. Cancer and lymph nodes

    MedlinePLUS

    ... the body and travel to an area of lymph nodes. The cancer cells often travel to nodes near the tumor ... American Cancer Society. Lymph Nodes and Cancer. Available at: ... Accessed June 4, 2014. Camp MS, Smith BL. ...

  5. Minimal residual disease detection by flow cytometry and PARR in lymph node, peripheral blood and bone marrow, following treatment of dogs with diffuse large B-cell lymphoma.

    PubMed

    Aresu, Luca; Aric, Arianna; Ferraresso, Serena; Martini, Valeria; Comazzi, Stefano; Riondato, Fulvio; Giantin, Mery; Dacasto, Mauro; Guadagnin, Eleonora; Frayssinet, Patrick; Rouquet, Nicole; Drigo, Michele; Marconato, Laura

    2014-05-01

    The most promising techniques for detecting minimal residual disease (MRD) in canine lymphoma are flow cytometry (FC) and polymerase chain reaction amplification of antigen receptor genes (PARR). However, the agreement between these methods has not been established. MRD was monitored by FC and PARR following treatment of dogs affected with diffuse large B-cell lymphoma (DLBCL), comparing results in lymph node (LN), peripheral blood (PB) and bone marrow (BM) samples. The prognostic impact of MRD on time to relapse (TTR) and lymphoma-specific survival (LSS) was also assessed. Fourteen dogs with previously untreated DLBCL were enrolled into the study; 10 dogs eventually relapsed, while four dogs with undetectable MRD were still in remission at the end of the study. At diagnosis, the concordance rate between FC and PARR was 100%, 78.6%, and 64.3% for LN, PB and BM, respectively. At the end of treatment, the agreement rates were 35.7%, 50%, and 57.1% for LN, PB and BM, respectively. At least one of the follow-up samples from dogs experiencing relapse was PARR(+); conversely, FC was not able to detect MRD in seven of the dogs that relapsed. PARR was more sensitive than FC in predicting TTR, whereas the combination of PARR and FC was more sensitive than either technique alone in predicting LSS using PB samples. The results suggest that immunological and molecular techniques should be used in combination when monitoring for MRD in canine DLBCL. PMID:24698669

  6. Influence of Bronchial Blood Flow and Conductance on Pulmonary Function in Stable Systolic Heart Failure

    PubMed Central

    Ceridon, Maile L.; Morris, Norman R.; Hulsebus, Minelle L.; Olson, Thomas P.; Lalande, Sophie; Johnson, Bruce D.

    2011-01-01

    The aim of this study was to determine the relationship between airway blood flow (Q?aw), airway conductance (Gf-aw) and pulmonary function in patients with stable HF. 12 controls (CTRL: age=639yr, FVC=9815%pred, LVEF=616%) (all data presented as meanSD), 16 patients with mild HF (HF-A, NYHA III: age=649yr, FVC=9017%pred, LVEF=286%), and 14 patients with moderate/severe HF (HF-B, NYHA IIIIV: age=656yr, FVC=8412%pred, LVEF=266%) were studied. Q?aw was assessed using soluble gas measurements; perfusion pressure across airway bed (?Paw) was estimated from systemic and pulmonary pressure measurements; Gf-aw was calculated as Q?aw/?Paw; PF was assessed by spirometry. While Q?aw was not significantly different between CTRL (61.317.9 ?Lmin?1ml?1), HF-A (70.126.9 ?Lmin?1ml?1) and HF-B (56.214.9 ?Lmin?1ml?1) groups, Gf-aw, was elevated in HF-A (1.10.4 ?Lmin?1ml?1mmHg?1, p<0.03) and tended to be elevated in HF-B (1.20.6 ?Lmin?1ml?1mmHg?1, p=0.07) when compared to CTRL (0.80.3 ?Lmin?1ml?1mmHg?1). Significant positive correlations were found between Gf-aw and RV/TLC for HF-A (r=0.63, p<0.02) and HF-B (r=0.58, p<0.05). These results support the hypothesis that increased bronchial conductance and bronchial congestion may be related to greater small airway obstruction and as such may play a role in the PF abnormalities and symptoms of congestion commonly observed in HF patients. PMID:21545852

  7. Recombinant tumor necrosis factor increases pulmonary vascular permeability independent of neutrophils.

    PubMed Central

    Horvath, C J; Ferro, T J; Jesmok, G; Malik, A B

    1988-01-01

    We studied the effects of intravenous infusion of recombinant human tumor necrosis factor type alpha (rTNF-alpha; 12 micrograms/kg) on lung fluid balance in sheep prepared with chronic lung lymph fistulas. The role of neutrophils was examined in sheep made neutropenic with hydroxyurea (200 mg/kg for 4 or 5 days) before receiving rTNF-alpha. Infusion of rTNF-alpha resulted in respiratory distress and 3-fold increases in pulmonary arterial pressure and pulmonary vascular resistance within 15 min, indicating intense pulmonary vasoconstriction. Pulmonary lymph flow (i.e., net transvascular fluid filtration rate) and transvascular protein clearance rate (a measure of vascular permeability to protein) increased 2-fold within 30 min. The increased permeability was associated with leukopenia and neutropenia. The pulmonary hypertension and vasoconstriction subsided but fluid filtration and vascular permeability continued to increase. Sheep made neutropenic had similar increases in pulmonary transvascular fluid filtration and vascular permeability. rTNF-alpha also produced concentration-dependent increases in permeability of 125I-labeled albumin across ovine endothelial cell monolayers in the absence of neutrophils or other inflammatory mediators. The results indicate that rTNF-alpha increases pulmonary vascular permeability to protein by an effect on the endothelium. PMID:3143114

  8. Thoracoscopic left mediastinal lymph node dissection.

    PubMed

    Nagashima, Takuya

    2016-01-01

    In Japan, the use of video-assisted thoracoscopic surgery (VATS) for primary lung cancer is increasing. However, it is not easy to perform mediastinal lymph node dissection using VATS as effectively as it is performed using thoracotomy. Herein, I have presented two techniques for subcarinal lymph node dissection from the left thoracic cavity: one involves the retraction of the lower bronchus towards the visceral and cranial side before inferior pulmonary vein resection to secure the view of the right lower portion. The other involves the separation of lymph nodes from the right main bronchus before separation from the left bronchus, to prevent the lymph nodes from falling down and interrupting the right-side view. Moreover, I have also described a technique that facilitates left upper mediastinal lymph node dissection. It involves traction of a thoracic cardiac branch from the recurrent laryngeal nerve allowing visualization of the bottom of the #4L lymph node, so that it can be dissected easily. There has been no observation of recurrent nerve paralysis using this procedure. PMID:26855946

  9. Thoracoscopic left mediastinal lymph node dissection

    PubMed Central

    2016-01-01

    In Japan, the use of video-assisted thoracoscopic surgery (VATS) for primary lung cancer is increasing. However, it is not easy to perform mediastinal lymph node dissection using VATS as effectively as it is performed using thoracotomy. Herein, I have presented two techniques for subcarinal lymph node dissection from the left thoracic cavity: one involves the retraction of the lower bronchus towards the visceral and cranial side before inferior pulmonary vein resection to secure the view of the right lower portion. The other involves the separation of lymph nodes from the right main bronchus before separation from the left bronchus, to prevent the lymph nodes from falling down and interrupting the right-side view. Moreover, I have also described a technique that facilitates left upper mediastinal lymph node dissection. It involves traction of a thoracic cardiac branch from the recurrent laryngeal nerve allowing visualization of the bottom of the #4L lymph node, so that it can be dissected easily. There has been no observation of recurrent nerve paralysis using this procedure. PMID:26855946

  10. Proteomic analysis of lymph.

    PubMed

    Leak, Lee V; Liotta, Lance A; Krutzsch, Henry; Jones, Michael; Fusaro, Vincent A; Ross, Sally J; Zhao, Yingming; Petricoin, Emanuel F; Fusaroa, Vincent A

    2004-03-01

    This report provides the first proteomic analysis of normal ovine lymph. By establishing the fact that lymph is more than an ultrafiltrate of blood plasma, it documents that the lymph proteome contains an array of proteins that differentiates it from plasma. The protein chip technology, surface-enhanced laser desorption/ionization-time of flight-mass spectrometry (SELDI-TOF-MS), two-dimensional gel electrophoresis (2-D PAGE) and MS, were employed to examine the protein expression profiles of ovine lymph. Using a weak cation exchange chip surface to assay lymph and plasma samples by SELDI-TOF-MS showed that the analysis of peak maps from lymph contained three protein peaks that were found only in lymph, while analysis of peak maps from plasma samples showed that five protein peaks were found only in plasma. Lymph and plasma samples showed eight peaks that were common to both. There were also more ions present in plasma than in lymph, which is consistent with the 2-D PAGE analysis. MS analysis of a large number of protein spots from 2-D PAGE gels of lymph produced MS/MS sequences for 18 proteins that were identified by searching against a comprehensive protein sequence database. As in plasma, large protein spots of albumin dominated the protein pattern in lymph. Other major proteins identified in 2-D PAGE gels of lymph included, fibrinogen alpha- and beta-chains, immunoglobulin G (IgG) heavy chain, serotransferrin precursor, lactoferrin, and apolipoprotein A-1. Two proteins that were identified and were differentially expressed in lymph were glial fibrillary astrocyte acidic protein and neutrophil cytosol factor-1. By bringing the technologies of proteomics to bear on the analysis of lymph, it is possible to detect proteins in lymph that are quantitatively and qualitatively differentially expressed from those of plasma. PMID:14997497

  11. 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.

  12. Diastolic function abnormalities in rheumatoid arthritis. Evaluation by echo Doppler transmitral flow and pulmonary venous flow: relation with duration of disease

    PubMed Central

    Di, F; Paradiso, M.; Mammarella, A.; Paoletti, V.; Labbadia, G.; Coppotelli, L.; Taccari, E.; Musca, A.

    2000-01-01

    OBJECTIVEThe aim of this study was to evaluate left ventricular filling in patients with rheumatoid arthritis (RA), analysing transmitral flow and pulmonary venous flow, with special regard to age and disease duration.?METHODS32 patients affected by RA according to ARA criteria were selected, without evidence of cardiac disease, and compared with matched control subjects. All patients and the control group were submitted to M-mode, two dimensional, Doppler and colour Doppler (continuous and pulsed wave) echocardiography. The following diastolic parameters were evaluated: transmitralic flow (E/A ratio), pulmonary venous flow (S/D ratio), a-Pw, IVRT and DT.?RESULTSIn RA patients left ventricular filling abnormalities were found characterised by a reduced E/A ratio (mean (SD) 1.16(0.31) v controls 1.37(0.32); p =0.02) and an increased S/D ratio (1.43(0.40) v controls 1.22(0.29); p=0.017). In the group of patients a relation was found between E/A ratio and disease duration (r= 0.40,p =0.01 Spearman rank correlation).?CONCLUSIONSAt present, it is concluded that RA patients, in absence of clinical evidence of heart disease, show diastolic dysfunction characterised by impaired E/A and S/D ratio. The relation between transmitral flow alteration and disease duration suggests a sub-clinical myocardial involvement.?? PMID:10700433

  13. Stress-induced changes in lymph microcirculation

    NASA Astrophysics Data System (ADS)

    Solov'eva, Anastasiya V.; Brill, Gregory E.; Galanzha, Ekateryna I.; Stepanova, Tatyana V.

    2001-05-01

    In the present study some characteristics of lymph microcirculation in mesentery of intact and stressed rats were investigated. The stress was modelled by simultaneous action of rigid immobilization and interrupting sound during 2 h. The direct observation of lymph circulation in microvessels was based on the light intravital videomicroscopy technique. The diameters of microvessels as well as parameters of phasic contractions and valve function of lymphatics were registered. After stress the mean diameter of lymphatic vessels was increased by 13%. The number of microvessels with phasic contractions raised by 20%. The amplitude and frequency of phasic contractions decreased by 31 and 39%, respectively. The percentage of microvessels with lymph flow comprised 86% in control and 93% in stressed animals. The mean velocity of lymph flow increased by 61 micrometers /s whereas the rate of valve work was not modified after stress.

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

    NASA Technical Reports Server (NTRS)

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

    2002-01-01

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

  15. Accuracy in the noninvasive estimation of pulmonary blood flow by identification of the CO2 uptake system.

    PubMed

    Noshiro, M; Maekawa, H; Ishida, A; Takahashi, M; Tsuji, T; Nakano, K

    1988-01-01

    Estimation of pulmonary blood flow, controlled by a roller pump, was carried out in dogs using a system identification technique. The system parameters in a linearized CO2 uptake model were estimated by the maximum-likelihood method from the input consisting of alveolar ventilation and inspired pCO2 and the output of end-tidal pCO2. The auto- and cross-correlations of the residuals showed that the model used for estimation was appropriate. The pulmonary blood flow calculated from the system parameters contained a degree of error which showed an average coefficient of variation of 23.8%. Error analysis revealed that the main sources of error lay in the estimates and in the error-magnifying effect arising in the calculation of the flow from these estimates. Reduction of the error in the estimates requires a long set of data for estimation; on the other hand, the error-magnifying effect is determined by physiological constants, so that it cannot be small even in clinical application. PMID:3155279

  16. 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 μg) 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

  17. [A case of pulmonary tumor thrombotic microangiopathy induced by early gastric cancer].

    PubMed

    Yasui, Hideki; Akamatsu, Taisuke; Nakamura, Yutarou; Inui, Naoki; Suda, Takafumi; Chida, Kingo; Meguro, Shiori; Baba, Satoshi

    2011-02-01

    A 56-year-old man with chief complaints of dry cough and dyspnea was admitted. He had severe hypoxemia, and his chest radiographs showed enhancement of pulmonary artery opacities with multiple defects on pulmonary blood flow scintigraphy. Enhanced computed tomography (CT) revealed swelling of the mediastinum and hilar lymph nodes, but no apparent thrombi in the pulmonary arteries was seen. A biopsy specimen of a left neck lymph node showed poorly differentiated adenocarcinoma, including signet-ring cell carcinoma components, but the origin was unclear. Despite receiving chemotherapy, his respiratory condition worsened, and he died 3 days after admission. Routine autopsy failed to clarify the tumor origin, but a detailed dissection of specimens confirmed early gastric cancer. Additionally, pathology of the pulmonary arteries was compatible with pulmonary tumor thrombotic microangiopathy (PTTM). PTTM is a rare condition characterized by the presence of diffuse thrombotic microthrombi and fibrocellular intimal proliferation in the pulmonary vasculature. Accompanied with early gastric cancer, this is an extremely rare but important case of PTTM. PMID:21400909

  18. Pulmonary Hypertension

    MedlinePLUS

    MENU Return to Web version Pulmonary Hypertension Overview What is pulmonary hypertension? "Pulmonary" means "in the lungs," and "hypertension" means "high blood pressure." Pulmonary hypertension is an increase ...

  19. Generation of Lymph Node-fat Pad Chimeras for the Study of Lymph Node Stromal Cell Origin

    PubMed Central

    Benezech, Cecile; Caamano, Jorge H.

    2013-01-01

    The stroma is a key component of the lymph node structure and function. However, little is known about its origin, exact cellular composition and the mechanisms governing its formation. Lymph nodes are always encapsulated in adipose tissue and we recently demonstrated the importance of this relation for the formation of lymph node stroma. Adipocyte precursor cells migrate into the lymph node during its development and upon engagement of the Lymphotoxin-b receptor switch off adipogenesis and differentiate into lymphoid stromal cells (Bnzechet al.14). Based on the lymphoid stroma potential of adipose tissue, we present a method using a lymph node/fat pad chimera that allows the lineage tracing of lymph node stromal cell precursors. We show how to isolate newborn lymph nodes and EYFP+ embryonic adipose tissue and make a LN/ EYFP+ fat pad chimera. After transfer under the kidney capsule of a host mouse, the lymph node incorporates local adipose tissue precursor cells and finishes its formation. Progeny analysis of EYFP+ fat pad cells in the resulting lymph nodes can be performed by flow-cytometric analysis of enzymatically digested lymph nodes or by immunofluorescence analysis of lymph nodes cryosections. By using fat pads from different knockout mouse models, this method will provide an efficient way of analyzing the origin of the different lymph node stromal cell populations. PMID:24378826

  20. [Metastatic thoracic lymph node carcinoma from extra-thoracic malignancy or from unknown primary site].

    PubMed

    Bagan, P; Mordant, P; Pricopi, C; Le Pimpec Barthes, F; Riquet, M

    2013-12-01

    Malignant mediastinal lymph nodes without pulmonary disease may be lymphomatous or the metastases from thoracic or extrathoracic malignancy. More rarely, metastatic lymph nodes are without primary site. Surgery is generally diagnostic, restricted to confirming the metastatic process, because of too numerous and disseminated or unresectable lymph nodes. Radical surgery consisting in lymphadenectomy can be effective in case of mediastinal lymph node malignancy without other extra- and intrathoracic disease. We observed in our experience and in several case reports long-term good results in such cases. We suggest that including surgery in the multimodality treatment of mediastinal metastatic lymph nodes may be advisable in selected patients. PMID:24210159

  1. Laparoscopic abdominoperineal resection with lateral lymph node dissection for anorectal melanoma: A case report.

    PubMed

    Matsuda, Kenji; Takifuji, Katsunari; Hotta, Tsukasa; Yokoyama, Shozo; Ieda, Junji; Iwamoto, Hiromitsu; Tsumura, Ayako; Kitadani, Junya; Yamaue, Hiroki

    2016-02-01

    Because anorectal melanoma, a rare cancer with a poor outcome, does not respond well to local radiation therapy or systemic chemotherapy, surgery is the primary treatment. Herein, we present a case of anorectal melanoma with lateral and inguinal lymph node metastases. A 61-year-old woman presented with rectal bleeding. Colonoscopy revealed a black tumor with ulceration in the anorectum. A CT scan revealed an anorectal tumor with left lateral lymph node swelling and right inguinal lymph node swelling. We performed a laparoscopic abdominoperineal resection with lateral lymph node dissection and right inguinal lymph node dissection. One year after the initial operation, pulmonary metastases were observed, and pulmonary resection was performed. After the pulmonary resection, brain metastases developed, and surgical resection was performed. Despite the recurrence of disease, the patient has survived for 52 months since the initial surgery and continues to receive systemic chemotherapy. PMID:26781530

  2. [Pelvic lymph nodes imaging].

    PubMed

    Roy, C

    2013-10-01

    Detecting metastatic pelvic lymph nodes is essential during the survey of a pelvic carcinoma. In routine clinical practice, CT scan is commonly used. However, its accuracy is quite low for small size lymph nodes. Diffusion-weighted imaging could be in the near future an efficient modality. PMID:23969242

  3. Comparison of Flow and Volume Incentive Spirometry on Pulmonary Function and Exercise Tolerance in Open Abdominal Surgery: A Randomized Clinical Trial

    PubMed Central

    Kumar, Amaravadi Sampath; Augustine, Alfred Joseph; Pazhyaottayil, Zulfeequer Chundaanveetil; Ramakrishna, Anand; Krishnakumar, Shyam Krishnan

    2016-01-01

    Introduction Surgical procedures in abdominal area lead to changes in pulmonary function, respiratory mechanics and impaired physical capacity leading to postoperative pulmonary complications, which can affect up to 80% of upper abdominal surgery. Aim To evaluate the effects of flow and volume incentive spirometry on pulmonary function and exercise tolerance in patients undergoing open abdominal surgery. Materials and Methods A randomized clinical trial was conducted in a hospital of Mangalore city in Southern India. Thirty-seven males and thirteen females who were undergoing abdominal surgeries were included and allocated into flow and volume incentive spirometry groups by block randomization. All subjects underwent evaluations of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow (PEF). Preoperative and postoperative measurements were taken up to day 5 for both groups. Exercise tolerance measured by Six- Minute Walk Test during preoperative period and measured again at the time of discharge for both groups. Pulmonary function was analysed by post-hoc analysis and carried out using Bonferroni’s ‘t’-test. Exercise tolerance was analysed by Paired ‘T’-test. Results Pulmonary function (FVC, FEV1, and PEFR) was found to be significantly decreased in 1st, 2nd and 3rd postoperative day when compared with preoperative day. On 4th and 5th postoperative day the pulmonary function (FVC, FEV1, and PEFR) was found to be better preserved in both flow and volume incentive spirometry groups. The Six-Minute Walk Test showed a statistically significant improvement in pulmonary function on the day of discharge than in the preoperative period. In terms of distance covered, the volume- incentive spirometry group showed a greater statistically significant improvement from the preoperative period to the time of discharge than was exhibited by the flow incentive spirometry group. Conclusion Flow and volume incentive spirometry can be safely recommended to patients undergoing open abdominal surgery as there have been no adverse events recorded. Also, these led to a demonstrable improvement in pulmonary function and exercise tolerance. PMID:26894090

  4. Tracking pulmonary gas exchange by breathing control during exercise: role of muscle blood flow

    PubMed Central

    Haouzi, Philippe

    2014-01-01

    Populations of group III and IV muscle afferent fibres located in the adventitia of the small vessels appear to respond to the level of venular distension and to recruitment of the vascular bed within the skeletal muscles. The CNS could thus be informed on the level of muscle hyperaemia when the metabolic rate varies. As a result, the magnitude and kinetics of the change in peripheral gas exchange which translates into pulmonary gas exchange can be sensed. We present the view that the respiratory control system uses these sources of information of vascular origin, among the numerous inputs produced by exercise, as a marker of the metabolic strain imposed on the circulatory and the ventilatory systems, resulting in an apparent matching between pulmonary gas exchange and alveolar ventilation. PMID:23981720

  5. Mediastinal lymph node size in lung cancer

    SciTech Connect

    Libshitz, H.I.; McKenna, R.J. Jr.

    1984-10-01

    Using a size criterion of 1 cm or greater as evidence for abnormality, the size of mediastinal lymph nodes identified by computed tomography (CT) was a poor predictor of mediastinal lymph node metastases in a series of 86 patients who had surgery for bronchogenic carcinoma. The surgery included full nodal sampling in all patients. Of the 86 patients, 36 had nodes greater than or equal to 1 cm identified by CT. Of the 21 patients with mediastinal metastases proven at surgery, 14 had nodes greater than or equal to 1 cm (sensitivity = 67%). Of the 65 patients without mediastinal metastases, 22 had nodes greater than or equal to 1 cm. Obstructive pneumonia and/or pulmonary collapse distal to the cancer was present in 39 patients (45%). Obstructive pneumonia and/or pulmonary collapse is a common occurrence in bronchogenic carcinoma, but mediastinal nodes greater than or equal to 1 cm in this circumstance cannot be presumed to represent metastatic disease. Metastatic mediastinal lymph node involvement was related to nodal size also in patients with evidence of prior granulomatous disease and in patients with no putative benign cause for nodes greater than or equal to 1 cm.

  6. Autologous Lymph Node Transfers.

    PubMed

    Becker, C

    2016-01-01

    Lymphedema is a common chronic and progressive condition complicating cancer treatment. Patients undergoing lymph node dissection and radiation therapy required for oncological treatment in breast and pelvic cancers are at high risk for secondary lymphedema. Reconstruction of the damaged region with a fatty flap containing lymph nodes may restore the anatomy. It has been postulated that the cytokines included in the fat surrounding the nodes VEGF-c allow regrowth of the lymphatic vessels. Hypoplasic congenital lymphedema are also positively improved by the autologous lymph node transfer, thanks to the same principles. PMID:26372688

  7. 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

  8. Group-wise construction of reduced models for understanding and characterization of pulmonary blood flows from medical images.

    PubMed

    Guibert, Romain; McLeod, Kristin; Caiazzo, Alfonso; Mansi, Tommaso; Fernndez, Miguel A; Sermesant, Maxime; Pennec, Xavier; Vignon-Clementel, Irene E; Boudjemline, Younes; Gerbeau, Jean-Frdric

    2014-01-01

    3D computational fluid dynamics (CFD) in patient-specific geometries provides complementary insights to clinical imaging, to better understand how heart disease, and the side effects of treating heart disease, affect and are affected by hemodynamics. This information can be useful in treatment planning for designing artificial devices that are subject to stress and pressure from blood flow. Yet, these simulations remain relatively costly within a clinical context. The aim of this work is to reduce the complexity of patient-specific simulations by combining image analysis, computational fluid dynamics and model order reduction techniques. The proposed method makes use of a reference geometry estimated as an average of the population, within an efficient statistical framework based on the currents representation of shapes. Snapshots of blood flow simulations performed in the reference geometry are used to build a POD (Proper Orthogonal Decomposition) basis, which can then be mapped on new patients to perform reduced order blood flow simulations with patient specific boundary conditions. This approach is applied to a data-set of 17 tetralogy of Fallot patients to simulate blood flow through the pulmonary artery under normal (healthy or synthetic valves with almost no backflow) and pathological (leaky or absent valve with backflow) conditions to better understand the impact of regurgitated blood on pressure and velocity at the outflow tracts. The model reduction approach is further tested by performing patient simulations under exercise and varying degrees of pathophysiological conditions based on reduction of reference solutions (rest and medium backflow conditions respectively). PMID:24148257

  9. 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

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

    SciTech Connect

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

    2012-08-01

    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 that (2) remaining differences are mainly due to uncertain airway segmentation and partial volume effects stemming from relatively coarse MRI resolution. Higher-fidelity testing of pulmonary airflow predictions should therefore be possible with future imaging improvements.

  11. Reperfusion pulmonary edema

    SciTech Connect

    Klausner, J.M.; Paterson, I.S.; Mannick, J.A.; Valeri, C.R.; Shepro, D.; Hechtman, H.B. )

    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.

  12. Lymph node culture

    MedlinePLUS

    Culture - lymph node ... or viruses grow. This process is called a culture. Sometimes, special stains are also used to identify specific cells or microorganisms before culture results are available. If needle aspiration does not ...

  13. Blood and Lymph Diseases

    MedlinePLUS

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

  14. Pulmonary embolism

    SciTech Connect

    Dunnick, N.R.; Newman, G.E.; Perlmutt, L.M.; Braun, S.D.

    1988-11-01

    Pulmonary embolism is a common medical problem whose incidence is likely to increase in our aging population. Although it is life-threatening, effective therapy exists. The treatment is not, however, without significant complications. Thus, accurate diagnosis is important. Unfortunately, the clinical manifestations of pulmonary embolism are nonspecific. Furthermore, in many patients the symptoms of an acute embolism are superimposed on underlying chronic heart or lung disease. Thus, a high index of suspicion is needed to identify pulmonary emboli. Laboratory parameters, including arterial oxygen tensions and electrocardiography, are as nonspecific as the clinical signs. They may be more useful in excluding another process than in diagnosing pulmonary embolism. The first radiologic examination is the chest radiograph, but the clinical symptoms are frequently out of proportion to the findings on the chest films. Classic manifestations of pulmonary embolism on the chest radiograph include a wedge-shaped peripheral opacity and a segmental or lobar diminution in vascularity with prominent central arteries. However, these findings are not commonly seen and, even when present, are not specific. Even less specific findings include cardiomegaly, pulmonary infiltrate, elevation of a hemidiaphragm, and pleural effusion. Many patients with pulmonary embolism may have a normal chest radiograph. The chest radiograph is essential, however, for two purposes. First, it may identify another cause of the patient's symptoms, such as a rib fracture, dissecting aortic aneurysm, or pneumothorax. Second, a chest radiograph is essential to interpretation of the radionuclide V/Q scan. The perfusion scan accurately reflects the perfusion of the lung. However, a perfusion defect may result from a variety of etiologies. Any process such as vascular stenosis or compression by tumor may restrict blood flow. 84 references.

  15. Lymphadenectomy During Pulmonary Metastasectomy.

    PubMed

    Reinersman, James Matthew; Wigle, Dennis A

    2016-02-01

    Pulmonary metastasectomy continues to be an effective approach to prolong survival in appropriately selected patients. The incidence of lymphatic spread is more common than previously recognized, with an estimate of 20% to 25% across multiple tumor types. The presence of metastatically involved lymph nodes adversely affects survival. What remains unclear is whether N1 vs N2, or the number of stations involved affects survival differently. The role of surgery for pulmonary metastasectomy in the patient with nodal metastases will likely expand with ongoing improvements in targeted and immunotherapies. PMID:26611508

  16. Ovine model for studying pulmonary immune responses

    SciTech Connect

    Joel, D.D.; Chanana, A.D.

    1984-11-25

    Anatomical features of the sheep lung make it an excellent model for studying pulmonary immunity. Four specific lung segments were identified which drain exclusively to three separate lymph nodes. One of these segments, the dorsal basal segment of the right lung, is drained by the caudal mediastinal lymph node (CMLN). Cannulation of the efferent lymph duct of the CMLN along with highly localized intrabronchial instillation of antigen provides a functional unit with which to study factors involved in development of pulmonary immune responses. Following intrabronchial immunization there was an increased output of lymphoblasts and specific antibody-forming cells in efferent CMLN lymph. Continuous divergence of efferent lymph eliminated the serum antibody response but did not totally eliminate the appearance of specific antibody in fluid obtained by bronchoalveolar lavage. In these studies localized immunization of the right cranial lobe served as a control. Efferent lymphoblasts produced in response to intrabronchial antigen were labeled with /sup 125/I-iododeoxyuridine and their migrational patterns and tissue distribution compared to lymphoblasts obtained from the thoracic duct. The results indicated that pulmonary immunoblasts tend to relocate in lung tissue and reappear with a higher specific activity in pulmonary lymph than in thoracic duct lymph. The reverse was observed with labeled intestinal lymphoblasts. 35 references, 2 figures, 3 tables.

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

    PubMed Central

    2011-01-01

    Background Involvement of inflammation in pulmonary hypertension (PH) has previously been demonstrated and recently, immune-modulating dendritic cells (DCs) infiltrating arterial lesions in patients suffering from idiopathic pulmonary arterial hypertension (IPAH) and in experimental monocrotaline-induced PH have been reported. Occurrence of perivascular inflammatory cells could be linked to local increase of oxidative stress (OS), as it has been shown for systemic atherosclerosis. The impact of OS on vascular remodeling in PH is still to be determined. We hypothesized, that augmented blood-flow could increase OS and might thereby contribute to DC/inflammatory cell-recruitment and smooth-muscle-cell-proliferation. Methods We applied a monocrotaline-induced PH-model and combined it with permanent flow-challenge. Thirty Sprague-Dawley rats were assigned to following groups: control, monocrotaline-exposure (MCT), monocrotaline-exposure/pneumonectomy (MCT/PE). Results Hemodynamic exploration demonstrated most severe effects in MCT/PE, corresponding in histology to exuberant medial and adventitial remodeling of pulmonary muscular arteries, and intimal remodeling of smaller arterioles; lung-tissue PCR evidenced increased expression of DCs-specific fascin, CD68, proinflammatory cytokines (IL-6, RANTES, fractalkine) in MCT/PE and to a lesser extent in MCT. Major OS enzyme NOX-4 was maximal in MCT/PE. Antioxidative stress enzymes Mn-SOD and glutathion-peroxidase-1 were significantly elevated, while HO-1 showed maximal expression in MCT with significant decrease in MCT/PE. Catalase was decreased in MCT and MCT/PE. Expression of NOX-4, but also of MN-SOD in MCT/PE was mainly attributed to a highly increased number of interstitial and perivascular CXCR4/SDF1 pathway-recruited mast-cells. Stress markers malonedialdehyde and nitrotyrosine were produced in endothelial cells, medial smooth muscle and perivascular leucocytes of hypertensive vasculature. Immunolabeling for OX62, CD68 and actin revealed adventitial and medial DC- and monocyte-infiltration; in MCT/PE, medial smooth muscle cells were admixed with CD68+/vimentin+ cells. Conclusion Our experimental findings support a new concept of immunologic responses to increased OS in MCT/PE-induced PAH, possibly linking recruitment of dendritic cells and OS-producing mast-cells to characteristic vasculopathy. PMID:21906276

  18. The value of assessing pulmonary venous flow velocity for predicting severity of mitral regurgitation: A quantitative assessment integrating left ventricular function

    NASA Technical Reports Server (NTRS)

    Pu, M.; Griffin, B. P.; Vandervoort, P. M.; Stewart, W. J.; Fan, X.; Cosgrove, D. M.; Thomas, J. D.

    1999-01-01

    Although alteration in pulmonary venous flow has been reported to relate to mitral regurgitant severity, it is also known to vary with left ventricular (LV) systolic and diastolic dysfunction. There are few data relating pulmonary venous flow to quantitative indexes of mitral regurgitation (MR). The object of this study was to assess quantitatively the accuracy of pulmonary venous flow for predicting MR severity by using transesophageal echocardiographic measurement in patients with variable LV dysfunction. This study consisted of 73 patients undergoing heart surgery with mild to severe MR. Regurgitant orifice area (ROA), regurgitant stroke volume (RSV), and regurgitant fraction (RF) were obtained by quantitative transesophageal echocardiography and proximal isovelocity surface area. Both left and right upper pulmonary venous flow velocities were recorded and their patterns classified by the ratio of systolic to diastolic velocity: normal (>/=1), blunted (<1), and systolic reversal (<0). Twenty-three percent of patients had discordant patterns between the left and right veins. When the most abnormal patterns either in the left or right vein were used for analysis, the ratio of peak systolic to diastolic flow velocity was negatively correlated with ROA (r = -0.74, P <.001), RSV (r = -0.70, P <.001), and RF (r = -0.66, P <.001) calculated by the Doppler thermodilution method; values were r = -0.70, r = -0.67, and r = -0.57, respectively (all P <.001), for indexes calculated by the proximal isovelocity surface area method. The sensitivity, specificity, and predictive values of the reversed pulmonary venous flow pattern for detecting a large ROA (>0.3 cm(2)) were 69%, 98%, and 97%, respectively. The sensitivity, specificity, and predictive values of the normal pulmonary venous flow pattern for detecting a small ROA (<0.3 cm(2)) were 60%, 96%, and 94%, respectively. However, the blunted pattern had low sensitivity (22%), specificity (61%), and predictive values (30%) for detecting ROA of greater than 0.3 cm(2) with significant overlap with the reversed and normal patterns. Among patients with the blunted pattern, the correlation between the systolic to diastolic velocity ratio was worse in those with LV dysfunction (ejection fraction <50%, r = 0.23, P >.05) than in those with normal LV function (r = -0.57, P <.05). Stepwise linear regression analysis showed that the peak systolic to diastolic velocity ratio was independently correlated with RF (P <.001) and effective stroke volume (P <.01), with a multiple correlation coefficient of 0.71 (P <.001). In conclusion, reversed pulmonary venous flow in systole is a highly specific and reliable marker of moderately severe or severe MR with an ROA greater than 0.3 cm(2), whereas the normal pattern accurately predicts mild to moderate MR. Blunted pulmonary venous flow can be seen in all grades of MR with low predictive value for severity of MR, especially in the presence of LV dysfunction. The blunted pulmonary venous flow pattern must therefore be interpreted cautiously in clinical practice as a marker for severity of MR.

  19. Pulmonary transvascular flux of transferrin

    SciTech Connect

    Cooper, J.A.; Malik, A.B. )

    1989-11-01

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

  20. Effect of nucleoprotein factor-kB (NF-?B) in endothelial cells during high blood flow-associated pulmonary vascular remodeling on vasoactive substances adrenomedullin and prostacyclin

    PubMed Central

    Yang, Jie; Wang, Weina; Dong, Meng; Yu, Xiaoxiao; Luo, Qiong

    2015-01-01

    The aim of this study was to investigate the role of nucleoprotein factor-kB (NF-?B) on the production and secretion of vasoactive substances adrenomedullin (ADM) and prostacyclin (PGI2) by endothelial cells in a high blood flow, pulmonary hypertension in vivo model. Fifty male Wistar rats were randomly divided into four groups: 15 rats received shunt surgery (Tn group); 15 rats received shunt surgery + NF-?B inhibitor [pyrrolidine dithiocarbamate (PDTC)] (Ti group); 10 rats received sham surgery (Co group); and 10 rats were negative controls (Cn group). A left to right shunt pulmonary hypertension model was established in groups Tn and Ti. Rats in the Ti group received an intraperitoneal injection of PDTC (120 mg/kgd) one hour before the operation for 2 weeks, and rats in the Co group were processed in the same fashion as that of the experimental groups, except that they did not undergo surgery. After 12 weeks, pulmonary artery systolic pressure was measured by cardiac catheterization, pulmonary arterial endothelial cells were isolated, and NF-?B, ADM and PGI2 protein expressions were measured in the endothelium using immunohistochemistry. ADM and PGI2 expressions were significantly lower in the Tn group relative to those of the Cn group (P<0.01) but no difference in the Ti group (P>0.05). Expressions in the Co and Cn groups were not significantly different (P>0.05). Heightened NF-?B activity in pulmonary arterial endothelial cells during high blood flow can suppress the synthesis and secretion of ADM and PGI2, potentially leading to vascular remodeling and pulmonary hypertension. PMID:26550335

  1. Solid lipid nanoparticles (SLN) of Efavirenz as lymph targeting drug delivery system: Elucidation of mechanism of uptake using chylomicron flow blocking approach.

    PubMed

    Makwana, Vivek; Jain, Rashmi; Patel, Komal; Nivsarkar, Manish; Joshi, Amita

    2015-11-10

    The aim of the present work was to develop a lymph targeted SLN formulation of antiretroviral (ARV) drug and to have an understanding of its underlying mechanism of uptake by the lymphatics. The lymphatics are the inaccessible reservoirs of HIV in human body. Efavirenz (EFV) is a BCS class II, ARV drug that undergoes extensive first pass metabolism. The EFV SLN formulation was prepared using Gelucire 44/14, Compritol 888 ATO, Lipoid S 75 and Poloxamer 188 by hot homogenization technique followed by ultrasonication method, with mean particle size of 168 nm, polydispersity index (PDI) <0.220, and mean zeta potential of -35.55 mV. DSC and XRPD studies revealed change in crystallinity index of drug when incorporated into SLN. In vitro drug release was found to be prolonged and biphasic in PBS pH 6.8. There was no significant change in the mean particle size, PDI, zeta potential and entrapment efficiency of EFV SLN after storage at 30 2C/60 5%RH for two months. The results from lymphatic transport and tissue distribution study indicate that a significant part of the EFV had by-passed portal system and was recovered in the lymph via chylomicron uptake mechanism. Reduction in the amount (44.70%) of the EFV reaching to liver indicates that major amount of EFV bypasses the liver and thereby, enhances the oral bioavailability of the EFV. A significant amount of EFV was found in spleen, a major lymphatic organ. EFV SLN seems to have potential to target the ARV to lymphatics for the better management of HIV. PMID:26367780

  2. Quantitative analysis of the central-chest lymph nodes based on 3D MDCT image data

    NASA Astrophysics Data System (ADS)

    Lu, Kongkuo; Bascom, Rebecca; Mahraj, Rickhesvar P. M.; Higgins, William E.

    2009-02-01

    Lung cancer is the leading cause of cancer death in the United States. In lung-cancer staging, central-chest lymph nodes and associated nodal stations, as observed in three-dimensional (3D) multidetector CT (MDCT) scans, play a vital role. However, little work has been done in relation to lymph nodes, based on MDCT data, due to the complicated phenomena that give rise to them. Using our custom computer-based system for 3D MDCT-based pulmonary lymph-node analysis, we conduct a detailed study of lymph nodes as depicted in 3D MDCT scans. In this work, the Mountain lymph-node stations are automatically defined by the system. These defined stations, in conjunction with our system's image processing and visualization tools, facilitate lymph-node detection, classification, and segmentation. An expert pulmonologist, chest radiologist, and trained technician verified the accuracy of the automatically defined stations and indicated observable lymph nodes. Next, using semi-automatic tools in our system, we defined all indicated nodes. Finally, we performed a global quantitative analysis of the characteristics of the observed nodes and stations. This study drew upon a database of 32 human MDCT chest scans. 320 Mountain-based stations (10 per scan) and 852 pulmonary lymph nodes were defined overall from this database. Based on the numerical results, over 90% of the automatically defined stations were deemed accurate. This paper also presents a detailed summary of central-chest lymph-node characteristics for the first time.

  3. 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

  4. Tumor cell entry into the lymph node is controlled by CCL1 chemokine expressed by lymph node lymphatic sinuses

    PubMed Central

    Das, Suvendu; Sarrou, Eliana; Podgrabinska, Simona; Cassella, Melanie; Mungamuri, Sathish Kumar; Feirt, Nikki; Gordon, Ronald; Nagi, Chandandeep S.; Wang, Yarong; Entenberg, David; Condeelis, John

    2013-01-01

    Lymphatic vessels are thought to contribute to metastasis primarily by serving as a transportation system. It is widely believed that tumor cells enter lymph nodes passively by the flow of lymph. We demonstrate that lymph node lymphatic sinuses control tumor cell entry into the lymph node, which requires active tumor cell migration. In human and mouse tissues, CCL1 protein is detected in lymph node lymphatic sinuses but not in the peripheral lymphatics. CCR8, the receptor for CCL1, is strongly expressed by human malignant melanoma. Tumor cell migration to lymphatic endothelial cells (LECs) in vitro is inhibited by blocking CCR8 or CCL1, and recombinant CCL1 promotes migration of CCR8+ tumor cells. The proinflammatory mediators TNF, IL-1β, and LPS increase CCL1 production by LECs and tumor cell migration to LECs. In a mouse model, blocking CCR8 with the soluble antagonist or knockdown with shRNA significantly decreased lymph node metastasis. Notably, inhibition of CCR8 led to the arrest of tumor cells in the collecting lymphatic vessels at the junction with the lymph node subcapsular sinus. These data identify a novel function for CCL1–CCR8 in metastasis and lymph node LECs as a critical checkpoint for the entry of metastases into the lymph nodes. PMID:23878309

  5. A rheumatoid nodule in an unusual location: mediastinal lymph node

    PubMed Central

    Yachoui, Ralph; Ward, Celine; Kreidy, Mazen

    2013-01-01

    Rheumatoid arthritis (RA) is a multisystem inflammatory disease characterised by destructive synovitis and varied extra-articular involvement. Rheumatoid lung nodules are the most common pulmonary manifestations of RA. Rheumatoid nodules in mediastinal lymph nodes are extremely uncommon. We describe a male patient with long-standing RA and subcutaneous rheumatoid nodules presenting with multiple lung nodules and mediastinal lymphadenopathies. Definite histopathology of a lymph node was consistent with necrobiotic granuloma due to RA. Clinicians should be aware of rheumatoid nodules as a potential cause of mediastinal lymphadenopathies, mainly in advanced rheumatoid arthritis. PMID:23645652

  6. 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

  7. PULMONARY CIRCULATION AT EXERCISE

    PubMed Central

    NAEIJE, R; CHESLER, N

    2012-01-01

    The pulmonary circulation is a high flow and low pressure circuit, with an average resistance of 1 mmHg.min.L?1 in young adults, increasing to 2.5 mmHg.min.L?1 over 46 decades of life. Pulmonary vascular mechanics at exercise are best described by distensible models. Exercise does not appear to affect the time constant of the pulmonary circulation or the longitudinal distribution of resistances. Very high flows are associated with high capillary pressures, up to a 2025 mmHg threshold associated with interstitial lung edema and altered ventilation/perfusion relationships. Pulmonary artery pressures of 4050 mmHg, which can be achieved at maximal exercise, may correspond to the extreme of tolerable right ventricular afterload. Distension of capillaries that decrease resistance may be of adaptative value during exercise, but this is limited by hypoxemia from altered diffusion/perfusion relationships. Exercise in hypoxia is associated with higher pulmonary vascular pressures and lower maximal cardiac output, with increased likelihood of right ventricular function limitation and altered gas exchange by interstitial lung edema. Pharmacological interventions aimed at the reduction of pulmonary vascular tone have little effect on pulmonary vascular pressure-flow relationships in normoxia, but may decrease resistance in hypoxia, unloading the right ventricle and thereby improving exercise capacity. Exercise in patients with pulmonary hypertension is associated with sharp increases in pulmonary artery pressure and a right ventricular limitation of aerobic capacity. Exercise stress testing to determine multipoint pulmonary vascular pressures-flow relationships may uncover early stage pulmonary vascular disease. PMID:23105961

  8. 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

  9. Influence of mildronat on left ventricular systolic, diastolic functional parameters, pulmonary arterial flow and systolic dyssynchrony in patients with congestive heart failure.

    PubMed

    Tsverava, M D

    2013-05-01

    The aim of the study was to investigate the influence of metabolic treatment with Mildronat on left and right ventricular function, pulmonary flow and systolic synchrony in patient with heart failure. We studied 16 persons with 2-3-d NYHA class Heart Failure, 8 male and 8 female (age 69.2±9.3). All where in stable condition at last for 3 months and take traditional medical treatment (ACE inhibitors or AT2-blockers, beta-blockers, Furosemide, Spirolactone). It was added Mildronat (500 mg 2x daily per os) for 2 months. All patient undergone standard EchoCG, PW and Color Tissue Doppler (TD) examination before and after 2 months of treatment with Mildronat. It was noted significant decrease LV end systolic volume and increase of Ejection Fraction and Fractional Shortening of LV after 2 month treatment with Mildronat. LV Tissue Doppler parameters did not change significantly, it was noted only tendency of increasing Right Ventricular systolic velocity. Pulmonary Arterial Acceleration Time significantly increased, right ventricular (RV) isovolumic relaxation time and RV TEI index (Systolic-Diastolic Index) on Tissue Doppler was significantly decreased after the treatment, which indicates improvement of RV function and decrease of Pulmonary Arterial Pressure. There was improvement of Intraventricular synchrony, systolic delay time between intraventricular septum and lateral wall became shorter after 2 month treatment with Mildronat but interventricular delay did not change significantly. Addition of Mildronat to traditional medical treatment improves left ventricular systolic function in patients with Heart Failure. Mildronat improves left ventricular systolic dissynchroni in patients with Heart Failure. Mildronat increases the pulmonary arterial flow acceleration time and shortens Right Ventricular isovolumic relaxation time and TEI index, this means that it reduces the Pulmonary Arterial Pressure and improves right ventricular function. PMID:23787504

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

    PubMed

    Hall, E T; S, R C; Holverda, S; Arai, T J; Dubowitz, D J; Theilmann, R J; Prisk, G K; Hopkins, S R

    2014-02-15

    The Zone model of pulmonary perfusion predicts that exercise reduces perfusion heterogeneity because increased vascular pressure redistributes flow to gravitationally nondependent lung, and causes dilation and recruitment of blood vessels. However, during exercise in animals, perfusion heterogeneity as measured by the relative dispersion (RD, SD/mean) is not significantly decreased. We evaluated the effect of exercise on pulmonary perfusion in six healthy supine humans using magnetic resonance imaging (MRI). Data were acquired at rest, while exercising (?27% of maximal oxygen consumption) using a MRI-compatible ergometer, and in recovery. Images were acquired in most of the right lung in the sagittal plane at functional residual capacity, using a 1.5-T MR scanner equipped with a torso coil. Perfusion was measured using arterial spin labeling (ASL-FAIRER) and regional proton density using a fast multiecho gradient-echo sequence. Perfusion images were corrected for coil-based signal heterogeneity, large conduit vessels removed and quantified (in mlmin(-1)ml(-1)) (perfusion), and also normalized for density and quantified (in mlmin(-1)g(-1)) (density-normalized perfusion, DNP) accounting for tissue redistribution. DNP increased during exercise (11.1 3.5 rest, 18.8 2.3 exercise, 13.2 2.2 recovery, mlmin(-1)g(-1), P < 0.0001), and the increase was largest in nondependent lung (110 61% increase in nondependent, 63 35% in mid, 70 33% in dependent, P < 0.005). The RD of perfusion decreased with exercise (0.93 0.21 rest, 0.73 0.13 exercise, 0.94 0.18 recovery, P < 0.005). The RD of DNP showed a similar trend (0.82 0.14 rest, 0.75 0.09 exercise, 0.81 0.10 recovery, P = 0.13). In conclusion, in contrast to animal studies, in supine humans, mild exercise decreased perfusion heterogeneity, consistent with Zone model predictions. PMID:24356515

  11. 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.

  12. [Study of the Identification Rate of Sentinel Lymph Node Biopsy after Partial Breast Resection].

    PubMed

    Suzuki, Shuhei; Sakurai, Kenichi; Adachi, Keita; Masuo, Yuki; Nagashima, Saki; Hara, Yukiko; Amano, Sadao; Enomoto, Katsuhisa; Makishima, Makoto

    2015-11-01

    Sentinel lymph node biopsy using the dye method is generally performed for patients with breast cancer. However, identification of the sentinel lymph node in the mammary gland is occasionally difficult after breast partial resection, as lymph flow is changed under the influence of surgery. Sentinel lymph node biopsy for patients with breast cancer who underwent partial mastectomy without axillary lymph node dissection is grade C1 in the breast cancer clinical practice guideline ver.2 2013. We examined the identification rate of the sentinel lymph node for patients with breast cancer who underwent lumpectomy or partial mastectomy. Lumpectomy and partial mastectomy were performed in 4 and 3 patients, respectively. It was possible to identify the sentinel lymph node in 6 patients, and no metastasis of cancer cells was identified in any patient. In 1 patient who underwent partial mastectomy, it was impossible to identify the sentinel lymph node, and thus, Level Ⅰlymph node sampling was performed. However, the pathological diagnosis was no metastasis of cancer cells. This patient underwent partial mastectomy of the C area and a smaller volume of the mammary gland. Therefore, we consider that lymph flow changed under the influence of surgery. Sentinel lymph node biopsy using the dye method after partial breast resection is useful, but partial mastectomy of the C area makes it difficult to perform sentinel lymph node biopsy. PMID:26805174

  13. Primary Pulmonary Lymphomas.

    PubMed

    Piña-Oviedo, Sergio; Weissferdt, Annikka; Kalhor, Neda; Moran, Cesar A

    2015-11-01

    Primary lung lymphoma (PLL) is a rare disease that comprises <0.5% of all primary lung tumors. It is defined as lymphoma confined to the lung with or without hilar lymph node involvement at the time of diagnosis or up to 3 months thereafter. Patients with PLL may be asymptomatic or manifest nonspecific clinical symptoms, for example, cough, chest pain, and dyspnea. Some individuals may be immunosupressed or have an autoimmune disorder. Radiologically, PLL can mimic pneumonia, lung carcinoma, or metastasis, and therefore, histologic confirmation is mandatory for definitive diagnosis. Primary lung marginal zone lymphoma of mucosa-associated lymphoid tissue type comprises 70% to 80% of cases. Less common B-cell lymphomas include diffuse large B-cell lymphoma, lymphomatoid granulomatosis (LyG), plasmacytoma, and other small lymphocytic lymphomas. PLLs of T-cell origin, largely represented by anaplastic large cell lymphoma, are extremely rare. LyG is an Epstein-Barr virus (EBV)-driven B-cell lymphoid neoplastic proliferation rich in T cells that produces vasculitis. The disease may present at different stages of progression. Differential diagnosis of PLL varies according to the lymphoma subtype: pulmonary mucosa-associated lymphoid tissue lymphoma should be distinguished from reactive inflammatory conditions, whereas high-grade lymphomas may resemble poorly differentiated lung carcinoma, metastatic disease, and other lymphomas. LyG can resemble inflammatory, infectious, and other lymphoid neoplastic processes. A panel of immunohistochemical markers, flow cytometry, and molecular methods are necessary to confirm the diagnosis in the majority of cases. In this article we review the clinical, radiologic, pathologic, and molecular characteristics of several B-cell and T-cell PLLs with exception of Hodgkin lymphoma and posttransplant lymphoproliferative disorder. PMID:26452211

  14. 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 ...

  15. Pulmonary Hypertension

    MedlinePLUS

    ... page from the NHLBI on Twitter. What Is Pulmonary Hypertension? Pulmonary hypertension (PULL-mun-ary HI-per-TEN-shun), or PH, is increased pressure in the pulmonary arteries. These arteries carry blood from your heart ...

  16. The simultaneous comparison of acetylene or carbon dioxide flux as a measure of effective pulmonary blood flow in children.

    PubMed

    Rosenthal, M; Bush, A

    1997-11-01

    Both acetylene (Ac) and carbon dioxide can be used to measure effective pulmonary blood flow (Q'eff) noninvasively. They are safe and reasonably accurate in adults during rest and exercise, but there have been no simultaneous comparisons in children. One hundred and six healthy children (55 males and 51 females, aged 8-17 yrs) were studied using an Innovision quadrupole mass spectrometer. They all underwent five rebreathing manoeuvres at rest, and then single measurements were again taken after 9 min of bicycle exercise. Mixed venous CO2 levels were calculated either by a linear (L) or curvilinear (C) extrapolation method. At rest, the coefficients of variation for Q'eff were Ac 8%, L 20%, and C 16% (p<0.001). The median resting values were: Ac 3.2 (95% confidence interval (95% CI) 3.1-3.4) L 5.1 (95 % CI 4.6-5.4) and C 4.7 (95 % CI 4.3-5.1) L x min(-1) x m(-2), (p<0.001). Compared to Ac, only 14 and 17% of L and C values, respectively, were +/-0.5 L x min(-1) x m(-2), whilst 41 and 29%, respectively were more than +/-2 L x min(-1) x m(-2). During exercise, median values were: Ac 6.7 (95% CI 6.3-7.0); L 8.0 (95% CI 7.3-8.4); and C 7.2 (95% CI 6.5-7.9) L x min(-1) x m(-2). L was significantly greater than C (p<0.001), but C was similar to Ac (p=0.06). More than 50% of L and C values could not be calculated for various reasons, whereas all 106 Ac values could be calculated. Neither carbon dioxide method is sufficiently reliable to be used in children in a clinical setting. Acetylene was safe, reliable, accurate and preferred. PMID:9426100

  17. Bradykinin Production and Increased Pulmonary Endothelial Permeability during Acute Respiratory Failure in Unanesthetized Sheep

    PubMed Central

    O'Brodovich, Hugh M.; Stalcup, S. Alex; Pang, Leila Mei; Lipset, Joel S.; Mellins, Robert B.

    1981-01-01

    To investigate mechanisms of pulmonary edema in respiratory failure, we studied unanesthetized sheep with vascular catheters, pleural balloons, and chronic lung lymph fistulas. Animals breathed either a hypercapnic-enriched oxygen (n = 5) or a hypercapnic-hypoxic (n = 5) gas mixture for 2 h. Every 15 min blood gases, pressures, cardiac output, lymph flow (Qlym), plasma and lymph albumin (mol wt, 70,000), IgG (mol wt, 150,000), IgM (mol wt, 900,000), and blood bradykinin concentrations were determined. In both groups, cardiac output and pulmonary arterial pressures increased, whereas left atrial pressures were unchanged. Acidosis alone (arterial pH = 7.16, PaCO2 = 81 mm Hg, PaO2 = 250 mm Hg) resulted in a doubling of lymph flow, a small increase in protein flux, and a decrease in lymph to plasma protein concentration (L/P) ratio for all three proteins. Acidotic-hypoxic animals (arterial pH = 7.16, PaCO2 = 84 mm Hg, PaO2 = 48 mm Hg) tripled Qlym. In these animals the increase in lymphatic flux of albumin, IgG, and IgM was significantly (P < 0.05) greater than that seen in either the acidosis alone group or in animals where left atrial pressures were elevated (n = 5; P < 0.05). Also, their percent increase in flux of the large protein (IgM) was greater than for the small protein (albumin) (P < 0.05). With acidosis alone, only pulmonary arterial bradykinin concentration increased (1.270.25 ng/ml SE), whereas acidosis plus hypoxia elevated both pulmonary arterial bradykinin concentrations (4.831.14 ng/ml) and aortic bradykinin concentration (2.740.78 ng/ml). These studies demonstrate that hypercapnic acidosis stimulates in vivo production of bradykinin. With superimposed hypoxia, and therefore decreased bradykinin degradation, there is an associated sustained rise in Qlym with increased lung permeability to proteins. PMID:7007439

  18. Treatment of smoke-induced pulmonary injury with nebulized dimethylsulfoxide.

    PubMed

    Kimura, R; Traber, L D; Herndon, D N; Neuhaus, G D; Traber, D L

    1988-08-01

    Inhalation injury was produced in sheep that were chronically prepared for study. The injury was induced by insufflating them with smoke from burning cotton cloth. One group of animals was treated with the oxygen-free radical scavenger dimethylsulfoxide (DMSO) and heparin. Another group received heparin treatment alone, and a third was untreated. The drugs were nebulized into the tracheostomy at 4-hr intervals beginning 1 hr after injury. Following the inhalation injury, lung lymph flow and extravascular lung water measured by thermal-dye dilution technique were both increased. These elevations were associated with minor increases in pulmonary artery pressure, and, thus, since the lymph to plasma protein ratio was unchanged, this increased extravascular fluid formation was probably the result of an elevated microvascular permeability. These changes were associated with a reduction in alpha 2 macroglobulin antiprotease activity. The treated groups showed much smaller responses to the inhalation insult. This was especially true in the animals that received the DMSO. These findings support the concept that oxygen free radicals are responsible for the pulmonary edema associated with inhalation injury. PMID:2458858

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

    PubMed

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

    2010-06-01

    The effect of hyperventilation-induced hypocapnic alkalosis (Hypo) on the adjustment of pulmonary O2 uptake (VO2p) and leg femoral conduit artery ("bulk") blood flow (LBF) during moderate-intensity exercise (Mod) was examined in eight young male adults. Subjects completed four to six repetitions of alternate-leg knee-extension exercise during normal breathing [Con; end-tidal partial pressure of CO2 (PetCO2) approximately 40 mmHg] and sustained hyperventilation (Hypo; PetCO2 approximately 20 mmHg). Increases in work rate were made instantaneously from baseline (3 W) to Mod (80% estimated lactate threshold). VO2p was measured breath by breath by mass spectrometry and volume turbine, and LBF (calculated from mean femoral artery blood velocity and femoral artery diameter) was measured simultaneously by Doppler ultrasound. Concentration changes of deoxy (Delta[HHb])-, oxy (Delta[O2Hb])-, and total hemoglobin-myoglobin (Delta[HbTot]) of the vastus lateralis muscle were measured continuously by near-infrared spectroscopy (NIRS). The kinetics of VO2p, LBF, and Delta[HHb] were modeled using a monoexponential equation by nonlinear regression. The time constants for the phase 2 VO2p (Hypo, 49+/-26 s; Con, 28+/-8 s) and LBF (Hypo, 46+/-16 s; Con, 23+/-6 s) were greater (P<0.05) in Hypo compared with Con. However, the mean response time for the overall Delta[HHb] response was not different between conditions (Hypo, 23+/-5 s; Con, 24+/-3 s), whereas the Delta[HHb] amplitude was greater (P<0.05) in Hypo (8.05+/-7.47 a.u.) compared with Con (6.69+/-6.31 a.u.). Combined, these results suggest that hyperventilation-induced hypocapnic alkalosis is associated with slower convective (i.e., slowed femoral artery and microvascular blood flow) and diffusive (i.e., greater fractional O2 extraction for a given DeltaVO2p) O2 delivery, which may contribute to the hyperventilation-induced slowing of VO2p (and muscle O2 utilization) kinetics. PMID:20339012

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

    PubMed Central

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

    2010-01-01

    The effect of hyperventilation-induced hypocapnic alkalosis (Hypo) on the adjustment of pulmonary O2 uptake (V?o2p) and leg femoral conduit artery (bulk) blood flow (LBF) during moderate-intensity exercise (Mod) was examined in eight young male adults. Subjects completed four to six repetitions of alternate-leg knee-extension exercise during normal breathing [Con; end-tidal partial pressure of CO2 (PetCO2) ?40 mmHg] and sustained hyperventilation (Hypo; PetCO2 ?20 mmHg). Increases in work rate were made instantaneously from baseline (3 W) to Mod (80% estimated lactate threshold). V?o2p was measured breath by breath by mass spectrometry and volume turbine, and LBF (calculated from mean femoral artery blood velocity and femoral artery diameter) was measured simultaneously by Doppler ultrasound. Concentration changes of deoxy (?[HHb])-, oxy (?[O2Hb])-, and total hemoglobin-myoglobin (?[HbTot]) of the vastus lateralis muscle were measured continuously by near-infrared spectroscopy (NIRS). The kinetics of V?o2p, LBF, and ?[HHb] were modeled using a monoexponential equation by nonlinear regression. The time constants for the phase 2 V?o2p (Hypo, 49 26 s; Con, 28 8 s) and LBF (Hypo, 46 16 s; Con, 23 6 s) were greater (P < 0.05) in Hypo compared with Con. However, the mean response time for the overall ?[HHb] response was not different between conditions (Hypo, 23 5 s; Con, 24 3 s), whereas the ?[HHb] amplitude was greater (P < 0.05) in Hypo (8.05 7.47 a.u.) compared with Con (6.69 6.31 a.u.). Combined, these results suggest that hyperventilation-induced hypocapnic alkalosis is associated with slower convective (i.e., slowed femoral artery and microvascular blood flow) and diffusive (i.e., greater fractional O2 extraction for a given ?V?o2p) O2 delivery, which may contribute to the hyperventilation-induced slowing of V?o2p (and muscle O2 utilization) kinetics. PMID:20339012

  1. Inhaled nitric oxide alters the distribution of blood flow in the healthy human lung, suggesting active hypoxic pulmonary vasoconstriction in normoxia

    PubMed Central

    Asadi, Amran K.; S, Rui Carlos; Kim, Nick H.; Theilmann, Rebecca J.; Hopkins, Susan R.; Buxton, Richard B.

    2014-01-01

    Hypoxic pulmonary vasoconstriction (HPV) is thought to actively regulate ventilation-perfusion (V?a/Q?) matching, reducing perfusion in regions of alveolar hypoxia. We assessed the extent of HPV in the healthy human lung using inhaled nitric oxide (iNO) under inspired oxygen fractions (FiO2) of 0.125, 0.21, and 0.30 (a hyperoxic stimulus designed to abolish HPV without the development of atelectasis). Dynamic measures of blood flow were made in a single sagittal slice of the right lung of five healthy male subjects using an arterial spin labeling (ASL) MRI sequence, following a block stimulus pattern (3 60 breaths) with 40 ppm iNO administered in the central block. The overall spatial heterogeneity, spatiotemporal variability, and regional pattern of pulmonary blood flow was quantified as a function of condition (FiO2 iNO state). While spatial heterogeneity did not change significantly with iNO administration or FiO2, there were statistically significant increases in Global Fluctuation Dispersion, (a marker of spatiotemporal flow variability) when iNO was administered during hypoxia (5.4 percentage point increase, P = 0.003). iNO had an effect on regional blood flow that was FiO2 dependent (P = 0.02), with regional changes in the pattern of blood flow occurring in hypoxia (P = 0.007) and normoxia (P = 0.008) tending to increase flow to dependent lung at the expense of nondependent lung. These findings indicate that inhaled nitric oxide significantly alters the distribution of blood flow in both hypoxic and normoxic healthy subjects, and suggests that some baseline HPV may indeed be present in the normoxic lung. PMID:25429099

  2. [Metastatic pulmonary angiosarcoma].

    PubMed

    Garca Clemente, M; Gonzlez Budio, T; Escobar Stein, J; Seco Garca, A J; Celorio Peinado, C; Rodrguez Rodrguez, J

    2004-01-01

    Angiosarcoma involving the lung, usually a result of metastatic disease, is a rare disorder. Primary angiosarcoma of the lung is an extremely rare tumor. The lung is one of the most common sites of metastatic involvement, along with liver and lymph nodes. Hemoptysis is the most frequent presenting symptom even with diffuse pulmonary hemorrhage. Chest radiography may reveal a spectrum of findings ranging form normal to bilateral nodular lesions. Early diagnosis is not common because of the rarity of angiosarcoma in the lung and hence, low index of suspicion. The prognosis is generally poor, with a median survival of 9 months after diagnosis. PMID:15195483

  3. The influence of pulmonary blood flow rate on vascular input impedance and hydraulic power in the sympathetically and noradrenaline stimulated cat lung.

    PubMed

    Piene, H

    1976-09-01

    This study was designed to evaluate the influence of sympathetic nerve stimulation (SN) and alpha-adrenergic receptor stimulation (alphaS) on the pulmonary vascular input impedance and hydraulic power output of the right heart during variations of cardiac output (CO). An open chest cat preparation was used and pulsatile pressure and flow in the pulmonary artery were measured by high frequency response transducers. Calculations showed that vascular resistance (VR) was inversely dependent on CO, but input impedance of the unstimulated lung was not influenced by CO variations. NS or alphaS increased VR and input impedance significantly, and the relation pulsatile hydraulic power/total hydraulic power (Wp/Wt) increased 40%, indicating that such stimulation has larger relative influence on impedance than on resistance. The reduction of arterial compliance during NS (maximal stimulus) was calculated to be 60%, independent of CO. Input impedance during NS or alphaS was reduced by CO elevations, probably because the concomitant distension of the arterial bed reduced arterial resistance and inertance. The ratio Wp/CO, which expresses the fraction of pulsatile hydraulic power lost per ml mean arterial flow, was found to be flow dependent both in control and stimulated conditions: Wp/CO was positively correlated to CO in control condition and weakly negatively correlated to CO during stimulation. At high CO the arterial vessels could be stimulated and stiffened without much extra load on the right heart. PMID:970156

  4. Lymph node staging.

    PubMed

    Vogl, Thomas; Bisdas, Sotirios; Bisdas, Sortirios

    2007-08-01

    Cancers of the head and neck (HNC) include cancers of the larynx, nasal passages/nose, oral cavity, pharynx, salivary glands, buccal regions, and thyroid. In these cancers, lymph node staging and localization of pathological lymph nodes are necessary to decide on either (neo) adjuvant or surgical therapy and are a major factor for the prognosis in HNC patients. Cervical node metastases have different incidence, and their presence is associated with a decrease in global survival to roughly half and with higher recurrence rates. The node metastases can be categorized in the following 2 groups: overt (clinical) or nonovert (occult). The latter can be subcategorized as metastases detectable by traditional methods (eg, staining) or "submicroscopic" metastases, only evident with immunohistochemical or molecular analysis. Compared with clinical invasive and laboratory examinations, which may have complications and are expensive, radiology plays an important role in lymph node staging. Mainly, the overt node metastases are the field of radiological imaging, and second, the detection of nonovert metastases is important and holds promise for the future because many patients of those initially classified as cN0 have, in fact, occult metastatic disease (pN1). Vice versa, radiological imaging has to avoid false-positive results that can lead to an elective or radical neck dissection, which are associated with increased morbidity and mortality and thus overshadow the improvement in survival. Radiological imaging plays a role not only as an initial staging of N+ but also in the case of N0 due to the continuing controversy for the treatment of N0 patients. A close observation of the patient may reveal a positive node in the follow-up. The imaging modalities used for the node staging in HNC patients include ultrasound, contrast-enhanced computed tomography, contrast-enhanced magnetic resonance imaging (MRI), and positron emission tomography scans. None of the above-mentioned methods reaches a 100% sensitivity or specificity, and the accuracy of the exact number of metastases or levels involved has not been studied; thus, neck dissection with subsequent pathological examination remains the gold standard for node staging. Among the described cross-sectional imaging modalities, MRI presents a lot of advantages mainly due to the increased soft tissue contrast and the ability to obtain tissue characteristics in different sequences, including diffusion- and perfusion-weighted sequences and proton spectroscopy imaging. The lack of the radiation burden makes MRI suitable for a close follow-up of the patient, and the imaging with the use of new intravenous contrast material (such as ultrasmall iron oxide particles) seems superior to the conventional. In this article, we will focus on the lymph node MRI staging in HNC patients and the MR anatomy of the nodes, the necessary diagnostic workup, and the advantages of the method over computed tomography. The possibilities of the new imaging sequences and the treatment implications will be addressed as well. PMID:17893595

  5. Successful treatment of sarcoidosis-associated pulmonary hypertension with bosentan.

    PubMed

    Foley, Raymond J; Metersky, Mark L

    2008-01-01

    Sarcoidosis is a systemic granulomatous disease of unknown etiology, in which the lungs and intrathoracic lymph nodes are predominant sites of involvement. Pulmonary hypertension is a known complication of sarcoidosis. Treatment of sarcoidosis-associated pulmonary hypertension has traditionally focused on the initiation of systemic corticosteroids, but has had inconsistent results. We present a patient with sarcoidosis-associated pulmonary hypertension who achieved substantial clinical improvement with the dual endothelin receptor antagonist bosentan. PMID:16293957

  6. Label free in vivo laser speckle imaging of blood and lymph vessels

    NASA Astrophysics Data System (ADS)

    Kalchenko, Vyacheslav; Kuznetsov, Yuri; Meglinski, Igor; Harmelin, Alon

    2012-05-01

    The peripheral lymphatic vascular system is a part of the immune body system comprising a complex network of lymph vessels and nodes that are flowing lymph toward the heart. Traditionally the imaging of lymphatic vessels is based on the conventional imaging modalities utilizing contrast fluorescence materials. Given the important role of the lymphatic system there is a critical need for the development of noninvasive imaging technologies for functional quantitative diagnosis of the lymph vessels and lymph flow without using foreign chemicals. We report a label free methodology for noninvasive in vivo imaging of blood and lymph vessels, using long-exposure laser speckle imaging approach. This approach entails great promise in the noninvasive studies of tissues blood and lymph vessels distribution in vivo.

  7. A stable approach for coupling multidimensional cardiovascular and pulmonary networks based on a novel pressure-flow rate or pressure-only Neumann boundary condition formulation.

    PubMed

    Ismail, M; Gravemeier, V; Comerford, A; Wall, W A

    2014-04-01

    In many biomedical flow problems, reversed flows along with standard treatment of Neumann boundary conditions can cause instabilities. We have developed a method that resolves these instabilities in a consistent way while maintaining correct pressure and flow rate values. We also are able to remove the necessary prescription of both pressure and velocities/flow rates to problems where only pressure is known. In addition, the method is extended to coupled 3D/reduced-D fluid and fluid-structure interaction models. Numerical examples mainly focus on using Neumann boundary condition in cardiovascular and pulmonary systems, particularly, coupled with 3D-1D and 3D-0D models. Inflow pressure, traction, and impedance boundary conditions are first tested on idealized tubes for various Womersley numbers. Both pressure and flow rate are shown to match the analytical solutions for these examples. Our method is then tested on a coupled 1D-3D-1D artery example, demonstrating the power and simplicity of extending this method toward fluid-structure interaction. Finally, the proposed method is investigated for a coupled 3D-0D patient-specific full lung model during spontaneous breathing. All coupled 3D/reduced-D results show a perfect matching of pressure and flow rate between 3D and corresponding reduced-D boundaries. The methods are straight-forward to implement in contrast to using Lagrange multipliers as previously proposed in other studies. PMID:24243701

  8. Computational fluid dynamics characterization of blood flow in central aorta to pulmonary artery connections: importance of shunt angulation as a determinant of shear stress-induced thrombosis.

    PubMed

    Celestin, Carey; Guillot, Martin; Ross-Ascuitto, Nancy; Ascuitto, Robert

    2015-03-01

    The central aortic shunt, consisting of a Gore-Tex (polytetrafluoroethylene) tube (graft) connecting the ascending aorta to the pulmonary artery, is a palliative operation for neonates with cyanotic congenital heart disease. These tubes often have an extended length, and therefore must be angulated to complete the connection to the posterior pulmonary arteries. Thrombosis of the graft is not uncommon and can be life-threatening. We have shown that a viscous fluid (such as blood) traversing a curve or bend in a small-caliber vessel or conduit can give rise to marked increases in wall shear stress, which is the major mechanical factor responsible for vascular thrombosis. Thus, the objective of this study was to use computational fluid dynamics to investigate whether wall shear stress (and shear rate) generated in angulated central aorta-to-pulmonary artery connections, invivo, can be of magnitude and distribution to initiate platelet activation/aggregation, ultimately leading to thrombus formation. Anatomical features required to construct the computer-simulated blood flow pathways were verified from angiograms of central aortic shunts in patients. For the modeled central aortic shunts, we found wall shear stresses of (80-200N/m(2)), with shear rates of (16,000-40,000/s), at sites of even modest curvature, to be high enough to cause platelet-mediated shunt thrombosis. The corresponding energy losses for the fluid transitions through the aorta-to-pulmonary connections constituted (70%) of the incoming flow's mechanical energy. The associated velocity fields within these shunts exhibited vortices, eddies, and flow stagnation/recirculation, which are thrombogenic in nature and conducive to energy dissipation. Angulation-induced, shear stress-mediated shunt thrombosis is insensitive to aspirin therapy alone. Thus, for patients with central aortic shunts of longer length and with angulation, aspirin alone will provide insufficient protection against clotting. These patients are at risk for shunt thrombosis and significant morbidity and mortality, unless their anticoagulation regimen includes additional antiplatelet medications. PMID:25404555

  9. A Single 9-Colour Flow Cytometric Method to Characterise Major Leukocyte Populations in the Rat: Validation in a Model of LPS-Induced Pulmonary Inflammation.

    PubMed

    Barnett-Vanes, Ashton; Sharrock, Anna; Birrell, Mark A; Rankin, Sara

    2016-01-01

    The rat is a commonly used model for immunological investigation. Yet basic research and characterisation of leukocyte populations and sub-sets lags far behind murine research, with inconsistency on reported leukocyte markers and their overlap. These shortcomings limit the opportunity for more complex and advanced rat immunology research. In this study, we developed a robust 9-colour flow-cytometric protocol to elucidate the major blood and tissue rat leukocyte populations, and validated it in a model of LPS-induced pulmonary inflammation. Blood and tissues (lung, BALF, spleen, liver, bone marrow) from nave Sprague-Dawley rats were collected and analysed by flow cytometry (FCM). Rats were exposed to aerosolised saline or LPS (1mg/mL), at 3 and 24hrs thereafter blood, lung and BALF were collected and analysed using FCM and ELISA. Neutrophils, two monocyte subsets, NK Cells, B Cells, CD4+, CD8+ T Cells and alveolar macrophages can be identified simultaneously across different tissues using a 9-colour panel. Neutrophils and monocytes can be distinguished based upon differential expression of CD43 and His48. Neutrophils and CD43Lo/His48Hi monocyte-macrophages are elevated in the lung at 3 and 24hrs during LPS-induced pulmonary inflammation. This validated method for leukocyte enumeration will offer a platform for greater consistency in future rat immunology and inflammation research. PMID:26764486

  10. A Single 9-Colour Flow Cytometric Method to Characterise Major Leukocyte Populations in the Rat: Validation in a Model of LPS-Induced Pulmonary Inflammation

    PubMed Central

    Barnett-Vanes, Ashton; Sharrock, Anna; Birrell, Mark A.; Rankin, Sara

    2016-01-01

    The rat is a commonly used model for immunological investigation. Yet basic research and characterisation of leukocyte populations and sub-sets lags far behind murine research, with inconsistency on reported leukocyte markers and their overlap. These shortcomings limit the opportunity for more complex and advanced rat immunology research. In this study, we developed a robust 9-colour flow-cytometric protocol to elucidate the major blood and tissue rat leukocyte populations, and validated it in a model of LPS-induced pulmonary inflammation. Blood and tissues (lung, BALF, spleen, liver, bone marrow) from naïve Sprague-Dawley rats were collected and analysed by flow cytometry (FCM). Rats were exposed to aerosolised saline or LPS (1mg/mL), at 3 and 24hrs thereafter blood, lung and BALF were collected and analysed using FCM and ELISA. Neutrophils, two monocyte subsets, NK Cells, B Cells, CD4+, CD8+ T Cells and alveolar macrophages can be identified simultaneously across different tissues using a 9-colour panel. Neutrophils and monocytes can be distinguished based upon differential expression of CD43 and His48. Neutrophils and CD43Lo/His48Hi monocyte-macrophages are elevated in the lung at 3 and 24hrs during LPS-induced pulmonary inflammation. This validated method for leukocyte enumeration will offer a platform for greater consistency in future rat immunology and inflammation research. PMID:26764486

  11. Diagnosis of pulmonary embolism by endobronchial ultrasound.

    PubMed

    Goyal, Rajiv; Chachra, Vaibhav; Gogia, Pratibha

    2015-01-01

    This is a case report of a young 20-year-old male who was referred for an endobronchial ultrasound (EBUS) procedure to investigate a fever and a left hilar lymph node and patchy pleural-based opacities seen on CT of the chest. During the EBUS procedure besides the left hilar node, a large thrombus was noticed in the main pulmonary artery and another one in the right pulmonary artery. EBUS proved invaluable in making a diagnosis in an unsuspected case of pulmonary embolism. PMID:26664168

  12. Altered Right Ventricular Kinetic Energy Work Density and Viscous Energy Dissipation in Patients with Pulmonary Arterial Hypertension: A Pilot Study Using 4D Flow MRI

    PubMed Central

    Han, Q. Joyce; Witschey, Walter R. T.; Fang-Yen, Christopher M.; Arkles, Jeffrey S.; Barker, Alex J.; Forfia, Paul R.; Han, Yuchi

    2015-01-01

    Introduction Right ventricular (RV) function has increasingly being recognized as an important predictor for morbidity and mortality in patients with pulmonary arterial hypertension (PAH). The increased RV after-load increase RV work in PAH. We used time-resolved 3D phase contrast MRI (4D flow MRI) to derive RV kinetic energy (KE) work density and energy loss in the pulmonary artery (PA) to better characterize RV work in PAH patients. Methods 4D flow and standard cardiac cine images were obtained in ten functional class I/II patients with PAH and nine healthy subjects. For each individual, we calculated the RV KE work density and the amount of viscous dissipation in the PA. Results PAH patients had alterations in flow patterns in both the RV and the PA compared to healthy subjects. PAH subjects had significantly higher RV KE work density than healthy subjects (94.733.7 mJ/mL vs. 61.714.8 mJ/mL, p = 0.007) as well as a much greater percent PA energy loss (21.16.4% vs. 2.21.3%, p = 0.0001) throughout the cardiac cycle. RV KE work density and percent PA energy loss had mild and moderate correlations with RV ejection fraction. Conclusion This study has quantified two kinetic energy metrics to assess RV function using 4D flow. RV KE work density and PA viscous energy loss not only distinguished healthy subjects from patients, but also provided distinction amongst PAH patients. These metrics hold promise as imaging markers for RV function. PMID:26418553

  13. Pulmonary function studies in rowers.

    PubMed

    Kesavachandran, C; Sanil, R; Nair, R H; Rauf, A A; Shashidhar, S

    1997-01-01

    The present study attempts to investigate the pulmonary functions of snake boat rowers before and after rowing. This is made on 12 healthy traditional snake boat rowers ranging from age 16-23 years of Kavanattinkara boat race, Kottayam, Kerala, India. The pulmonary function tests were carried out with vitallograph compact-II spirometer. The results show a decrease in pulmonary functions "lung volumes" and "flow rates" after rowing in comparison to basal condition. PMID:10225029

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

    PubMed

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

    2015-05-01

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

  15. Pulmonary Hypertension and Pulmonary Vasodilators.

    PubMed

    Keller, Roberta L

    2016-03-01

    Pulmonary hypertension in the perinatal period can present acutely (persistent pulmonary hypertension of the newborn) or chronically. Clinical and echocardiographic diagnosis of acute pulmonary hypertension is well accepted but there are no broadly validated criteria for echocardiographic diagnosis of pulmonary hypertension later in the clinical course, although there are significant populations of infants with lung disease at risk for this diagnosis. Contributing cardiovascular comorbidities are common in infants with pulmonary hypertension and lung disease. It is not clear who should be treated without confirmation of pulmonary vascular disease by cardiac catheterization, with concurrent evaluation of any contributing cardiovascular comorbidities. PMID:26876130

  16. Pulmonary Embolism

    MedlinePLUS

    ... pulmonary embolism is a sudden blockage in a lung artery. The cause is usually a blood clot ... loose and travels through the bloodstream to the lung. Pulmonary embolism is a serious condition that can ...

  17. Pulmonary Rehabilitation

    MedlinePLUS

    Pulmonary Rehabilitation If you have shortness of breath because of lung problems, you may have asked yourself: Can I ... medications do I really need to take? Pulmonary rehabilitation can help answer these and other questions. Enrolling ...

  18. Pulmonary Embolism.

    PubMed

    Rali, Parth; Gandhi, Viral; Malik, Khalid

    2016-01-01

    Pulmonary embolism covers a wide spectrum of presentation from an asymptomatic individual to a life-threatening medical emergency. It is of paramount importance to appropriately risk stratify patients with pulmonary embolism, particularly with those who present without hypotension. Right ventricular dysfunction can evolve after a patient has received a diagnosis of pulmonary embolism, necessitating aggressive measures rather than simple anticoagulation. In this review, we discuss definition, risk stratification, pathogenesis, diagnostic approach, and management, with particular focus on massive pulmonary embolism. PMID:26919674

  19. Flow cytometric assessment of circulating platelet and erythrocytes microparticles in young thalassemia major patients: relation to pulmonary hypertension and aortic wall stiffness.

    PubMed

    Tantawy, Azza A G; Adly, Amira A M; Ismail, Eman A R; Habeeb, Nevin M

    2013-06-01

    Heart disease is the leading cause of mortality and morbidity in ?-thalassemia major (?-TM). Aggregability of abnormal red cells and membrane-derived microparticles (MPs) stemming from activated platelets and erythrocytes are responsible for thrombotic risk. We measured platelet and erythrocyte MPs (PMPs and ErMPs) in 60 young ?-TM patients compared with 40 age- and sex-matched healthy controls and assessed their relation to clinicopathological characteristics and aortic elastic properties. Patients were studied stressing on transfusion history, splenectomy, thrombotic events, chelation therapy, hematological and coagulation profiles, flow cytometric measurement of PMPs (CD41b(+) ) and ErMPs (glycophorin A(+) ) as well as echocardiographic assessment of aortic elastic properties. Aortic stiffness index and pulmonary artery pressure were significantly higher, whereas aortic strain and distensibility were lower in TM patients than controls (P < 0.001). Both PMPs and ErMPs were significantly elevated in TM patients compared with controls, particularly patients with risk of pulmonary hypertension, history of thrombosis, splenectomy or serum ferritin >2500 ?g/L (P < 0.001). Compliant patients on chelation therapy had lower MPs levels than non-compliant patients (P < 0.001). PMPs and ErMPs were positively correlated to markers of hemolysis, serum ferritin, D-dimer, vWF Ag, and aortic stiffness, whereas negatively correlated to hemoglobin level and aortic distensibility (P < 0.05). We suggest that increased MPs may be implicated in vascular dysfunction, pulmonary hypertension risk, and aortic wall stiffness observed in thalassemia patients. Their quantification could provide utility for early detection of cardiovascular abnormalities and monitoring the biological efficacy of chelation therapy. PMID:23506251

  20. The importance of determining surgical indications in cases of lung cancer and interstitial pneumonia with multiple intrapulmonary lymph nodes

    PubMed Central

    Nakajima, Yuki; Akiyama, Hirohiko; Kinoshita, Hiroyasu; Atari, Maiko; Fukuhara, Mitsuro; Sakai, Hiroshi; Uramoto, Hidetaka

    2015-01-01

    Introduction When considering treatment for pulmonary cancer complicated by interstitial pneumonia, the greatest problem is acute exacerbation. We report two cases of pulmonary cancer complicated by interstitial pneumonia in which multiple intrapulmonary lymph nodes were noted. Case presentations Cases 1 and 2 were 76- and 62-year-old males, respectively. Both cases were diagnosed as pulmonary cancer complicated by interstitial pneumonia, and upon chest CT, it was noted that, in addition to the primary lesions, there were multiple nodule shadows under the pleura in the lung lobe, which required identification in order to rule out lung metastasis. In Case 1, the pulmonary nodules were first resected during surgery and a swift diagnosis was made, determining them to be intrapulmonary lymph nodes, which were then operated on curatively. In Case 2, the patient underwent thoracoscopic observation during surgery, the shadows were diagnosed visually as intrapulmonary lymph nodes, and curative surgery was implemented. Discussion and conclusions The greatest problem in treating pulmonary cancer complicated with interstitial pneumonia is acute exacerbation, wherein, in the absence of any surgical indications, alternative treatment is limited. Thus, contra-indicating surgery for a patient due to a diagnosis of metastasis within the lungs, based only on nodule images, should be avoided. If nodules are noted in the area of the pleura, the possibility exists that these could be intrapulmonary lymph nodes, along with metastasis within the lung, and thoracoscopic surgery should be implemented proactively while keeping these in mind. PMID:26656149

  1. The correlation of sequential changes in the distribution of pulmonary blood flow in hemorrhagic shock with the histopathologic anatomy.

    PubMed

    Tiefenbrun, J; Dikman, S; Shoemaker, W C

    1975-11-01

    Histopathologic changes were described and correlated with hemodynamic changes in a series of farm-reared dogs by a preparation and a protocol which were shown to simulate closely physiologic events in clinical hemorrhagic shock; neither anesthesia nor thoracotomy was used and flush solutions for catheters were strictly limited; a series of sham-treated controls was used for comparison. Five different isotopes were used to label microspheres to measure blood flow sequentially at the tissue level at various stages of the shock protocol. At death, multiple tissue sections were taken relative to six parallel segments of the lung arranged according to dependency so that correlations of structure and function might be related to the influence of gravity. The degrees of severity of atelectasis, hemorrhage, edema, congestion, inflammation, and hyperaeration were evaluated by rating scales. Tissues from the most dependent areas had a higher incidence and greater severity of histologic lesions. Tissues with mild histologic rating tended to have lower percentages of flow after hemorrhage, but normal or increased flow after reinfusion. The severely damaged tissue received greater than average flow throughout. Tissues with severe atelectasis paralleled the course of those with a high over-all severe pathologic rating. Tissues with severe inflammation had less blood flow in the control period, increased flow in Stages B1 and B2 and a subsequent return to control values. Those with severe edema had reduced flow in Stages B2 and B3, but high flows after reinfusion. PMID:1188605

  2. Pulmonary Sarcoidosis.

    PubMed

    Valeyre, Dominique; Bernaudin, Jean-François; Jeny, Florence; Duchemann, Boris; Freynet, Olivia; Planès, Carole; Kambouchner, Marianne; Nunes, Hilario

    2015-12-01

    Sarcoidosis is a systemic disease, with lung involvement in almost all cases. Abnormal chest radiography is usually a key step for considering diagnosis. Lung impact is investigated through imaging; pulmonary function; and, when required, 6-minute walk test, cardiopulmonary exercise testing, or right heart catheterization. There is usually a reduction of lung volumes, and forced vital capacity is the most accurate parameter to reflect the impact of pulmonary sarcoidosis with or without pulmonary infiltration at imaging. Various evolution patterns have been described. Increased risk of death is associated with advanced pulmonary fibrosis or cor pulmonale, particularly in African American patients. PMID:26593138

  3. 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.

  4. Pulmonary capillary pressure. A review.

    PubMed

    Ganter, C C; Ganter, C G; Jakob, S M; Takala, J

    2006-01-01

    Pulmonary capillary pressure (Pcap) is the predominant force that drives fluid out of the pulmonary capillaries into the interstitium. Increasing hydrostatic capillary pressure is directly proportional to the lung's transvascular filtration rate, and in the extreme leads to pulmonary edema. In the pulmonary circulation, blood flow arises from the transpulmonary pressure gradient, defined as the difference between pulmonary artery (diastolic) pressure and left atrial pressure. The resistance across the pulmonary vasculature consists of arterial and venous components, which interact with the capacitance of the compliant pulmonary capillaries. In pathological states such as acute respiratory distress syndrome, sepsis, and high altitude or neurogenic lung edema, the longitudinal distribution of the precapillary arterial and the postcapillary venous resistance varies. Subsequently, the relationship between Pcap and pulmonary artery occlusion pressure (PAOP) is greatly variable and Pcap can no longer be predicted from PAOP. In clinical practice, PAOP is commonly used to guide fluid therapy, and Pcap as a hemodynamic target is rarely assessed. This approach is potentially misleading. In the presence of a normal PAOP and an increased pressure gradient between Pcap and PAOP, the tendency for fluid leakage in the capillaries and subsequent edema development may substantially be underestimated. Tho-roughly validated methods have been developed to assess Pcap in humans. At the bedside, measurement of Pcap can easily be determined by analyzing a pressure transient after an acute pulmonary artery occlusion with the balloon of a Swan-Ganz catheter. PMID:16407804

  5. Swollen lymph nodes in the groin (image)

    MedlinePLUS

    Lymph nodes play an important part in the body's defense against infection. Swelling might occur even if the infection is trivial or not apparent. Swelling of lymph nodes generally results from localized or systemic infection, abscess ...

  6. 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 μg/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

  7. Pulmonary function of herdsmen.

    PubMed Central

    VanderJagt, Dorothy J.; Mcclung, Keith D.; Kassam, Hussein A.; Harkins, Michelle S.; Glew, Robert H.

    2004-01-01

    OBJECTIVE: To determine whether the pulmonary function deficit documented previously in Fulani children is also present in adult Fulani herdsmen in northern Nigeria. SUBJECTS AND METHODS: The subjects for this study consisted of adult Fulani men from the hamlet of Magama Gumau and adult non-Fulani men from the city of Jos. Age, height, weight, mid-arm circumference (MAC), triceps skin-fold thickness, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory flow during the middle half of the FVC maneuver (FEF25-75%), and peak expiratory flow rate (PEF) were measured. Body mass index (BMI) and FEV1/FVC were calculated for all subjects. Multiple regression analysis was performed to identify correlations between pulmonary function parameters and anthropometric variables. RESULTS: The 44 Fulani subjects and 28 urban subjects were well-matched for age and height. The Fulani men weighed significantly less than the urban men (58.5+/-9.4 versus 67.4+/-11.3 kg, p <0.001) and consequently had significantly lower BMI, MAC, and triceps skin-fold thickness. The only significant difference in pulmonary function parameters between the two groups was in FEV1/FVC (0.93+/-0.1 versus 0.85+/-0.1, p <0.001). Small but significant correlations were found between pulmonary function parameters and anthropometric variables for both study populations. CONCLUSIONS: The pulmonary function deficits documented previously in Fulani children and adolescents were not present in adult Fulani men. However, the observed elevation in FEV1/FVC in the rural Fulani men as compared to their urban counterparts, which is often seen in restrictive pulmonary patterns, deserves further study. PMID:15101676

  8. Relative rates of albumin equilibration in the skin interstitium and lymph during increased permeability

    SciTech Connect

    Powers, M.R.; Wallace, J.R.; Bell, D.R.

    1986-03-05

    The initial equilibration of /sup 125/I-labelled albumin between the vascular and extravascular compartments was studied in hindpaw heel skin of anesthetized rabbits. Bradykinin (0.3 ..mu..g/min) was infused into a small branch of the femoral artery. A second group of rabbits served as control. Following bradykinin, prenodal popliteal lymph flow was 4 times control flow. The lymph-to-plasma concentration ratios for total protein and albumin were, respectively, 60% and 50% larger than control. Tissue albumin concentration was twice control. After reaching a steady, elevated lymph flow, tracer albumin was infused to maintain plasma activity constant for 3 hrs. The plasma volume in tissue samples was measured using /sup 131/I-labeled albumin injected 10 min before ending the experiment. Endogenous albumin was measured in plasma, lymph, and tissue samples using rocket electroimmunoassay. After 3 hrs of tracer infusion, lymph specific activity was 3 times greater than control. In the control group, plasma albumin equilibrated more rapidly with lymph than with tissue (p < 0.05). Following bradykinin, extravascular specific activity was 4 times control, resulting in lymph and tissue equilibrating with plasma at similar rates. Thus, increasing capillary permeability causes the extravascular albumin mass to behave as if distributed in a single compartment.

  9. Catheter rehabilitation of occluded aberrant pulmonary artery

    PubMed Central

    Noonan, Patrick M.E.; Ramchandani, Bharat; Barron, David J.; Stumper, Oliver

    2013-01-01

    A 10-year old girl underwent a CT angiogram to investigate right lung hypoplasia. This showed a normal bronchial tree, lung parenchyma and pulmonary venous drainage, but an absent right pulmonary artery. Cardiac catheterization with pulmonary vein wedge injections identified a disconnected hypoplastic right pulmonary artery system supplied by an occluded right-sided ductus arteriosus. Transcatheter recanalization of the ductus re-established right pulmonary artery flow and growth. Ultimately, this allowed for complete surgical repair and restoration of normal perfusion of the right lung, leading to complete functional rehabilitation. PMID:23529755

  10. Pulmonary lymphangiomyomatosis. A review.

    PubMed Central

    Corrin, B.; Liebow, A. A.; Friedman, P. J.

    1975-01-01

    Anatomic and clinical observations of 28 cases, including 23 previously unpublished, of pulmonary lymphangiomyomatosis are recorded and discussed. This brings the total reported to 57. All patients were women in the reproductive age group with the major complaint of breathlessness. This was usually progressive, and death from pulmonary insufficiency resulted within 10 years. Functional changes were obstructive or restrictive, or both. Pneumothorax, chylous effusions and hemoptysis were frequent complications. Radiographically the lesions initially appear as fine, linear and nodular, predominantly basal densities, and progress to a pattern of bullous change, or honeycombing, involving all portions of the lungs not sparing the region of the costophrenic sinuses as is typical of eosinophilic granuloma. There may be associated pleural effusions. A progressively increasing lung volume is characteristic. The lesions consist of an irregular, nodular or laminar "irrational" proliferation of smooth muscle within all portions of the lung, with loss of parenchyma leading to honeycombing. Proliferated muscle can obstruct bronchioles (with air trapping and formation of bullae often complicated by pneumothorax), venules (with pulmonary hemorrhage and hemosiderosis accompanied clinically by hemoptysis) and lymphatics (with chylothorax or chyloperitoneum). Both thoracic and abdominal lymph nodes and the thoracic duct can also be involved in the myoproliferative process with formation of subsidiary minute channels and obstruction. Renal or perirenal angiomyolipomas can also occur, as exemplified by 2 patients in the present series. Identical pulmonary lesions occasionally occur in tuberous sclerosis. Especially since these patients usually have no neurologic disturbances and are almost women, the possibility of a relationship between tuberous sclerosis and lymphangiomyomatosis must be considered. One feature of note in pulmonary lesions of tuberous sclerosis is the presence of adenomatoid proliferations of epithelium. Such changes were also observed in 2 patients of the present series, and it is remarkable that both of these women had "retarded"children. At present the question of whether by lymphangiomyomatosis is a forme fruste of tuberous sclerosis must be considered as unresolved. It may yield to further investigation, possibility including chromosomal studies. Images Fig 34 Fig 35 Fig 36 Fig 37 Fig 7 Fig 8 Fig 9 Figs 38-39 Fig 40 Fig 41 Fig 42 Figs 10-14 Fig 43 Fig 44 Fig 45 p[373]-a Fig 46 Fig 47 Fig 48 Fig 49 Fig 15 Fig 16 Fig 17 Fig 18 Fig 19 Fig 20 Fig 21 Fig 22 Fig 23 Fig 24 Fig 25 Fig 26 Fig 27 Fig 28 Fig 1 Fig 2 Figs 3-6 Fig 29 Fig 30 Figs 31-32 Fig 33 PMID:1146965

  11. Elective ilioingunial lymph node irradiation

    SciTech Connect

    Henderson, R.H.; Parsons, J.T.; Morgan, L.; Million, R.R.

    1984-06-01

    Most radiologists accept that modest doses of irradiation (4500-5000 rad/4 1/2-5 weeks) can control subclinical regional lymph node metastases from squamous cell carcinomas of the head and neck and adenocarcinomas of the breast. There have been few reports concerning elective irradiation of the ilioinguinal region. Between October 1964 and March 1980, 91 patients whose primary cancers placed the ilioinguinal lymph nodes at risk received elective irradiation at the University of Florida. Included are patients with cancers of the vulva, penis, urethra, anus and lower anal canal, and cervix or vaginal cancers that involved the distal one-third of the vagina. In 81 patients, both inguinal areas were clinically negative; in 10 patients, one inguinal area was positive and the other negative by clinical examination. The single significant complication was a bilateral femoral neck fracture. The inguinal areas of four patients developed mild to moderate fibrosis. One patient with moderate fibrosis had bilateral mild leg edema that was questionably related to irradiation. Complications were dose-related. The advantages and dis-advantages of elective ilioinguinal node irradiation versus elective inguinal lymph node dissection or no elective treatment are discussed.

  12. Pulmonary tuberculosis

    MedlinePLUS

    Pulmonary tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis (M. tuberculosis) . TB is contagious. This means ... chap 332. Fitzgerald DW, Sterling TR, Haas DW. Mycobacterium tuberculosis. In: Bennett JE, Dolan R, Blaser MJ, ...

  13. Pulmonary Hypertension

    MedlinePLUS

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

  14. Pulmonary embolus

    MedlinePLUS

    Venous thromboembolism; Lung blood clot; Blood clot - lung; Embolus; Tumor embolus; Embolism - pulmonary ... blood clot breaks off and travels to the lungs. Less common causes include air bubbles, fat droplets, ...

  15. Pulmonary atresia

    MedlinePLUS

    ... another type of congenital heart defect called a patent ductus arteriosus (PDA). Pulmonary atresia may occur with ... artery and aorta. The vessel is called a patent ductus arteriosus (PDA). Multiple treatments are possible, but ...

  16. Relative rates of albumin equilibration in the skin interstitium and lymph during vasodilation

    SciTech Connect

    Powers, M.R.; Wallace, J.R.; Bell, D.R.

    1986-03-01

    The initial equilibration of /sup 125/I-labeled albumin between the vascular and extravascular compartments was studied in hindpaw skin of 6 anesthetized rabbits. Papavarine (200 ug/min) was infused into a small branch of the femoral artery of one limb with the contralateral limb as a control. There was a 1.2-fold increase in lymph flow (p < 0.01) with no significant change in the lymph-to-plasma total protein concentration ratio from prepopliteal lymphatics following papavarine. After reaching a constant, elevated lymph flow, tracer labeled albumin was infused to maintain the plasma activity constant for 3 hrs. The plasma volume in tissue samples was measured using /sup 131/I-labeled albumin injected 10 min before ending the experiment. Endogenous albumin was measured in plasma, lymph, and tissue samples using rocket electroimmunoassay. After 3 hrs of tracer infusion, lymph specific activity relative to plasma was significantly greater in the vasodilated hindlimb (0.30 +/- 0.07 vs 0.13 +/- 0.05; mean +/- SE; p < 0.01). Extravascular specific activity relative to plasma was greater in the vasodilated limb (0.13 +/- 0.02 vs 0.09 +/- 0.02; p < 0.05). Thus, vasodilation increased the rates at which lymph and tissue equilibrate with plasma. Also, the difference between lymph and tissue equilibration was greater in the vasodilated hindlimb.

  17. Pulmonary thin-section CT findings in acute Moraxella catarrhalis pulmonary infection

    PubMed Central

    Okada, F; Ando, Y; Nakayama, T; Tanoue, S; Ishii, R; Ono, A; Watanabe, M; Takaki, H; Maeda, T; Mori, H

    2011-01-01

    Objective Moraxella catarrhalis is an important pathogen in the exacerbation of chronic obstructive pulmonary disease. The aim of this study was to assess the clinical and pulmonary thin-section CT findings in patients with acute M. catarrhalis pulmonary infection. Methods Thin-section CT scans obtained between January 2004 and March 2009 from 292 patients with acute M. catarrhalis pulmonary infection were retrospectively evaluated. Clinical and pulmonary CT findings in the patients were assessed. Patients with concurrent infection including Streptococcus pneumoniae (n = 72), Haemophilus influenzae (n = 61) or multiple pathogens were excluded from this study. Results The study group comprised 109 patients (66 male, 43 female; age range 28102 years; mean age 74.9 years). Among the 109 patients, 34 had community-acquired and 75 had nosocomial infections. Underlying diseases included pulmonary emphysema (n = 74), cardiovascular disease (n = 44) or malignant disease (n = 41). Abnormal findings were seen on CT scans in all patients and included ground-glass opacity (n = 99), bronchial wall thickening (n = 85) and centrilobular nodules (n = 79). These abnormalities were predominantly seen in the peripheral lung parenchyma (n = 99). Pleural effusion was found in eight patients. No patients had mediastinal and/or hilar lymph node enlargement. Conclusions M. catarrhalis pulmonary infection was observed in elderly patients, often in combination with pulmonary emphysema. CT manifestations of infection were mainly ground-glass opacity, bronchial wall thickening and centilobular nodules. PMID:21123308

  18. Proteomic Analysis of Human Mesenteric Lymph

    PubMed Central

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

    2011-01-01

    Extensive animal work has established mesenteric lymph as the mechanistic link between gut ischemia/reperfusion (I/R) and distant organ injury. Our trauma and transplant services provide a unique opportunity to assess the relevance of our animal data to human mesenteric lymph under conditions that simulate those used in the laboratory. Mesenteric lymph was collected from eleven patients; with lymphatic injuries, during semi-elective spine reconstruction, or immediately before organ donation. The lymph was tested for its ability to activate human neutrophils in vitro, and was analyzed by label-free proteomic analysis. Human mesenteric lymph primed human PMNs in a pattern similar to that observed in previous rodent, swine, and primate studies. A total of 477 proteins were identified from the 11 subjects lymph samples with greater than 99% confidence. In addition to classical serum proteins, markers of hemolysis, extracellular matrix components, and general tissue damage were identified. Both tissue injury and shock correlate strongly with production of bioactive lymph. Products of red blood cell hemolysis correlate strongly with human lymph bioactivity and immunoglobulins have a negative correlation with the pro-inflammatory lymph. These human data corroborate the current body of research implicating post shock mesenteric lymph in the development of systemic inflammation and multiple organ failure. Further studies will be required to determine if the proteins identified participate in the pathogenesis of multiple organ failure and if they can be used as diagnostic markers. PMID:21192285

  19. 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, ...

  20. Is tuberculosis a lymphatic disease with a pulmonary portal

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  1. 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 ( ...

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

    PubMed Central

    Palange, David; Doucet, Danielle; Bonitz, Robert P.; Lu, Qi; Colorado, Iriana; Sheth, Sharvil U.; Chandler, Benjamin; Kannan, Kolenkode B.; Ramanathan, Madhuri; Xu, Da Zhong; Deitch, Edwin A.; Feinman, Rena

    2011-01-01

    Background Injurious non-microbial factors released from the stressed gut during shocked states contribute to the development of acute lung injury (ALI) and multiple organ dysfunction syndrome (MODS). Since Toll-like receptors (TLR) act as sensors of tissue injury as well as microbial invasion and TLR4 signaling occurs in both sepsis and noninfectious models of ischemia/reperfusion (I/R) injury, we hypothesized that factors in the intestinal mesenteric lymph after trauma hemorrhagic shock (T/HS) mediate gut-induced lung injury via TLR4 activation. Methods/Principal Findings The concept that factors in T/HS lymph exiting the gut recreates ALI is evidenced by our findings that the infusion of porcine lymph, collected from animals subjected to global T/HS injury, into nave wildtype (WT) mice induced lung injury. Using C3H/HeJ mice that harbor a TLR4 mutation, we found that TLR4 activation was necessary for the development of T/HS porcine lymph-induced lung injury as determined by Evan's blue dye (EBD) lung permeability and myeloperoxidase (MPO) levels as well as the induction of the injurious pulmonary iNOS response. TRIF and Myd88 deficiency fully and partially attenuated T/HS lymph-induced increases in lung permeability respectively. Additional studies in TLR2 deficient mice showed that TLR2 activation was not involved in the pathology of T/HS lymph-induced lung injury. Lastly, the lymph samples were devoid of bacteria, endotoxin and bacterial DNA and passage of lymph through an endotoxin removal column did not abrogate the ability of T/HS lymph to cause lung injury in nave mice. Conclusions/Significance Our findings suggest that non-microbial factors in the intestinal mesenteric lymph after T/HS are capable of recreating T/HS-induced lung injury via TLR4 activation. PMID:21829592

  3. Nomogram to Predict Occult N2 Lymph Nodes Metastases in Patients With Squamous Nonsmall Cell Lung Cancer

    PubMed Central

    Jiang, Long; Jiang, Shanshan; Lin, Yongbin; Yang, Han; Xie, Zehua; Lin, Yaobin; Long, Hao

    2015-01-01

    Abstract For nonsmall cell lung cancer (NSCLC) patients without distant metastases, occult involvement of N2 lymph nodes would be of the utmost importance in determining both treatment and survival. The key to optimal treatment strategies relied on accurate diagnosis, in particular accurate clinical tumor staging. Patients with clinical N0 or N1 staging preoperatively had a sizeable risk to have occult N2 lymph nodes metastases. From November 2004 to March 2007, the entire database in a tertiary hospital of all patients with a pathologic diagnosis of squamous NSCLC underwent anatomical pulmonary resection and systematic mediastinal lymph node dissection were retrospectively collected and reviewed. A nomogram was developed on the basis of a multivariable logistic regression model with a combination of all potential variables. In order to surmount the potential of overestimating predictive performance, both bootstrapping for internal validation and an independent external validation set were employed. A nomogram incorporating the significant risk factors was created to predict the probability of occult N2 lymph nodes metastases. The calibration plot for the probability of occult N2 lymph nodes metastases showed an optimal agreement between the predicted probabilities by nomogram and actual observed probabilities. An objective and accurate nomogram predictive model for occult N2 lymph nodes metastases was drawn up and validated internally and externally in patients with squamous NSCLC. The nomogram model, as a robust tool in predicting occult N2 lymph nodes involvement, could be involved in a cost-effective application of specific diagnostic and therapeutic strategies. PMID:26579815

  4. Pulmonary compliance and lung volume are related to terrestriality in anuran amphibians.

    PubMed

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

    2014-01-01

    Dehydration tolerance of anuran amphibians is directly related to their ability to mobilize lymphatic reserves, with more terrestrial species having more effective lymph mobilization dependent on specialized skeletal muscles acting directly on the lymph sacs and via pulmonary ventilation. Consequently, we tested the hypothesis that pulmonary compliance, lung volume, and femoral lymphatic sac volume were related to terrestriality-and, hence, lymph mobilization-for 18 species of aquatic, semiaquatic, or terrestrial anuran amphibians. Lung compliance and volume were significantly related to body mass, but there was no significant phylogenetic pattern. There were significant habitat-related patterns for mass-corrected and phylogenetically corrected residuals for these pulmonary variables. Femoral lymph volume was significantly related to body mass, with no significant phylogenetic pattern, and there was only a weak correlation for habitat with mass-corrected and phylogenetically corrected residuals. These results suggest that pulmonary volume and compliance are strongly related to terrestriality in anuran amphibians and are under significant selection pressure to enhance lymph mobilization, but lymph sac volume does not appear to have a major role in adaptation to terrestriality. PMID:24769702

  5. Sentinel lymph node in lung cancer surgery.

    PubMed

    Melfi, Franca M A; Davini, Federico; Boni, Giuseppe; Mussi, Alfredo

    2012-05-01

    The greatest utility of sentinel lymph node (SLN) assessment is the avoidance of lymph node dissection and related morbidity. Another potential utility is the ability to direct pathologic examination and more sensitive techniques to detect occult micrometastatic disease. New pathologic methods can identify single tumor cells or even genetic material within a single lymph node station, bringing the concept of ultrastaging and micrometastasis in the field on staging. This article describes the SLN technique in patients with early non-small-cell lung cancer, as unique and useful targeting enables pathologists to localize micrometastatic foci within an otherwise normal lymph node. PMID:22520287

  6. 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

  7. Pulmonary Embolism

    PubMed Central

    Kumar, Gagan; Taneja, Amit; Patel, Jayshil; Deshmukh, Abhishek; Tarima, Sergey; Jacobs, Elizabeth R.; Whittle, Jeff

    2012-01-01

    Background: Pulmonary embolism is a common, often fatal condition that requires timely recognition and rapid institution of therapy. Previous studies have documented worse outcomes for weekend admissions for a variety of time-sensitive medical conditions. This phenomenon has not been clearly demonstrated for pulmonary embolism. Methods: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for the years 2000 to 2008 to identify people with a principal discharge diagnosis of pulmonary embolism. We classified admissions as weekend if they occurred between midnight Friday and midnight Sunday. We compared all-cause in-hospital mortality between weekend and weekday admissions and investigated the timing of inferior vena cava (IVC) filter placement and thrombolytic infusion as potential explanations for differences in mortality. Results: Unadjusted mortality was higher for weekend admissions than weekday admissions (OR, 1.19; 95% CI, 1.13-1.24). This increase in mortality remained statistically significant after controlling for potential confounding variables (OR, 1.17; 95% CI, 1.11-1.22). Among patients who received an IVC filter, a larger proportion of those admitted on a weekday than on the weekend received it on their first hospital day (38% vs 29%, P < .001). The timing of thrombolytic therapy did not differ between weekday and weekend admissions. Conclusions: Weekend admissions for pulmonary embolism were associated with higher mortality than weekday admissions. Our finding that IVC filter placement occurred later in the hospital course for patients admitted on weekends with pulmonary embolism suggests differences in the timeliness of diagnosis and treatment between weekday and weekend admissions. Regardless of cause, physicians should be aware that weekend admissions for pulmonary embolism have a 20% increased risk of death and warrant closer attention than provided during the week. PMID:22459777

  8. Pulmonary blastoma

    PubMed Central

    Barson, A. J.; Jones, Aled W.; Lodge, K. V.

    1968-01-01

    A case of pulmonary blastoma is described in a man dying at the age of 50 from hepatic and cerebral metastases. Eleven previously reported cases are reviewed and the histogenesis is discussed. It is concluded that these rare tumours are a distinct form of pulmonary carcinosarcoma in which the epithelial element is an adenocarcinoma. It is this that gives it its characteristic and probably coincidental histological resemblance to foetal lung and the evidence for a blastomatous origin is regarded as insufficient. Images PMID:5697348

  9. Pulmonary Hypertension: Types and Treatments

    PubMed Central

    Rose-Jones, Lisa J; Mclaughlin, Vallerie V

    2015-01-01

    Pulmonary arterial hypertension (PAH) is a panvasculopathy that affects the distal pulmonary arteries and leads to restricted blood flow. This increased afterload leads to adaptive mechanisms of the right ventricle, with eventual failure once it can no longer compensate. Pulmonary hypertension from associated conditions, most importantly left heart disease, i.e. heart failure, can also lead to the same sequela. Patients often experience early vague symptoms of dyspnea and exercise intolerance, and thus PH can elude clinicians until right heart failure symptoms predominate. Evidence-based treatment options with pulmo-nary vasodilators are available for those with PAH and should be employed early. It is essential that patients be accurately categorized by their etiology of PH, as treatment strategies differ, and can potentially be dangerous if employed in the wrong clinical scenario. PMID:24251459

  10. Changes in symptoms, peak expiratory flow, and sputum flora during treatment with antibiotics of exacerbations in patients with chronic obstructive pulmonary disease in general practice.

    PubMed Central

    Sachs, A. P.; Koter, G. H.; Groenier, K. H.; van der Waaij, D.; Schiphuis, J.; Meyboom-de Jong, B.

    1995-01-01

    BACKGROUND--Bacterial infections of the lower airways during an exacerbation in patients with asthma or chronic obstructive pulmonary disease (COPD) may be the cause of an exacerbation or the consequence of a viral infection or an increase in airways limitation. To determine whether bacterial infection is an important component in the pathogenesis of an exacerbation, the effects of antimicrobial treatment must be studied. METHODS--Patients with asthma or COPD seen in general practice were studied in a double blind randomised manner to investigate whether the antimicrobial drugs amoxicillin (500 mg three times daily), cotrimoxazole (960 mg twice daily), or a placebo, each when added to a short course of oral corticosteroids, can accelerate recovery from exacerbations. Patients were instructed to contact their own physician early in the morning when complaints of increased shortness of breath, wheezing, or exacerbations of cough with or without sputum production occurred. Treatment effects were evaluated over the next 14 days by studying symptom scores (wheeze, dyspnoea, cough with and without mucus production, and awakening with dyspnoea), peak expiratory flow values (PEF, expressed as % predicted), and sublingual temperature. Bacteriological study of the sputum was made at the onset of an exacerbation and 7, 21 and 35 days afterwards. RESULTS--Of 195 patients enrolled 71 (36%) contacted their physician for symptoms of an exacerbation. Symptoms improved in all three groups, improvements ranging from 0.54 to 0.75 points per day on a four point scale. PEF% predicted showed improvements in the three groups after the exacerbation, ranging from 0.34% to 0.78% predicted per day, finally returning to baseline values. Sublingual temperature did not change. Six of 71 patients consulted their physician because of a relapse between four and 24 days after the start of treatment. In only two of the 50 sputum samples, collected during an exacerbation, and which contained > or = 10(5) bacteria in culture sensitive to the chosen antibiotic given, did any benefit from antimicrobial treatment occur. During the recovery period sputum purulence improved irrespective of antibiotic treatment. CONCLUSIONS--Antibiotics given with a short course of oral prednisolone during an exacerbation do not accelerate recovery as measured by changes in peak flow and symptom scores in ambulatory patients with mild to moderate asthma or COPD when treated by their general practitioners. Moreover, antibiotics do not reduce the number of relapses after treating an exacerbation. PMID:7570411

  11. Pulmonary function in space

    NASA Technical Reports Server (NTRS)

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

    1997-01-01

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

  12. Pulmonary Fibrosis

    MedlinePLUS

    ... your medical history, imaging tests, a biopsy, and lung function tests to diagnose pulmonary fibrosis. There is no cure. Treatments can help with symptoms and improve your quality of life. ... or a lung transplant. NIH: National Heart, Lung, and Blood Institute

  13. PULMONARY TOXICOLOGY

    EPA Science Inventory

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

  14. Contrast enhanced ultrasound of sentinel lymph nodes

    PubMed Central

    Cui, XinWu; Ignee, Andre; Nielsen, Michael Bachmann; Schreiber-Dietrich, Dagmar; De Molo, Chiara; Pirri, Clara; Jedrzejczyk, Maciej

    2013-01-01

    Sentinel lymph nodes are the first lymph nodes in the region that receive lymphatic drainage from a primary tumor. The detection or exclusion of sentinel lymph node micrometastases is critical in the staging of cancer, especially breast cancer and melanoma because it directly affects patient's prognosis and surgical management. Currently, intraoperative sentinel lymph node biopsies using blue dye and radioisotopes are the method of choice for the detection of sentinel lymph node with high identification rate. In contrast, conventional ultrasound is not capable of detecting sentinel lymph nodes in most cases. Contrast enhanced ultrasound with contrast specific imaging modes has been used for the evaluation and diagnostic work-up of peripherally located suspected lymphadenopathy. The method allows for real-time analysis of all vascular phases and the visualization of intranodal focal avascular areas that represent necrosis or deposits of neoplastic cells. In recent years, a number of animal and human studies showed that contrast enhanced ultrasound can be also used for the detection of sentinel lymph node, and may become a potential application in clinical routine. Several contrast agents have been used in those studies, including albumin solution, hydroxyethylated starch, SonoVue, Sonazoid and Definity. This review summarizes the current knowledge about the use of ultrasound techniques in detection and evaluation of sentinel lymph node.

  15. The lymph node pre-metastatic niche.

    PubMed

    Sleeman, Jonathan P

    2015-11-01

    Lymph node metastases occur frequently during the progression of many types of cancer, and their presence often reflects poor prognosis. The drainage of tumor-derived factors such as antigens, growth factors, cytokines, and exosomes through the lymphatic system to the regional lymph nodes plays an important role in the pre-metastatic conditioning of the microenvironment in lymph nodes, making them receptive and supportive metastatic niches for disseminating tumor cells. Modified immunological responses and remodeling of the vasculature are the most studied tumor-induced pre-metastatic changes in the lymph node microenvironment that promote metastasis, although other metastasis-relevant alterations are also starting to be studied. Here, I review our current understanding of the lymph node pre-metastatic niche, how tumors condition this niche, and the relevance of this conditioning for our understanding of the process of metastasis. PMID:26489604

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

    PubMed Central

    Voutsadakis, Ioannis A; Spadafora, Silvana

    2015-01-01

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

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

    PubMed

    Voutsadakis, Ioannis A; Spadafora, Silvana

    2015-02-10

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

  18. Theileria parva infection in calves causes massive lymphocyte death in the thymus, spleen and lymph nodes without initial proliferation.

    PubMed

    Mbassa, G K; Kipanyula, M J; Mellau, L S B; Mwamakali, E D; Bulegeya, F R; Kauto-Mboni, K

    2006-12-20

    In a study of trends and magnitudes of lymphocytes proliferation, destruction or apoptosis eleven 3-month-old healthy calves were experimentally infected with the protozoan parasite Theileria parva, which is reported to cause lymphocyte proliferation. Four control calves were not infected. Infected and non-infected calves were sacrificed on days 9, 12, 16, 19, 23, 24 and 25 to examine lymphoid tissue changes and lymphocyte proliferation, apoptosis or necrosis in the thymus, spleen and lymph nodes. All infected calves developed severe East Coast fever, with enlargement of lymph nodes, dyspnoea, high fever and pulmonary oedema. Lymphocyte proliferation was not observed in lymph nodes, thymus and spleen; instead there were massive deaths of lymphocytes and other cells. The terminal severe disease caused massive lymphoid parenchyma coagulation terminating with caseation, organs and cells being undeterminable histologically. Tissues surrounding the lymph nodes were oedematous. Lymph node and thymus parenchyma were caseated and cortices and medulla indistinguishable because of severe lymphocyte and accessory cell deaths. The lymph node fibrous reticular stroma was necrotic and caseated. Lymphoid follicles in lymph nodes degenerated and lacked germinal centres. Lymph nodes, spleen and thymus were grossly enlarged, hardened, potato or cheese like, but microscopically very hypocellular and in the terminal disease acellular because of massive lymphocytes destruction. In the thymus there was extensive thymocyte and epithelioid cell necrosis and loss of distinction between cortex and medulla. The spleen white and red pulps were indistinguishable because of extensive lymphoid cell necrosis. The white pulp degenerated more than the red pulp. The massive lymphocyte deaths in the lymph nodes, thymus and spleen, without lymphocyte proliferation in this T. parva infection in calves leads to a conclusion that this parasite is lympho-destructive and lympho-degenerative in vivo rather than lympho-proliferative. PMID:16962242

  19. 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-Flrl, 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

  20. Effect of voluntary hyperventilation with supplemental CO2 on pulmonary O2 uptake and leg blood flow kinetics during moderate-intensity exercise.

    PubMed

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

    2013-12-01

    Pulmonary O2 uptake (V(O₂p)) and leg blood flow (LBF) kinetics were examined at the onset of moderate-intensity exercise, during hyperventilation with and without associated hypocapnic alkalosis. Seven male subjects (25 ± 6 years old; mean ± SD) performed alternate-leg knee-extension exercise from baseline to moderate-intensity exercise (80% of estimated lactate threshold) and completed four to six repetitions for each of the following three conditions: (i) control [CON; end-tidal partial pressure of CO2 (P(ET, CO₂)) ~40 mmHg], i.e. normal breathing with normal inspired CO2 (0.03%); (ii) hypocapnia (HYPO; P(ET, CO₂) ~20 mmHg), i.e. sustained hyperventilation with normal inspired CO2 (0.03%); and (iii) normocapnia (NORMO; P(ET, CO₂) ~40 mmHg), i.e. sustained hyperventilation with elevated inspired CO2 (~5%). The V(O₂p) was measured breath by breath using mass spectrometry and a volume turbine. Femoral artery mean blood velocity was measured by Doppler ultrasound, and LBF was calculated from femoral artery diameter and mean blood velocity. Phase 2 V(O₂p) kinetics (τV(O₂p)) was different (P < 0.05) amongst all three conditions (CON, 19 ± 7 s; HYPO, 43 ± 17 s; and NORMO, 30 ± 8 s), while LBF kinetics (τLBF) was slower (P < 0.05) in HYPO (31 ± 9 s) compared with both CON (19 ± 3 s) and NORMO (20 ± 6 s). Similar to previous findings, HYPO was associated with slower V(O₂p) and LBF kinetics compared with CON. In the present study, preventing the fall in end-tidal P(CO₂) (NORMO) restored LBF kinetics, but not V(O₂p) kinetics, which remained 'slowed' relative to CON. These data suggest that the hyperventilation manoeuvre itself (i.e. independent of induced hypocapnic alkalosis) may contribute to the slower V(O₂p) kinetics observed during HYPO. PMID:23975901

  1. 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).

  2. Tattoo-pigmented cervical lymph node that masqueraded as the sentinel lymph node in oral squamous cell carcinoma.

    PubMed

    Pinto, Amith; Wieshmann, Hulya; Triantafyllou, Asterios; Shaw, Richard

    2015-11-01

    We describe a case of a pigmented cervical lymph node mimicking the sentinel node during sentinel lymph node biopsy (SLNB) on a patient with oral squamous cell carcinoma (OSCC). The patient had extensive tattoos on his neck. This pigmented lymph node was not identified to be the sentinel lymph node using static and dynamic lymphoscintigraphy. Subsequent histological analysis revealed tattoo pigment within this lymph node. It is important during cervical SLNB to be aware that cutaneous tattoos can pigment lymph nodes. PMID:26188933

  3. Convective diffusion of nanoparticles from the epithelial barrier towards regional lymph nodes

    PubMed Central

    Dukhin, Stanislav S; Labib, Mohamed E.

    2013-01-01

    Drug delivery using nanoparticles as drug carriers has recently attracted the attention of many investigators. Targeted delivery of nanoparticles to lymph nodes is especially important to prevent cancer metastasis or infection, and to diagnose disease stage. However, systemic injection of nanoparticles often results in organ toxicity because they reach and accumulate in all the lymph nodes in the body. An attractive strategy would be to deliver the drug-loaded nanoparticles to a subset of draining lymph nodes corresponding to a specific site or organ to minimize systemic toxicity. In this respect, mucosal delivery of nanoparticles to regional draining lymph nodes of a selected site creates a new opportunity to accomplish this task with minimal toxicity. One example is the delivery of nanoparticles from the vaginal lumen to draining lymph nodes to prevent the transmission of HIV in women. Other known examples include mucosal delivery of vaccines to induce immunity. In all cases, molecular and particle transport by means of diffusion and convective diffusion play a major role. The corresponding transport processes have common inherent regularities and are addressed in this review. Here we use nanoparticles delivery from the vaginal lumen to lymph nodes as an example to address the many aspects of associated transport processes. In this case, nanoparticles penetrate the epithelial barrier and move through the interstitium (tissue) to the initial lymphatics until they finally reach the lymph nodes. Since the movement of interstitial liquid near the epithelial barrier is retarded, nanoparticles transport was found to take place through special foci present in the epithelium. Immediately after nanoparticles emerge from the foci, they move through the interstitium due to diffusion affected by convection (convective diffusion). Specifically, the convective transport of nanoparticles occurs due to their convection together with interstitial fluid through the interstitium towards the initial lymph capillaries. Afterwards, nanoparticles move together with the lymph flow along the initial lymph capillaries and then enter the afferent lymphatics and ultimately reach the lymph node. As the liquid moves through the interstitium towards the initial lymph capillaries due to the axial movement of lymph along the lymphatics, the theory for coupling between lymph flow and concomitant flow through the interstitium is developed to describe this general case. The developed theory is applied to interpret the large uptake of Qdots by lymph nodes during inflammation, which is induced by pre-treating mouse vagina with the surfactant Nonoxynol-9 prior to instilling the Qdots. Inflammation is viewed here to cause broadening of the pores within the interstitium with the concomitant formation of transport channels which function as conduits to transport the nanoparticles to the initial lymph capillaries. We introduced the term “effective channels” to denote those channels which interconnect with foci present in the epithelial barrier and which function to transport nanoparticles to initial lymph capillaries. The time of transport towards the lymph node, predicated by the theory, increases rapidly with increasing the distance y0 between the epithelial barrier and the initial lymph capillaries. Transport time is only a few hours, when y0 is small, about some R (where R is the initial lymph capillary radius), due to the predomination of a rather rapid convection in this case. This transport time to lymph nodes may be tens of hours (or longer) when y0 is essentially larger and the slow diffusion controls the transport rate in a zone not far from the epithelial barrier, where convection is weak at large y0. Accounting for transport by diffusion only, which is mainly considered in many relevant publications, is not sufficient to explain our nanoparticles uptake kinetics because the possibility of fast transport due to convection is overlooked. Our systematic investigations have revealed that the information about the main transport conditions, namely, y0 and the pore broadening up to the dimension of the interstitial transport channels, is necessary to create the quantitative model of enhanced transport during inflammation with the use of the proposed model as a prerequisite. The modeling for convective diffusion of nanoparticles from the epithelial barrier to the lymph node has been mainly accomplished here, while the diffusion only scenario is accounted for in other studies. This first modeling is a semi-quantitative one. A more rigorous mathematical approach is almost impossible at this stage because the transport properties of the model are introduced here for the first time. These properties include: discovery of foci in the epithelium, formation of transport channels, definition of channels interconnecting with foci (effective foci and channels), generation of flow in the interstitium towards the initial lymph capillaries due to axial flow within afferent lymphatics, deformation of this flow due to hydrodynamic impermeability of the squamous layer with the formation of the hydrodynamic stagnation zone near the epithelial barrier, predomination of slow diffusion transport within the above zone, and predomination of fast convection of nanoparticles near the initial lymph capillaries. PMID:23859221

  4. Pulmonary arterial compliance: How and why should we measure it?

    PubMed Central

    Ghio, Stefano; Schirinzi, Sandra; Pica, Silvia

    2015-01-01

    The pulmonary circulation is a high-flow/low-pressure system, coupled with a flow generator chamberthe right ventricle, which is relatively unable to tolerate increases in afterload. A right heart catheterization, using a fluid-filled, balloon-tipped Swan-Ganz catheter allows the measurement of all hemodynamic parameters characterizing the pulmonary circulation: the inflow pressure, an acceptable estimate the outflow pressure, and the pulmonary blood flow. However, the study of the pulmonary circulation as a continuous flow system is an oversimplification and a thorough evaluation of the pulmonary circulation requires a correct understanding of the load that the pulmonary vascular bed imposes on the right ventricle, which includes static and dynamic components. This is critical to assess the prognosis of patients with pulmonary hypertension or with heart failure. Pulmonary compliance is a measure of arterial distensibility and, either alone or in combination with pulmonary vascular resistance, gives clinicians the possibility of a good prognostic stratification of patients with heart failure or with pulmonary hypertension. The measurement of pulmonary arterial compliance should be included in the routine clinical evaluation of such patients. PMID:26779530

  5. Structural Aspects of the Lymphocyte Traffic in Rat Submandibular Lymph Node

    NASA Astrophysics Data System (ADS)

    Okada, Shigenori; Albrecht, Ralph M.; Aharinejad, Seyedhossein; Schraufnagel, Dean E.

    2002-04-01

    Modulation of lymphocyte flow in the lymphatic compartment of the lymph node may serve, in part, to promote lymphocyte sensitization during an antigenic challenge. This study was undertaken to show where this might occur by examining the structural relationships of the intranodal lymphatic pathways, blood vessels, and connective tissue support with respect to lymphocyte and lymph flow. Differently stained plastic resins were injected into the blood vessels and lymphatics of the submandibular lymph node and visualized with a confocal laser scanning microscope. The specimens were corroded to study the three-dimensional cast structures by scanning electron microscopy. Alkali digestion was also used to prepare the reticular fiber network in the lymph node for scanning electron microscopic examination. At the hilus of the node, two to three arteries gave off arterioles running in medullary cords towards the cortex. The medullary cords, the periphery of the deep cortex, and the perifollicular zones had dense capillary networks. In contrast, the center of the follicle and the center of the deep cortex were less highly vascularized. High-endothelial venules were restricted to the perifollicular zone and the periphery of the deep cortex. At the cortico-medullary boundary, they abruptly transformed into medullary venules with a normal endothelium. The marginal sinus of the lymph node was crossed by thick reticular fibers that arose from the inner sheets of the capsule. The lymph pathway went through the marginal sinus, into the trabecular sinus, to the cortical perifollicular sinus, the dense lymphatic sinus around the deep cortex, and finally into the medullary sinus. At present, the exact functional significance of the complex lymph node lymphatic architecture is not clear. However, the highly organized structural organization may play a significant role in regulating and directing lymphocyte flow to facilitate antigen presentation.

  6. What Causes Pulmonary Hypertension?

    MedlinePLUS

    ... page from the NHLBI on Twitter. What Causes Pulmonary Hypertension? Pulmonary hypertension (PH) begins with inflammation and changes in the ... that can cause them, go to "Types of Pulmonary Hypertension." Rate This Content: NEXT >> Updated: August 2, 2011 ...

  7. Types of Pulmonary Hypertension

    MedlinePLUS

    ... page from the NHLBI on Twitter. Types of Pulmonary Hypertension The World Health Organization divides pulmonary hypertension (PH) ... small blood vessels of the lungs. Group 2 Pulmonary Hypertension Group 2 includes PH with left heart disease. ...

  8. Gemcitabine-Induced Pulmonary Toxicity: A Case Report of Pulmonary Veno-Occlusive Disease

    PubMed Central

    Turco, Clia; Jary, Marine; Kim, Stefano; Moltenis, Mlanie; Degano, Bruno; Manzoni, Philippe; Nguyen, Thierry; Genet, Bruno; Rabier, Marie-Blanche Valnet; Heyd, Bruno; Borg, Christophe

    2015-01-01

    INTRODUCTION Gemcitabine is a chemotherapeutic agent frequently used by for the treatment of several malignancies both in the adjuvant and metastatic setting. Although myelosuppression is the most adverse event of this therapy, gemcitabine might induce severe pulmonary toxicities. We describe a case of pulmonary veno-occlusive disease (PVOD) related to gemcitabine. CASE PRESENTATION The patient was an 83-year-old man with a metastatic pancreatic cancer who was treated by gemcitabine as first-line therapy. He was in good health and received no other chemotherapy. A dose of 1000 mg/m2 of gemcitabine was administered over a 30-minute intravenous infusion on days 1, 8, and 15 of a 28-day cycle. After a period of 6 months, a complete response was observed. Nevertheless, the patient developed a severe dyspnea, with arterial hypoxemia and very low lung diffusion for carbon monoxide. A CT scan showed diffuse ground glass opacities with septal lines, bilateral pleural effusion, and lymph node enlargement. On echocardiography, there was a suspicion of pulmonary hypertension with elevated systolic pulmonary artery pressure and normal left ventricular pressures. Right heart catheterization confirmed pulmonary hypertension and normal pulmonary artery occlusion pressure. Diagnosis of PVOD was made, and a gemcitabine-induced toxicity was suspected. A symptomatic treatment was started. At last follow-up, patient was in functional class I with near-normal of CT scan, arterial blood gases, and echocardiography. A gemcitabine-induced PVOD is the more likely diagnosis. PMID:26380562

  9. Increased lymphangiogenesis in lung metastases from colorectal cancer is associated with early lymph node recurrence and decreased overall survival.

    PubMed

    Schweiger, Thomas; Nikolowsky, Christoph; Graeter, Thomas; Seebacher, Gernot; Laufer, Jrgen; Glueck, Olaf; Glogner, Christoph; Birner, Peter; Lang, Gyrgy; Klepetko, Walter; Ankersmit, Hendrik Jan; Hoetzenecker, Konrad

    2016-02-01

    Pulmonary metastasectomy (PM) is an accepted treatment modality in colorectal cancer (CRC) patients with pulmonary tumor spread. Positive intrathoracic lymph nodes at the time of PM are associated with a poor prognosis and 5-year survival rates of <20%. Increased lymphangiogenesis in pulmonary metastases might represent an initial step for a subsequent lymphangiogenic spreading. We aimed to evaluate the presence of lymphangiogenesis in clinically lymph node negative patients undergoing PM and its impact on outcome parameters. 71 patients who underwent PM for CRC metastases were included in this dual-center study. Tissue specimens of pulmonary metastases and available corresponding primary tumors were assessed by immunohistochemistry for lymphatic microvessel density (LMVD) and lymphovascular invasion (LVI). Results were correlated with clinical outcome parameters. LMVD was 13.98.1 and 13.38.5 microvessels/field (meanSD) in metastases and corresponding primary CRC; LVI was evident in 46.5 and 58.6% of metastases and corresponding primary CRC, respectively. Samples with high LMVD had a higher likelihood of LVI. LVI was associated with early tumor recurrence in intrathoracic lymph nodes and a decreased overall survival (p<0.001 and p=0.029). Herein, we present first evidence in a well-defined patient collective that increased lymphangiogenesis is already present in a subtype of pulmonary metastases of patients staged as N0 at the time of PM. This lymphangiogenic phenotype has a strong impact on patients' prognosis. Our findings may have impact on the post-surgical therapeutic management of CRC patients with pulmonary spreading. PMID:26498830

  10. Optimized imaging of pulmonary embolism.

    PubMed

    Tillich, Manfred; Schoellnast, Helmut

    2005-12-01

    Pulmonary embolism (PE) is a common disease with considerable mortality. There are no specific signs or symptoms of PE; the diagnosis relies on imaging tests. The development of multi-detector computed tomography has led to an improvement in the diagnosis of PE due to faster scanning and improved spatial resolution along the longitudinal axis of the patient. Apart from fast scanning and thin collimation, optimal arterial attenuation remains one of the most crucial determinants of sufficient depiction of the pulmonary arteries. Arterial attenuation over time is generally determined by iodine flow concentration, which may be increased either by raising the contrast medium flow rate, and/or by using a high iodine concentration contrast medium. The scan duration necessary for imaging the whole thorax ranges from about 20 s with a four-detector row scanner to about 5 s with a 64-detector row detector scanner. The collimation ranges from 0.5 mm to 1 mm depending on the scanner used. This enables the most detailed display of the pulmonary arteries. Bolus triggering devices are a valuable tool for accurate timing of scanning. The administration of the contrast material bolus is performed using a power injector at a flow rate of about 4 mL/s. A saline flush immediately after contrast material administration avoids pooling of the contrast material in the arm veins and in the injection system and reduces perivenous artifacts in the superior vena cava. The use of a high concentration contrast material significantly improves attenuation of the pulmonary arteries leading to better visualisation of sub-segmental and lower order pulmonary arteries in multi-row-detector-CTA. In addition, the higher attenuation may improve the conspicuity of emboli within the pulmonary arteries. PMID:18637232

  11. Mechanoinduction of lymph vessel expansion

    PubMed Central

    Planas-Paz, Lara; Strili?, Boris; Goedecke, Axel; Breier, Georg; Fssler, Reinhard; Lammert, Eckhard

    2012-01-01

    In the mammalian embryo, few mechanical signals have been identified to influence organ development and function. Here, we report that an increase in the volume of interstitial or extracellular fluid mechanically induces growth of an organ system, that is, the lymphatic vasculature. We first demonstrate that lymph vessel expansion in the developing mouse embryo correlates with a peak in interstitial fluid pressure and lymphatic endothelial cell (LEC) elongation. In loss-of-fluid' experiments, we then show that aspiration of interstitial fluid reduces the length of LECs, decreases tyrosine phosphorylation of vascular endothelial growth factor receptor-3 (VEGFR3), and inhibits LEC proliferation. Conversely, in gain-of-fluid' experiments, increasing the amount of interstitial fluid elongates the LECs, and increases both VEGFR3 phosphorylation and LEC proliferation. Finally, we provide genetic evidence that ?1 integrins are required for the proliferative response of LECs to both fluid accumulation and cell stretching and, therefore, are necessary for lymphatic vessel expansion and fluid drainage. Thus, we propose a new and physiologically relevant mode of VEGFR3 activation, which is based on mechanotransduction and is essential for normal development and fluid homeostasis in a mammalian embryo. PMID:22157817

  12. Simple pulmonary eosinophilia

    MedlinePLUS

    Pulmonary infiltrates with eosinophilia; Loffler syndrome; Eosinophilic pneumonia; Pneumonia - eosinophilic ... simple pulmonary eosinophilia is a severe type of pneumonia called acute idiopathic eosinophilic pneumonia.

  13. Perspectives in nuclear medicine: pulmonary studies

    SciTech Connect

    Budinger, T.F.; McNeil, B.J.; Alderson, P.O.

    1982-01-01

    Since the introduction of I-131 labeled macroaggregates in 1964, noninvasive techniques involving injection of radiolabeled agents and remote detection of emitted radiation have become well established in detecting pulmonary disorders in routine clinical medicine. In the past, pulmonary nuclear medicine has been dominated by studies that depict the distribution of pulmonary perfusion and/or ventilation-perfusion balance (e.g., for the detection of pulmonary embolism, obstructive airway disease, lung carcinoma). With the recent development of emission tomography and the potential for new, function-oriented radiopharmaceuticals, however, pulmonary nuclear medicine is entering a new era. The status of contemporary pulmonary nuclear medicine is briefly reviewed in several areas of major interest and applications and focus on areas where new developments are needed and seem feasible in the near future. Several important regional physiological processes measurable by these techniques include: (a) the presence or absence of pulmonary embolism, (b) relative pulmonary blood flow, (c) permeability to specific molecules, (d) lung tissue metabolism, (e) ventilation distribution and (f) the relationship between ventilation and blood flow (perfusion). (JMT)

  14. Prevention of Lymphedematous Change in the Mouse Hindlimb by Nonvascularized Lymph Node Transplantation.

    PubMed

    Shioya, Ryuta; Furukawa, Hiroshi; Murao, Naoki; Hayashi, Toshihiko; Oyama, Akihiko; Funayama, Emi; Yamamoto, Yuhei; Saito, Noriko

    2016-04-01

    Lymphedema is a condition characterized by progressive swelling and adipose deposition that occurs commonly after lymphadenectomy. Recent clinical studies have suggested that the transfer of lymph nodes to the lymphedematous limb can improve lymphatic function. In this report, we investigate dynamic modulation of lymphatic flow and the microscopic changes of lymphatic regeneration using a lymphedema mouse model that was treated with nonvascularized lymph node transplantation. To evaluate the effect of lymph node transplantation in this model, paw volume was measured using a water displacement plethysmometer; an indocyanine green fluorescence-sensitive camera system was used. The improvement of edema was evident in the paw of the transplantation group. The abnormal fluorescence image pattern gradually improved and disappeared 4 weeks postoperatively in the transplantation group. Uptake in the transplanted lymph node was observed 4 weeks postoperatively. This finding suggested that the transplanted lymph node was engrafted. A collateral pathway was observed in the ventral area 1 week postoperatively. The collateral pathway may have contributed to the early improvement of edema. Our findings suggest that lymph node transplantation can restore lymphatic function. This result has important conceptual implications in the treatment of postsurgical lymphedema. PMID:25664410

  15. Mesenteric lymph node cavitation in coeliac disease.

    PubMed Central

    Holmes, G K

    1986-01-01

    A patient with coeliac disease and mesenteric lymph node cavitation is reported. This is a rare occurrence and has received very little attention in the English literature. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:3721297

  16. 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, Waldenstrm's macroglobulinemia, and multiple myeloma

  17. Extraction and visualization of the central chest lymph-node stations

    NASA Astrophysics Data System (ADS)

    Lu, Kongkuo; Merritt, Scott A.; Higgins, William E.

    2008-03-01

    Lung cancer remains the leading cause of cancer death in the United States and is expected to account for nearly 30% of all cancer deaths in 2007. Central to the lung-cancer diagnosis and staging process is the assessment of the central chest lymph nodes. This assessment typically requires two major stages: (1) location of the lymph nodes in a three-dimensional (3D) high-resolution volumetric multi-detector computed-tomography (MDCT) image of the chest; (2) subsequent nodal sampling using transbronchial needle aspiration (TBNA). We describe a computer-based system for automatically locating the central chest lymph-node stations in a 3D MDCT image. Automated analysis methods are first run that extract the airway tree, airway-tree centerlines, aorta, pulmonary artery, lungs, key skeletal structures, and major-airway labels. This information provides geometrical and anatomical cues for localizing the major nodal stations. Our system demarcates these stations, conforming to criteria outlined for the Mountain and Wang standard classification systems. Visualization tools within the system then enable the user to interact with these stations to locate visible lymph nodes. Results derived from a set of human 3D MDCT chest images illustrate the usage and efficacy of the system.

  18. Robotic-assisted inguinal lymph node dissection: A preliminary report

    PubMed Central

    Dogra, P. N.; Saini, Ashish Kumar; Singh, Prabhjot

    2011-01-01

    Penile cancer with inguinal lymph node metastasis is a common cancer in India. Open inguinal lymphadenectomy is the gold standard treatment of metastatic inguinal lymph nodes. We report our experience and technique of robotic assisted inguinal lymph node dissection in two patients presented with palpable inguinal lymph nodes, which to our knowledge is the first reported case series from India. PMID:22022077

  19. 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

  20. Lymph node disease after radical prostatectomy.

    PubMed

    Wirth, M P; Froehner, M

    2007-03-01

    Most patients with lymph node involvement at radical prostatectomy are destined to experience disease progression. Since the detection rate of lymph node metastases depends on the extension of lymphadenectomy, comparison between series may be biased and there is no generally accepted treatment approach. Although one small randomized study demonstrated a survival benefit for patients receiving immediate hormonal treatment compared with treatment onset at clinical progression, in patients with minimal lymph node involvement the benefit of immediate treatment is uncertain. It is possible that treatment onset at PSA relapse is sufficient in such cases thus sparing side effects and costs of hormonal treatment. The role of adjuvant radiotherapy is unclear in patients with lymph node involvement at radical prostatectomy. Since spread into the lymph nodes in most cases indicates systemic disease, local measures only are unlikely to cure those patients. Possibly, in select cases, adjuvant radiotherapy may improve local control and maintain quality of life, even if no survival benefit may be expected. Overall, there is a need to enroll patients with lymph node involvement at radical prostatectomy onto clinical studies to improve the body of knowledge on optimal management in these cases. PMID:17431370

  1. Primary pulmonary liposarcoma--a case report.

    PubMed

    Achir, A; Ouadnouni, Y; Smahi, M; Bouchikh, M; Msougar, Y; Benosman, A

    2009-03-01

    Liposarcoma of the lung is an extremely rare disease with less than 10 cases reported to date. A case of a locally advanced, pulmonary mixed liposarcoma in a 49-year-old male is presented here. Left pneumonectomy with radical lymph node dissection was performed. The postoperative course was uneventful and no recurrence or metastasis was observed for 3 years. Although liposarcoma of the lung is classified as an aggressive, highly metastatic disease, complete resection may result in disease-free survival. PMID:19241318

  2. Surface-active phospholipid in muscle lymph and its lubricating and adhesive properties.

    PubMed

    Hills, B A

    1990-03-01

    In order to investigate the role of phospholipid in facilitating lymph flow, "deep-thigh" lymph was collected from ten anesthetized dogs and analyzed for phospholipids using thin-layer chromatography. The lymph was found to be surface active at liquid and at solid surfaces at which it deposited a hydrophobic monolayer in vitro. Extracted phospholipid was found to be an effective release agent as a monolayer, reducing the force of adhesion of 5% protein solutions by 76% according to a standard test for tacky glues. The same monolayers were effective lubricants, reducing friction by 96%; while mixtures of the same phospholipids from synthetic sources gave similar results for release and lubrication. Surfaces in contact with extracellular fluid or lymph in vivo were found to be hydrophobic with a drop of saline on semitendinosus muscle fibers displaying a contact angle of 40.2 degrees +/- 7.2 degrees. The results are considered compatible with the hypothesis that surface-active phospholipid facilitates the flow of lymph; while it could also provide boundary lubrication for sliding of connective tissue in locomotion and for any relative movement of motor units in muscle contraction and fatigue. PMID:2352443

  3. Intrapulmonary unicentric Castleman disease mimicking peripheral pulmonary malignancy

    PubMed Central

    Liu, Yi; Chen, Gang; Qiu, Xiaoming; Xu, Song; Wu, Yi; Liu, Renwang; Zhou, Qinghua; Chen, Jun

    2014-01-01

    Castleman disease, also known as angiofollicular lymph node hyperplasia, can manifest as a unicentric or multicentric disorder. Intrapulmonary Castleman disease is very rare. Here, we present a patient with intrapulmonary Castleman disease who underwent left upper pulmonary lobectomy for suspected early lung cancer. The histopathologic diagnosis of the lobar mass was hyaline-type Castleman disease. The patient has remained well after surgery, showing no local recurrence or distant disease during a two-year follow-up period. Although unicentric Castleman disease originating in the lung is rare, it should be considered in the differential diagnosis of primary pulmonary malignant tumors.

  4. Pulmonary embolus diagnosed by endobronchial ultrasound

    PubMed Central

    Segraves, Justin M.; Daniels, Craig E.

    2015-01-01

    Endobronchial ultrasound (EBUS) imaging is commonly used to evaluate and aid in biopsy of mediastinal lymph nodes. Pulmonary arteries are readily viewable with this type of imaging modality. We present a case report of a pulmonary embolism (PE) diagnosed by EBUS. Our patient had no smoking history and presented with respiratory and constitutional symptoms, urinary retention, and leg weakness suspicious for malignancy with metastasis to spine. Chest computed tomography (CT) was suggestive of lung carcinoma and specifically showed no PE. EBUS with TBNA was requested for tissue diagnosis. A mobile filling defect consistent with a PE was observed and reported to primary team. Follow-up chest CT showed an acute PE which confirmed the diagnosis originally made by EBUS. Bronchoscopists should be aware of potential to diagnose a PE while performing EBUS. Additionally, there may be a role in using EBUS specifically to diagnose a PE in the right patient population. PMID:26744670

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

    PubMed

    Nakwan, Narongwit

    2015-04-01

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

  6. Postoperative Acute Pulmonary Embolism Following Pulmonary Resections.

    PubMed

    Shonyela, Felix Samuel; Yang, Shuangqiang; Liu, Bo; Jiao, Jia

    2015-01-01

    Postoperative acute pulmonary embolism after pulmonary resections is highly fatal complication. Many literatures have documented cancer to be the highest risk factor for acute pulmonary embolism after pulmonary resections. Early diagnosis of acute pulmonary embolism is highly recommended and computed tomographic pulmonary angiography is the gold standard in diagnosis of acute pulmonary embolism. Anticoagulants and thrombolytic therapy have shown a great success in treatment of acute pulmonary embolism. Surgical therapies (embolectomy and inferior vena cava filter replacement) proved to be lifesaving but many literatures favored medical therapy as the first choice. Prophylaxis pre and post operation is highly recommended, because there were statistical significant results in different studies which supported the use of prophylaxis in prevention of acute pulmonary embolism. Having reviewed satisfactory number of literatures, it is suggested that thoroughly preoperative assessment of patient conditions, determining their risk factors complicating to pulmonary embolism and the use of appropriate prophylaxis measures are the key options to the successful minimization or eradication of acute pulmonary embolism after lung resections. PMID:26354232

  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. Phthalate exposure and pulmonary function.

    PubMed

    Hoppin, Jane A; Ulmer, Ross; London, Stephanie J

    2004-04-01

    Exposure to phthalates is widespread because of their use in plastics, cosmetics, and other consumer products. Phthalate exposure has been associated with adverse respiratory outcomes in children. With urinary phthalate measures, we assessed the association between phthalate exposure and four pulmonary function parameters [forced vital capacity (FVC), forced expiratory volume at 1 sec (FEV1), peak expiratory flow (PEF), and maximum mid-expiratory flow] among the 240 adult Third National Health and Nutrition Examination Survey (NHANES III) participants with urinary phthalate data. Linear regression models controlled for race, age, age squared, standing height, body mass index, cumulative smoking, and current smoking. Monobutyl phthalate (MBP) was significantly associated with decrements in three measures of pulmonary function (FVC, FEV1, PEF) in males but not in females. For a change from the 25th to the 75th percentile in MBP level among men, FEV1 decreased 112 mL (SE = 51, p = 0.03). Monoethyl phthalate (MEP) was associated with lower FVC and FEV1 values in men. Monoethylhexyl phthalate (MEHP), the metabolite of the plasticizer commonly used in medical tubing, was not adversely associated with any of the pulmonary function parameters evaluated. Our results suggest that MBP and MEP, but not MEHP, may influence pulmonary function among adult males. PMID:15064163

  9. Pulmonary manifestations of renal cell carcinoma.

    PubMed

    Agrawal, Abhinav; Sahni, Sonu; Iftikhar, Asma; Talwar, Arunabh

    2015-12-01

    Renal cell carcinoma (RCC) accounts for majority of all primary renal neoplasms. Classic manifestations of RCC include the triad of flank pain, hematuria and a palpable renal mass. Patients with RCC can develop various extra renal manifestations including involvements of the lungs, inferior vena cava, liver and the bones. The pulmonary manifestations of renal cell carcinoma include metastatic disease including endobronchial, pleural, parenchymal or lymph node metastasis, pleural effusion or hemothorax. Pulmonary embolism and tumor embolism is another common manifestation of renal cell carcinoma. RCC is a highly vascular tumor and can cause pulmonary arterio-venous fistulas leading to high output failure. Rarely, RCC can also present with paraneoplastic presentations including cough or bilateral diaphragm paralysis. Drugs used to treat RCC have been associated with drug related pneumonitis and form an important differential diagnosis in patients with RCC on therapy presenting with shortness of breath. In this review we discuss the various pulmonary manifestations of RCC. A high index of suspicion with these presentations can lead to an early diagnosis and assist in instituting an appropriate intervention. PMID:26525375

  10. Diagnosis of chronic obstructive pulmonary disease earlier than current Global Initiative for Obstructive Lung Disease guidelines using a feasible spirometry parameter (maximal-mid expiratory flow/forced vital capacity).

    PubMed

    Mirsadraee, Majid; Boskabady, Mohammad Hosein; Attaran, Davood

    2013-01-01

    Some patients suffer from clinical symptoms of chronic obstructive pulmonary disease (COPD) but their pulmonary function tests are in the normal range (at risk group). The objective of this study was to discover a practical test to distinguish these patients from non-COPD subjects. A total of 77 subjects including 40 COPD patients, 37 subjects at risk for developing COPD, and 32 control subjects were entered in this study. The accuracy of maximal-mid expiratory flow (MMEF)/forced vital capacity (FVC) for the diagnosis of COPD in at risk patients and its capability to differentiate from early COPD and normal patients were evaluated. Body plethysmography was used for measurement of lung volume as the Global Initiative for Obstructive Lung Disease standard. MMEF/FVC in the at risk group of COPD (0.730.19) was significantly lower than the normal control group (0.90.24, respectively), and also, it was significantly higher than the COPD group (0.310.17). There was significant correlation between the MMEF/FVC and amount of smoking measured by pack year (r2=0.112, p=0.005) and stages of COPD (Spearman's ?=0.82, p=0.0001). Early stage COPD (smoker subjects without spirometry derangement) can be diagnosed by MMEF/FVC. Using this tool we may be able to detect this highly preventable disease at an earlier stage. PMID:24177680

  11. Pulmonary tumor thrombotic microangiopathy: the challenge of the antemortem diagnosis.

    PubMed

    Patrignani, Anna; Purcaro, Augusto; Calcagnoli, Francesca; Mandolesi, Alessandra; Bearzi, Italo; Ciampani, Nino

    2014-11-01

    Pulmonary tumor thrombotic microangiopathy (PTTM) is known as a rare and severe cancer-related pulmonary complication. Nowadays, fewer than 80 cases have been reported in the literature and very few cases have been diagnosed antemortem. We describe an autopsy case of PTTM associated with cancer of unknown origin. A 56-year-old male patient came to our attention due to a 2-day history of dyspnea. Analysis of the clinical context in combination with laboratory and imaging tests led us to suspect acute pulmonary thromboembolism. However, the computed tomography pulmonary angiogram was negative for thromboembolism; on the contrary it revealed multiple lymphadenopathy. Microscopic pulmonary tumor embolism was suspected and a lymph node biopsy was planned. However, the patient's condition progressively worsened; death occurred 3 days after admission. After autopsy, histologically extensive neoplastic emboli involved the small pulmonary arteries and arterioles, often admixed with fibrin thrombi. The involved and noninvolved arteries also demonstrated fibrocellular intimal proliferation causing marked luminal stenosis and occlusion. These pathological features were characteristic of PTTM, which should be distinguished from microscopic tumor embolism and should be considered in the differential diagnosis of acute/subacute cor pulmonale and pulmonary hypertension in cancer as well as in noncancer patients. We propose a review of the literature and an algorithm to improve PTTM antemortem diagnosis. PMID:22710763

  12. Pulmonary pathology

    SciTech Connect

    Dail, D.H.; Hammar, S.P.

    1988-01-01

    This book contains 34 chapters. Some of the titles are: Radiographic correlation; Pleural neoplasms; Cytologic correlations; Hypertension and low-flow states; Common neoplasms; Lymphoproliferative diseases; and Uncommon tumors.

  13. Minimal Thorotrast deposition in parapancreatic lymph nodes.

    PubMed

    Okuda, K; Ichinohe, A; Kono, K; Ueda, S; Noguchi, T

    1976-04-01

    The characteristic roentgenologic features of Thorotrast deposition in the perihepatic and parapancreatic lymphatics are described. Minimal deposits of Thorotrast were seen in the liver and spleen on the abdominal radiograph in 6 patients who had no clinical symptoms. Inquiry into the patient's history invariably disclosed angiography for vascular surgery several years earlier. The typical configuration of the affected lymph node is an oval, heavy density with a long tail, resembling a tadpole or teardrop. Other irregular radiopacities in the same area, including linear ones, probably represent colloid deposition along the lymphatics. Roentgenologic differentiation of Thorotrast deposits from pancreas stones and calcified lymph nodes is discussed. PMID:1257448

  14. [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

  15. Drainage of brain extracellular fluid into blood and deep cervical lymph and its immunological significance.

    PubMed

    Cserr, H F; Harling-Berg, C J; Knopf, P M

    1992-10-01

    Cerebral extracellular fluids drain from brain to blood across the arachnoid villi and to lymph along certain cranial nerves (primarily olfactory) and spinal nerve root ganglia. Quantification of the connection to lymph in rabbit, cat and sheep, using radiolabelled albumin as a marker of flow, indicates that a minimum of 14 to 47% of protein injected into different regions of brain or cerebrospinal fluid passes through lymph. The magnitude of the outflow to lymph is at variance with the general assumption that the absence of conventional lymphatics from the brain interrupts the afferent arm of the immune response to brain antigens. The immune response to antigens (albumin or myelin basic protein) introduced into the central nervous system (CNS) has been analysed using a rat model with normal brain barrier permeability. The micro-injection of antigen into brain or cerebrospinal fluid elicits a humoral immune response, with antibody production in cervical lymph nodes and spleen, and also affects cell-mediated immunity. Furthermore, antigen may be more immunogenic when administered into the CNS than into conventional extracerebral sites. Clearly, the afferent arm of the immune response to antigens, within the CNS, is intact. Modern studies suggest that the efferent arm is also intact with passage of activated lymphocytes into the brain. Results support a new view of CNS immunology which incorporates continuous and highly regulated communication between the brain and the immune system in both health and disease. PMID:1341962

  16. Pulmonary Hypertension in Sarcoidosis.

    PubMed

    Baughman, Robert P; Engel, Peter J; Nathan, Steven

    2015-12-01

    Pulmonary hypertension is a complication of sarcoidosis leading to dyspnea and associated with increased morbidity and mortality. Sarcoidosis-associated pulmonary hypertension (SAPH) can be due to several factors, including vascular involvement by the granulomatous inflammation, compression of the pulmonary arteries by adenopathy, fibrotic changes within the lung, and left ventricular diastolic dysfunction. Several case series have suggested that some patients with SAPH benefit from specific therapy for pulmonary hypertension. A randomized, placebo-controlled trial found 16weeks' bosentan therapy to be associated with significant improvement in pulmonary artery pressure. Future studies may better define who would respond to treatment of pulmonary hypertension. PMID:26593143

  17. [Idiopathic pulmonary trunk aneurysm].

    PubMed

    Uehara, Mayuko; Kuroda, Yosuke; Ohori, Syunsuke; Mawatari, Toru; Morishita, Kiyofumi

    2010-07-01

    Pulmonary trunk aneurysm is generally associated with congenital cardiac defects, pulmonary hypertension, or infection. Idiopathic pulmonary trunk aneurysm without any associated diseases is a rare lesion and has seldom been reported. Here, we report a case of a 68-year-old woman with idiopathic pulmonary trunk aneurysm. The maximum diameter of the aneurysm was 53 mm while she was 142 cm in height. We successfully performed aneurysmorrhaphy and her postoperative course was uneventful. Aneurysmorrhaphy was an effective technique for idiopathic pulmonary trunk aneurysm without pulmonary hypertention. PMID:20662238

  18. Early diagnosis of lymph node metastasis: Importance of intranodal pressures.

    PubMed

    Miura, Yoshinobu; Mikada, Mamoru; Ouchi, Tomoki; Horie, Sachiko; Takeda, Kazu; Yamaki, Teppei; Sakamoto, Maya; Mori, Shiro; Kodama, Tetsuya

    2016-03-01

    Regional lymph node status is an important prognostic indicator of tumor aggressiveness. However, early diagnosis of metastasis using intranodal pressure, at a stage when lymph node size has not changed significantly, has not been investigated. Here, we use an MXH10/Mo-lpr/lpr mouse model of lymph node metastasis to show that intranodal pressure increases in both the subiliac lymph node and proper axillary lymph node, which are connected by lymphatic vessels, when tumor cells are injected into the subiliac lymph node to induce metastasis to the proper axillary lymph node. We found that intranodal pressure in the subiliac lymph node increased at the stage when metastasis was detected by in vivo bioluminescence, but when proper axillary lymph node volume (measured by high-frequency ultrasound imaging) had not increased significantly. Intravenously injected liposomes, encapsulating indocyanine green, were detected in solid tumors by in vivo bioluminescence, but not in the proper axillary lymph node. Basic blood vessel and lymphatic channel structures were maintained in the proper axillary lymph node, although sinus histiocytosis was detected. These results show that intranodal pressure in the proper axillary lymph node increases at early stages when metastatic tumor cells have not fully proliferated. Intranodal pressure may be a useful parameter for facilitating early diagnosis of lymph node metastasis. PMID:26716604

  19. Visualization of the primo vascular system afloat in a lymph duct.

    PubMed

    Jung, Sharon Jiyoon; Lee, Seung-Hwan; Bae, Kyoung-Hee; Kwon, Hee Min; Song, Yoon Kyu; Soh, Kwang-Sup

    2014-12-01

    Because of the potential roles of the primo vascular system (PVS) in cancer metastasis, immune function, and regeneration, understanding the molecular biology of the PVS is desirable. The current state of PVS research is comparable to that of lymph research prior to the advent of Lymphatic vessel endothelial hyaluronan receptor 1 (LYVE-1). There is very little knowledge of the molecular biology of the PVS due to difficulties in identifying and isolating primo endothelial cells. Present investigations rely on the morphology and the use of differential staining procedures to identify the PVS within tissues, making detailed molecular studies all but impossible. To overcome such difficulties, one may emulate the explosive development of lymph molecular biology. For this purpose, there is a need for a reliable method to obtain PVS specimens to initiate the molecular investigation. One of the most reliable methods is to detect the primo vessels and primo nodes afloat in the lymph flow. The protocols for observation of the PVS in the large lymph ducts in the abdominal cavity and the thoracic cavity were reported earlier. These methods require a laparectomy and skillful techniques. In this work, we present a protocol to identify and harvest PVS specimens from the lymph ducts connecting the inguinal and the axillary nodes, which are located entirely in the skin. Thus, the PVS specimen is more easily obtainable. This method is a stepping-stone toward development of a system to monitor migration of cancer cells in metastasis from a breast tumor to the axillary nodes, where cancer cells use the PVS as a survival rope in hostile lymph flow. PMID:25499568

  20. Pulmonary response of normal human subjects to inhaled vasodilator substances.

    PubMed

    Brett, S J; Chambers, J; Bush, A; Rosenthal, M; Evans, T W

    1998-11-01

    1. Inhaled vasodilators such as nitric oxide and epoprostenol (prostaglandin I2) are now widely employed as supportive therapies to improve oxygenation and reduce pulmonary vascular resistance in patients with acute and chronic pulmonary hypertension. However, few data exist concerning their effects in normal individuals. The aim of this study was to characterize the response of the pulmonary circulation in normal individuals to inhaled nitric oxide and nebulized prostaglandin I2.2.Eight healthy volunteers were exposed to inhaled nitric oxide (0, 20 and 40 p.p.m.) and nebulized prostaglandin I2 (10 microgram/ml). Changes in effective pulmonary blood flow and diffusing capacity of the lung for carbon monoxide (TLCO) were measured using respiratory mass spectrometry. Bicycle ergometry was used to increase effective pulmonary blood flow as a positive control.3. Exercise produced significant increases in both effective pulmonary blood flow and TLCO, but neither nitric oxide nor prostaglandin I2 produced significant changes in either parameter.4.No significant change in pulmonary haemodynamics was demonstrated in response to inhaled nitric oxide or nebulized prostaglandin I2, using doses known to be effective in patients with acute and chronic pulmonary hypertension. These data suggest that the normal pulmonary vascular bed is not amenable to vasodilatation by inhaled drugs. The study further suggests that the normal pulmonary vasodilatation seen on exercise is not mediated pharmacologically, but is a secondary consequence to the mechanical effects of a rise in pulmonary blood flow. This study thus supports the view that there is no resting vasoconstrictor tone in the pulmonary vascular bed. PMID:9791049

  1. Differential Gene Expression Profiles and Selected Cytokine Protein Analysis of Mediastinal Lymph Nodes of Horses with Chronic Recurrent Airway Obstruction (RAO) Support an Interleukin-17 Immune Response

    PubMed Central

    2015-01-01

    Recurrent airway obstruction (RAO) is a pulmonary inflammatory condition that afflicts certain mature horses exposed to organic dust particulates in hay. Its clinical and pathological features, manifested by reversible bronchoconstriction, excessive mucus production and airway neutrophilia, resemble the pulmonary alterations that occur in agricultural workers with occupational asthma. The immunological basis of RAO remains uncertain although its chronicity, its localization to a mucosal surface and its domination by a neutrophilic, non-septic inflammatory response, suggest involvement of Interleukin-17 (IL-17). We examined global gene expression profiles in mediastinal (pulmonary-draining) lymph nodes isolated from RAO-affected and control horses. Differential expression of > 200 genes, coupled with network analysis, supports an IL-17 response centered about NF-κB. Immunohistochemical analysis of mediastinal lymph node sections demonstrated increased IL-17 staining intensity in diseased horses. This result, along with the finding of increased IL-17 concentrations in lymph node homogenates from RAO-affected horses (P = 0.1) and a down-regulation of IL-4 gene and protein expression, provides additional evidence of the involvement of IL-17 in the chronic stages of RAO. Additional investigations are needed to ascertain the cellular source of IL-17 in this equine model of occupational asthma. Understanding the immunopathogenesis of this disorder likely will enhance the development of therapeutic interventions beneficial to human and animal pulmonary health. PMID:26561853

  2. Novel Methods of Lymph Node Evaluation for Predicting the Prognosis of Colorectal Cancer Patients with Inadequate Lymph Node Harvest

    PubMed Central

    Kwon, Taek Soo; Choi, Sung Bong; Lee, Yoon Suk; Kim, Jun-Gi; Oh, Seong Taek; Lee, In Kyu

    2016-01-01

    Purpose Lymph node metastasis is an important factor for predicting the prognosis of colorectal cancer patients. However, approximately 60% of patients do not receive adequate lymph node evaluation (less than 12 lymph nodes). In this study, we identified a more effective tool for predicting the prognosis of patients who received inadequate lymph node evaluation. Materials and Methods The number of metastatic lymph nodes, total number of lymph nodes examined, number of negative metastatic lymph nodes (NL), lymph node ratio (LR), and the number of apical lymph nodes (APL) were examined, and the prognostic impact of these parameters was examined in patients with colorectal cancer who underwent surgery from January 2004 to December 2011. In total, 806 people were analyzed retrospectively. Results In comparison of different lymph node analysis methods for rectal cancer patients who did not receive adequate lymph node dissection, the LR showed a significant difference in overall survival (OS) and the APL predicted a significant difference in disease-free survival (DFS). In the case of colon cancer patients who did not receive adequate lymph node dissection, LR predicted a significant difference in DFS and OS, and the APL predicted a significant difference in DFS. Conclusion If patients did not receive adequate lymph node evaluation, the LR and NL were useful parameters to complement N stage for predicting OS in colon cancer, whereas LR was complementary for rectal cancer. The APL could be used for prediction of DFS in all patients. PMID:25943323

  3. 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 patients 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

  4. Responsiveness of raised pulmonary vascular resistance to oxygen assessed by pulsed Doppler echocardiography.

    PubMed Central

    Vogel, M; Weil, J; Stern, H; Bhlmeyer, K

    1991-01-01

    OBJECTIVE--To assess whether changes in Doppler echocardiographic indices in the pulmonary artery correlated with changes in pulmonary vascular resistance. DESIGN--Acceleration time, ejection time, maximal flow velocity, and velocity time integrals were measured at the same time as pressure and oxygen saturation measurements in room air and during 10 minutes of oxygen breathing in the catheterisation laboratory. Pulmonary vascular resistance and pulmonary blood flow (Qp) were calculated from catheterisation data by use of the Fick principle. PATIENTS--14 consecutive patients with a congenital heart defect and a left to right shunt associated with raised pulmonary artery pressure who underwent routine diagnostic cardiac catheterisation to assess their pulmonary vascular resistance. RESULTS--Though pulmonary vascular resistance and systolic pulmonary artery pressure fell significantly during oxygen administration, there was no significant change in the acceleration time or ejection time. Peak velocity increased significantly during oxygen administration. During oxygen breathing Doppler derived measurements of pulmonary flow showed a significant increase in Qp similar to the increase in Qp measured by the Fick principle. There was no significant correlation between the fall in pulmonary vascular resistance and the increase in acceleration time or ejection time, increase in peak velocity, increase in pulmonary artery diameter, or increase in Doppler derived pulmonary blood flow. CONCLUSIONS--Measurements of acceleration and ejection time by Doppler echocardiography did not predict the response of pulmonary artery pressure and resistance to oxygen. Though changes in maximal flow velocity across the pulmonary artery and in Doppler derived pulmonary blood flow measurements became significant during oxygen breathing, the correlation of these changes with fall in pulmonary vascular resistance was poor. PMID:1747277

  5. [Combined pulmonary fibrosis and emphysema].

    PubMed

    Cottin, Vincent; Brillet, Pierre-Yves; Nunes, Hilario; Cordier, Jean-Franois

    2007-06-01

    A syndrome including upper-lobe emphysema and pulmonary fibrosis of the lower lungs was recently characterized. It is found most often in men who are smokers or ex-smokers of more than 40 pack-years; their mean age is 65 years. Exertional dyspnea is always present. There are basal crackles. The disease has no known cause; the only certain risk factor is smoking. Pulmonary function tests show respiratory volumes and flows that are often normal or subnormal, while carbon monoxide transfer is substantially reduced and exercise hypoxemia is present. Diagnosis is based on findings from millimeter-slices of computed tomography of the chest, which show either centrilobular emphysema or upper-zone bullous emphysema, associated in 90% of cases with very suggestive paraseptal emphysema and diffuse infiltrating fibrosing lung disease at the bases (subpleural reticular opacities, honeycomb images, traction bronchiectasis), with more frequent ground glass opacities than in idiopathic pulmonary fibrosis. Pulmonary hypertension is present in almost half of all patients and represents the principal negative prognostic factor for this condition, which has a median survival of 6 years. PMID:17446036

  6. Expression profiling of lymph nodes in tuberculosis patients reveal inflammatory milieu at site of infection

    PubMed Central

    Maji, Abhijit; Misra, Richa; Kumar Mondal, Anupam; Kumar, Dhirendra; Bajaj, Divya; Singhal, Anshika; Arora, Gunjan; Bhaduri, Asani; Sajid, Andaleeb; Bhatia, Sugandha; Singh, Sompal; Singh, Harshvardhan; Rao, Vivek; Dash, Debasis; Baby Shalini, E; Sarojini Michael, Joy; Chaudhary, Anil; Gokhale, Rajesh S.; Singh, Yogendra

    2015-01-01

    Extrapulmonary manifestations constitute 15 to 20% of tuberculosis cases, with lymph node tuberculosis (LNTB) as the most common form of infection. However, diagnosis and treatment advances are hindered by lack of understanding of LNTB biology. To identify host response, Mycobacterium tuberculosis infected lymph nodes from LNTB patients were studied by means of transcriptomics and quantitative proteomics analyses. The selected targets obtained by comparative analyses were validated by quantitative PCR and immunohistochemistry. This approach provided expression data for 8,728 transcripts and 102 proteins, differentially regulated in the infected human lymph node. Enhanced inflammation with upregulation of T-helper1-related genes, combined with marked dysregulation of matrix metalloproteinases, indicates tissue damage due to high immunoactivity at infected niche. This expression signature was accompanied by significant upregulation of an immunoregulatory gene, leukotriene A4 hydrolase, at both transcript and protein levels. Comparative transcriptional analyses revealed LNTB-specific perturbations. In contrast to pulmonary TB-associated increase in lipid metabolism, genes involved in fatty-acid metabolism were found to be downregulated in LNTB suggesting differential lipid metabolic signature. This study investigates the tissue molecular signature of LNTB patients for the first time and presents findings that indicate the possible mechanism of disease pathology through dysregulation of inflammatory and tissue-repair processes. PMID:26469538

  7. Familial Pulmonary Fibrosis

    MedlinePLUS

    ... are here: Health Information > Condition Information Familial Pulmonary Fibrosis: Overview When two or more members within the ... Programs and Services Doctors Who Treat Familial Pulmonary Fibrosis No doctors are currently listed for this condition. ...

  8. Pulmonary hypertension - at home

    MedlinePLUS

    Pulmonary hypertension (PAH) is abnormally high blood pressure in the arteries of the lungs. With PAH, the right ... Chin K, Channick RN. Pulmonary hypertension. In: Broaddus VC, ... Nadel's Textbook of Respiratory Medicine . 6th ed. Philadelphia, ...

  9. 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 ...

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

    PubMed Central

    Lehnert, B E

    1992-01-01

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

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

    SciTech Connect

    Lehnert, B.E. )

    1992-07-01

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

  12. Chronic thromboembolic pulmonary hypertension.

    PubMed

    O'Connell, Caroline; Montani, David; Savale, Laurent; Sitbon, Olivier; Parent, Florence; Seferian, Andrei; Bulifon, Sophie; Fadel, Elie; Mercier, Olaf; Mussot, Sacha; Fabre, Dominique; Dartevelle, Philippe; Humbert, Marc; Simonneau, Grald; Jas, Xavier

    2015-12-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of pulmonary hypertension (PH) characterized by the persistence of thromboembolic obstructing the pulmonary arteries as an organized tissue and the presence of a variable small vessel arteriopathy. The consequence is an increase in pulmonary vascular resistance resulting in progressive right heart failure. CTEPH is classified as group IV pulmonary hypertension according to the WHO classification of pulmonary hypertension. CTEPH is defined as precapillary pulmonary hypertension (mean pulmonary artery pressure?25mmHg with a pulmonary capillary wedge pressure?15mmHg) associated with mismatched perfusion defects on ventilation-perfusion lung scan and signs of chronic thromboembolic disease on computed tomography pulmonary angiogram and/or conventional pulmonary angiography, in a patient who received at least 3 months of therapeutic anticoagulation. CTEPH as a direct consequence of symptomatic pulmonary embolism (PE) is rare, and a significant number of CTEPH cases develop in the absence of history of PE. Thus, CTEPH should be considered in any patient with unexplained PH. Splenectomy, chronic inflammatory conditions such as inflammatory bowel disease, indwelling catheters and cardiac pacemakers have been identified as associated conditions increasing the risk of CTEPH. Ventilation-perfusion scan (V/Q) is the best test available for establishing the thromboembolic nature of PH. When CTEPH is suspected, patients should be referred to expert centres where pulmonary angiography, right heart catheterization and high-resolution CT scan will be performed to confirm the diagnosis and to assess the operability. Pulmonary endarterectomy (PEA) remains the gold standard treatment for CTEPH when organized thrombi involve the main, lobar or segmental arteries. This operation should only be performed by experienced surgeons in specialized centres. For inoperable patients, current ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension recommend the use of riociguat and say that off-label use of drugs approved for PAH and pulmonary angioplasty may be considered in expert centres. PMID:26585271

  13. Pulmonary hypertension: NO therapy?

    PubMed Central

    Adnot, S.; Raffestin, B.

    1996-01-01

    Endothelium-derived nitric oxide (NO) is a powerful pulmonary vasodilator which also prevents adhesion and aggregation of platelets, controls growth of smooth muscle, and influences the expression of growth promoting and vasoactive substances. Impaired endothelial NO production contributes to pulmonary vasoconstriction and vascular remodelling in several forms of pulmonary hypertension. Exogenous NO gas delivered via the airspaces is a selective pulmonary vasodilator now used as treatment in various lung disorders. PMID:8882087

  14. 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 ...

  15. Salmonella prevalence in bovine lymph nodes differs among feedyards

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

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

    PubMed

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

    2014-12-01

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

  17. Evaluation of pulmonary embolism

    SciTech Connect

    Blinder, R.A.; Coleman, R.E.

    1985-09-01

    Pulmonary embolism is a common disease entity that is difficult to diagnose accurately by noninvasive methods. Ventilation-perfusion is a pivotal study in the evaluation of patients with suspected pulmonary embolism. The role of standard and newer modalities in evaluating pulmonary embolism is discussed in this article. 65 references.

  18. Radionuclide angiocardiographic assessment of pulmonary vascular reactivity in patients with left to right shunt and pulmonary hypertension

    SciTech Connect

    Fujii, A.M.; Rabinovitch, M.; Keane, J.F.; Fyler, D.C.; Treves, S.

    1982-02-01

    Radionuclide angiocardiography was used to assess pulmonary vascular reactivity in eight patients (nine studies) with a large, relatively unrestrictive intracardiac defect and pulmonary arterial hypertension. Radionuclide angiocardiograms, using technetium-99m pertechnetate, were performed first with the patient breathing room air and then after 10 minutes of breathing a mixture containing 90 percent or more of oxygen. The pulmonary to systemic flow ratios obtained by gamma variate analysis of the radionuclide time-activity curves were compared with those calculated with the Fick principle at the time of cardiac catheterization. There was a good correlation between the two methods both in room air studies (r . 0.88) and in those obtained with 90 percent or more of oxygen (r . 0.94). All six studies (in five patients) with a reactive pulmonary vasculature (judged by a pulmonary vascular resistance at cardiac catheterization of less than 6 units/m2 with oxygen or after tolazoline) had a radionuclide pulmonary to systemic flow ratio of 3.0 or greater with oxygen. The three patients with a nonreactive pulmonary vasculature had a radionuclide pulmonary to systemic flow ratio of 2.3 or less with oxygen, a value that was unchanged from the room air value. These data suggest that radionuclide angiocardiography may be a useful, relatively noninvasive method of assessing pulmonary vascular reactivity in patients with a large, relatively unrestrictive intracardiac defect.

  19. Local immunity and Ostertagia circumcincta: changes in the gastric lymph of sheep after a primary infection.

    PubMed

    Smith, W D; Jackson, F; Jackson, E; Williams, J

    1983-07-01

    Some aspects of the kinetics of the primary local immune response to O. circumcincta were studied by monitoring the flow and composition of gastric lymph from 4 sheep for 3 weeks after infection with 50 000 larvae. A significant increase in the frequency of lymphoblasts in the lymph showed that all the sheep were responding immunologically to the parasites from day 8 onwards. However, considerable individual variation in degree and timing was evident in other aspects of the immune response; 2 animals responded with large increases in lymphocyte output which reached a peak on day 5 or day 10, whereas the main response in the other 2 sheep appeared to be inflammatory in nature, with large increases in lymph flow and eosinophil output which occurred during the third week of infection. No significant changes in the content of IgA or IgA anti-worm antibody were detected in the lymph, but pepsinogen concentrations were significantly raised from day 12 onwards. PMID:6886088

  20. Reperfusion pulmonary edema after pulmonary endarterectomy.

    PubMed

    Lee, K C; Cho, Y L; Lee, S Y

    2001-06-01

    Pulmonary artery thromboendarterectomy is a potentially curative procedure in chronic, major vessel thromboembolic pulmonary hypertension. However, persistent pulmonary hypertension and unrelenting reperfusion edema have serious complications, often requiring prolonged mechanical ventilation. A 50-year-old man who was diagnosed with a thromboembolism in both pulmonary arteries underwent a bilateral pulmonary endarterectomy. He received O2-isoflurane-fentanyl anesthesia. When the lungs were reperfused with CPB weaning, massive hemorrhage occurred in the left lung. After the operation, the patient was taken to the intensive care unit. Mechanical ventilation was performed immediately and then both inhaled NO and i.v. furosemide therapies were administered. The patient was discharged from ICU 15 days postoperation. PMID:11475183

  1. Hypoxic pulmonary vasoconstriction: physiology and anesthetic implications.

    PubMed

    Lumb, Andrew B; Slinger, Peter

    2015-04-01

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

  2. A case report: Pulmonary venous malformation complicated with pulmonary hemorrhage.

    PubMed

    Supakul, Nucharin; Fan, Rong; Karmazyn, Boaz

    2012-12-01

    Pulmonary venous malformation is extremely rare. We present imaging and clinical findings of a 17-year-old male with multifocal subcutaneous venous malformations and multiple cystic lesions in the liver and spleen, suggestive of slow flow vascular malformation. In the right lung, chest radiography followed by chest CT demonstrated large tortuous pulmonary veins and cystic emphysematous changes. Tc99m-MAA (pertechnetate-labeled macroaggregated albumin) lung perfusion scan demonstrated only 3% of normal perfusion to the right lung, with no evidence of arteriovenous shunting. The child had diffuse intraparenchymal hemorrhage throughout the right lower and middle lobes and underwent resection. Pathology confirmed the diagnosis of venous malformation complicated with bleeding. PMID:23217914

  3. [Long-term survival of a patient with advanced colon cancer and para-aortic lymph node metastases treated with re-administration of high-dose molecular targeted agent bevacizumab].

    PubMed

    Ebisawa, Yoshiaki; Chisato, Naoyuki; Okayama, Taishi; Tani, Chikayoshi; Kono, Toru; Taniguchi, Masahiko; Furukawa, Hiroyuki

    2013-10-01

    A 49-year-old woman was admitted to our hospital because of epigastralgia and abdominal distension. She was diagnosed as advanced colon cancer with para-aortic and common iliac lymph node metastases, without liver and lung metastasis. Extended right hemicolectomy was performed to remove symptoms of stenosis. Bevacizumab (BV) (5 mg/kg) + mFOLFOX6 was performed as the initial postoperative chemotherapy. The tumor marker CEA, CA19-9 decreased, and reduction in the size of distant lymph node metastasis was confirmed, which obtained PR. In July 2009, computed tomography revealed the right pulmonary hilar lymph node metastases and progressive disease was confirmed; therefore, cetuximab and FOLFIRI combination therapy was initiated. However, in October 2009, bilateral inguinal lymph node metastases was seen; therefore we changed chemotherapy to BV (10 mg/kg) and FOLFIRI. Although the abdominal lymph node was decreased slightly after 2 months, chemotherapy was changed to BV (10 mg/kg) and mFOLFOX6 since the inguinal lymph node had enlarged. Skin metastases appeared, and there was no change in the inguinal lymph node and abdominal lymph node. She was deceased due to peritonitis carcinomatosis; however, her survival time exceeded 30 months. There was a possibility that long-term survival could be obtained by increasing the quantity of BV and re-administering it in second-line chemotherapy after PD in BV + FOLFOX first-line chemotherapy. PMID:24196080

  4. 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

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

    PubMed Central

    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

    2015-01-01

    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

  6. [Particular features of lymph dissection in operations for gastric cancer].

    PubMed

    Iaitski?, A N; Danilov, I N

    2008-01-01

    In order to optimize the technique of lymph dissection, a method of intraoperative mapping of lymph outflow tracts was used with a lymphotropic dye Blue patente V. It allowed better orientation during lymphodissection in operations for gastric cancer. The detection and investigation of the "signal" lymph node as the most probable object of lymphogenic metastazing can improve the accuracy of postoperative staging of gastric cancer. Visualization of the lymph nodes in the preparation made it possible to increase the number of lymph nodes sent for histological investigation. PMID:18522180

  7. Pulmonary Artery Sarcoma

    PubMed Central

    Shomaf, Maha; Obeidat, Nathir; Al-Fares, Fatin; Najjar, Saleh

    2014-01-01

    Pulmonary artery sarcomas (PAS) are extremely rare sarcomas of uncertain histogenesis that often mimic pulmonary thromboemboli. This is a report of a 60-year-old female patient who presented with recurrent chest pain and cough. The patient was first diagnosed with pulmonary embolism but she did not improve on anticoagulant therapy. Follow-up imaging studies revealed a mass in the left hilar region extending into the pulmonary trunk and branches of the left pulmonary artery. The tru-cut biopsy revealed an undifferentiated sarcoma. The patient died 10 months after her initial presentation.

  8. Pulmonary Artery Sarcoma

    PubMed Central

    Shomaf, Maha; Obeidat, Nathir; Najjar, Saleh

    2014-01-01

    Pulmonary artery sarcomas (PAS) are extremely rare sarcomas of uncertain histogenesis that often mimic pulmonary thromboemboli. This is a report of a 60-year-old female patient who presented with recurrent chest pain and cough. The patient was first diagnosed with pulmonary embolism but she did not improve on anticoagulant therapy. Follow-up imaging studies revealed a mass in the left hilar region extending into the pulmonary trunk and branches of the left pulmonary artery. The tru-cut biopsy revealed an undifferentiated sarcoma. The patient died 10 months after her initial presentation. PMID:26425600

  9. Digital subtraction pulmonary angiography

    SciTech Connect

    Goodman, P.C.; Brant-Zawadski, M.

    1982-08-01

    Digital subtraction pulmonary angiography was performed in 14 patients suspected of having pulmonary embolism. In 13 of 14, useful clinical information was obtained. Four patients were found to have pulmonary emboli. In nine patients, digital subtraction angiography was performed through pulmonary artery catheters already in place for monitoring critically ill patients. Conventional angiography in nine patients confirmed the findings by digital angiography. This initial experience suggests that digital subtraction pulmonary angiography provides adequate image quality in certain circumstances with several advantages over conventional angiography.

  10. 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 ventriclepulmonary 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

  11. 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) 63100%] and specificity of 91% (95% CI 7598%) 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

  12. [Pulmonary manifestations of tuberculosis in children].

    PubMed

    Olivier, C

    1997-12-01

    The occurrence of tuberculosis in children is dependent on a contagious bacillus carrying adult. Among 500 cases notified annually, perhaps 5 or 6% of the total infectious reservoir in France, 75% have parenchymal pulmonary disease and/or lymph nodes. These tuberculous diseases only represent 10% of the pulmonary disorders: 90% remain primary infections (PI active) or latent infections. These are most often asymptomatic (PI Latent) or of low grade activity (PI active). The CT scanner and fibreoptic bronchoscopy are indispensable complementary investigations in tuberculous disease. Whatever the clinical picture the diagnosis rests on bacteriological confirmation (but only 30% of cultures are positive) and most often rests on a body of evidence: for example a contagious adult living in proximity or a contagious family, or other risk factors are present. The evidence of a child with whatever form of pulmonary tuberculosis, even a latent primary infection, requires treatment which is adapted in such a way to enable a cure and to protect against subsequent endogenous re-activation. A coherent system of co-operation between the hospital and community service and between paediatricians and adult physicians is indispensable to find the index adult case to break the chain of contagion. There are two specific aspects in children, first congenital tuberculosis when a diagnosis is difficult and secondly tuberculosis in a child who is HIV positive when the management can be delicate. PMID:9496592

  13. [Ultrasound diagnosis of pulmonary infarction in emergencies. A case presentation].

    PubMed

    Jaloud-Saavedra, E; Oviedo-Garca, A A; Algaba-Montes, M; Nez-Hospital, D

    2013-01-01

    Pulmonary infarction is a parenchymal ischemic lesion that occurs in the context of a pulmonary embolism when arterial blockage deprives perfusion to that area and the adjacent bronchial circulation does not provide the necessary flow. It appears in approximately 40% of pulmonary embolisms. Emergency Physicians are able to diagnose a pulmonary infraction at the patient bedside, in a quick, easy, safe and efficient way with the availability of ultrasound in our Emergency Rooms and Health Centres. The possibility of approaching the aetiology, firstly with a clinical suspicion then adding risk factors, symptoms, clinical and radiological signs and the use of in situ imaging, increases the sensitivity and specificity of the diagnosis. PMID:23834986

  14. 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 59.410.9 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. PMID:26029642

  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. Preservation of micro-architecture and angiogenic potential in a pulmonary acellular matrix obtained using intermittent intra-tracheal flow of detergent enzymatic treatment.

    PubMed

    Maghsoudlou, Panagiotis; Georgiades, Fanourios; Tyraskis, Athanasios; Totonelli, Giorgia; Loukogeorgakis, Stavros P; Orlando, Giuseppe; Shangaris, Panicos; Lange, Peggy; Delalande, Jean-Marie; Burns, Alan J; Cenedese, Angelo; Sebire, Neil J; Turmaine, Mark; Guest, Brogan N; Alcorn, John F; Atala, Anthony; Birchall, Martin A; Elliott, Martin J; Eaton, Simon; Pierro, Agostino; Gilbert, Thomas W; De Coppi, Paolo

    2013-09-01

    Tissue engineering of autologous lung tissue aims to become a therapeutic alternative to transplantation. Efforts published so far in creating scaffolds have used harsh decellularization techniques that damage the extracellular matrix (ECM), deplete its components and take up to 5 weeks to perform. The aim of this study was to create a lung natural acellular scaffold using a method that will reduce the time of production and better preserve scaffold architecture and ECM components. Decellularization of rat lungs via the intratracheal route removed most of the nuclear material when compared to the other entry points. An intermittent inflation approach that mimics lung respiration yielded an acellular scaffold in a shorter time with an improved preservation of pulmonary micro-architecture. Electron microscopy demonstrated the maintenance of an intact alveolar network, with no evidence of collapse or tearing. Pulsatile dye injection via the vasculature indicated an intact capillary network in the scaffold. Morphometry analysis demonstrated a significant increase in alveolar fractional volume, with alveolar size analysis confirming that alveolar dimensions were maintained. Biomechanical testing of the scaffolds indicated an increase in resistance and elastance when compared to fresh lungs. Staining and quantification for ECM components showed a presence of collagen, elastin, GAG and laminin. The intratracheal intermittent decellularization methodology could be translated to sheep lungs, demonstrating a preservation of ECM components, alveolar and vascular architecture. Decellularization treatment and methodology preserves lung architecture and ECM whilst reducing the production time to 3 h. Cell seeding and in vivo experiments are necessary to proceed towards clinical translation. PMID:23727263

  17. Lymph Node-Targeted Immunotherapy Mediates Potent Immunity Resulting in Regression of Isolated or Metastatic HPV-Transformed Tumors

    PubMed Central

    Smith, Kent A.; Meisenburg, Brenna L.; Tam, Victor L.; Pagarigan, Robb R.; Wong, Raymond; Joea, Diljeet K.; Lantzy, Liz; Carrillo, Mayra A.; Gross, Todd M.; Malyankar, Uriel M.; Chiang, Chih-Sheng; Da Silva, Diane M.; Kndig, Thomas M.; Kast, W. Martin; Qiu, Zhiyong; Bot, Adrian

    2009-01-01

    Purpose The goal of this study was to investigate the therapeutic potential of a novel immunotherapy strategy resulting in immunity to localized or metastatic HPV 16-transformed murine tumors. Experimental design Animals bearing E7-expressing tumors were co-immunized by lymph node injection with E7 49-57 antigen and TLR3-ligand (synthetic dsRNA). Immune responses were measured by flow cytometry and anti-tumor efficacy was evaluated by tumor size and survival. In situ cytotoxicity assays and identification of tumor-infiltrating lymphocytes and T regulatory cells were used to assess the mechanisms of treatment resistance in bulky disease. Chemotherapy with cyclophosphamide was explored to augment immunotherapy in late-stage disease. Results In therapeutic and prophylactic settings, immunization resulted in a considerable expansion of E7 49-57 antigen-specific T lymphocytes in the range of 1/10 CD8+ T cells. The resulting immunity was effective in suppressing disease progression and mortality in a pulmonary metastatic disease model. Therapeutic immunization resulted in control of isolated tumors up to a certain volume, and correlated with anti-tumor immune responses measured in blood. In situ analysis showed that within bulky tumors, T cell function was affected by negative regulatory mechanisms linked to an increase in T regulatory cells and could be overcome by cyclophosphamide treatment in conjunction with immunization. Conclusions This study highlights a novel cancer immunotherapy platform with potential for translatability to the clinic and suggests its potential usefulness for controlling metastatic disease, solid tumors of limited size, or larger tumors when combined with cytotoxic agents that reduce the number of tumor-infiltrating T regulatory cells. PMID:19789304

  18. [Lymph nodes of esophagus cancer: radiological approach].

    PubMed

    Aubert, E; Servois, V

    2014-10-01

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

  19. 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

  20. Multidetector computed tomography pulmonary angiography in childhood acute pulmonary embolism.

    PubMed

    Tang, Chun Xiang; Schoepf, U Joseph; Chowdhury, Shahryar M; Fox, Mary A; Zhang, Long Jiang; Lu, Guang Ming

    2015-09-01

    Pulmonary embolism is a life-threatening condition affecting people of all ages. Multidetector row CT pulmonary angiography has improved the imaging of pulmonary embolism in both adults and children and is now regarded as the routine modality for detection of pulmonary embolism. Advanced CT pulmonary angiography techniques developed in recent years, such as dual-energy CT, have been applied as a one-stop modality for pulmonary embolism diagnosis in children, as they can simultaneously provide anatomical and functional information. We discuss CT pulmonary angiography techniques, common and uncommon findings of pulmonary embolism in both conventional and dual-energy CT pulmonary angiography, and radiation dose considerations. PMID:25846076

  1. Sentinel lymph node biopsy in breast cancer

    PubMed Central

    Alsaif, Abdulaziz A.

    2015-01-01

    Objectives: To report our experience in sentinel lymph node biopsy (SLNB) in early breast cancer. Methods: This is a retrospective study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 2005 and December 2014. There were 120 patients who underwent SLNB with frozen section examination. Data collected included the characteristics of patients, index tumor, and sentinel node (SN), SLNB results, axillary recurrence rate and SLNB morbidity. Results: There were 120 patients who had 123 cancers. Sentinel node was identified in 117 patients having 120 tumors (97.6% success rate). No SN was found intraoperatively in 3 patients. Frozen section results showed that 95 patients were SN negative, those patients had no immediate axillary lymph node dissection (ALND), whereas 25 patients were SN positive and subsequently had immediate ALND. Upon further examination of the 95 negative SN’s by hematoxylin & eosin (H&E) and immunohistochemical staining for doubtful H&E cases, 10 turned out to have micrometastases (6 had delayed ALND and 4 had no further axillary surgery). Median follow up of patients was 35.5 months and the mean was 38.8 months. There was one axillary recurrence observed in the SN negative group. The morbidity of SLNB was minimal. Conclusion: The obtainable results from our local experience in SLNB in breast cancer, concur with that seen in published similar literature in particular the axillary failure rate. Sentinel lymph node biopsy resulted in minimal morbidity. PMID:26318461

  2. Preservation of micro-architecture and angiogenic potential in a pulmonary acellular matrix obtained using intermittent intra-tracheal flow of detergent enzymatic treatment

    PubMed Central

    Maghsoudlou, Panagiotis; Georgiades, Fanourios; Tyraskis, Athanasios; Totonelli, Giorgia; Loukogeorgakis, Stavros P.; Orlando, Giuseppe; Shangaris, Panicos; Lange, Peggy; Delalande, Jean-Marie; Burns, Alan J.; Cenedese, Angelo; Sebire, Neil J.; Turmaine, Mark; Guest, Brogan N.; Alcorn, John F.; Atala, Anthony; Birchall, Martin A.; Elliott, Martin J.; Eaton, Simon; Pierro, Agostino; Gilbert, Thomas W.; De Coppi, Paolo

    2013-01-01

    Tissue engineering of autologous lung tissue aims to become a therapeutic alternative to transplantation. Efforts published so far in creating scaffolds have used harsh decellularization techniques that damage the extracellular matrix (ECM), deplete its components and take up to 5 weeks to perform. The aim of this study was to create a lung natural acellular scaffold using a method that will reduce the time of production and better preserve scaffold architecture and ECM components. Decellularization of rat lungs via the intratracheal route removed most of the nuclear material when compared to the other entry points. An intermittent inflation approach that mimics lung respiration yielded an acellular scaffold in a shorter time with an improved preservation of pulmonary micro-architecture. Electron microscopy demonstrated the maintenance of an intact alveolar network, with no evidence of collapse or tearing. Pulsatile dye injection via the vasculature indicated an intact capillary network in the scaffold. Morphometry analysis demonstrated a significant increase in alveolar fractional volume, with alveolar size analysis confirming that alveolar dimensions were maintained. Biomechanical testing of the scaffolds indicated an increase in resistance and elastance when compared to fresh lungs. Staining and quantification for ECM components showed a presence of collagen, elastin, GAG and laminin. The intratracheal intermittent decellularization methodology could be translated to sheep lungs, demonstrating a preservation of ECM components, alveolar and vascular architecture. Decellularization treatment and methodology preserves lung architecture and ECM whilst reducing the production time to 3 h. Cell seeding and in vivo experiments are necessary to proceed towards clinical translation. PMID:23727263

  3. Pulmonary Vasodilator Responses to Nitroprusside and Nitroglycerin in the Dog

    PubMed Central

    Kadowitz, Philip J.; Nandiwada, Premanand; Gruetter, Carl A.; Ignarro, Louis J.; Hyman, Albert L.

    1981-01-01

    The objective of this study was to determine the direct actions of nitroprusside and nitroglycerin on the pulmonary vascular bed in the intactchest dog. These widely used nitrogen oxide-containing vasodilator agents decreased pulmonary arterial pressure and increased cardiac output without altering left atrial pressure. Reductions in pulmonary arterial pressure and pulmonary vascular resistance were small under resting conditions, but were enhanced when pulmonary vascular tone was elevated by infusion of a stable prostaglandin analog that increases pulmonary vascular resistance by constricting intrapulmonary veins and upstream segments. In studies in which pulmonary blood flow to the left lower lobe was maintained constant, nitroprusside and nitroglycerin caused small but significant reductions in lobar arterial and small-vein pressures without significantly affecting left atrial pressure. With constant blood flow, lobar vascular pressures that were reduced in response to the vasodilators were more greatly reduced when lobar vascular resistance was increased by infusion of the prostaglandin analog or serotonin. However, when lobar vascular pressures were elevated by passive obstruction of lobar venous outflow, vasodilator responses to nitroprusside and nitroglycerin were not enhanced. These data suggest that nitroprusside and nitroglycerin decrease pulmonary vascular resistance by dilating intrapulmonary veins and upstream segments. These responses were minimal under control conditions but were enhanced when vascular tone was increased. This vasodilator action is independent of passive factors such as changes in pulmonary blood flow or left atrial pressure and is not secondary to an effect of these agents on the systemic circulation. Pulmonary vasodilator responses to nitroprusside and nitroglycerin were, however, found to be dependent on the existing level of vasomotor tone in the pulmonary vascular bed. PMID:6782123

  4. 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.

  5. Pulmonary schistosomiasis - imaging features.

    PubMed

    T, Niemann; Marti, Hp; Duhnsen, Sh; G, Bongartz

    2010-01-01

    Schistosomiasis is a helminthic infection that is endemic in tropical and subtropical regions. Pulmonary involvement can be divided into two categories: acute or chronic compromise. Chronic and recurrent infection develops in persons living or travelling in endemic areas. In the lungs, granuloma formation and fibrosis around the schistosome eggs retained in the pulmonary vasculature may result in obliterative arteriolitis and pulmonary hypertension leading to cor pulmonale. Acute schistosomiasis is associated with primary exposure and is commonly seen in nonimmune travelers. The common CT findings in acute pulmonary schistosomiasis are small pulmonary nodules ranging from 2 to 15 mm and larger nodules with ground glass-opacity halo. Katayama fever is a severe clinical manifestation of acute involvement. We present a case of pulmonary involvement in schistosomiasis and provide a discussion about typical imaging findings in the acute and chronic form. PMID:22470757

  6. Leiomyosarcoma of pulmonary truncus.

    PubMed

    Iwasaki, I; Iwase, H; Horie, H; Ide, G; Saito, T; Furukawa, Y

    1984-07-01

    Insidious and progressive right heart failure of obscure origin warrants differential diagnosis of primary sarcoma of the pulmonary artery in patients of both sexes and 20 years of age and older. We report a case of primary leiomyosarcoma of the pulmonary truncus in a 67 years old woman. She had been well in general until when she started having fluctuating and progressive right heart failure three years ago. Clinical data included systolic murmurs in the pulmonary valve area, right ventricular hypertrophy, diminished x-ray density of the pulmonary vasculature, moderate elevation of serum LDH, alkaline phosphatase, and uric acid, and prolonged or unobtainable circulation time from the arm to lungs. The immediate cause of death was attributable to right heart failure due to pulmonary arterial stenosis caused by a locally invasive leiomyosarcoma apparently arising in the pulmonary truncus. Contributing to this right heart failure were 280 ml of serosanguinous pericardial effusion and fibrinous pericarditis. PMID:6485801

  7. Pulmonary arterial hypertension due to pulmonary vascular amyloid deposition in a patient with multiple myeloma

    PubMed Central

    Hashimoto, Hirotsugu; Kurata, Atsushi; Mizuno, Hideaki; Nashiro, Tamaki; Hangaishi, Akira; Kuroda, Masahiko; Usuki, Kensuke; Horiuchi, Hajime

    2015-01-01

    Systemic amyloidosis is characterized by amyloid deposition throughout the body and subsequent dysfunction of various organs. Although pulmonary amyloidosis does occur, pulmonary hypertension (PH) caused by amyloidosis is extremely rare. In most of these cases, amyloid deposition occurred diffusely in alveolar septa, indicating that PH was due to lung disease and/or hypoxia. On the other hand, the mechanism of PH due to amyloid deposition in the pulmonary arteries has never been demonstrated. Here, we report the first case of PH due to amyloid deposition in pulmonary elastic arteries and muscular artery, which was complicated by multiple myeloma (MM). In the autopsy specimen of the patient, amyloid deposition was found mainly in the pulmonary arterial media, along with intimal thickening with luminal narrowing. PH thus appeared to be caused by marked decrease of pulmonary elasticity due to the amyloid deposition in the arterial media that resulted in stasis of the blood flow and subsequent luminal narrowing. Our present data demonstrates a new concept of PH caused by amyloidosis, namely, pulmonary arterial hypertension due to amyloidosis. PMID:26823900

  8. Pulmonary valvuloplasty for pulmonary atresia-restrictive ventricular septal defect.

    PubMed

    Reshmi, Liza Jose; Gadhinglajkar, Shrinivas; Mathew, Thomas; Venkateshwaran, Subramanian; Sreedhar, Rupa; Dharan, Baiju

    2016-02-01

    Pulmonary atresia with restrictive ventricular septal defect is a rare congenital cardiac anomaly. A Blalock-Taussig shunt and surgical perforation of the atretic pulmonary valve is often performed as the initial palliation. We present our experience of utilizing both transesophageal and epicardial echocardiography during surgical pulmonary valvuloplasty in a 22-day-old neonate with pulmonary atresia with restrictive ventricular septal defect. The atretic pulmonary valve was perforated using a sheath introduced through the pulmonary artery. PMID:25293418

  9. Effects of ouabain on pulmonary haemodynamics in patients with hypoxic pulmonary hypertension.

    PubMed

    Zieli?ski, J; Hawry?kiewicz, I; Jedrzejewska-Makowska, M

    1980-01-01

    Differing opinions about the use of digitalis in patients with cor pulmonale have led the authors to study haemodynamic effect of strophantin, a cardiotonic glycoside used as therapy of choice of decompensated cor pulmonale. Five patients with severe airways obstruction recovering from heart failure were studied. Ouabain at a dose of 0.01 mg/kg was infused into the pulmonary artery. Pulmonary artery pressure and flow were measured before, at the end of the infusion, 15 and 30 min after it. There was no change in the heart rate or mean pulmonary artery pressure and a slight increase in the pulmonary wedge pressure was observed after ouabain. The most important change concerned the pulmonary blood flow. The cardiac index rose from the initial 2.48 +/- 0.44 l/min/m2 to 3.67 +/- 1.3 l/min/m2 15 min after ouabain. The increase in cardiac output was entirely due to the increase in the stroke volume. Pulmonary vascular resistance fell from 502 +/- 208 dyn. s. cm-5 to 315 +/- 216 dyn. s. cm-5 15 min after ouabain. The findings support clinical preference for strophantin in patients with decompensated cor pulmonale. PMID:7449398

  10. Prediction of therapeutic response in steroid-treated pulmonary sarcoidosis. Evaluation of clinical parameters, bronchoalveolar lavage, gallium-67 lung scanning, and serum angiotensin-converting enzyme levels

    SciTech Connect

    Hollinger, W.M.; Staton, G.W. Jr.; Fajman, W.A.; Gilman, M.J.; Pine, J.R.; Check, I.J.

    1985-07-01

    To find a pretreatment predictor of steroid responsiveness in pulmonary sarcoidosis the authors studied 21 patients before and after steroid treatment by clinical evaluation, pulmonary function tests, bronchoalveolar lavage (BAL), gallium-67 lung scan, and serum angiotensin-converting enzyme (SACE) level. Although clinical score, forced vital capacity (FVC), BAL percent lymphocytes (% lymphs), quantitated gallium-67 lung uptake, and SACE levels all improved with therapy, only the pretreatment BAL % lymphs correlated with the improvement in FVC (r = 0.47, p less than 0.05). Pretreatment BAL % lymphs of greater than or equal to 35% predicted improvement in FVC of 10/11 patients, whereas among 10 patients with BAL % lymphs less than 35%, 5 patients improved and 5 deteriorated. Clinical score, pulmonary function parameters, quantitated gallium-67 lung uptake, and SACE level used alone, in combination with BAL % lymphs or in combination with each other, did not improve this predictive value. The authors conclude that steroid therapy improves a number of clinical and laboratory parameters in sarcoidosis, but only the pretreatment BAL % lymphs are useful in predicting therapeutic responsiveness.

  11. Neostigmine and pulmonary oedema.

    PubMed

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

    2014-01-01

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

  12. How Is Pulmonary Hypertension Diagnosed?

    MedlinePLUS

    ... page from the NHLBI on Twitter. How Is Pulmonary Hypertension Diagnosed? Your doctor will diagnose pulmonary hypertension (PH) ... Tests To Look for the Underlying Cause of Pulmonary Hypertension PH has many causes, so many tests may ...

  13. How Is Pulmonary Hypertension Treated?

    MedlinePLUS

    ... page from the NHLBI on Twitter. How Is Pulmonary Hypertension Treated? Pulmonary hypertension (PH) has no cure. However, ... healthy organs from a deceased donor. Group 2 Pulmonary Hypertension Conditions that affect the left side of the ...

  14. Pulmonary Foreign Body Granulomatosis in Dental Technician.

    PubMed

    Chung, Sung Jun; Koo, Gun Woo; Park, Dong Won; Kwak, Hyun Jung; Yhi, Ji Young; Moon, Ji-Yong; Kim, Sang-Heon; Sohn, Jang Won; Yoon, Ho Joo; Shin, Dong Ho; Park, Sung Soo; Pyo, Ju Yeon; Oh, Young-Ha; Kim, Tae-Hyung

    2015-10-01

    Occupational lung diseases are caused by several toxic substances including heavy metals; however, the exact pathologic mechanisms remain unknown. In the workplace, dental technicians are often exposed to heavy metals such as cobalt, nickel, or beryllium and occasionally develop occupational lung diseases. We described a case of occupational lung disease in a patient who was employed as a dental technician for over a decade. A 31-year-old, non-smoking woman presented with productive cough and shortness of breath of several weeks duration. Chest computed tomography revealed a large number of scattered, bilateral small pulmonary nodules throughout the lung field, and multiple mediastinal lymph nodes enlargement. Percutaneous needle biopsy showed multifocal small granulomas with foreign body type giant cells suggestive of heavy metals inhalation. The patient's condition improved on simple avoidance strategy for several months. This case highlighted the importance of proper workplace safety. PMID:26508943

  15. Pulmonary Foreign Body Granulomatosis in Dental Technician

    PubMed Central

    Chung, Sung Jun; Koo, Gun Woo; Park, Dong Won; Kwak, Hyun Jung; Yhi, Ji Young; Moon, Ji-Yong; Kim, Sang-Heon; Sohn, Jang Won; Yoon, Ho Joo; Shin, Dong Ho; Park, Sung Soo; Pyo, Ju Yeon; Oh, Young-Ha

    2015-01-01

    Occupational lung diseases are caused by several toxic substances including heavy metals; however, the exact pathologic mechanisms remain unknown. In the workplace, dental technicians are often exposed to heavy metals such as cobalt, nickel, or beryllium and occasionally develop occupational lung diseases. We described a case of occupational lung disease in a patient who was employed as a dental technician for over a decade. A 31-year-old, non-smoking woman presented with productive cough and shortness of breath of several weeks duration. Chest computed tomography revealed a large number of scattered, bilateral small pulmonary nodules throughout the lung field, and multiple mediastinal lymph nodes enlargement. Percutaneous needle biopsy showed multifocal small granulomas with foreign body type giant cells suggestive of heavy metals inhalation. The patient's condition improved on simple avoidance strategy for several months. This case highlighted the importance of proper workplace safety. PMID:26508943

  16. Localized pulmonary histiocytic sarcomas in Pembroke Welsh Corgi

    PubMed Central

    KAGAWA, Yumiko; NAKANO, Yuko; KOBAYASHI, Tetsuya; ASANO, Kazushi; TAKAGI, Satoshi

    2015-01-01

    Nineteen cases of histiocytic sarcomas in Pembroke Welsh Corgi were examined histopathologically. Focal or multiple masses were detected in the lung or in regional lymph nodes, or in both lung and nodes. All neoplastic lesions had common histological features characterized by the proliferation of pleomorphic histiocytic cells combined with various inflammatory cells. Most of the pleomorphic neoplastic cells were immunopositive for human leukocyte antigen (HLA)-DR and Iba-1. The median survival time for all dogs was 133 days. In the present study, several prognostic factors, such as gender, age, single or multiple lesions, lymph node involvement at the time of diagnosis, surgical resection status and additional chemotherapy, were examined, although none of these factors approached statistical significance. Histiocytic sarcoma must be considered in the differential diagnosis of dogs with pulmonary masses, especially in the canine breed. PMID:26155931

  17. Localized pulmonary histiocytic sarcomas in Pembroke Welsh Corgi.

    PubMed

    Kagawa, Yumiko; Nakano, Yuko; Kobayashi, Tetsuya; Asano, Kazushi; Takagi, Satoshi

    2016-01-01

    Nineteen cases of histiocytic sarcomas in Pembroke Welsh Corgi were examined histopathologically. Focal or multiple masses were detected in the lung or in regional lymph nodes, or in both lung and nodes. All neoplastic lesions had common histological features characterized by the proliferation of pleomorphic histiocytic cells combined with various inflammatory cells. Most of the pleomorphic neoplastic cells were immunopositive for human leukocyte antigen (HLA)-DR and Iba-1. The median survival time for all dogs was 133 days. In the present study, several prognostic factors, such as gender, age, single or multiple lesions, lymph node involvement at the time of diagnosis, surgical resection status and additional chemotherapy, were examined, although none of these factors approached statistical significance. Histiocytic sarcoma must be considered in the differential diagnosis of dogs with pulmonary masses, especially in the canine breed. PMID:26155931

  18. Greater auricular nerve masquerading as lymph node

    PubMed Central

    Saxena, Shilpi; Deb, Prabal; Nijhawan, Vijay Shrawan; Kharayat, Veena; Verma, Rajesh

    2015-01-01

    Hansen's disease is on the verge of being eliminated from India and often missed by clinicians due to low index of suspicion. We present an unusual case in which greater auricular nerve thickening masqueraded as enlarged lymph node in the neck. The patient was referred for fine needle aspiration cytology, which revealed epithelioid cell granulomas suggestive of Hansen's disease. Further clinical examination and investigations including the skin biopsy confirmed the disease, highlighting the role of pathologist in the management of such unusual presentation of a common disease. PMID:26229249

  19. Comparative proteomic analysis of rodent plasma and mesenteric lymph.

    PubMed

    Yuan, Kuo-Ching; Fang, Jen-Feng; Hsieh, Sen-Yung; Shih, Hsin-Nung

    2013-06-30

    The lymph has long been considered as the plasma filtrate and the proteomes of the lymph have received scanty attention. Currently, mesenteric lymph is reported to play an important role in the pathogenesis of multiple organ dysfunction syndrome in some critical illnesses. A better understanding of the composition and proteomes of mesenteric lymph becomes imperative to disclose the mechanistic role of mesenteric lymph. Seven male Sprague-Dawley rats were fasted overnight, and anesthetized to collect plasma and mesenteric lymph. The specimens were subjected to proteomic analysis using two-dimensional gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). An average of 434 and 412 protein spots were found in the gels of the plasma and mesenteric lymph respectively. Peptide mass fingerprint analysis identified 77 proteins for 212 protein spots. The 2-DE proteomic pattern of mesenteric lymph was largely similar to that of the plasma. As in the plasma, large protein spots of albumin dominated the protein pattern in mesenteric lymph. Other major proteins identified in 2-DE gels included immunoglobulin heavy and light chains, fibrinogen alpha-, beta- and gamma-chains, serotransferrin, protease inhibitors, kininogens, macroglobulins, haptoglobin, and apolipoproteins. Meanwhile, mesenteric lymph contained an array of proteins that differentiated it from the plasma. The most differentially expressed proteins in mesenteric lymph were gamma-fibrinogen, protease inhibitors, and proteins related to lipid transport/metabolism. The study presents a detailed description of mesenteric lymph proteomes of a common experimental animal in physiological status using a common proteomic approach. These results provide the basis for future research. PMID:23656218

  20. Pulmonary vein isolation using new technologies to improve ablation lesion formation: Initial results comparing enhanced catheter tip irrigation (Surround Flow®) with contact force measurement (Smarttouch®)

    PubMed Central

    Fichtner, Stephanie; Reents, Tilko; Ammar, Sonia; Semmler, Verena; Kathan, Susanne; Dillier, Roger; Buiatti, Alexandra; Hessling, Gabriele; Deisenhofer, Isabel

    2015-01-01

    Introduction Pulmonary vein reconnection after pulmonary vein isolation (PVI) is a significant problem in the treatment of paroxysmal atrial fibrillation (AF). We report about patients who underwent contact force (CF) guided PVI using CF catheter and compared them to patients with PVI using an ablation catheter with enhanced tip irrigation. Methods A total of 59 patients were included in the analysis. In 30 patients circumferential PVI was performed using the Thermocool Smarttouch® ablation catheter (ST) whereas in 29 patients circumferential PVI using the Thermocool Surround Flow SF® ablation catheter (SF) was performed. Patients were compared in regard to procedure time, fluoroscopy time/dose as well as RF-application duration and completeness of PVI. Adverse events (pericardial effusion, PV stenosis, stroke, death) were evaluated. The presence of sinus rhythm off antiarrhythmic medication was assessed during 6 months follow-up using multiple 7 day Holter-ECGs. Results In both groups, all PVs were isolated without serious adverse events. Procedure time was 2.15 ± 0.5 h (ST) vs. 2.37 ± 1.13 h (SF) (p = 0.19). Duration of RF-applications was 46.6 ± 18 min (ST) and 49.8 ± 19 min (SF) (p = 0.52). Fluoroscopy time was 25.2 ± 13 min (ST) vs. 29 ± 18 min (SF), fluoroscopy dose 2675.6 ± 1658 versus 3038.3 ± 1997 cGym2 (p = 0.36 and 0.46 respectively). Sinus rhythm off antiarrhythmic medication validated with 7 day Holter ECGs was present in both groups in 72% of patients after 6 months of follow up. Conclusion PVI using the new contact force catheter is safe and effective in patients with paroxysmal AF. PMID:26937108

  1. What Causes Idiopathic Pulmonary Fibrosis?

    MedlinePLUS

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

  2. Isolated axillary lymph node tuberculosis in ultrasonography. A case report

    PubMed Central

    Urba?ska-Krawiec, Dagmara; Kajor, Maciej; Stefa?ski, Leszek

    2012-01-01

    We present a rare case of isolated axillary lymph node tuberculosis. A 66-year-old patient was admitted in order to perform the diagnostics of a painless tumor of the left armpit. Blood biochemistry tests and chest X-ray did not show any abnormalities. In the ultrasound examination a solid structure of the dimensions of 1.81 cm of irregular outline with adjacent hypoechogenic lymph nodes was visualized. The diagnosis of tuberculosis was based on histopathologic examination of the excised tumor. In the latter years an increase in extrapulmonary type of tuberculosis has been observed. Extrapulmonary tuberculosis may appear in practically each organ, nevertheless it affects pleura most often. Lymph node tuberculosis is the second, when it comes to the prevalence rate, type of extrapulmonary tuberculosis. In the majority of cases of lymph node tuberculosis it affects superficial lymph nodes. In the ultrasound examination a packet of pathological, enlarged and hypoechogenic lymph nodes is stated. In 1/3 of cases the central part of the nodes is hyperechogenic which indicates its caseation necrosis. Lymph nodes have a tendency to be matted and they have blurred outline. We observed this type of lymph node image in the presented patient. This image may be a diagnostic hint. Nevertheless, in the differentiation diagnostics one should take many other disease entities into consideration, inter alia: sarcoidosis, lymphomas, fungal infections, neoplastic metastases; the latter ones have an image most similar to tuberculosis lymph nodes. Tuberculosis ought to be considered in differential diagnosis of atypical masses.

  3. Automatic detection of pelvic lymph nodes using multiple MR sequences

    NASA Astrophysics Data System (ADS)

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

    2007-03-01

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

  4. Surgical Management of Lymph Node Compartments in Papillary Thyroid Cancer.

    PubMed

    Sturgeon, Cord; Yang, Anthony; Elaraj, Dina

    2016-01-01

    Although papillary thyroid cancer (PTC) commonly metastasizes to cervical lymph nodes, prophylactic central neck dissection is controversial. The primary treatment for lymph node metastases is surgical resection. Patients diagnosed with PTC should be assessed preoperatively by cervical ultrasound to evaluate central and lateral neck lymph node compartments. Sonographically suspicious lymph nodes in the lateral neck should be biopsied for cytology or thyroglobulin levels. Any compartment (central or lateral) that has definitive proof of nodal metastases should be formally dissected at the time of thyroidectomy. PMID:26610772

  5. The Critical Role of Pulmonary Arterial Compliance in Pulmonary Hypertension.

    PubMed

    Thenappan, Thenappan; Prins, Kurt W; Pritzker, Marc R; Scandurra, John; Volmers, Karl; Weir, E Kenneth

    2016-02-01

    The normal pulmonary circulation is a low-pressure, high-compliance system. Pulmonary arterial compliance decreases in the presence of pulmonary hypertension because of increased extracellular matrix/collagen deposition in the pulmonary arteries. Loss of pulmonary arterial compliance has been consistently shown to be a predictor of increased mortality in patients with pulmonary hypertension, even more so than pulmonary vascular resistance in some studies. Decreased pulmonary arterial compliance causes premature reflection of waves from the distal pulmonary vasculature, leading to increased pulsatile right ventricular afterload and eventually right ventricular failure. Evidence suggests that decreased pulmonary arterial compliance is a cause rather than a consequence of distal small vessel proliferative vasculopathy. Pulmonary arterial compliance decreases early in the disease process even when pulmonary artery pressure and pulmonary vascular resistance are normal, potentially enabling early diagnosis of pulmonary vascular disease, especially in high-risk populations. With the recognition of the prognostic importance of pulmonary arterial compliance, its impact on right ventricular function, and its contributory role in the development and progression of distal small-vessel proliferative vasculopathy, pulmonary arterial compliance is an attractive target for the treatment of pulmonary hypertension. PMID:26848601

  6. Inhibition of active lymph pump by simulated microgravity in rats.

    PubMed

    Gashev, Anatoliy A; Delp, Michael D; Zawieja, David C

    2006-06-01

    During spaceflight the normal head-to-foot hydrostatic pressure gradients are eliminated and body fluids shift toward the head, resulting in a diminished fluid volume in the legs and an increased fluid volume in the head, neck, and upper extremities. Lymphatic function is important in the maintenance of normal tissue fluid volume, but it is not clear how microgravity influences lymphatic pumping. We performed a detailed evaluation of the influence of simulated microgravity on lymphatic diameter, wall thickness, elastance, tone, and other measures of phasic contractility in isolated lymphatics. Head-down tail suspension (HDT) rats were used to simulate the effects of microgravity. Animals were exposed to HDT for 2 wk, after which data were collected and compared with the control non-HDT group. Lymphatics from four regional lymphatic beds (thoracic duct, cervical, mesenteric, and femoral lymphatics) were isolated, cannulated, and pressurized. Input and output pressures were adjusted to apply a range of transmural pressures and flows to the lymphatics. Simulated microgravity caused a potent inhibition of pressure/stretch-stimulated pumping in all four groups of lymphatics. The greatest inhibition was found in cervical lymphatics. These findings presumably are correlated to the cephalic fluid shifts that occur in HDT rats as well as those observed during spaceflight. Flow-dependent pump inhibition was increased after HDT, especially in the thoracic duct. Mesenteric lymphatics were less strongly influenced by HDT, which may support the idea that lymph hydrodynamic conditions in the mesenteric lymphatic during HDT are not dramatically altered. PMID:16399874

  7. Inhaled nitric oxide reverses hypoxic pulmonary vasoconstriction without impairing gas exchange

    SciTech Connect

    Pison, U.; Lopez, F.A.; Heidelmeyer, C.F.; Rossaint, R.; Falke, K.J. )

    1993-03-01

    Nitric oxide (NO) is an endogenous endothelium-derived relaxing factor that participates in the regulation of vascular tone. The authors studied the effects of inhaled NO gas on transient hypoxic pulmonary vasoconstriction and normal lungs in mechanically ventilated sheep. They measured hemodynamics and pulmonary gas exchange. For gas exchange measurements they used conventional blood gas analysis and the multiple inert gas elimination technique to estimate ventilation-perfusion heterogeneity. The hypotheses were (1) inhaled NO reverses hypoxic pulmonary vasoconstriction, (2) the hemodynamic effects of inhaled NO are limited to the pulmonary circulation, and (3) inhaled NO does not impair pulmonary gas exchange and may redistribute blood flow to better ventilated areas of the lungs. Hypoxic pulmonary vasoconstriction was induced by using a hypoxic inspiratory gas mixture. The addition of 20 ppm NO to the hypoxic inspiratory gases returned pulmonary arterial pressure to baseline values. Systemic hemodynamics and gas exchange indexes derived from conventional blood gas analysis remained constant. Gas exchange indexes for ventilation-perfusion ratios and gas dispersions improved. The addition of 20 ppm NO to medical air (21% O[sub 2]) had no such significant effects on hemodynamics or pulmonary gas exchange. The findings show that inhaled NO reverses transient hypoxic pulmonary vasoconstriction. The hemodynamic effects of NO are limited to the pulmonary circulation; it does not impair pulmonary gas exchange. Moreover, it redistributes blood flow to better ventilated alveoli. As such, NO has potential in the treatment of lung diseases associated with pulmonary hypertension. 35 refs., 4 figs., 3 tabs.

  8. Pulmonary Vascular Pressure Profiles in Broilers Selected for Susceptibility to Pulmonary Hypertension Syndrome: Age and Gender Comparisons

    PubMed Central

    Wideman, R. F.; Eanes, M. L.; Hamal, K. R.; Anthony, N. B.

    2011-01-01

    Broilers that are susceptible to pulmonary hypertension syndrome (PHS, ascites) have an elevated pulmonary arterial pressure (PAP) when compared with PHS-resistant broilers. Two distinctly different syndromes, pulmonary arterial hypertension (PAH) and pulmonary venous hypertension (PVH), both are associated with increases in PAP. Pulmonary arterial hypertension occurs when the right ventricle must elevate the PAP to overcome increased resistance to flow through restrictive pulmonary arterioles upstream from the pulmonary capillaries. In contrast, PVH is commonly caused by increased downstream (post-capillary) resistance. The sites of resistance to pulmonary blood flow are deduced by making contemporaneous measurements of the PAP and the wedge pressure (WP), and calculating the trans-pulmonary pressure gradient (TPG = PAP-WP). We obtained PAP and WP values from 8, 12, 16, 20 and 24 wk old anesthetized male and female broilers from a PHS-susceptible line. Pressures were recorded as a catheter was advanced through a wing vein to the pulmonary artery and onward until the WP was obtained. In addition to gender and age comparisons of vascular pressure gradients, the data also were pooled to obtain three cohorts for broilers having the lowest PAP values (n = 52; range: 12 to 22.9 mmHg), intermediate PAP values (n = 63; range: 23 to 32.9 mmHg), and highest PAP values (n = 62; range: 33 to 62 mmHg) independent of age or gender. Within each of the age, gender and PAP cohort comparisons, broilers with elevated PAP consistently exhibited the hemodynamic characteristics of PAH (elevated PAP and TPG combined with a normal WP) and not PVH (elevated PAP and WP combined with a normal or reduced TPG). Susceptibility to PHS can be attributed primarily to pulmonary arterial hypertension associated with increased pre-capillary (arteriole) resistance. PMID:20709965

  9. Acute Pulmonary Schistosomiasis

    PubMed Central

    Baharoon, SA; Al-Jahdali, HH; Bamefleh, HS; Elkeir, AM; Yamani, NM

    2011-01-01

    Acute pulmonary schistosomiasis affects non-immune individuals returning from endemic areas. Pathogenesis is not well understood. We report a case of acute pulmonary schistosomiasis in which lung biopsy was done 10 weeks after exposure and it identified the presence of schistosomal ovum surrounded by granuloma. PMID:21887064

  10. Pulmonary Arterial Hypertension

    MedlinePLUS

    ... also decrease the amount of oxygen getting to your brain. What are the Symptoms of Pulmonary Arterial Hypertension? ... hypertension are treated differently, it is important that your health care provider takes the time and orders the necessary tests to nd out what kind of pulmonary ...

  11. Comparison of the effects of isoflurane with those of propofol on pulmonary vascular impedance in experimental embolic pulmonary hypertension.

    PubMed

    Ewalenko, P; Brimioulle, S; Delcroix, M; Lejeune, P; Naeije, R

    1997-11-01

    Inhaled but not i.v. anaesthetics are reported to decrease pulmonary vascular resistance. The aim of this study was to compare the effects of isoflurane with those of propofol on the interaction between right ventricular (RV) function and the pulmonary vascular system in embolic pulmonary hypertension. Nine dogs received in random sequence propofol 18 mg kg-1 h-1 and 1.4% end-tidal isoflurane. Pulmonary haemodynamic state was evaluated by pulmonary arterial pressure/flow (PAP/Q) plots and pulmonary vascular impedance (PVZ) spectra. Right ventricular function was assessed by total hydraulic power (Wtot), ratio of oscillatory power (Wosc) to Wtot, and dP/dtmax. Measurements were obtained, with both anaesthetics, before and after pulmonary embolic hypertension induced by autologous blood clots. Embolism increased PAP, 0 Hz and low frequency input impedance, displaced first minimum of PAP/Q moduli and zero crossing of phase to higher frequencies, decreased characteristic impedance, decreased Wosc/Wtot without affecting Wtot, and increased dP/dtmax. Compared with propofol, isoflurane at baseline did not affect PAP/Q plots, PVZ or hydraulic power data, but decreased dP/dtmax. After embolism, isoflurane shifted PAP/Q plots to lower PAP without affecting PVZ, did not affect hydraulic power data and decreased dP/dtmax. We conclude that in canine embolic pulmonary hypertension, isoflurane compared with propofol impeded RV vascular coupling caused by decreased RV contractility, while after-load remained unchanged despite some decrease in pulmonary vascular tone. PMID:9422903

  12. The pulmonary extracellular lining.

    PubMed Central

    George, G; Hook, G E

    1984-01-01

    The extracellular lining of the lungs is reviewed. The pulmonary extracellular lining is a complex mixture of phospholipids, proteins and carbohydrates which is absolutely essential for the maintenance of normal pulmonary functions such as gas exchange. Without the lining the lungs would collapse. Alterations in the pulmonary extracellular lining may underlie some disease conditions induced by toxic agents, especially those which interfere with the formation of pulmonary surfactant. The extracellular lining could be used to detect and monitor damage and disease caused by agents toxic to the lungs. The lining contains many hydrolytic enzymes which may act to detoxify certain toxic agents such as those which contain ester groups. The pulmonary extracellular lining could play a significant role mediating the toxic action of inhaled agents as well as the removal of those agents from the lungs. Images FIGURE 1. PMID:6376100

  13. Photoacoustic detection of melanoma micrometastasis in sentinel lymph nodes.

    PubMed

    McCormack, Devin; Al-Shaer, Mays; Goldschmidt, Benjamin S; Dale, Paul S; Henry, Carolyn; Papageorgio, Chris; Bhattacharyya, Kiran; Viator, John A

    2009-07-01

    Melanoma is the deadliest form of skin cancer and has the fastest growth rate of all cancer types. Proper staging of melanoma is required for clinical management. One method of staging melanoma is performed by taking a sentinel node biopsy, in which the first node in the lymphatic drainage path of the primary lesion is removed and tested for the presence of melanoma cells. Current standard of care typically involves taking fewer than ten histologic sections of the node out of the hundreds of possible sections available in the tissue. We have developed a photoacoustic method that probes the entire intact node. We acquired a lymph node from a healthy canine subject. We cultured a malignant human melanoma cell line HS 936. Approximately 1 x 10(6) cells were separated and injected into the lymph node. We also had a healthy lymph node in which no melanoma cells were implanted. We used a tunable laser system set at 532 nm to irradiate the lymph nodes. Three piezoelectric acoustic detectors were positioned near the lymph node to detect photoacoustic pulses generated within the lymph nodes. We also acquired lymph nodes from pigs and repeated the experiments with increased amplification and improved sensors. We detected photoacoustic responses from a lymph node with as few as 500 melanoma cells injected into the tissue, while normal lymph nodes showed no response. Photoacoustic generation can be used to detect melanoma micrometastasis in sentinel lymph nodes. This detection can be used to guide further histologic study of the node, increasing the accuracy of the sentinel lymph node biopsy. PMID:19640155

  14. Regional lymph node metastases; a singular manifestation of the process of clinical metastases in cancer: contemporary animal research and clinical reports suggest unifying concepts.

    PubMed

    Cady, Blake

    2007-06-01

    Research results from laboratory animals and human clinical reports provide insight into cancer cell disseminations and elaborate the complex metastatic cascade of cells into both regional lymph nodes and other distant organs. Critical appraisal of clinical trials indicates that lymph node metastases are themselves non-lethal, but indicate prognosis, confirming laboratory conclusions. Distant vital organ metastases can be resected with long term survival in highly selective situations, demonstrating metastatic specificity in oligometastatic disease. Appreciating lymphatic system embryology, anatomy, and physiology is necessary for understanding lymph node metastases. The primary lymphatic system function was to return interstitial fluid to the circulation. Later evolutionary insertion of lymphocyte collections in lymph nodes interrupting lymph flow completed a system of analyzing external antigens to enable adaptive immunologic responses. Human cancers seldom elicit major immunological responses; they are not generally "foreign" enough. Therefore, lymphatic metastases have little meaning in evolutionary terms. Organ specificity of both lymphatic and distant metastases occurs as metastatic cells lie dormant, but grow selectively only in liver, lung, bone, or lymph nodes. These organ specific metastatic cells have little ability to produce different organ site clinical metastases. Thus, laboratory findings and clinical correlations emphasize that surgical lymph node removal should be de-emphasized or omitted. More physiological approaches to the highly manipulable multi-step processes of clinical metastases arising from host microenvironments will eventually prevail. PMID:17342568

  15. Doppler assessment of hypoxic pulmonary vasoconstriction and susceptibility to high altitude pulmonary oedema.

    PubMed Central

    Vachiry, J. L.; McDonagh, T.; Moraine, J. J.; Berr, J.; Naeije, R.; Dargie, H.; Peacock, A. J.

    1995-01-01

    BACKGROUND--Subjects with previous high altitude pulmonary oedema may have stronger than normal hypoxic pulmonary vasoconstriction. Susceptibility to high altitude pulmonary oedema may be detectable by echo Doppler assessment of the pulmonary vascular reactivity to breathing a hypoxic gas mixture at sea level. METHODS--The study included 20 healthy controls, seven subjects with a previous episode of high altitude pulmonary oedema, and nine who had successfully climbed to altitudes of 6000-8842 m during the 40th anniversary British expedition to Mount Everest. Echo Doppler measurements of pulmonary blood flow acceleration time (AT) and ejection time (ET), and of the peak velocity of the tricuspid regurgitation jet (TR), were obtained under normobaric conditions of normoxia (fraction of inspired oxygen, FIO2, 0.21), of hyperoxia (FIO2 1.0), and of hypoxia (FIO2 0.125). RESULTS--Hypoxia decreased AT/ET by mean (SE) 0.06 (0.01) in the control subjects, by 0.11 (0.01) in those susceptible to high altitude pulmonary oedema, and by 0.02 (0.02) in the successful high altitude climbers. Hypoxia increased TR in the three groups by 0.22 (0.06) (n = 14), 0.56 (0.13) (n = 5), and 0.18 (0.1) (n = 7) m/s, respectively. However, AT/ET and/or TR measurements outside the normal range, defined as mean +/- 2 SD of measurements obtained in the controls under hypoxia, were observed in only two of the subjects susceptible to high altitude pulmonary oedema and in five of the successful high altitude climbers. CONCLUSIONS--Pulmonary vascular reactivity to hypoxia is enhanced in subjects with previous high altitude pulmonary oedema and decreased in successful high altitude climbers. However, echo Doppler estimates of hypoxic pulmonary vaso-constriction at sea level cannot reliably identify subjects susceptible to high altitude pulmonary oedema or successful high altitude climbers from a normal control population. Images PMID:7886643

  16. Studies on the structure and permeability of the microvasculature in normal rat lymph nodes.

    PubMed Central

    Anderson, A. O.; Anderson, N. D.

    1975-01-01

    The structure and permeability of the microvasculature in normal rat lymph nodes was studied by regional perfusion techniques. The results indicated that characteristic vascular units supplied each cortical lobule of lymphatic tissue. Numerous arteriovenous communications and venous sphincters innervated by unmyelinated nerve fibers were found in this vascular bed. These specialized vascular structures permitted regional control of blood flow through high endothelial venules. Lymphocytes migrated across these venular walls by moving through intercellular spaces in the endothelium and between gaps in the laminated, reticular sheath. No direct anastomoses between blood vessels and lymphatics were seen, but tracer studies with horseradish peroxidase suggested that functional lymph node-venous communications were present in the walls of high endothelial venules. Images Figure 17 Figure 18 Figure 19 Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 PMID:1163637

  17. Computed tomography of children with pulmonary Mycobacterium tuberculosis infection.

    PubMed

    Peng, Steven Shinn-Forng; Chan, Pei-Chun; Chang, Yeun-Chung; Shih, Tiffany Ting-Fang

    2011-12-01

    Surveillance and control of tuberculous infection in pediatric patients, especially in those with a contact history, is important to prevent tuberculous infection in the general population. Totally 26 patients, younger than 14 years of age, who had a diagnosis of pulmonary Mycobacterium tuberculosis (TB), underwent both chest radiographs and computed tomography (CT), which were retrospectively reviewed and compared with those of 20 patients with community-acquired bacterial pneumonia (CABP). TB patients were commonly afebrile and had less cavitating lesions or pleural fluid than CABP patients had. Focal or sub-segmental lung opacities suggested the diagnosis of TB than of CABP. Chest CT could also help to identify enlarged, calcified, necrotic mediastinal lymph nodes, which are less frequently found in CABP and frequently obscured by thymic shadows on chest radiographs of children. Low-dose CT for children or infants suspected to have pulmonary TB infection could help to make the decision of further antibiotic treatment. PMID:22248827

  18. Novel method and applications for labeling and identifying lymph nodes

    NASA Astrophysics Data System (ADS)

    Kiraly, Atilla P.; Naidich, David P.; Guendel, Lutz; Zhang, Li; Novak, Carol L.

    2007-03-01

    The lymphatic system comprises a series of interconnected lymph nodes that are commonly distributed along branching or linearly oriented anatomic structures. Physicians must evaluate lymph nodes when staging cancer and planning optimal paths for nodal biopsy. This process requires accurately determining the lymph node's position with respect to major anatomical landmarks. In an effort to standardize lung cancer staging, The American Joint Committee on Cancer (AJCC) has classified lymph nodes within the chest into 4 groups and 14 sub groups. We present a method for automatically labeling lymph nodes according to this classification scheme, in order to improve the speed and accuracy of staging and biopsy planning. Lymph nodes within the chest are clustered around the major blood vessels and the airways. Our fully automatic labeling method determines the nodal group and sub-group in chest CT data by use of computed airway and aorta centerlines to produce features relative to a given node location. A classifier then determines the label based upon these features. We evaluate the efficacy of the method on 10 chest CT datasets containing 86 labeled lymph nodes. The results are promising with 100% of the nodes assigned to the correct group and 76% to the correct sub-group. We anticipate that additional features and training data will further improve the results. In addition to labeling, other applications include automated lymph node localization and visualization. Although we focus on chest CT data, the method can be generalized to other regions of the body as well as to different imaging modalities.

  19. 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...

  20. Automatic Synthesis of Anthropomorphic Pulmonary CT Phantoms

    PubMed Central

    Jimenez-Carretero, Daniel; San Jose Estepar, Raul; Diaz Cacio, Mario; Ledesma-Carbayo, Maria J.

    2016-01-01

    The great density and structural complexity of pulmonary vessels and airways impose limitations on the generation of accurate reference standards, which are critical in training and in the validation of image processing methods for features such as pulmonary vessel segmentation or artery–vein (AV) separations. The design of synthetic computed tomography (CT) images of the lung could overcome these difficulties by providing a database of pseudorealistic cases in a constrained and controlled scenario where each part of the image is differentiated unequivocally. This work demonstrates a complete framework to generate computational anthropomorphic CT phantoms of the human lung automatically. Starting from biological and image-based knowledge about the topology and relationships between structures, the system is able to generate synthetic pulmonary arteries, veins, and airways using iterative growth methods that can be merged into a final simulated lung with realistic features. A dataset of 24 labeled anthropomorphic pulmonary CT phantoms were synthesized with the proposed system. Visual examination and quantitative measurements of intensity distributions, dispersion of structures and relationships between pulmonary air and blood flow systems show good correspondence between real and synthetic lungs (p > 0.05 with low Cohen’s d effect size and AUC values), supporting the potentiality of the tool and the usefulness of the generated phantoms in the biomedical image processing field. PMID:26731653

  1. Automatic Synthesis of Anthropomorphic Pulmonary CT Phantoms.

    PubMed

    Jimenez-Carretero, Daniel; San Jose Estepar, Raul; Diaz Cacio, Mario; Ledesma-Carbayo, Maria J

    2016-01-01

    The great density and structural complexity of pulmonary vessels and airways impose limitations on the generation of accurate reference standards, which are critical in training and in the validation of image processing methods for features such as pulmonary vessel segmentation or artery-vein (AV) separations. The design of synthetic computed tomography (CT) images of the lung could overcome these difficulties by providing a database of pseudorealistic cases in a constrained and controlled scenario where each part of the image is differentiated unequivocally. This work demonstrates a complete framework to generate computational anthropomorphic CT phantoms of the human lung automatically. Starting from biological and image-based knowledge about the topology and relationships between structures, the system is able to generate synthetic pulmonary arteries, veins, and airways using iterative growth methods that can be merged into a final simulated lung with realistic features. A dataset of 24 labeled anthropomorphic pulmonary CT phantoms were synthesized with the proposed system. Visual examination and quantitative measurements of intensity distributions, dispersion of structures and relationships between pulmonary air and blood flow systems show good correspondence between real and synthetic lungs (p > 0.05 with low Cohen's d effect size and AUC values), supporting the potentiality of the tool and the usefulness of the generated phantoms in the biomedical image processing field. PMID:26731653

  2. Increased lymph node yield in colorectal cancer is not necessarily associated with a greater number of lymph node positive cancers.

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  4. Chronic pulmonary artery dissection associated with pulmonary arterial hypertension

    PubMed Central

    2013-01-01

    Abstract Pulmonary artery dissection is a complication associated with pulmonary arterial hypertension. This complication is described as acute in onset and is frequently fatal without intervention. We describe a patient with idiopathic pulmonary arterial hypertension and chest pain found to have an unsuspected chronic pulmonary artery dissection on postmortem examination. Chronic pulmonary artery dissection should be considered in patients with chest pain and worsening dyspnea, as the frequency this condition may be underestimated. PMID:24618553

  5. Modulation of the LKB1-AMPK Signalling Pathway Underpins Hypoxic Pulmonary Vasoconstriction and Pulmonary Hypertension.

    PubMed

    Evans, A Mark; Lewis, Sophronia A; Ogunbayo, Oluseye A; Moral-Sanz, Javier

    2015-01-01

    Perhaps the defining characteristic of pulmonary arteries is the process of hypoxic pulmonary vasoconstriction (HPV) which, under physiological conditions, supports ventilation-perfusion matching in the lung by diverting blood flow away from oxygen deprived areas of the lung to oxygen rich regions. However, when alveolar hypoxia is more widespread, either at altitude or with disease (e.g., cystic fibrosis), HPV may lead to hypoxic pulmonary hypertension. HPV is driven by the intrinsic response to hypoxia of pulmonary arterial smooth muscle and endothelial cells, which are acutely sensitive to relatively small changes in pO2 and have evolved to monitor oxygen supply and thus address ventilation-perfusion mismatch. There is now a consensus that the inhibition by hypoxia of mitochondrial oxidative phosphorylation represents a key step towards the induction of HPV, but the precise nature of the signalling pathway(s) engaged thereafter remains open to debate. We will consider the role of the AMP-activated protein kinase (AMPK) and liver kinase B1 (LKB1), an upstream kinase through which AMPK is intimately coupled to changes in oxygen supply via mitochondrial metabolism. A growing body of evidence, from our laboratory and others, suggests that modulation of the LKB1-AMPK signalling pathway underpins both hypoxic pulmonary vasoconstriction and the development of pulmonary hypertension. PMID:26303471

  6. Allergic Lung Inflammation Reduces Tissue Invasion and Enhances Survival from Pulmonary Pneumococcal Infection in Mice, Which Correlates with Increased Expression of Transforming Growth Factor ?1 and SiglecFlow Alveolar Macrophages

    PubMed Central

    Sanfilippo, Alan M.; Furuya, Yoichi; Roberts, Sean; Salmon, Sharon L.

    2015-01-01

    Asthma is generally thought to confer an increased risk for invasive pneumococcal disease (IPD) in humans. However, recent reports suggest that mortality rates from IPD are unaffected in patients with asthma and that chronic obstructive pulmonary disease (COPD), a condition similar to asthma, protects against the development of complicated pneumonia. To clarify the effects of asthma on the subsequent susceptibility to pneumococcal infection, ovalbumin (OVA)-induced allergic lung inflammation (ALI) was induced in mice followed by intranasal infection with A66.1 serotype 3 Streptococcus pneumoniae. Surprisingly, mice with ALI were significantly more resistant to lethal infection than non-ALI mice. The heightened resistance observed following ALI correlated with enhanced early clearance of pneumococci from the lung, decreased bacterial invasion from the airway into the lung tissue, a blunted inflammatory cytokine and neutrophil response to infection, and enhanced expression of transforming growth factor ?1 (TGF-?1). Neutrophil depletion prior to infection had no effect on enhanced early bacterial clearance or resistance to IPD in mice with ALI. Although eosinophils recruited into the lung during ALI appeared to be capable of phagocytizing bacteria, neutralization of interleukin-5 (IL-5) to inhibit eosinophil recruitment likewise had no effect on early clearance or survival following infection. However, enhanced resistance was associated with an increase in levels of clodronate-sensitive, phagocytic SiglecFlow alveolar macrophages within the airways following ALI. These findings suggest that, while the risk of developing IPD may actually be decreased in patients with acute asthma, additional clinical data are needed to better understand the risk of IPD in patients with different asthma phenotypes. PMID:25964474

  7. Endoscopic ultrasound: Elastographic lymph node evaluation

    PubMed Central

    Dietrich, Christoph F.; Jenssen, Christian; Arcidiacono, Paolo G.; Cui, Xin-Wu; Giovannini, Marc; Hocke, Michael; Iglesias-Garcia, Julio; Saftoiu, Adrian; Sun, Siyu; Chiorean, Liliana

    2015-01-01

    Different imaging techniques can bring different information which will contribute to the final diagnosis and further management of the patients. Even from the time of Hippocrates, palpation has been used in order to detect and characterize a body mass. The so-called virtual palpation has now become a reality due to elastography, which is a recently developed technique. Elastography has already been proving its added value as a complementary imaging method, helpful to better characterize and differentiate between benign and malignant masses. The current applications of elastography in lymph nodes (LNs) assessment by endoscopic ultrasonography will be further discussed in this paper, with a review of the literature and future perspectives. PMID:26374575

  8. Pulmonary vascular imaging

    SciTech Connect

    Fedullo, P.F.; Shure, D.

    1987-03-01

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

  9. Lymph Node Macrophages Restrict Murine Cytomegalovirus Dissemination

    PubMed Central

    Farrell, Helen E.; Davis-Poynter, Nick; Bruce, Kimberley; Lawler, Clara; Dolken, Lars; Mach, Michael

    2015-01-01

    ABSTRACT Cytomegaloviruses (CMVs) establish chronic infections that spread from a primary entry site to secondary vascular sites, such as the spleen, and then to tertiary shedding sites, such as the salivary glands. Human CMV (HCMV) is difficult to analyze, because its spread precedes clinical presentation. Murine CMV (MCMV) offers a tractable model. It is hypothesized to spread from peripheral sites via vascular endothelial cells and associated monocytes. However, viral luciferase imaging showed footpad-inoculated MCMV first reaching the popliteal lymph nodes (PLN). PLN colonization was rapid and further spread was slow, implying that LN infection can be a significant bottleneck. Most acutely infected PLN cells were CD169+ subcapsular sinus macrophages (SSM). Replication-deficient MCMV also reached them, indicating direct infection. Many SSM expressed viral reporter genes, but few expressed lytic genes. SSM expressed CD11c, and MCMV with a cre-sensitive fluorochrome switch showed switched infected cells in PLN of CD11c-cre mice but yielded little switched virus. SSM depletion with liposomal clodronate or via a CD169-diphtheria toxin receptor transgene shifted infection to ER-TR7+ stromal cells, increased virus production, and accelerated its spread to the spleen. Therefore, MCMV disseminated via LN, and SSM slowed this spread by shielding permissive fibroblasts and poorly supporting viral lytic replication. IMPORTANCE HCMV chronically infects most people, and it can cause congenital disability and harm the immunocompromised. A major goal of vaccination is to prevent systemic infection. How this is established is unclear. Restriction to humans makes HCMV difficult to analyze. We show that peripheral MCMV infection spreads via lymph nodes. Here, MCMV infected filtering macrophages, which supported virus replication poorly. When these macrophages were depleted, MCMV infected susceptible fibroblasts and spread faster. The capacity of filtering macrophages to limit MCMV spread argued that their infection is an important bottleneck in host colonization and might be a good vaccine target. PMID:25926638

  10. Characterization of sheep lung lymph lipoproteins: chemical and physical properties

    SciTech Connect

    Forte, T.M.; Cross, C.E.; Gunther, R.A.; Kramer, G.C.

    1983-01-01

    The authors have determined the composition and distribution of plasma and lung lymph lipoproteins from unanesthetized ewes. Cholesterol, triglyceride, and phospholipid levels in lung lymph were 45%, 50%, and 50%, respectively, of those in plasma. Lipoproteins from both lymph and plasma were separated into two major fractions: d < 1.063 g/ml or LDL, and d 1.063-1.21 g/ml or HDL. HDL was the major lipoprotein species in the plasma and lymph. Gradients gel electrophoresis of HDL on 4-30% gels showed that, in lymph, HDL particles were shifted to larger sizes; in addition to a peak at 8.5 nm, which was similar to plasma HDL, there were two additional components of larger size, one at 9.2 nm and the other at 12 nm. Electron microscopy revealed that lymph HDL contained two new particles not seen in plasma: large, round particles, 13.6 nm diameter, and discoidal particles, 18.7 by 4.9 nm, long and short axis, respectively. Compositional analysis of lymph HDL revealed a relative enrichment in free cholesterol as well as an enrichment in apolipoprotein E. Lymph LDL on gradient gel electrophoresis was extremely heterogeneous. Several peaks were evident in the 23-30 nm size range (similar to plasma LDL), but a supplementary component at approximately 15-16 nm was also present. Whereas plasma LDL on electron microscopy contained only round particles 26 nm in diameter, lymph contained an additional, unusual particle which was close-packed, with square geometry, and was 15 nm in diameter. Changes in the physical and chemical properties of lung lymph lipoproteins suggest that these particles are metabolically modified.

  11. Noninvasive Methods for Determining Pulmonary Vascular Function in Children with Pulmonary Arterial Hypertension: Application of a Mechanical Oscillator Model

    PubMed Central

    Hunter, Kendall S.; Gross, Justin K.; Lanning, Craig J.; Kirby, K. Scott; Dyer, Karrie L.; Ivy, D. Dunbar; Shandas, Robin

    2011-01-01

    Objective Noninvasive diagnostics for pulmonary arterial hypertension (PAH) have traditionally sought to predict main pulmonary artery pressure from qualitative or direct quantitative measures of the flow velocity pattern obtained from spectral Doppler ultrasound examination of the main pulmonary artery. A more detailed quantification of flow velocity patterns in the systemic circuit has been obtained by parameterizing the flow trace with a simple dynamic system model. Here, we investigate such a models utility as a noninvasive predictor of total right heart afterload and right heart function. Design Flow velocity and pressure was measured within the main pulmonary artery during right heart catheterization of patients with normal hemodynamics (19 subjects, 20 conditions) and those with PAH undergoing reactivity evaluation (34 patients, 69 conditions). Our model parameters were obtained by least-squares fitting the model velocity to the measured flow velocity. Results Five parameter means displayed significant (P < .05) differences between normotensive and hypertensive groups. The model stiffness parameter correlated to actual pulmonary vascular resistance (r = 0.4924), pulmonary vascular stiffness (r = 0.6811), pulmonary flow (r = 0.6963), and stroke work (r = 0.7017), while the model initial displacement parameter had good correlation to stiffness (r = 0.6943) and flow (r = 0.6958). Conclusions As predictors of total right heart afterload (resistance and stiffness) and right ventricle work, the model parameters of stiffness and initial displacement offer more comprehensive measures of the disease state than previous noninvasive methods and may be useful in routine diagnostic monitoring of patients with PAH. PMID:18380759

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

    PubMed Central

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

    2015-01-01

    Mastocytosis is defined as a heterogeneous group of disorders characterized by an accumulation of mast cells in one or more organs, particularly in the skin, bone marrow, liver, spleen and lymph nodes. However here we describe an 11-month-old girl child presented with diffuse cutaneous mastocytosis with bullous lesion, having pulmonary involvement, which is very rare and there is no available case report from India. PMID:25814708

  13. Diffuse cutaneous mastocytosis with bullous lesions and pulmonary involvement: a rare case.

    PubMed

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

    2015-01-01

    Mastocytosis is defined as a heterogeneous group of disorders characterized by an accumulation of mast cells in one or more organs, particularly in the skin, bone marrow, liver, spleen and lymph nodes. However here we describe an 11-month-old girl child presented with diffuse cutaneous mastocytosis with bullous lesion, having pulmonary involvement, which is very rare and there is no available case report from India. PMID:25814708

  14. Pulmonary vaccine delivery.

    PubMed

    Lu, Dongmei; Hickey, Anthony J

    2007-04-01

    This review will discuss developments in the field of pulmonary vaccine delivery. The possibilities of adopting aerosol-generation technology and specific pharmaceutical formulations for the purpose of pulmonary immunization are described. Aerosol-generation systems might offer advantages with respect to vaccine stability and antigenicity. Adjuvants and their inclusion in vaccine-delivery systems are described. Other formulation components, such as surfactants, particulate systems and dispersion of the aerosols are detailed in this paper. The noninvasive, relatively safe and low-cost nature of pulmonary delivery may provide great benefits to the public health vaccination campaign. PMID:17408371

  15. Pulmonary vascular diseases.

    PubMed

    Cummings, Kristopher W; Bhalla, Sanjeev

    2015-06-01

    Pulmonary vascular diseases encompass a large and diverse group of underlying pathologies ranging from venous thromboembolism to congenital malformations to inflammatory vasculitides. As a result, patients can present either acutely with dyspnea and chest pain or chronically with dyspnea on exertion, hypoxia, and right heart failure. Imaging, particularly with multidetector CT, plays a key role in the evaluation and management of patients with suspected pulmonary vascular disease and, given the widespread routine use of high-quality CT pulmonary angiography, it is imperative that radiologists be familiar these pathologies. PMID:26024602

  16. Acute pulmonary oedema.

    PubMed

    Powell, Jessica; Graham, David; O'Reilly, Sarah; Punton, Gillian

    2016-02-01

    Acute pulmonary oedema is a distressing and life-threatening illness that is associated with a sudden onset of symptoms. For the best possible patient outcomes, it is essential that nurses in all clinical areas are equipped to accurately recognise, assess and manage patients with acute pulmonary oedema. This article outlines the pathophysiology of acute cardiogenic and non-cardiogenic pulmonary oedema, and suggests a systematic approach to the recognition and management of its most serious manifestations. Long-term care and symptom recognition are discussed and suggestions for ongoing patient self-management are provided. PMID:26838657

  17. Predictive Value of Tumor Load in Breast Cancer Sentinel Lymph Nodes for Second Echelon Lymph Node Metastases

    PubMed Central

    van Deurzen, C. H. M.; van Hillegersberg, R.; Hobbelink, M. G. G.; Seldenrijk, C. A.; Koelemij, R.; van Diest, P. J.

    2007-01-01

    Background: The need for routine axillary lymph node dissection (ALND) in patients with invasive breast cancer and low-volume sentinel node (SN) involvement is questionable. Accurate prediction of second echelon lymph node involvement could identify those patients most likely to benefit from ALND. Methods: A consecutive series of 317 patients with invasive breast cancer and a tumor positive axillary SN followed by ALND was reviewed. Clinicopathologic features of the primary tumor and the SN were assessed as possible predictors of second echelon lymph node involvement. Results: Second echelon metastases were found in 116/317 cases (36.6%). Frequency of second echelon lymph node involvement in patients with isolated tumor cells (ITC, N = 23), micro- (N = 101) and macrometastases (N = 193) was 13%, 20% and 48%, respectively (p < 0.001). Based on the area % of SN occupied by tumor no subgroup of patients could be selected with less than 20% second echelon lymph node involvement. However, none of the patients with SN ITC or micrometastases and a primary tumor size ?1 cm (N = 12, 3.8%) had second echelon lymph node involvement. Conclusions: Accurately measured SN tumor load predicts second echelon lymph node involvement. However, even in patients with ITC, the second echelon lymph nodes are involved in 13% justifying ALND. PMID:18032826

  18. Cutting Edge: Role of NK Cells and Surfactant Protein D in Dendritic Cell Lymph Node Homing: Effects of Ozone Exposure.

    PubMed

    Ge, Moyar Qing; Kokalari, Blerina; Flayer, Cameron H; Killingbeck, Sarah S; Redai, Imre G; MacFarlane, Alexander W; Hwang, Jin W; Kolupoti, Anisha; Kemeny, Michael D; Campbell, Kerry S; Haczku, Angela

    2016-01-15

    The roles of NK cells, surfactant protein D (SP-D), and IFN-?, as well as the effect of ozone (O3) inhalation, were studied on recirculation of pulmonary dendritic cells (DC) to the mediastinal lymph nodes. O3 exposure and lack of SP-D reduced NK cell IFN-? and lung tissue CCL21 mRNA expression and impaired DC homing to the mediastinal lymph nodes. Notably, addition of recombinant SP-D to naive mononuclear cells stimulated IFN-? release in vitro. Because NKp46, a glycosylated membrane receptor, was necessary for dose-dependent SP-D binding to NK cells in vitro and DC migration in vivo, we speculate that SP-D may constitutively stimulate IFN-? production by NK cells, possibly via NKp46. This mechanism could then initiate the IFN-?/IL-12 feedback circuit, a key amplifier of DC lymph node homing. Inhibition of this process during an acute inflammatory response causes DC retention in the peripheral lung tissue and contributes to injury. PMID:26673133

  19. Internal mammary sentinel lymph node biopsy should still be performed, especially in the patient with clinically positive axillary lymph nodes.

    PubMed

    Qiu, Peng-fei; Zhao, Rong-rong; Liu, Yan-bing; Wang, Yong-sheng

    2013-10-01

    Current studies suggest that the internal mammary sentinel lymph node biopsy (IM-SLNB) should not be performed routinely, for it did not alter clinical management of breast cancer patients in terms of adjuvant treatment. However, consideration should be given to the fact, the study population in all current research relate to IM-SLNB is the patients with clinically negative axillary lymph nodes. As internal mammary lymph nodes metastases are mostly found concomitantly with axillary metastases, clinical trials currently fail to evaluate the status of internal mammary lymph nodes who really in need. In consideration of the impact to staging and accurate indication of radiation to the internal mammary area, we recommend that research on IM-SLNB should still be encouraged, especially in patients with clinically positive axillary lymph nodes. PMID:23838319

  20. Pancreatic Endocrine Tumor with Disseminated Pulmonary Thromboembolism in an Owl Monkey (Aotus nancymae)

    PubMed Central

    Gozalo, Alfonso S; Zerfas, Patricia M; Starost, Matthew F; Lambert, Lynn E; Elkins, William R

    2013-01-01

    Summary Pulmonary thromboembolism associated with pancreatic endocrine neoplasia is extremely uncommon in humans and animals. Post mortem examination of an adult owl monkey revealed extensive pulmonary arterial thromboembolism and a well-demarcated mass attached to the pancreas. Histologically, the mass consisted of areas of interstitial fibrosis with loss of acini and islets and replaced by nests and sheets of polygonal cells with amphophilic cytoplasm, an eccentric rounded nucleus with stippled chromatin, and in some cells, with a single prominent eccentric nucleolus. Clusters of these cells were noted within vessels and adjacent lymph nodes. The cells did not stain with S-100 and insulin, stained rare individual cells with glucagon and somatostatin, but strongly stained with SP-1 Chromogranin. A few cells in pulmonary thrombi/emboli and adjacent lymph node stained also with SP-1 Chromogranin. Based on cell morphology, location, and immunohistochemical staining, the tumor was classified as pancreatic endocrine (islet cell) carcinoma with metastasis to regional lymph nodes and lung. PMID:23453490

  1. Pancreatic endocrine tumour with disseminated pulmonary thromboembolism in an owl monkey (Aotus nancymae).

    PubMed

    Gozalo, A S; Zerfas, P M; Starost, M F; Lambert, L E; Elkins, W R

    2013-07-01

    Pulmonary thromboembolism associated with pancreatic endocrine neoplasia is extremely uncommon in man and animals. Post-mortem examination of an adult owl monkey (Aotus nancymae) revealed extensive pulmonary arterial thromboembolism and a well-demarcated mass attached to the pancreas. Microscopically, the mass consisted of areas of interstitial fibrosis with loss of acini and islets and replacement by nests and sheets of polygonal cells with amphophilic cytoplasm, an eccentric round nucleus with stippled chromatin and, in some cells, with a single prominent eccentric nucleolus. Clusters of these cells were noted within vessels and adjacent lymph nodes. The cells did not express S100 or insulin, but were labelled strongly with SP-1/chromogranin. Rare individual cells expressed glucagon and somatostatin. A few cells in pulmonary thrombi/emboli and the adjacent lymph node also expressed SP-1/chromogranin. Based on cell morphology, location and immunohistochemistry the tumour was classified as pancreatic endocrine (islet cell) carcinoma with metastasis to regional lymph nodes and lung. PMID:23453490

  2. Absent pulmonary valve

    MedlinePLUS

    ... that they press on the tubes that bring air to the lungs (bronchi) and cause breathing problems. Other heart defects that can occur with absent pulmonary valve include: Abnormal tricuspid valve Atrial septal defect Double ...

  3. Diagnosis of pulmonary embolism.

    PubMed

    Righini, Marc; Robert-Ebadi, Helia; Le Gal, Grgoire

    2015-12-01

    Pulmonary embolism is the third cause of mortality by cardiovascular disease after coronary artery disease and stroke, and its incidence is around 1/1000 per year. During the last two decades, many different non-invasive diagnostic tests have been developed and validated. For hemodynamically stable outpatients, the diagnosis of acute pulmonary embolism mainly rests on the sequential use of clinical assessment, D-dimer measurement and multidetector CT. In patients with a contraindication to CT, lower limb venous ultrasonography and ventilation-perfusion scintigraphy remain valid options. Massive pulmonary embolism is a distinct clinical entity with a specific diagnostic approach. In unstable patients with suspected pulmonary embolism, echocardiography should be the initial test. PMID:26585743

  4. Chronic thromboembolic pulmonary hypertension

    PubMed Central

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

    2006-01-01

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

  5. Acute massive pulmonary embolism

    PubMed Central

    Miller, G. A. H.; Sutton, G. C.

    1970-01-01

    Twenty-three patients are reported in whom a diagnosis of acute massive pulmonary embolism was confirmed by pulmonary arteriography. All patients had a history of less than 48 hours' duration and only two had previous cardiorespiratory disease. In such patients the haemodynamic abnormalities determined at catheterization are due to pulmonary embolism as an isolated disturbance. These abnormalities include an only moderate degree of pulmonary hypertension (PA systolic pressure 38.46.8 mm. Hg), right ventricular `failure' (RVED 11.54.9 mm. Hg), arterial oxygen desaturation (86.411.2%) and a wide arteriovenous oxygen difference (8.11.8 ml./100 ml.), and low cardiac output. These haemodynamic abnormalities find their expression in the presentation and the clinical, electrocardiographic, and radiological findings which are described. Images PMID:5433313

  6. Idiopathic pulmonary fibrosis

    MedlinePLUS

    ... around the mouth or fingernails due to low oxygen (with advanced disease) Enlargement of the fingernail bases, ... scan Chest x-ray Echocardiogram Measurements of blood oxygen level (arterial blood gases) Pulmonary function tests Six- ...

  7. Novel Pulmonary Artery Reduction Plasty for Pulmonary Artery Aneurysm With Pulmonary Arterial Hypertension.

    PubMed

    Shin, Hong Ju; Suh, Young Joo

    2016-01-01

    We present the case of a 60-year-old female with pulmonary artery aneurysm (PAA) associated with an atrial septal defect and pulmonary arterial hypertension. There is no standard therapeutic approach for PAA at the present time. We performed a novel surgical repair of a 67-mm PAA consisting of internal plication of the pulmonary artery to reduce the diameter and approximation of remnant unfolding pulmonary artery to reinforce the stability of the pulmonary artery and prevent bleeding. PMID:26715001

  8. 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

  9. The pulmonary artery catheter.

    PubMed

    Vincent, Jean-Louis

    2012-10-01

    The pulmonary artery catheter (PAC) has been widely used for monitoring of critically ill patients over the years, but with advances in less invasive monitoring techniques, notably echocardiography, there are fewer indications for PAC insertion. Nevertheless, the PAC provides simultaneous monitoring of pulmonary artery pressures, cardiac filling, cardiac output and mixed venous oxygen saturation, and still has an important role in complex cases. Adequate and continued training are required to ensure that PAC-derived data are correctly interpreted and applied. PMID:22886686

  10. 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

  11. Incidental Nodal Lymphangioleiomyomatosis Is Not a Harbinger of Pulmonary Lymphangioleiomyomatosis: A Study of 19 Cases With Evaluation of Diagnostic Immunohistochemistry.

    PubMed

    Schoolmeester, J Kenneth; Park, Kay J

    2015-10-01

    Lymphangioleiomyomatosis (LAM) is a proliferation of perivascular epithelioid cells typically affecting the lung as a low-grade, destructive and progressive disease but may also be found in lymph nodes and other organs. LAM is sometimes seen as an incidental finding in lymph node dissections performed for staging of gynecologic tumors. To our knowledge, no study has investigated the clinical significance of incidental nodal LAM in relation to subsequent development of pulmonary LAM. We identified 19 patients from our institution with LAM in lymph nodes. Follow-up was available for 100% of patients and ranged from 3 to 123 months (mean 33.8 mo). All were women, ranging in age from 35 to 71 years (mean 56.3 y). None had a history of tuberous sclerosis, renal angiomyolipoma, or pulmonary LAM. LAM involvement spanned 1 to 6 nodes (mean 2), ranging from 1% to 100% of the total excised lymph nodes. The single largest focus of nodal LAM ranged from 1 to 9 mm (mean 4.3 mm) in 18 patients without evidence of persistent or recurrent nodal LAM. In the 1 patient with persistent local nodal LAM, the greatest diameter was 25 mm. Affected lymph node sites were regional pelvic and retroperitoneal chains routinely sampled in staging operations. An immunohistochemical panel of HMB45, A103, and ?-catenin was evaluated in 18 cases. HMB45 showed strong but usually focal staining in every case compared with A103, which was very focally expressed (39%) or negative. ?-catenin showed strong, diffuse cytoplasmic and membranous (non-nuclear) reactivity in 100% of cases. At the last clinic visit, all 19 patients had no manifestations of pulmonary LAM. In an absence of signs of symptoms of extranodal LAM, patients with incidentally discovered nodal LAM smaller than 10 mm are not at risk of developing pulmonary LAM. PMID:26135558

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

    PubMed Central

    2014-01-01

    Abstract Patients present with a wide range of hypoxemia after acute pulmonary thromboembolism (APTE). Recent studies using fluorescent microspheres demonstrated that the scattering of regional blood flows after APTE, created by the embolic obstruction unique in each patient, significantly worsened regional ventilation/perfusion (V/Q) heterogeneity and explained the variability in gas exchange. Furthermore, earlier investigators suggested the roles of released vasoactive mediators in affecting pulmonary hypertension after APTE, but their quantification remained challenging. The latest study reported that mechanical obstruction by clots accounted for most of the increase in pulmonary vascular resistance, but that endothelin-mediated vasoconstriction also persisted at significant level during the early phase. PMID:25006441

  13. Histopathological Evidence of Lymph Node Metastasis in Papillary Thyroid Carcinoma.

    PubMed

    Can, Nuray; Tastekin, Ebru; Ozyilmaz, Filiz; Sezer, Yavuz Atakan; Guldiken, Sibel; Sut, Necdet; Sarikas, Nurtac; Oz Puyan, Fulya; Guler, Beril; Ayturk, Semra; Celik, Mehmet

    2015-09-01

    Prophylactic lymph node dissection is still controversial due to the potentially surgery-related morbidity in management of papillary thyroid carcinomas. So, some histopathological predictors for lymph node metastasis in thyroidectomy specimens may reveal importance. The objective of this study was to define histomorphological indicators of lymph node metastasis in the patients who had been performed thyroidectomy without lymph node dissection. Clinicopathological features of patients archived in Department of Pathology at Trakya University Medical Faculty were reviewed. A total of 211 patients who had been diagnosed as papillary carcinoma and had been performed total thyroidectomy/lobectomy with central/cervical lymph node dissection were included in the study. Clinical features (age, gender, preoperative/postoperative clinical, and laboratory findings) and histopathological features (histological variant, tumor size, focality, extrathyroidal extension, tumor border, lateral tubular growth, intraglandular dissemination, stromal and lymphocytic tumor response, lymphocytic thyroiditis, lymphovascular invasion, lymph node metastasis, number of metastatic lymph nodes, extranodal extension, size of the metastatic foci) were evaluated. Male gender, conventional variant, tumor size greater than 10 mm, multifocality, extrathyroidal extension, lateral tubular growth, intraglandular dissemination, lymphocytic and stromal tumor response, and absence of lymphocytic thyroiditis were predictive, and older age (≥45 years) and follicular variant PTC were protective for lymph node metastasis. In order to optimize the management of papillary thyroid carcinomas, pathologists should search for the clues of lymph node metastasis particularly intraglandular dissemination, lateral tubular growth, tumor border and lymphocytic/stromal tumor response, multifocality, concomitant lymphocytic thyroiditis besides the actual prognostic criteria especially in younger aged male patients. PMID:26209182

  14. Anoxic ventilation improves systemic perfusion during extracorporeal circulation with uncontrolled systemic-to-pulmonary shunt.

    PubMed

    Hammel, James M; Deptula, Joseph; Hunt, Peter W; Lang, Haili; Duncan, Kim F

    2007-01-01

    Uncontrolled systemic-to-pulmonary shunt results in decreased systemic flow during extracorporeal life support (ECLS). Ligation of systemic-to-pulmonary shunts during ECLS is associated with poor outcome and is not always readily achieved. In ex vivo preparations, alveolar hypoxia results in pulmonary vasoconstriction despite normoxic pulmonary perfusate. We hypothesized that anoxic ventilation would result in reduced pulmonary shunting and increased systemic flow during ECLS in piglets with systemic-to-pulmonary shunt. Four piglets were placed on ECLS with right and left atrial drainage. A shunt was created between the bicarotid trunk and pulmonary artery, using 5-mm ePTFE tubing. Inspired oxygen was reduced to <1% for 10 minutes, then returned to room air; pH, hematocrit, temperature, ventilatory pressures, and total pump flow were maintained constant. Systemic arterial pressure and right atrial return volume and hemoglobin saturation were measured: All decreased significantly upon shunt unclamping. Anoxic ventilation caused increased systemic pressure (34 vs. 28 mm Hg, p < 0.05), flow (335 vs. 278 mL/min, p < 0.05), and systemic venous saturation (53% vs. 48%, p = 0.13) compared with room air ventilation. In conclusion, anoxic ventilation during normoxic ECLS in subjects with systemic-to-pulmonary shunts results in a significant and potentially clinically useful reduction in pulmonary shunting. PMID:17413566

  15. Pulmonary response and transmigration of inorganic fibers by inhalation exposure.

    PubMed Central

    Lee, K. P.; Barras, C. E.; Griffith, F. D.; Waritz, R. S.

    1981-01-01

    Rats, hamsters, and guinea pigs were exposed by inhalation to different concentrations of potassium octatitanate fibers. Following 3 months of exposure, the animals were sacrificed between the 15th and 24th month. The exposed animals showed dose-related dust deposition and pulmonary fibrosis mainly in the respiratory bronchiolar region. Most short fibers (less than 5 micrograms) were phagocytized by alveolar macrophages, but long fibers (greater than 10 micrograms) were phagocytized by foreign body giant cells. Dust-laden macrophages (dust cells) entered into the lumen of bronchial lymphatic or pulmonary blood vessels. Numerous dust cells were transported from the lung to the tracheobronchial and mediastinal lymph nodes where some dust cells penetrated into the blood or lymphatic circulation. Massive direct cell migration of the mediastinal adipose tissue from the lymph nodes occurred occasionally. Dust-laden giant cells were found only occasionally in the liver, and there was widespread migration of the fibers into other vital organs and tissues without any significant responses. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 PMID:7212016

  16. Successful Treatment of a Large Pulmonary Arteriovenous Malformation by Repeated Coil Embolization

    PubMed Central

    Park, Jimyung; Kim, Hyung-Jun; Kim, Jee min

    2015-01-01

    Pulmonary arteriovenous malformations (AVMs) are caused by abnormal vascular communications between the pulmonary arteries and pulmonary veins, which lead to the blood bypassing the normal pulmonary capillary beds. Pulmonary AVMs result in right-to-left shunts, resulting in hypoxemia, cyanosis, and dyspnea. Clinical signs and symptoms vary depending on the size, number, and flow of the AVMs. Transcatheter embolization is the treatment of choice for pulmonary AVMs. However, this method can fail if the AVM is large or has multiple complex feeding arteries. Surgical resection is necessary in those kind of cases. Here, we report the case of a patient with a 6-cm pulmonary AVM with multiple feeding arteries that was successfully treated by repeated coil embolization without surgery. PMID:26508934

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

    PubMed Central

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

    2013-01-01

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

  18. Evidence of Th2 polarization of the sentinel lymph node (SLN) in melanoma

    PubMed Central

    Grotz, Travis E; Jakub, James W; Mansfield, Aaron S; Goldenstein, Rachel; Enninga, Elizabeth Ann L; Nevala, Wendy K; Leontovich, Alexey A; Markovic, Svetomir N

    2015-01-01

    Melanoma has a propensity for lymphatogenous metastasis. Improved understanding of the sentinel lymph node (SLN) immunological environment may improve outcomes. The immune phenotype of fresh melanoma SLNs (n = 13) were compared to fresh control lymph nodes (n = 13) using flow cytometry. RNA was isolated from CD4+ T cells of the SLN and control lymph node and assessed for Th1/Th2 gene expression pathways using qRT-PCR. In addition, VEGF expression was compared between primary melanoma (n = 6) and benign nevi (n = 6) using immunohistochemistry. Melanoma SLNs had fewer CD8+ T cells compared to controls (9.2% vs. 19.5%, p = 0.0005). The CD8+ T cells within the SLN appeared to have an exhausted phenotype demonstrated by increased PD-1 mRNA expression (2.2% vs. 0.8%, p = 0.004) and a five-fold increase in CTLA-4 mRNA expression. The SLN also contained an increased number of CD14 (22.7% vs. 7.7%, p = 0.009) and CD68 (9.3% vs. 2.7%, p = 0.001) macrophages, and CD20 B cells (31.1% vs. 20.7%, p = 0.008), suggesting chronic inflammation. RT-PCR demonstrated a significant Th2 bias within the SLN. In vitro studies demonstrated a similar Th2 polarization with VEGF treatment of control lymph nodes. The primary melanoma demonstrated strong VEGF expression and an increase in VEGFR1 within the SLN. Melanoma is associated with Th2-mediated chronic inflammation, fewer cytotoxic T cells, and an exhausted T cell phenotype within the SLN combined with VEGF overproduction by the primary melanoma. These immunologic changes precede nodal metastasis and suggests consideration of VEGF inhibitors in future immunotherapy studies. PMID:26405583

  19. 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

  20. Ultrastructure of the Normal Lymph Node

    PubMed Central

    Nopajaroonsri, Charn; Luk, Shing C.; Simon, Grard T.

    1971-01-01

    The normal lymph node has been studied by electron microscopy. The lymphoid tissue can be divided into three distinct zones. Zone 1 consists of loosely arranged cells surrounding the lymphatic sinuses and blood vessels. This is the only zone in which plasma cells are present. Zone 2 is surrounded by zone 1 and consists of compactly arranged cells in which lymphocytes predominate. Zone 3 (germinal center) appears only after antigenic stimulation. It is characterized by large, ribosome-rich cells and macrophages containing phagocytosed lymphocytes. These zones are arranged with their longest diameters pointing towards the hilus. Zone 1 is the longest and extends across the cortex, paracortex and medulla. Zone 2 spans across cortex and paracortex. Zone 3 usually is confined to the cortex. Our preliminary studies indicate that zone 1 is mainly bursal dependent, zone 2 is mainly thymic dependent and zone 3 is bursal dependent. ImagesFig 14Fig 1Fig 9Fig 10Fig 6Fig 2Fig 3Fig 12Fig 11Fig 13Fig 15Fig 5Fig 7Fig 8Fig 4 PMID:5096365

  1. 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

  2. Tracheal venous blood and lymph collection: a model to study airway injury in sheep.

    PubMed

    Barrow, R E; Morris, S E; Linares, H A; Herndon, D N

    1991-04-01

    Airway injury is a frequent result of the inhalation or aspiration of toxic material. Although upper airway damage can be identified endoscopically, pathophysiological changes are difficult to evaluate. This paper describes an animal model in which changes in tracheal blood and lymph flow rates, wet-to-dry weight ratios, and lymph-to-plasma protein ratios can be evaluated after injury. In this model, 12 cm of the cervical trachea were isolated using a double-cuffed endotracheal tube and injured with cotton smoke at near room temperature. Injury to the trachea was evaluated in twenty-five anesthetized sheep 4 (n = 3), 8 (n = 3), 24 (n = 3), 48 (n = 3), 96 (n = 3), and 192 (n = 2) h after smoke exposure and compared with sham control animals (n = 8). A significant increase in tracheal venous blood flow from 1.3 +/- 0.4 (SD) ml.min-1.cm-1 for the noninjured trachea to 2.8 +/- 1.2 was noted 24 h after injury (P less than 0.01). Lymph flow significantly increased from 1.3 +/- 0.4 microliters.min-1.cm-1 for the noninjured trachea to 9.8 +/- 3.3 24 h after injury while wet-to-dry weight ratios were elevated from 3.0 +/- 0.2 for noninjured trachea to 4.6 +/- 0.9 from 4 to 24 h after injury (P less than 0.01) and decreased to 3.7 +/- 0.5 by 96 h. Cast material consisting of airway exudate, cellular debris, and intact ciliated epithelial cells was both expectorated and found in the trachea when the animals were killed.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2055845

  3. Predictors of Pulmonary Infarction.

    PubMed

    Miniati, Massimo; Bottai, Matteo; Ciccotosto, Cesario; Roberto, Luca; Monti, Simonetta

    2015-10-01

    In the setting of acute pulmonary embolism (PE), pulmonary infarction is deemed to occur primarily in individuals with compromised cardiac function.The current study was undertaken to establish the prevalence of pulmonary infarction in patients with acute PE, and the relationship between infarction and: age, body height, body mass index (BMI), smoking habits, clot burden, and comorbidities.The authors studied prospectively 335 patients with acute PE diagnosed by computed tomographic angiography (CT) in 18 hospitals throughout central Italy. The diagnosis of pulmonary infarction on CT was based on Hampton and Castleman's criteria (cushion-like or hemispherical consolidation lying along the visceral pleura). Multivariable logistic regression was used to model the relationship between covariates and the probability of pulmonary infarction.The prevalence of pulmonary infarction was 31%. Patients with infarction were significantly younger and with significantly lower prevalence of cardiovascular disease than those without (P?pulmonary infarction occurs in nearly one-third of the patients with acute PE. Those with infarction are often young and otherwise healthy. Increasing body height and active smoking are predisposing risk factors. PMID:26469892

  4. Predictors of Pulmonary Infarction

    PubMed Central

    Miniati, Massimo; Bottai, Matteo; Ciccotosto, Cesario; Roberto, Luca; Monti, Simonetta

    2015-01-01

    Abstract In the setting of acute pulmonary embolism (PE), pulmonary infarction is deemed to occur primarily in individuals with compromised cardiac function. The current study was undertaken to establish the prevalence of pulmonary infarction in patients with acute PE, and the relationship between infarction and: age, body height, body mass index (BMI), smoking habits, clot burden, and comorbidities. The authors studied prospectively 335 patients with acute PE diagnosed by computed tomographic angiography (CT) in 18 hospitals throughout central Italy. The diagnosis of pulmonary infarction on CT was based on Hampton and Castleman's criteria (cushion-like or hemispherical consolidation lying along the visceral pleura). Multivariable logistic regression was used to model the relationship between covariates and the probability of pulmonary infarction. The prevalence of pulmonary infarction was 31%. Patients with infarction were significantly younger and with significantly lower prevalence of cardiovascular disease than those without (P?pulmonary infarction occurs in nearly one-third of the patients with acute PE. Those with infarction are often young and otherwise healthy. Increasing body height and active smoking are predisposing risk factors. PMID:26469892

  5. The Pulmonary Circulation and Exercise Responses in the Elderly

    PubMed Central

    Taylor, Bryan J.; Johnson, Bruce D.

    2014-01-01

    Aging is associated with a progressive deterioration in the structure and function of the pulmonary circulation. Remodeling of the pulmonary vasculature occurs from maturity to senescence that is characterized by an increase in pulmonary vascular stiffness, pulmonary vascular pressures, and pulmonary vascular resistance along with increased heterogeneity of alveolar ventilation and pulmonary perfusion and decreased pulmonary capillary blood volume and membrane diffusing capacity that is consistent with a reduction in alveolar-capillary surface area. In theory, the aforementioned age-related changes in the pulmonary circulation may conspire to make elderly individuals more susceptible to gas exchange abnormalities during exercise. However, despite the erosion in ventilatory reserve with aging, the healthy older adult appears able to maintain alveolar ventilation at a level that allows maintenance of arterial blood gases within normal limits, even during heavy exercise. This ability to maintain adequate gas exchange likely occurs because age-related reductions in the maximal metabolic demand of exercise occur at a rate equal to or greater than the rate of deterioration in ventilatory reserve. A more prominent aspect of aging is the loss of lung elastic recoil that is associated with a modest reduction in the expiratory boundary of the maximal flow-volume envelope. This in turn increases the severity of expiratory airflow limitation and induces dynamic lung hyperinflation during exercise. The consequences of this age-associated decrease in elastic recoil on the pulmonary circulation are speculative, but an age-associated decline in elastic recoil may influence pulmonary vascular resistance and cardiac output, in addition to its impact on the work and oxygen cost of breathing. PMID:20941654

  6. Qualitative evaluation of pulmonary CT angiography findings in pregnant and postpartum women with suspected pulmonary thromboembolism

    PubMed Central

    Moradi, Maryam; Monfared, Leyla Jalali

    2015-01-01

    Background: Considering the importance of using more appropriate imaging technique for accurate diagnosis of pulmonary thromboembolism (PTE) with less side effects, we aimed to evaluate the quality of pulmonary 64-multidetector computed tomographic (MDCT) angiography in pregnant and postpartum women with suspected PTE in Isfahan. Materials and Methods: In this descriptive study, radiological findings of pregnant and postpartum women with suspected PTE who underwent pulmonary 64-MDCT angiography were evaluated. Prevalence of PTE in pregnant and postpartum women, mean of pulmonary arteries density for right and left pulmonary arteries, and their lobar and segmental branches, diagnostic quality of the pulmonary arteries density and their scoring, frequency of diagnostic and nondiagnostic images, mean of radiation dose and mean of bolus time, and the correlation between the quality of the vascular density with the peak density of the pulmonary artery were determined. Results: In this study, 44 pregnant and postpartum women with suspected PTE were selected. The overall prevalence of PTE was 9.1% (4/44). PTE was diagnosed in 1 (3.7%) pregnant and 3 (17.5%) postpartum women (P = 0.14). Mean density of pulmonary trunk was 278.81 108.16 Hounsfield unit (HU) and 308.41 59.30 HU in pregnant and postpartum women, respectively. Mean of bolus timing, kilovoltage peak (kVp), tube current, and dose length product (DLP) were 12.53 2.36 s, 105.22 45.71 milliamperage (MA), 382.9 173.5 MA, and 317.98 78.92 mGy/cm, respectively. The rate of nondiagnostic images was 4.5%. Conclusion: Our findings indicated that pulmonary 64-MDCT angiography is an appropriate imaging method for diagnosing PTE in pregnant and postpartum women with suspected PTE. It seems that, using fast CT systems (64-MDCT), in accordance with high flow rate, high contrast medium concentration and low kVp could explain the obtained appropriate quality of images more efficiently than computed tomographic pulmonary angiography (CTPA). PMID:26941814

  7. 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

  8. Endocervicosis involving axillary lymph nodes: first case report.

    PubMed

    Mukonoweshuro, Pinias; McCluggage, W Glenn

    2014-11-01

    The occurence of Mullerian epithelial inclusions, especially endosalpingiosis, in pelvic and other subdiaphragmatic lymph nodes is well known. In contrast, Mullerian inclusions involving lymph nodes above the diaphragm is uncommon, although occasional cases of endosalpingiosis have been reported. We report a case of benign Mullerian inclusions of mucinous endocervical type (endocervicosis) coexistent with metastatic breast-infiltrating ductal carcinoma in 2 axillary lymph nodes. The inclusions exhibited diffuse positive staining with CK7, PAX8, CA125, and estrogen receptor and were WT1 negative. To our knowledge, this is the first report of endocervicosis involving supradiaphragmatic lymph nodes. Close morphologic examination and immunohistochemistry assists in distinguishing Mullerian inclusions from metastatic adenocarcinoma. PMID:25272302

  9. Lymph node dissection for gastric cancer: a critical review

    PubMed Central

    Batista, Thales Paulo; Martins, Mário Rino

    2012-01-01

    Gastric cancer is one of the most common neoplasms and an important cause of cancer-related death worldwide. Efforts to reduce its high mortality rates are currently focused on multidisciplinary management. However, surgery remains a cornerstone in the management of patients with resectable disease. There is still some controversy as to the extent of lymph node dissection for potentially curable stomach cancer. Surgeons in eastern countries favor more extensive lymph node dissection, whereas those in the West favor less extensive dissection. Thus, extent of lymph node dissection remains one of the most hotly discussed aspects of gastric surgery, particularly because most stomach cancers are now often comprehensively treated by adding some perioperative chemotherapy or chemo-radiation. We provide a critical review of lymph nodes dissection for gastric cancer with a particular focus on its benefits in a multimodal approach. PMID:25992202

  10. Nanoparticle Transport from Mouse Vagina to Adjacent Lymph Nodes

    PubMed Central

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

    2012-01-01

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

  11. Pulmonary artery sling with tracheal stenosis: primary one-stage repair in infancy.

    PubMed

    Ziemer, G; Heinemann, M; Kaulitz, R; Freihorst, J; Seidenberg, J; Wilken, M

    1992-11-01

    Pulmonary artery sling is often associated with tracheal stenosis. In many cases repair of the vascular anomaly alone does not relieve dyspnea. Primary one-stage repair with long segment tracheal resection (2.4 cm) and relocation of the left pulmonary artery using cardiopulmonary bypass and deep hypothermic circulatory arrest is described in a 6.5-month-old girl weighing 6.5 kg. This technique resulted in normal ventilation and pulmonary flow distribution. PMID:1417295

  12. Specific Echocardiographic Findings Useful for the Diagnosis of Common Pulmonary Vein Atresia

    PubMed Central

    Hirata, Kazuhiro

    2015-01-01

    In this paper, we report a case of common pulmonary vein atresia, which is a very rare disease characterized by cyanosis, heart failure and pulmonary hypertension. Reverse flow in the pulmonary artery at end-diastole as well as in the isthmus of the aorta from early systole to end-diastole detected by echocardiography were found to be specific features useful in diagnosing the disease.

  13. Peripheral pulmonary artery aneurysm presenting as a solitary pulmonary nodule

    PubMed Central

    Tamagno, Mauro Federico Luis; Bibas, Benoit Jacques; Minamoto, Helio

    2015-01-01

    We report the case of a 63-year-old female patient who was evaluated due to a solitary pulmonary nodule. The final diagnosis was a solitary peripheral pulmonary artery saccular aneurysm. The patient was submitted to a pulmonary lobectomy with excellent recovery. Peripheral pulmonary artery aneurysms that arise from segmental or intrapulmonary branches are extremely rare, and their management is still controversial. PMID:26484335

  14. Computer-aided lymph node detection in abdominal CT images

    NASA Astrophysics Data System (ADS)

    Liu, Jiamin; White, Jacob M.; Summers, Ronald M.

    2010-03-01

    Many malignant processes cause abdominal lymphadenopathy, and computed tomography (CT) has become the primary modality for its detection. A lymph node is considered enlarged (swollen) if it is more than 1 centimeter in diameter. Which lymph nodes are swollen depends on the type of disease and the body parts involved. Identifying their locations is very important to determine the possible cause. In the current clinical workflow, the detection and diagnosis of enlarged lymph nodes is usually performed manually by examining all slices of CT images, which can be error-prone and time consuming. 3D blob enhancement filter is a usual way for computer-aided node detection. We proposed a new 3D blob detector for automatic lymph node detection in contrast-enhanced abdominal CT images. Since lymph nodes are usually next to blood vessels, abdominal blood vessels were first segmented as a reference to set the search region for lymph nodes. Then a new detection response measure, blobness, is defined based on eigenvalues of the Hessian matrix and the object scale in our new blob detector. Voxels with higher blobness were clustered as lymph node candidates. Finally some prior anatomical knowledge was utilized for false positive reduction. We applied our method to 5 patients and compared the results with the performance of the original blobness definition. Both methods achieved sensitivity of 83.3% but the false positive rates per patient were 14 and 26 for our method and the original method, respectively. Our results indicated that computer-aided lymph node detection with this new blob detector may yield a high sensitivity and a relatively low FP rate in abdominal CT.

  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. Lymph node characteristics of sarcoidosis with endobronchial ultrasound

    PubMed Central

    Ozgul, Mehmet Akif; Cetinkaya, Erdo?an; Kirkil, Gamze; Ozgul, Guler; Abul, Yasin; Acat, Murat; Onaran, Hilal; Urer, Halide Nur; Tutar, Nuri; Dincer, H. Erhan

    2014-01-01

    Background: Sonographic features of lymph nodes on endobronchial ultrasound (EBUS) have been shown to be useful in prediction of malignancy in mediastinum and hilum. The aim of this study was to assess the utility of morphologic features of mediastinal and/or hilar lymph nodes obtained by EBUS in patients with sarcoidosis. Materials and Methods: We retrospectively reviewed the records of 224 patients with mediastinal/hilar lymph node enlargements who underwent EBUS for diagnostic purpose. The lymph nodes were characterized based on the EBUS images as follows: (1) Size; based on short-axis dimension, <1 cm or ?1 cm, (2) shape; oval or round, (3) margin; distinct or indistinct, (4) echogenicity; homogeneous or heterogeneous, (5) presence or absence of central hilar structure, and (6) presence or absence of granular (sandpaper) appearance. Results: One hundred (24.4%) nodes exhibited indistinct margins while 309 (75.6%) had distinct margins. One hundred and ninety nine (48.7%) nodes were characterized as homogeneous, and 210 (51.3%) nodes as heterogeneous. Granular appearance was observed in 130 (31.8%) lymph nodes. The presence of granules in lymph nodes on EBUS had the highest specificity (99.3%) for the diagnosis of sarcoidosis. Logistic regression analysis revealed the finding of distinct margin alone as an independent predictive factor for the diagnosis of sarcoidosis. Conclusions: The presence of granular appearance in lymph nodes by EBUS had the highest specificity (99.3%) for the diagnosis of sarcoidosis. Lymph nodes having distinct margins tend to suggest sarcoidosis. PMID:25485271

  17. Assessment of lymph node involvement in colorectal cancer

    PubMed Central

    Ong, Mark L H; Schofield, John B

    2016-01-01

    Lymph node metastasis informs prognosis and is a key factor in deciding further management, particularly adjuvant chemotherapy. It is core to all contemporary staging systems, including the widely used tumor node metastasis staging system. Patients with node-negative disease have 5-year survival rates of 70%-80%, implying a significant minority of patients with occult lymph node metastases will succumb to disease recurrence. Enhanced staging techniques may help to identify this subset of patients, who might benefit from further treatment. Obtaining adequate numbers of lymph nodes is essential for accurate staging. Lymph node yields are affected by numerous factors, many inherent to the patient and the tumour, but others related to surgical and histopathological practice. Good lymph node recovery relies on close collaboration between surgeon and pathologist. The optimal extent of surgical resection remains a subject of debate. Extended lymphadenectomy, extra-mesenteric lymph node dissection, high arterial ligation and complete mesocolic excision are amongst the surgical techniques with plausible oncological bases, but which are not supported by the highest levels of evidence. With further development and refinement, intra-operative lymphatic mapping and sentinel lymph node biopsy may provide a guide to the optimum extent of lymphadenectomy, but in its present form, it is beset by false negatives, skip lesions and failures to identify a sentinel node. Once resected, histopathological assessment of the surgical specimen can be improved by thorough dissection techniques, step-sectioning of tissue blocks and immunohistochemistry. More recently, molecular methods have been employed. In this review, we consider the numerous factors that affect lymph node yields, including the impact of the surgical and histopathological techniques. Potential future strategies, including the use of evolving technologies, are also discussed.

  18. Pulmonary artery CTA.

    PubMed

    Schoepf, U Joseph

    2006-12-01

    The latest with the introduction of multidetector row computed tomography (MDCT), CT has been firmly established as the modality of choice for imaging the pulmonary arteries, particularly as the de facto first line test for imaging patients with suspected acute pulmonary embolism (PE). Before the introduction of MDCT, remaining concerns regarding CTs accuracy for diagnosis of isolated peripheral emboli had prevented the unanimous acceptance of this test as the reference standard for imaging PE. After a decade of uncertainty, there is now conclusive evidence that CT, if positive, provides reliable confirmation of the presence of PE and, more importantly, if negative effectively rules out clinically significant PE. Current endeavors to streamline and facilitate workflow for CT diagnosis of PE will further improve the acceptance, utility, and importance of this test. Examples include improvements in workflow, CT derivation of right ventricular function parameters for triage and prognostication of patients with acute PE and the comprehensive assessment of patients with acute chest pain for PE, coronary disease, aortic disease, and pulmonary disease by means of a single, contrast enhanced, ECG-synchronized CT scan. Although the diagnosis or exclusion of acute PE is the most common and important application of CT pulmonary angiography, the ease of scan acquisition and the high spatial resolution of modern CT techniques make this test ideally suited for the greatest majority of congenital and acquired, acute and chronic disorders of the pulmonary arteries. PMID:17709083

  19. Fluorescence imaging to study cancer burden on lymph nodes

    NASA Astrophysics Data System (ADS)

    D'Souza, Alisha V.; Elliott, Jonathan T.; Gunn, Jason R.; Samkoe, Kimberley S.; Tichauer, Kenneth M.; Pogue, Brian W.

    2015-03-01

    Morbidity and complexity involved in lymph node staging via surgical resection and biopsy calls for staging techniques that are less invasive. While visible blue dyes are commonly used in locating sentinel lymph nodes, since they follow tumor-draining lymphatic vessels, they do not provide a metric to evaluate presence of cancer. An area of active research is to use fluorescent dyes to assess tumor burden of sentinel and secondary lymph nodes. The goal of this work was to successfully deploy and test an intra-nodal cancer-cell injection model to enable planar fluorescence imaging of a clinically relevant blue dye, specifically methylene blue along with a cancer targeting tracer, Affibody labeled with IRDYE800CW and subsequently segregate tumor-bearing from normal lymph nodes. This direct-injection based tumor model was employed in athymic rats (6 normal, 4 controls, 6 cancer-bearing), where luciferase-expressing breast cancer cells were injected into axillary lymph nodes. Tumor presence in nodes was confirmed by bioluminescence imaging before and after fluorescence imaging. Lymphatic uptake from the injection site (intradermal on forepaw) to lymph node was imaged at approximately 2 frames/minute. Large variability was observed within each cohort.

  20. Methamphetamine Use and Pulmonary Hypertension

    MedlinePLUS

    Methamphetamine Use Pulmonary & PH Hypertension Did you know that if you have used methamphetamines you are at risk for Pulmonary Hypertension? www. ... are made every year. PH in Association with Methamphetamine Use My doctor recently told me that I ...

  1. 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

  2. Pulmonary veno-occlusive disease

    MedlinePLUS

    ... difficulty breathing Pulmonary hypertension Right-sided heart failure (cor pulmonale) Coughing up blood ... Channick RN, Rubin LJ. Pulmonary hypertension. In: Mason RJ, ... Nadel's Textbook of Respiratory Medicine . 5th ed. Philadelphia, ...

  3. Low thoracic epidural anaesthesia for elective cholecystectomy in a patient with congenital heart disease and pulmonary hypertension.

    PubMed

    Mallampati, S R

    1983-01-01

    A 52-year-old male with pulmonary hypertension secondary to partial anomalous pulmonary venous return unassociated with atrial septal defect was given thoracic epidural anaesthesia for elective cholecystectomy. Partial anomalous pulmonary venous return is a rare congenital anomaly characterized by increased pulmonary blood flow which in severe cases results in pulmonary hypertension subjecting the right ventricle to strain. An epidural catheter was placed at the T11-T12 interspace and anaesthesia was established to the T4 dermatomal level with bupivacaine (180 mg) and lidocaine (100 mg). Central venous pressure, pulmonary artery pressure, radial artery pressure, and cardiac output were monitored. There was minimal change in pulmonary arterial pressure, although there was a significant drop in systemic arterial pressure. Thoracic epidural block is recommended for upper abdominal surgery in clinical situations with pulmonary hypertension. PMID:6824989

  4. Development of pulmonary vascular response to oxygen

    SciTech Connect

    Morin, F.C. III, Egan, E.A.; Ferguson, W.; Lundgren, C.E. )

    1988-03-01

    The ability of the pulmonary circulation of the fetal lamb to respond to a rise in oxygen tension was studied from 94 to 146 days of gestation. The unanesthetized ewe breathed room air at normal atmospheric pressure, followed by 100% oxygen at three atmospheres absolute pressure in a hyperbaric chamber. In eleven near-term lambs, fetal arterial oxygen tension (Pa{sub O{sub 2}}) increased from 25 to 55 Torr, which increased the proportion or right ventricular output distributed to the fetal lungs from 8 to 59%. In five very immature lambs fetal Pa{sub O{sub 2}} increased from 27 to 174 Torr, but the proportion of right ventricular output distributed to the lung did not change. In five of the near-term lambs, pulmonary blood flow was measured. For each measurement of the distribution of blood flow, approximately 8 {times} 10{sup 5} spheres of 15-{mu}m diameter, labeled with either {sup 153}Gd, {sup 113}Sn, {sup 103}Ru, {sup 95}Nb, or {sup 46}Sc were injected. It increased from 34 to 298 ml {center dot} kg fetal wt{sup {minus}1} {center dot} min{sup {minus}1}, an 8.8-fold increase. The authors conclude that the pulmonary circulation of the fetal lamb does not respond to an increase in oxygen tension before 101 days of gestation; however, near term an increase in oxygen tension alone can induce the entire increase in pulmonary blood flow that normally occurs after the onset of breathing at birth.

  5. [Pulmonary nodules and arachnophobia].

    PubMed

    Colinet, B; Dargent, J-L; Fremault, A

    2014-01-01

    Pulmonary nodules are a common reason for consultation and their investigation must always exclude a possible neoplastic cause. This means that, in addition to a thorough history, investigations may be necessary which are sometimes invasive and therefore potentially a cause of iatrogenic harm. The toxic aetiologies for pulmonary nodules are rare. We report a case of a patient with pulmonary nodules occurring predominantly in the right lung, about 1cm in diameter, non-cavitating without calcification, and sometimes surrounded by a peripheral halo. The nodules were a chance finding during preoperative evaluation. After a comprehensive review, a reaction to an inhaled irritant was the preferred hypothesis, specifically overuse of a compound insecticide containing, in addition to the propellant gas and solvent type hydrocarbon - a mixture of piperonyl butoxide, of esbiothrine and permethrin. Removal of this led to the complete disappearance of nodules. Pathological examination identified bronchiolitis obliterans with organising pneumonia accompanied by non-necrotizing granulomas and lipid vacuoles. PMID:24461445

  6. Gestational pulmonary arterial hypertension

    PubMed Central

    Moll, Matthew; Payne, Julie G.; Tukey, Melissa H.

    2015-01-01

    Abstract Pulmonary arterial hypertension (PAH) is a progressive disease marked by the irreversible pulmonary vascular changes of vasoconstriction, thrombosis, and proliferation of smooth muscle and endothelial cells. The untreated clinical course is characterized by progressive dyspnea and a median survival of less than 3 years. Many of these patients are of child-bearing age; however, pregnancy leads to physiologic changes that are particularly poorly tolerated in PAH, conferring a 30%56% mortality. We present a case of PAH that spontaneously resolved after termination of pregnancy and recurred during each of two subsequent pregnancies. To our knowledge, this case is unique, because no cases of spontaneous resolution of idiopathic PAH have been reported in adults, nor have there been any reports of pulmonary hypertension that is isolated to the gestational period. PMID:26697182

  7. Histopathological, lymphoscintigraphical, and immunological changes in the inguinal lymph nodes of rhesus monkeys during the early course of infection with Brugia malayi.

    PubMed

    Dennis, V A; Lasater, B L; Blanchard, J L; Lowrie, R C; Campeau, R J

    1998-06-01

    The relationship of the early lymphatic pathophysiological alterations with those of tissue inflammatory and cellular responses in the inguinal lymph nodes of Brugia malayi-infected rhesus monkeys was examined. Each of five animals was inoculated subcutaneously in the right calf with 200 third stage larvae (L3) and 5 weeks later, before the onset of patency [10 to 12 weeks postinoculation (PI)], their right inguinal nodes began to show signs of enlargement, becoming most prominent between weeks 10 to 16 PI. Histopathologically, the right nodes had eosinophilic lymphadenitis, lymphoid hyperplasia, and pronounced germinal centers. Lymphoscintigraphy using 99mTc-antimony trisulfide colloid showed pathophysiological alterations of the lymph flow rate in the right leg but not in the left leg at weeks 7 and 15 PI. In vitro blastogenesis to B. malayi antigens at week 10 PI showed the inguinal lymph node cells proliferated more vigorously than did peripheral blood cells early in infection. However, at week 24 PI both lymph node and peripheral blood cells proliferated to antigens. Flow cytometry showed an upregulation of HLA-DR+ lymphocytes in right lymph node cells from infected animals when compared to those from control animals. No changes in CD2, CD4, CD8, CD20, CD29, and CD45R cell numbers in lymph node of infected animals were seen when compared to control animals. Our results show that lymphatic pathology occurs early before the onset of patency, correlating with a marked tissue inflammatory and cellular responses of lymph node cells in B. malayi-infected rhesus monkeys. The rhesus could be an extremely useful model for understanding the evolution of pathology and pathogenesis of the disease. PMID:9635437

  8. Nomogram for predicting lymph node metastasis rate of submucosal gastric cancer by analyzing clinicopathological characteristics associated with lymph node metastasis

    PubMed Central

    Zheng, Zhixue; Zhang, Yinan; Zhang, Lianhai; Li, Ziyu; Wu, Aiwen; Wu, Xiaojiang; Liu, Yiqiang

    2015-01-01

    Background To combine clinicopathological characteristics associated with lymph node metastasis for submucosal gastric cancer into a nomogram. Methods We retrospectively analyzed 262 patients with submucosal gastric cancer who underwent D2 gastrectomy between 1996 and 2012. The relationship between lymph node metastasis and clinicopathological features was statistically analyzed. With multivariate logistic regression analysis, we made a nomogram to predict the possibility of lymph node metastasis. Receiver operating characteristic (ROC) analysis was also performed to assess the predictive value of the model. Discrimination and calibration were performed using internal validation. Results A total number of 48 (18.3%) patients with submucosal gastric cancer have pathologically lymph node metastasis. For submucosal gastric carcinoma, lymph node metastasis was associated with age, tumor location, macroscopic type, size, differentiation, histology, the existence of ulcer and lymphovascular invasion in univariate analysis (all P<0.05). The multivariate logistic regression analysis identified that age ?50 years old, macroscopic type III or mixed, undifferentiated type, and presence of lymphovascular invasion were independent risk factors of lymph node metastasis in submucosal gastric cancer (all P<0.05). We constructed a predicting nomogram with all these factors for lymph node metastasis in submucosal gastric cancer with good discrimination [area under the curve (AUC) =0.844]. Internal validation demonstrated a good discrimination power that the actual probability corresponds closely with the predicted probability. Conclusions We developed a nomogram to predict the rate of lymph node metastasis for submucosal gastric cancer. With good discrimination and internal validation, the nomogram improved individualized predictions for assisting clinicians to make appropriated treatment decision for submucosal gastric cancer patients. PMID:26752931

  9. Pulmonary air embolism.

    PubMed

    Souders, J E

    2000-01-01

    Pulmonary air embolism is a well-known consequence of surgery, trauma, diving, and aviation. This article reviews the physiological effects, means of detection and methods of prevention and treatment of pulmonary air embolism. The primary physiological effects are elevated pulmonary artery pressures, increased ventilation-perfusion inhomogeneity, and right ventricular failure. The degree of physiological impairment depends on the volume of gas entrained, the rate of entrainment, the type of gas entrained, and the position of the patient when the embolism occurs. Transesophageal echocardiography is the most sensitive method of detection, but it is invasive. Precordial Doppler ultrasound is almost as sensitive and poses no risk to the patient. End-tidal carbon dioxide monitoring is used on all patients and is a moderately sensitive method of detection, which is useful during surgeries that have a low incidence of air embolism. For high-risk procedures, precordial Doppler ultrasound and a multi-orifice right heart catheter should be used to detect and treat pulmonary air embolism. Prevention measures include volume expansion, careful positioning, positive end-expiratory pressure, military anti-shock trousers, and jugular venous compression. Treatment of pulmonary air embolism includes flooding the surgical site with saline, controlling sites of air entry, repositioning the patient with the surgical site below the right atrium, aspiration of air from a central venous catheter, cessation of inhaled nitrous oxide, and resuscitation with oxygen, intravenous fluids, and inotropic agents. Some hypotheses on the effects of air in the pulmonary vasculature and investigational treatment options are discussed. PMID:12580220

  10. Isolated pulmonary Langerhans cell histiocytosis.

    PubMed

    Varkki, Sneha; Tergestina, Mintoo; Bhonsle, Vaishali Sharad; Moses, Prabhakar D; Mathai, John; Korula, Sophy

    2013-08-01

    Isolated pulmonary involvement in Langerhans Cell Histiocytosis (LCH) is rare in childhood. The authors report a 6-y- old boy presenting with recurrent pneumothorax, whose CT thorax showed diffuse pulmonary cystic lucencies bilaterally. Biopsy of the lesions confirmed pulmonary LCH with Cd1a and S 100 positivity. PMID:23001923

  11. Pulmonary Langerhans Cell Histiocytosis: Case Series and Literature Review

    PubMed Central

    Wei, Ping; Lu, Hai-Wen; Jiang, Sen; Fan, Li-Chao; Li, Hui-Ping; Xu, Jin-Fu

    2014-01-01

    Abstract Pulmonary Langerhans cell histiocytosis (PLCH) is a rare disease with insidious onset and nonspecific manifestations. The objective of this article was to characterize the clinical manifestations and features of PLCH by retrospectively analyzing clinical data of patients with PLCH in addition to simultaneous review of literature. A retrospective analysis was conducted on clinical data of patients with PLCH (n?=?7), whose conditions were diagnosed by biopsy from pulmonary tissue (n?=?6) or enlarged lymph nodes in the neck (n?=?1) and confirmed by PLCH typical radiological features on computed tomography (CT) scan, between January 2001 and September 2012 at the Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China. The review of published reports was made to further emphasize the clinical manifestation and radiological features of PLCH. Long history of cigarette smoking was found in 6 patients. Two patients had recurrent pneumothorax and the other 2 had pulmonary arterial hypertension (World Health Organization group 5 pulmonary hypertension), diagnosed through ultrasonic cardiogram. The nodular shadows were revealed by chest CT scan in 5 patients, cystic shadows in 5 patients, and reticular shadows in 2 patients, as major manifestations, respectively; most of the lesions were located in the middle or upper segments of the lung. The obvious shrank of lesion was found in 1 patient after completely quitting smoking. The pathogenesis of PLCH might be closely associated with smoking. The cystic or nodular lesion was the typical radiological features. Further prospective studies with large sample size are required to further validate the study results and understand the clinical characteristics of PLCH to avoid misdiagnosis. PMID:25415669

  12. 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

  13. [Pulmonary Echinococcosis: Surgical Aspects].

    PubMed

    Eichhorn, M E; Hoffmann, H; Dienemann, H

    2015-10-01

    Pulmonary cystic echinococcosis is a very rare disease in Germany. It is caused by the larvae of the dog tapeworm (echinococcus granulosus). The liver is the most affected organ, followed by the lungs. Surgery remains the main therapeutic approach for pulmonary CE. Whenever possible, parenchyma-preserving lung surgery should be preferred over anatomic lung resections. To ensure best therapeutic results, surgery needs to be performed under precise consideration of important infectiological aspects and patients should be treated in specialised centres based on interdisciplinary consensus. In addition to surgical aspects, this review summarises special infectiological features of this disease, which are crucial to the surgical approach. PMID:26351761

  14. Bosentan for pulmonary hypertension secondary to idiopathic pulmonary fibrosis.

    PubMed

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

    2015-01-01

    Pulmonary hypertension is a poor prognostic factor in patients with interstitial lung disease. No established treatment exists for pulmonary hypertension secondary to interstitial pneumonia. We describe the case of an 81-year-old woman with idiopathic pulmonary fibrosis (IPF), who was admitted to our hospital due to aggravation of dyspnea and decreased oxygen saturation, as well as onset of orthopnea and rapidly progressing edema. The transthoracic echocardiography and right heart catheterization showed the mean pulmonary artery pressure was 39mmHg and the mean pulmonary capillary wedge pressure was 9mmHg. After various examinations, the diagnoses of pulmonary hypertension (PH) due to IPF and of congestive heart failure secondary to PH were established. Diuretic therapy was started, but the patient's condition showed poor improvement. Subsequent initiation of oral bosentan therapy led to improvement in symptoms and findings. At the follow-up assessment one year later her pulmonary function showed no significant changes and no apparent worsening of arterial blood gases, with evident improvement of PH, WHO functional class, maximum exercise tolerance on treadmill exercise testing, right heart catheterization, and transthoracic echocardiography. This report describes a case of successful treatment with bosentan for severe pulmonary hypertension in a patient with idiopathic pulmonary fibrosis. We also present a review of the literature on treatment of pulmonary hypertension in patients with chronic lung disease. Bosentan appears to be efficacious in some patients with pulmonary hypertension secondary to idiopathic interstitial pneumonitis. PMID:26029570

  15. Effects of sildenafil on hypoxic pulmonary vascular function in dogs.

    PubMed

    Fesler, Pierre; Pagnamenta, Alberto; Rondelet, Benoit; Kerbaul, François; Naeije, Robert

    2006-10-01

    Sildenafil has been shown to be an effective treatment of pulmonary arterial hypertension and is believed to present with pulmonary selectivity. This study was designed to determine the site of action of sildenafil compared with inhaled nitric oxide (NO) and intravenous sodium nitroprusside (SNP), known as selective and nonselective pulmonary vasodilators, respectively. Inhaled NO (40 ppm), and maximum tolerated doses of intravenous SNP and sildenafil, (5 microg x kg(-1) x min(-1) and 0.1 mg x kg(-1) x h(-1)), respectively, were administered to eight dogs ventilated in hypoxia. Pulmonary vascular resistance (PVR) was evaluated by pulmonary arterial pressure (Ppa) minus left atrial pressure (Pla) vs. flow curves, and partitioned into arterial and venous segments by the occlusion method. Right ventricular hydraulic load was defined by pulmonary arterial characteristic impedance (Zc) and elastance (Ea) calculations. Right ventricular arterial coupling was estimated by the ratio of end-systolic elastance (Ees) to Ea. Decreasing the inspired oxygen fraction from 0.4 to 0.1 increased Ppa - Pla at a standardized flow of 3 l x min(-1) x m(-2) from 6 +/- 1 to 18 +/- 1 mmHg (mean +/- SE). Ppa - Pla was decreased to 9 +/- 1 by inhaled NO, 14 +/- 1 by SNP, and 14 +/- 1 mmHg by sildenafil. The partition of PVR, Zc, Ea, and Ees/Ea was not affected by the three interventions. Inhaled NO did not affect systemic arterial pressure, which was similarly decreased by sildenafil and SNP, from 115 +/- 4 to 101 +/- 4 and 98 +/- 5 mmHg, respectively. We conclude that inhaled NO inhibits hypoxic pulmonary vasoconstriction more effectively than sildenafil or SNP, and sildenafil shows no more selectivity for the pulmonary circulation than SNP. PMID:16778005

  16. Breast Cancer Subtype is Associated With Axillary Lymph Node Metastasis

    PubMed Central

    He, Zhen-Yu; Wu, San-Gang; Yang, Qi; Sun, Jia-Yuan; Li, Feng-Yan; Lin, Qin; Lin, Huan-Xin

    2015-01-01

    Abstract The purpose of this study was to assess whether breast cancer subtype (BCS) as determined by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 can predict the axillary lymph node metastasis in breast cancer. Patients who received breast conserving surgery or mastectomy and axillary lymph node dissection were identified from 2 cancer centers. The associations between clinicopathological variables and axillary lymph node involvement were evaluated in univariate and multivariate regression analyses. A total of 3471 patients met the inclusion criteria, and 53.0% had axillary lymph node metastases at diagnosis. Patients with hormone receptor (HR)?/human epidermal growth factor receptor 2 (HER2)? subtype had a higher grade disease and the lowest rate of lymphovascular invasion. Univariate and multivariable logistic regression analyses showed that BCS was significantly associated with lymph node involvement. Patients with the HR?/HER2? subtype had the lowest odds of having nodal positivity than those with other BCSs. HR+/HER2? (odds ratio [OR] 1.651, 95% confidence interval [CI]: 1.3492.021, P?lymph node metastasis in breast cancer. HR?/HER2? is associated with a reduced risk of axillary lymph node metastasis compared to other BCSs. Our findings may play an important role in guiding axillary treatment considerations if further confirmed in larger sample size studies. PMID:26632910

  17. 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

  18. Acute pulmonary embolism decreases adenosine plasma levels in anesthetized pigs.

    PubMed

    Kerbaul, Franois; By, Youlet; Gariboldi, Vlad; Mekkaoui, Choukri; Fesler, Pierre; Collart, Frdric; Brimioulle, Serge; Jammes, Yves; Ruf, Jean; Guieu, Rgis

    2011-01-01

    Adenosine plays a role in pulmonary arterial (PA) resistance due to its vasodilator properties. However, the behavior of adenosine plasma levels (APLs) during pulmonary embolism remains unknown. We investigated the effects of gradual pulmonary embolism on right ventricular (RV) contractility and PA coupling and on APLs in an piglet experimental model of RV failure. PA distal resistance by pressure-flow relationships and pulmonary vascular impedance were measured. RV contractility was determined by the end-systolic pressure-volume relationship (Ees), PA effective elastance by the end-diastolic to end-systolic relationship (Ea), and RV-PA coupling efficiency by the Ees/Ea ratio. APLs were measured before and during gradual pulmonary embolization. PA embolism increased PA resistance and elastance, increased Ea from 1.08 0.15 to 5.62 0.32?mmHg/mL, decreased Ees from 1.82 0.10 to 1.20 0.23?mmHg/mL, and decreased Ees/Ea from 1.69 0.15 to 0.21 0.07. APLs decreased from 2.7 0.26 to 1.3 0.12??M in the systemic bed and from 4.03 0.63 to 2.51 0.58??M in the pulmonary bed during embolism procedure. Pulmonary embolism worsens PA hemodynamics and RV-PA coupling. APLs were reduced, both in the systemic and in the pulmonary bed, leading then to pulmonary vasoconstriction. PMID:22347654

  19. Schwannoma of the pulmonary artery.

    PubMed

    Elstner, Kristen; Granger, Emily; Wilson, Stephanie; Kumaradevan, Nirmala; Chew, Melvin; Harris, Craig

    2013-03-01

    Schwannoma (neurilemmoma) originating from the pulmonary artery has not before been described. A 65 year-old male presented with dyspnoea on exertion. CT scan was negative for pulmonary thromboembolism, but showed a well circumscribed, heterogeneous mass, 52 mm 45 mm 41 mm, straddling the left pulmonary artery and compressing the left atrium. The mass was found at surgery to be originating from the lateral wall of the left pulmonary artery. The tumour was completely resected, and the pulmonary artery reconstructed. The mass was found to be a benign schwannoma on histopathology. PMID:22883626

  20. Pulmonary hypertension and hepatic cirrhosis.

    PubMed

    Téllez Villajos, L; Martínez González, J; Moreira Vicente, V; Albillos Martínez, A

    2015-01-01

    Pulmonary hypertension is a relatively common phenomenon in patients with hepatic cirrhosis and can appear through various mechanisms. The most characteristic scenario that binds portal and pulmonary hypertension is portopulmonary syndrome. However, hyperdynamic circulation, TIPS placement and heart failure can raise the mean pulmonary artery pressure without increasing the resistances. These conditions are not candidates for treatment with pulmonary vasodilators and require a specific therapy. A correct assessment of hemodynamic, ultrasound and clinical variables enables the differential diagnosis of each situation that produces pulmonary hypertension in patients with cirrhosis. PMID:25862424

  1. Criteria for diagnosis of exercise pulmonary hypertension.

    PubMed

    Herve, Philippe; Lau, Edmund M; Sitbon, Olivier; Savale, Laurent; Montani, David; Godinas, Laurent; Lador, Frederic; Jas, Xavier; Parent, Florence; Gnther, Sven; Humbert, Marc; Simonneau, Gerald; Chemla, Denis

    2015-09-01

    The previous definition of exercise pulmonary hypertension (PH) with a mean pulmonary artery pressure (mPAP) >30?mmHg was abandoned because healthy individuals can exceed this threshold at high cardiac output (CO). We hypothesised that incorporating assessment of the pressure-flow relationship using the mPAP/CO ratio, i.e. total pulmonary resistance (TPR), might enhance the accuracy of diagnosing an abnormal exercise haemodynamic response.Exercise haemodynamics were evaluated in 169 consecutive subjects with normal resting mPAP ?20?mmHg. Subjects were classified into controls without heart or lung disease (n=68) versus patients with pulmonary vascular disease (PVD) (n=49) and left heart disease (LHD) (n=52).TPR and mPAP at maximal exercise produced diagnostic accuracy with area under the receiver operating curve of 0.99 and 0.95, respectively, for discriminating controls versus patients with PVD and LHD. The old criterion of mPAP >30?mmHg had sensitivity of 0.98 but specificity of 0.77. Combining maximal mPAP >30?mmHg and TPR >3?mmHgminL(-1) retained sensitivity at 0.93 but improved specificity to 1.0. The accuracy of the combined criteria was high across different age groups, sex, body mass index and diagnosis (PVD or LHD).Combining mPAP >30?mmHg and TPR >3?mmHgminL(-1) is superior to mPAP >30?mmHg alone for defining a pathological haemodynamic response of the pulmonary circulation during exercise. PMID:26022955

  2. Primary Pulmonary Hodgkin Lymphoma

    PubMed Central

    Tanveer, Shumaila; El Damati, Ahmed; El Baz, Ayman; Alsayyah, Ahmed; ElSharkawy, Tarek

    2015-01-01

    Primary pulmonary Hodgkin lymphoma (PPHL) is a rare disease. Herein, we report a case of PPHL with diagnostic concerns encountered during initial evaluation which is of paramount importance to keep the differential diagnosis in cases with high index of suspicion for this rare entity. PMID:26788271

  3. Primary Pulmonary Hodgkin Lymphoma.

    PubMed

    Tanveer, Shumaila; El Damati, Ahmed; El Baz, Ayman; Alsayyah, Ahmed; ElSharkawy, Tarek; Regal, Mohamed

    2015-12-29

    Primary pulmonary Hodgkin lymphoma (PPHL) is a rare disease. Herein, we report a case of PPHL with diagnostic concerns encountered during initial evaluation which is of paramount importance to keep the differential diagnosis in cases with high index of suspicion for this rare entity. PMID:26788271

  4. Cavitation of pulmonary metastases.

    PubMed

    Wolpowitz, A

    1975-02-01

    Although cavitation of pulmonary metastases is not as frequent as that of primary involvement, it should always be considered in the differential diagnosis of multiple cavitary lesions. The most frequent cause is squamous cell carcinoma, but it is by no means confined to this type of pathology. PMID:1124450

  5. An unexpected pulmonary bystander.

    PubMed

    Wouthuyzen-Bakker, M; Vorm, P A; Koning, K J; van der Werf, T S

    2016-01-01

    A 30-year-old man from Eritrea was admitted with a pulmonary bacterial abscess. Unexpectedly, histopathology of the resected lobe also revealed an infection with Schistosoma mansoni with surrounding granulomatous tissue and fibrosis. Patients from endemic areas are often asymptomatic with blood eosinophilia being the only diagnostic clue. Early recognition is important as ongoing fibrosing inflammation may result in organ damage. PMID:26819361

  6. [Pulmonary hypertension and pregnancy].

    PubMed

    Valds, Gloria; Matthei, Robert; Fernndez, Mara Soledad; Schacht, Carmen; Corthorn, Jenny; German, Alfredo M

    2002-02-01

    A 36 year old woman, with an 18 year history of syncope, became pregnant shortly after a cardiac catheterization demonstrated a high pulmonary arterial pressure and resistance and a low cardiac output. During pregnancy she remained stable at NYHA FC III, on nifedipine, apresoline, isosorbide, aspirin and bed rest. At 28 weeks, catheterization showed a decreased pulmonary pressure and an increased cardiac output. At 38 weeks, she was submitted to an elective caesarean section, and delivered a healthy newborn of 2820 g. After 5 months, her catheterization showed a pulmonary artery pressure similar to the pre-pregnancy study. Her condition deteriorated, leading to death 10 months later. Urinary 6-keto-PGF1[symbol: see text], nitrates/nitrites, kallikrein and angiotensin-(1-7) were increased from 13 to 33 weeks, to drop in week 35 of pregnancy. The safe maternal and fetal outcome, and the intragestational hemodynamic improvement are attributed to a close multidisciplinary surveillance, and to the effects of the endogenous vasodilators of pregnancy on the reversible component of the pulmonary hypertension. Reports in the literature show a decrease in maternal mortality rate, from 56% for the period previous to 1963, to 34 and 30% for those spanning between 1978-1996 y 1997-2001 respectively. PMID:11974533

  7. [Pulmonary embolism diagnosis].

    PubMed

    Castaño, João; Alpendre, João; Pisco, João Martins

    2003-01-01

    Pulmonary Embolism is often considered a difficult diagnosis to establish. It is important to recognise clinical situations that leads to it. There are a few laboratory and imaging tests, that should be tailored to the available facilities in each institution. PMID:14685638

  8. Heart and unilateral lung transplantation for cardiomyopathy with high pulmonary vascular resistance.

    PubMed

    da Silva, J P; Vila, J H; Cascudo, M M; Baumgratz, J F; Saraiva, P A; Netto, C D

    1992-04-01

    Heart and left lung (en bloc) transplantation was used as an approach to end-stage cardiomyopathy with very high pulmonary vascular resistance. This surgical method was applied to a 13-year-old girl who did very well initially, but died 5 months later of severe pulmonary and cardiac rejection. The pulmonary perfusion scintigraphy showed equalization of the blood flow in both lungs after 42 days, and complete reversal of the pulmonary vascular changes in the opposite lung was observed at autopsy. PMID:1554287

  9. Right Aortic Arch Detected Prenatally: A Rare Case With Bilateral Arterial Duct and Nonconfluent Pulmonary Arteries.

    PubMed

    Ricci, Silvia; Fainardi, Valentina; Spaziani, Gaia; Favilli, Silvia; Chiappa, Enrico

    2015-09-01

    We describe a rare case of right aortic arch (RAA) and nonconfluent pulmonary arteries. RAA and a right-sided arterial duct (AD) were identified on the prenatal scan, but a second left-sided AD and disconnection of the left pulmonary artery were missed. The missed diagnosis in fetal life adversely affected postnatal management. We suggest that fetuses with a prenatal diagnosis of RAA and right-sided AD be delivered in tertiary care centres to rule out an association with bilateral AD and nonconfluent pulmonary arteries after birth. Prompt postnatal diagnosis will enable preservation of flow in the disconnected pulmonary artery through prostaglandin E1 infusion until surgical reconstruction. PMID:26118445

  10. Lymph node cortical sinus organization and relationship to lymphocyte egress dynamics and antigen exposure

    PubMed Central

    Grigorova, Irina L.; Panteleev, Mikhail; Cyster, Jason G.

    2010-01-01

    Recent studies have identified cortical sinuses as sites of sphingosine-1-phosphate receptor-1 (S1P1)-dependent T- and B-cell egress from the lymph node (LN) parenchyma. However, the distribution of cortical sinuses in the entire LN and the extent of lymph flow within them has been unclear. Using 3D reconstruction and intravital two-photon microscopy we describe the branched organization of the cortical sinus network within the inguinal LN and show that lymphocyte flow begins within blunt-ended sinuses. Many cortical sinuses are situated adjacent to high endothelial venules, and some lymphocytes access these sinuses within minutes of entering a LN. However, upon entry to inflamed LNs, lymphocytes rapidly up-regulate CD69 and are prevented from accessing cortical sinuses. Using the LN reconstruction data and knowledge of lymphocyte migration and cortical sinus entry dynamics, we developed a mathematical model of T-cell egress from LNs. The model suggests that random walk encounters with lymphatic sinuses are the major factor contributing to LN transit times. A slight discrepancy between predictions of the model and the measured transit times may be explained by lymphocytes undergoing a few rounds of migration between the parenchyma and sinuses before departing from the LN. Because large soluble antigens gain rapid access to cortical sinuses, such parenchymasinus shuttling may facilitate antibody responses. PMID:21059923

  11. Spontaneous fibrinolysis in pulmonary embolism

    PubMed Central

    Wilson, James E.; Frenkel, Eugene P.; Pierce, Alan K.; Johnson, Robert L.; Winga, Edward R.; Curry, George C.; Mierzwiak, Donald S.

    1971-01-01

    This study correlated levels of activated fibrinolysis with the presence, extent, and rate of resolution of angiographically documented pulmonary emboli. Pulmonary emboli demonstrable by angiography were associated with detectable fibrin split products in the serum of 24 of 25 patients. In the absence of increased fibrin split products, pulmonary emboli large enough to be demonstrated by angiography were found in only 2 of 25 positive pulmonary angiograms. Spontaneous resolution of pulmonary emboli could not be correlated with the the concentration or persistence of fibrin split products but did correlate well with the presence of a reversible precipitating cause. Thrombophlebitis in the absence of clinical evidence of pulmonary embolism was not associated with increased concentrations of fibrin split products in eight of nine patients. The one patient with increased fibrin split product concentration had evidence on lung scan of silent pulmonary embolism. PMID:5101775

  12. Echocardiographic Assessment of Pulmonary Arteries Pulsatility Index in Fontan Circulation

    PubMed Central

    Shabanian, Reza; Dadkhah, Minoo; Hosseini, Mehdi; Rahimzadeh, Mitra; Akbari Asbagh, Parvin; Navabi, Mohammad Ali

    2015-01-01

    Background Late complications after Fontan procedure may be due to the absence of pump and pulsatile pulmonary blood flow in this type of palliation. Our aim was to quantify the degree of pulsation by echocardiographic method in patients with extracardiac total cavopulmonary connection (ECTCPC) in comparison with biventricular circulation and few cases of pulsatile Fontan. Methods In a case series study, pulsatility index (PI) derived by echocardiographic method were compared between 20 patients with ECTCPC, 6 patients with pulsatile Fontan and 18 normal individual aged 4 to 20 years old. All patients were in New York Heart Association class of I and there was no report of complication. Results In patients with ECTCPC pulmonary artery branches Doppler flow study showed lower peak and mean velocities compared to the pulsatile Fontan and normal groups. ECTCPC patients had PI of 0.59 0.14 and 0.59 0.09 for right and left pulmonary arteries (RPA and LPA) respectively. PI was higher in patients with preserved antegrade flow (RPA PI = 0.94 0.26, LPA PI = 0.98 0.27) and in normal individuals (RPA PI = 1.59 0.12, LPA PI = 1.64 0.17) for both branches (p = 0.000). Conclusion Using a Doppler derived index for pulsatility, patients with ECTCPC had the least pulsation. The pulmonary artery flow pattern in patients with preserved antegrade flow showed higher pulsatility indices in both branches. Normal individuals had the greatest pulsatility index. PMID:26755931

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

    PubMed Central

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

    2015-01-01

    Purpose To investigate the coverage of axillary lymph node with tangential breast irradiation fields by using virtual lymph node (LN) analysis. Materials and Methods Forty-eight women who were treated with whole breast irradiation after breast-conserving surgery were analyzed. The axillary and breast volumes were delineated according to the Radiation Therapy Oncology Group (RTOG) contouring atlas. To generate virtual LN contours, preoperative fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans with identifiable LN were fused with the CT scans, and the virtual LN contour were delineated on the CT. Results The median level I and II axillary volume coverage percentages at the VD95% line were 33.5% (range, 5.3% to 90.4%) and 0.6% (range, 0.0% to 14.6%), respectively. Thirty-one LNs in 18 patients were delineated (26 in level I and 5 in level II). In the level I axilla, 84.6% of virtual LNs were encompassed by the 95% isodose line. In the level II axilla, by contrast, none of the virtual LNs were encompassed by the 95% isodose volumes. There was a substantial discrepancy between the RTOG contouring atlas-based axillary volume analysis and the virtual LN analysis, especially for the level I axillary coverage. The axillary volume coverage was associated with the body mass index (BMI) and breast volume. Conclusion The tangential breast irradiation did not deliver adequate therapeutic doses to the axillary region, particularly those in the level II axilla. Patients with small breast volumes or lower BMI showed reduced axillary coverage from the tangential breast fields. For axillary LN irradiation, individualized anatomy-based radiation fields for patients would be necessary. PMID:25874178

  14. Pulmonary rehabilitation for COPD.

    PubMed

    Reardon, Jane; Casaburi, Richard; Morgan, Michael; Nici, Linda; Rochester, Carolyn

    2005-12-01

    Pulmonary rehabilitation is a therapeutic process, which entails taking a holistic approach to the welfare of the patient with chronic respiratory illness--most commonly chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation is considered essential throughout the lifetime management of patients with symptomatic chronic respiratory disease. It requires the coordinated action of a multidisciplinary healthcare team in order to deliver an individualised rehabilitation programme to best effect--incorporating multiple modalities, such as advice on smoking cessation, exercise training and patient self-management education, among others. As core components of pulmonary rehabilitation, exercise training and self-management education have been shown to be beneficial in improving health-related quality of life (HRQoL) in patients with chronic respiratory disease. Physical training can help to reduce the muscle de-conditioning that occurs when the activity of patients is restricted by their breathlessness and fatigue, and is often associated with an increase in patient HRQoL. HRQoL can also be improved by the use of self-management education, which is designed to provide the patient with the skills to manage the health consequences of their disease. In doing so, patients are better able to cope with disease symptoms, potentially leading to reduced healthcare costs. A great deal of research has been conducted to try and fully define which patients will benefit most from pulmonary rehabilitation. Although progress has been made, many questions remain as to the best means of delivering rehabilitation, particularly with respect to the optimum programme of physical training and patient self-management education. PMID:16253495

  15. Occurrence of salmonella in the ileum, ileocolic lymph nodes, tonsils, mandibular lymph nodes and carcasses of pigs slaughtered for consumption.

    PubMed

    Vieira-Pinto, M; Temudo, P; Martins, C

    2005-12-01

    This study evaluates the occurrence of Salmonella in pork carcasses and in some risk tissues (ileum, ileocolic and mandibular lymph nodes and tonsils), that can be involved in Salmonella contamination during slaughter. Salmonella was identified in 27 (26.7%) pigs and in 13 (12.9%) carcasses. From these positive carcasses, 69.2% presented the same serotype as that identified in the corresponding pig, which emphasize the pigs importance as a source of Salmonella during the slaughter, suggesting that measures should be taken at the level of pig production in order to reduce the slaughtering of Salmonella-positive animals. The highest value of Salmonella occurrence was reached in the ileocolic lymph nodes (18.8%) and in the ileum (13.9%), representing Salmonella potential faecal source during pork processing at the abattoir. In these samples, a high level of Salmonella was observed in the ileocolic lymph nodes in comparison with the ileum. The mandibular lymph nodes (12.9%) also presented a higher occurrence in comparison with the tonsils (9.9%). These results indicate that the lymph nodes analysis could be more sensitive in the detection of Salmonella than the closer drainage tissue. Otherwise, the presence of Salmonella in the lymph nodes indicates lymphatic spread of the organism, which reflects an increased risk of pork contamination. These results also indicate that, in order to achieve a better control of Salmonella contamination during the slaughter process, it is important to consider the improvement of the evisceration practices and the tonsils as well the extraction of mandibular lymph nodes after slaughter. PMID:16364024

  16. Modeling lymphocyte homing and encounters in lymph nodes

    PubMed Central

    2009-01-01

    Background The efficiency of lymph nodes depends on tissue structure and organization, which allow the coordination of lymphocyte traffic. Despite their essential role, our understanding of lymph node specific mechanisms is still incomplete and currently a topic of intense research. Results In this paper, we present a hybrid discrete/continuous model of the lymph node, accounting for differences in cell velocity and chemotactic response, influenced by the spatial compartmentalization of the lymph node and the regulation of cells migration, encounter, and antigen presentation during the inflammation process. Conclusion Our model reproduces the correct timing of an immune response, including the observed time delay between duplication of T helper cells and duplication of B cells in response to antigen exposure. Furthermore, we investigate the consequences of the absence of dendritic cells at different times during infection, and the dependence of system dynamics on the regulation of lymphocyte exit from lymph nodes. In both cases, the model predicts the emergence of an impaired immune response, i.e., the response is significantly reduced in magnitude. Dendritic cell removal is also shown to delay the response time with respect to normal conditions. PMID:19939270

  17. Proteome changes in mesenteric lymph induced by sepsis.

    PubMed

    Zhang, Ping; Li, Yan; Zhang, Lian-Dong; Wang, Liang-Hua; Wang, Xi; He, Chao; Lin, Zhao-Fen

    2014-12-01

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

  18. Automatic mediastinal lymph node detection in chest CT

    NASA Astrophysics Data System (ADS)

    Feuerstein, Marco; Deguchi, Daisuke; Kitasaka, Takayuki; Iwano, Shingo; Imaizumi, Kazuyoshi; Hasegawa, Yoshinori; Suenaga, Yasuhito; Mori, Kensaku

    2009-02-01

    Computed tomography (CT) of the chest is a very common staging investigation for the assessment of mediastinal, hilar, and intrapulmonary lymph nodes in the context of lung cancer. In the current clinical workflow, the detection and assessment of lymph nodes is usually performed manually, which can be error-prone and timeconsuming. We therefore propose a method for the automatic detection of mediastinal, hilar, and intrapulmonary lymph node candidates in contrast-enhanced chest CT. Based on the segmentation of important mediastinal anatomy (bronchial tree, aortic arch) and making use of anatomical knowledge, we utilize Hessian eigenvalues to detect lymph node candidates. As lymph nodes can be characterized as blob-like structures of varying size and shape within a specific intensity interval, we can utilize these characteristics to reduce the number of false positive candidates significantly. We applied our method to 5 cases suspected to have lung cancer. The processing time of our algorithm did not exceed 6 minutes, and we achieved an average sensitivity of 82.1% and an average precision of 13.3%.

  19. Analysis of the movement of calcified lymph nodes during breathing

    SciTech Connect

    Jenkins, Peter . E-mail: peter.jenkins@glos.nhs.uk; Salmon, Clare; Mannion, Cathy

    2005-02-01

    Purpose: To identify and measure the respiratory-induced movement of calcified mediastinal lymph nodes. Methods and materials: Twenty-one patients receiving radiation therapy for primary lung or pleural tumors were noted to have calcification within one or more mediastinal lymph nodes. The breathing motion of 27 such nodes was measured with orthogonal fluoroscopic imaging during quiet respiration. Results: All 27 nodes showed some motion synchronous with breathing. The mean respiratory movement was 6.6 mm, 2.6 mm, and 1.4 mm in the craniocaudal, dorsoventral, and mediolateral planes, respectively. There was a significant difference in the amplitude of motion in the craniocaudal plane compared with movement in the other two directions (p < 0.001). No differences were seen in the movement of lymph nodes dependent on position within the mediastinum (supracarinal vs. infracarinal or hilar vs. mediastinal). Neither size of the primary tumor nor spirometric parameters were correlated with the amplitude of lymph node movement. Conclusions: Mediastinal lymph nodes move during breathing, and this needs to be accounted for when the internal margin component of the PTV is defined. The amplitude of this movement is anisotropic and seems to be less than that reported for primary lung tumors. This should permit a modest reduction in the margin allowed for breathing movement around involved mediastinal nodes, particularly in the mediolateral and dorsoventral planes.

  20. Papillary thyroid carcinoma with thyroiditis: lymph node metastasis, complications

    PubMed Central

    Choi, Hye-Jeong; Kim, Eun Sook

    2013-01-01

    Purpose The aim of this study was to evaluate the clinicopathologic characteristics of papillary thyroid cancer with thyroiditis, and to determine the rate of its complications for it. Methods A retrospective review of 1,247 patients with papillary thyroid cancer who underwent primary thyroidectomy was performed. Among them, 316 patients had thyroiditis (group I) while 931 patients had no thyroiditis (group II), as reflected in the final pathologic reports. The two groups' clinicopathologic results and rate of complications were compared. Results Female gender, preoperative hypothyroidism, total thyroidectomy, no extrathyroid extension, no lymphovascular invasion, and no perineural invasion were associated with group I. More central lymph nodes were removed in group I than in group II, but there were fewer central lymph nodes with metastasis in group I than in group II. For the lateral lymph nodes, the two groups had the same numbers of removed nodes and nodes with metastatic tumor. Multivariate analysis revealed female predominance, more cases of preoperative hypothyroidism, more dissected lymph nodes, and fewer lymph nodes with metastasis in group I. Among the patients who underwent lobectomy, postoperative hypothyroidism occurred more in group I than in group II (P < 0.001). There was no difference in postoperative complications between the two groups. Conclusion Papillary thyroid cancer with thyroiditis showed less aggressive features. Postoperative hypothyroidism occurred more in the patients with thyroiditis. PMID:23833756

  1. Immunomorphologic lymph node changes in rats bearing experimental breast tumors.

    PubMed Central

    Ciocca, D. R.

    1980-01-01

    In this paper regional lymph nodes draining tumors and also nonregional lymph nodes have been studied at the light- and electron-microscopic levels. These nodes were obtained from rats bearing long-evolving autochthonous breast cancers. They were compared with a control group of the same age. A morphometric quantitative analysis was done to evaluate immunologically competent cell populations. In the experimental group there were no differences between regional and distal lymph nodes in the tumor challenge. However, when the experimental group was compared with the control group, differences appeared. The changes involved were diminution of the paracortical area with stimulation of plasma cells in the medullary cords. Ultrastructurally, in lymph nodes of the experimental group there were lymphoblasts in the paracortex and germinal centers, suggesting active lymphopoiesis. In addition, many plasma cells showed morphologic evidence of involution or other alterations. It is suggested that regional and distal lymph nodes have similar morphologic behavior when the tumor grows for a long period of time, a finding that contributes to our knowledge of the systemic implications of the lymphatic system. Images Figure 3 Figure 4 Figure 1 Figure 2 PMID:6965822

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

    PubMed

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

    2014-11-01

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

  3. Pulmonary banding complicated by low origin of right pulmonary artery.

    PubMed Central

    Galinanes, M; Stanley, P; Gurin, R; Kratz, C; Chartrand, C

    1993-01-01

    In our attempt to band the main pulmonary artery above the valve in a 4-month-old prematurely born infant, we erroneously banded only the left pulmonary artery, owing to the unusually low origin of the right pulmonary artery (which arose partially in the sinus of Valsalva). When severe cardiac failure recurred, the anomaly was noted upon reoperation and the band was repositioned at the level of the pulmonary valve. Since this revision, the postoperative course has been good. Low origin of the right pulmonary artery is normal in premature infants. However, origin of the right pulmonary artery from the sinus of Valsalva is a sufficiently extreme variant to constitute a surgically important anomaly. Our postmortem studies of the pulmonary arteries of 25 premature infants born without cardiac malformation showed that while the right pulmonary artery was lower than the left, it never originated from the sinus of Valsalva. This anomalous configuration of the pulmonary arteries has, to our knowledge, never been found in an infant as old as 4 months; yet we believe it should be taken into account when banding pulmonary arteries in infants. Images PMID:8219829

  4. Pulmonary functions in air conditioner users.

    PubMed

    Khaliq, Farah; Sharma, Sameer; Tandon, O P

    2006-01-01

    Air conditioning may affect human health since it has profound effect on our environment, than just lowering temperature. The present study was planned to assess the effect of air conditioners (AC) on pulmonary functions in young healthy non-smoker males. The study group comprised of ten subjects who were using AC's in their cars for at least 1 hr daily since last 6 months. While ten subjects who did not use AC at all served as controls. The pulmonary functions were assessed using PK Morgan 232 spirometer in a closed room. The peak expiratory flow rate (PEFR) and Forced expiratory flow between 25-75% of vital capacity (FEF25-75) were significantly reduced in subjects using car AC's. Inspiratory flow rates also showed a trend towards decline in AC users but could not reach the level of significance. The lung volumes and capacities were not significantly different in the two groups except for forced expiratory volume in 0.5 sec (FEV 0.5 sec), which also decreased in AC users. The airway resistance and lung compliance did not show significant change. In the presence of normal FEV1, reduced FEF25-75% which is the flow rate over the middle half of vital capacity, is an evidence of mild airflow limitation. The result is suggestive of predisposition of AC users towards respiratory disorders in form of mild airflow restriction. PMID:16850906

  5. Laser speckle flow velocity sensor for functional biomicroscopy

    NASA Astrophysics Data System (ADS)

    Fedosov, Ivan V.; Galanzha, Ekateryna I.; Solov'eva, Anastasiya V.; Stepanova, Tatyana V.; Brill, Gregory E.; Tuchin, Valery V.

    2002-07-01

    Laser speckle based direction sensitive flow velocity sensor has been developed for use with transmission microscope for in vivo bioflow monitoring. The instrument allows for measurements of blood and lymph flow parameters in micro vessels simultaneously with biomicroscopic measurements. The performance of the instrument was tested using the model of lymph micro vessel and was illustrated by the results of in vivo experiments on micro vessels of rat mesentery.

  6. 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.

  7. 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. )

    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.

  8. Pulmonary functions in workers of fertiliser and chemical industry.

    PubMed

    Geetha, B; Nair, R H; Kesavachandran, C; Chandy, S; Shashidhar, S

    2001-04-01

    The present study was undertaken to assess the pulmonary functions in fertiliser and chemical industry workers of Kerala. Pulmonary function test was performed with Vitalograph Compact-II spirometer. Exposure to different chemicals, noxious gases and particulate matter of fertiliser and chemical industry was injurious to the normal pulmonary function. Significant decline in lung volumes, viz. FVC, FEV1, FEV1/FVC% (P < 0.01) and flow rates, viz. FEF25-75%, FEF0.2-1.2, FEF25%, FEF50%, FEF75% (P < 0.01) among non-smokers and smokers than that of normal controls was observed. The findings of this study also suggest that with increased duration of exposure to industrial pollutants, lung volumes and flow rates were significantly reduced in workers. PMID:11480228

  9. Pulmonary arterial hypertension

    PubMed Central

    2013-01-01

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

  10. Pulmonary arterial hypertension.

    PubMed

    Montani, David; Gnther, Sven; Dorfmller, Peter; Perros, Frdric; Girerd, Barbara; Garcia, Gilles; Jas, Xavier; Savale, Laurent; Artaud-Macari, Elise; Price, Laura C; Humbert, Marc; Simonneau, Grald; Sitbon, Olivier

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2011-03-01

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

  12. Lymph node hemangioma in one-humped camel.

    PubMed

    Aljameel, M A; Halima, M O

    2015-01-01

    Hemangioma is a benign tumor of blood and lymphatic vessels. It is common in skin, mucosa and soft tissues, and its occurrence in lymph nodes is extremely rare. A 10 year-old she-camel was slaughtered at Nyala slaughterhouse, South Darfur State, Sudan. Grossly, the carcass was emaciated. The left ventral superficial cervical lymph node was enlarged, hard on palpation and protruded outside the body. Its cut surface was dark red in color and measured (18 cm) in diameter. Histopathologically, the sections revealed vascular masses were composed of non-encapsulated clusters of small and medium sized with thick and thin-walled, filled with blood, separated by courageous stroma and surrounded by closely packed proliferating capillaries. To the best of our knowledge, this is the first record of the left ventral superficial cervical lymph node hemangioma in a camel in the Sudan. PMID:26753134

  13. Propionibacterium acnes isolated from lymph nodes of patients with sarcoidosis.

    PubMed

    de Brouwer, Bart; Veltkamp, Marcel; Wauters, Carla A; Grutters, Jan C; Janssen, Rob

    2015-01-01

    Propionibacterium acnes has been repeatedly suggested as a candidate causative agent of sarcoidosis. It is the only microorganism that has been isolated from sarcoid lesions by bacterial culture so far and this has been described in Japanese patients only. We report two non-Japanese patients in whom mediastinoscopy was performed in order to obtain lymph node tissue for histopathology, which was suggestive for sarcoidosis. Bacterial culture of these uncontaminated mediastinal lymph nodes revealed P. acnes in both patients. As shown in these two cases, P. acnes can be isolated from sterile biopsied sarcoid lymph nodes of non-Japanese patients and supports the belief that there is an etiologic link between P. acnes sarcoidosis. Further elucidation could provide an opening to novel strategies using antibiotics for treating sarcoidosis. PMID:26422574

  14. Lymph node hemangioma in one-humped camel

    PubMed Central

    Aljameel, M.A.; Halima, M.O.

    2015-01-01

    Hemangioma is a benign tumor of blood and lymphatic vessels. It is common in skin, mucosa and soft tissues, and its occurrence in lymph nodes is extremely rare. A 10 year-old she-camel was slaughtered at Nyala slaughterhouse, South Darfur State, Sudan. Grossly, the carcass was emaciated. The left ventral superficial cervical lymph node was enlarged, hard on palpation and protruded outside the body. Its cut surface was dark red in color and measured (18 cm) in diameter. Histopathologically, the sections revealed vascular masses were composed of non-encapsulated clusters of small and medium sized with thick and thin-walled, filled with blood, separated by courageous stroma and surrounded by closely packed proliferating capillaries. To the best of our knowledge, this is the first record of the left ventral superficial cervical lymph node hemangioma in a camel in the Sudan. PMID:26753134

  15. 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

  16. Axillary lymph node dose with tangential breast irradiation

    SciTech Connect

    Reed, Daniel R. . E-mail: drreed@u.washington.edu; Lindsley, Skyler Karen; Mann, Gary N.; Austin-Seymour, Mary; Korssjoen, Tammy; Anderson, Benjamin O.; Moe, Roger

    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.

  17. When a pulmonary embolism is not a pulmonary embolism: a rare case of primary pulmonary leiomyosarcoma

    PubMed Central

    Muganlinskaya, Nargiz; Guzman, Amanda; Dahagam, Chanukya; Selinger, Stephen R.

    2015-01-01

    Arterial leiomyosarcomas account for up to 21% of vascular leiomyosarcomas, with 56% of arterial leiomyosarcomas occurring in the pulmonary artery. While isolated cases of primary pulmonary artery leiomyosarcoma document survival up to 36 months after treatment, these uncommon, aggressive tumors are highly lethal, with 1-year survival estimated at 20% from the onset of symptoms. We discuss a rare case of a pulmonary artery leiomyosarcoma that was originally diagnosed as a pulmonary embolism (PE). A 72-year-old Caucasian female was initially diagnosed with saddle pulmonary embolism based on computerized tomographic angiography of the chest 2 months prior to admission and placed on anticoagulation. Dyspnea escalated, and serial computed tomography scans showed cardiomegaly with pulmonary emboli involving the right and left main pulmonary arteries with extension into the right and left upper and lower lobe branches. An echocardiogram on admission showed severe pulmonary hypertension with a pulmonary artery pressure of 82.9 mm Hg, and a severely enlarged right ventricle. Respiratory distress and multiorgan failure developed and, unfortunately, the patient expired. Autopsy showed a lobulated, yellow mass throughout the main pulmonary arteries measuring 13 cm in diameter. The mass extended into the parenchyma of the right upper lobe. On microscopy, the mass was consistent with a high-grade primary pulmonary artery leiomyosarcoma. Median survival of patients with primary pulmonary artery leiomyosarcoma without surgery is one and a half months, and mortality is usually due to right-sided heart failure. Pulmonary artery leiomyosarcoma is a rare but highly lethal disease commonly mistaken for PE. Thus, we recommend clinicians to suspect this malignancy when anticoagulation fails to relieve initial symptoms. In conclusion, early detection and suspicion of pulmonary artery leiomyosarcoma should be considered in patients refractory to anticoagulation, prompting initiation of early intervention. PMID:26653696

  18. Sentinel Lymph Node Biopsy in Breast Cancer: Predictors of Axillary and Non-Sentinel Lymph Node Involvement

    PubMed Central

    Postac?, Hakan; Zengel, Baha; Yararba?, lkem; Uslu, Adam; Eliyatk?n, Nuket; Akp?nar, Gksever; Cengiz, Fevzi; Durusoy, Raika

    2013-01-01

    Background: Sentinel lymph node biopsy is a standard method for the evaluation of axillary status in patients with T1-2N0M0 breast cancers. Aims: To determine the prognostic significance of primary tumour-related clinico-histopathological factors on axillary and non-sentinel lymph node involvement of patients who underwent sentinel lymph node biopsy. Study design: Retrospective clinical study. Methods: In the present study, 157 sentinel lymph node biopsies were performed in 151 consecutive patients with early stage breast cancer between June 2008 and December 2011. Results: Successful lymphatic mapping was obtained in 157 of 158 procedures (99.4%). The incidence of larger tumour size (2.5431.21 vs. 1.9741.04), lymphatic vessel invasion (70.6% vs. 29.4%), blood vessel invasion (84.2% vs. 15.8%), and invasive lobular carcinoma subtype (72.7% vs. 27.3%) were statistically significantly higher in patients with positive SLNs. Logistic stepwise regression analysis disclosed tumour size (odds ratio: 1.51, p=0.0021) and lymphatic vessel invasion (odds ratio: 4.68, p=0.001) as significant primary tumour-related prognostic determinants of SLN metastasis. Conclusion: A close relationship was identified between tumour size and lymphatic vessel invasion of the primary tumour and axillary lymph node involvement. However, the positive predictive value of these two independent variables is low and there is no compelling evidence to recommend their use in routine clinical practice. PMID:25207151

  19. Hantavirus Pulmonary Syndrome

    PubMed Central

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

    1995-01-01

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

  20. Vascular Remodeling in Pulmonary Hypertension

    PubMed Central

    Shimoda, Larissa A; Laurie, Steven S.

    2013-01-01

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

  1. 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 (111111), 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.

  2. Endobronchial ultrasound elastography strain ratio for mediastinal lymph node diagnosis

    PubMed Central

    Rozman, Ales; Malovrh, Mateja Marc; Adamic, Katja; Subic, Tjasa; Kovac, Viljem; Flezar, Matjaz

    2015-01-01

    Background Ultrasound elastography is an imaging procedure that can assess the biomechanical characteristics of different tissues. The aim of this study was to define the diagnostic value of the endobronchial ultrasound (EBUS) elastography strain ratio of mediastinal lymph nodes in patients with a suspicion of lung cancer. The diagnostic values of the strain ratios were compared with the EBUS brightness mode (B-mode) features of selected mediastinal lymph nodes and with their cytological diagnoses. Patients and methods This prospective, single-centre study enrolled patients with an indication for biopsy and mediastinal staging after a non-invasive diagnostic workup of a lung tumour. EBUS with standard B-mode evaluation and elastography with strain ratio measurement were performed before endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Results Thirty-three patients with 80 suspicious mediastinal lymph nodes were included. Malignant infiltration was confirmed in 34 (42.5%) lymph nodes. The area under the receiver operating characteristic curve for the strain ratio was 0.87 (p < 0.0001). At a strain ratio ? 8, the accuracy for malignancy prediction was 86.25% (sensitivity 88.24%, specificity 84.78%, positive predictive value [PPV] 81.08%, negative predictive value [NPV] 90.70%). The strain ratio is more accurate than conventional B-mode EBUS modalities for differentiating between malignant and benign lymph nodes. Conclusions EBUS-guided elastography with strain ratio assessment can distinguish malignant from benign mediastinal lymph nodes with greater accuracy than conventional EBUS modalities. This new method may reduce the number of mediastinal EBUS-TBNAs and thus reduce the invasiveness and expense of mediastinal staging in patients with non-small lung cancer (NSCLC). PMID:26834519

  3. Longitudinal distribution of vascular resistance in the pulmonary arteries, capillaries, and veins

    PubMed Central

    Brody, Jerome S.; Stemmler, Edward J.; DuBois, Arthur B.

    1968-01-01

    A new method has been described for measuring the pressure and resistance to blood flow in the pulmonary arteries, capillaries, and veins. Studies were performed in dog isolated lung lobes perfused at constant flow with blood from a donor dog. Pulmonary artery and vein volume and total lobar blood volume were measured by the ether plethysmograph and dyedilution techniques. The longitudinal distribution of vascular resistance was determined by analyzing the decrease in perfusion pressure caused by a bolus of low viscosity liquid introduced into the vascular inflow of the lobe. The pulmonary arteries were responsible for 46% of total lobar vascular resistance, whereas the pulmonary capillaries and veins accounted for 34 and 20% of total lobar vascular resistance respectively. Vascular resistance was 322 dynes ·sec·cm-5/ml of vessel in the lobar pulmonary arteries, 112 dynes·sec·cm-5/ml in the pulmonary capillaries, and 115 dynes·sec·cm-5/ml in the lobar pulmonary veins. Peak vascular resistivity (resistance per milliliter of volume) was in an area 2 ml proximal to the capillary bed, but resistivity was high throughout the pulmonary arterial tree. The pulmonary arteries accounted for approximately 50% of vascular resistance upstream from the sluice point when alveolar pressure exceeded venous pressure. The method described provides the first measurements of pulmonary capillary pressure. Mid-capillary pressure averaged 13.3 cm H2O, pulmonary artery pressure averaged 20.4 cm H2O, and pulmonary vein pressure averaged 9.2 cm H2O. These techniques also provide a way of analyzing arterial, capillary, and venous responses to various pharmacologic and physiologic stimuli. PMID:4868032

  4. 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

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

    PubMed Central

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

    2012-01-01

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

  6. Histoplasmosis of skin and lymph nodes and chronic lymphocytic leukemia.

    PubMed

    Johnston, C A; Tang, C K; Jiji, R M

    1979-03-01

    Nodular skin and cervical lymph node lesions of histoplasmosis, unassociated with systemic symptoms of the infection, developed in a 63-year-old man with untreated chronic lymphocytic leukemia. The histologic patterns in both the skin and lymph node were those of a lymphoproliferative disorder, but Histoplasma organisms were found within a few scattered histiocytes after a careful search. The subtle clinical and pathologic presentation might lead one to overlook the organisms and to believe that the leukemic process had progressed, resulting in potentially dangerous systemic involvement of histoplasmosis and unnecessary chemotherapy for his leukemic process. Complete remission of histoplasmosis was obtained with amphotericin B therapy. PMID:434852

  7. Vascularized Lymph Node Transfer: A Review of the Current Evidence.

    PubMed

    Tourani, Saam S; Taylor, G Ian; Ashton, Mark W

    2016-03-01

    Over the past decade, lymph node transfer has rapidly gained popularity among plastic surgeons for the treatment of chronic lymphedema because of the initial promising results and its unique technical advantages compared with the other reconstructive options. However, its functional mechanism is still a matter of great debate, and some concerning reports have emerged regarding the safety of this procedure in patients with chronic lymphedema. The authors review the literature on the experimental and clinical evidence for lymph node transfer, discuss its proposed functional mechanisms, review the potential risk of iatrogenic lymphedema following this procedure, and discuss the suggested strategies to avoid this complication. PMID:26809038

  8. [Lymph node involvement in sophageal cancer: surgical approach].

    PubMed

    Gronnier, C; Mariette, C

    2014-10-01

    Lymph node invasion is an early event in the oesophageal carcinogenesis and represents the main prognostic factor in the curative setting. Even though the primacy of surgical resection has been challenged by the definitive radiochemotherapy for locally advanced squamous cell carcinomas of the oesophagus, surgery is now again a gold standard, in combination with (radio)chemotherapy, to improve locoregional disease control and long term survival. Surgery, especially lymphadenectomy, has consequently to be standardized through quality criteria. Lymph node stations invaded in sophageal and junctional cancers, lymphadenectomy, and its impact on outcomes are discussed in this review based on the highest level of evidence published data. PMID:25195112

  9. 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 Sjgren'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

  10. Pulmonary Artery Denervation Reduces Pulmonary Artery Pressure and Induces Histological Changes in an Acute Porcine Model of Pulmonary Hypertension

    PubMed Central

    Arnold, Nadine D.; Chang, William; Watson, Oliver; Swift, Andrew J.; Condliffe, Robin; Elliot, Charlie A.; Kiely, David G.; Suvarna, S. Kim; Gunn, Julian; Lawrie, Allan

    2015-01-01

    Background— Pulmonary arterial hypertension is a devastating disease with high morbidity and mortality and limited treatment options. Recent studies have shown that pulmonary artery denervation improves pulmonary hemodynamics in an experimental model and in an early clinical trial. We aimed to evaluate the nerve distribution around the pulmonary artery, to determine the effect of radiofrequency pulmonary artery denervation on acute pulmonary hypertension induced by vasoconstriction, and to demonstrate denervation of the pulmonary artery at a histological level. Methods and Results— Histological evaluation identified a circumferential distribution of nerves around the proximal pulmonary arteries. Nerves were smaller in diameter, greater in number, and located in closer proximity to the luminal aspect of the pulmonary arterial wall beyond the pulmonary artery bifurcation. To determine the effect of pulmonary arterial denervation acute pulmonary hypertension was induced in 8 pigs by intravenous infusion of thromboxane A2 analogue. Animals were assigned to either pulmonary artery denervation, using a prototype radiofrequency catheter and generator, or a sham procedure. Pulmonary artery denervation resulted in reduced mean pulmonary artery pressure and pulmonary vascular resistance and increased cardiac output. Ablation lesions on the luminal surface of the pulmonary artery were accompanied by histological and biochemical alteration in adventitial nerves and correlated with improved hemodynamic parameters. Conclusions— Pulmonary artery denervation offers the possibility of a new treatment option for patients with pulmonary arterial hypertension. Further work is required to determine the long-term efficacy and safety. PMID:26553697

  11. [Pulmonary Langerhans cell histiocytosis].

    PubMed

    Popper, H H

    2015-09-01

    Pulmonary Langerhans cell histiocytosis is regarded as a reactive proliferation of the dendritic Langerhans cell population stimulated by chronic tobacco-derived plant proteins due to incomplete combustion but can also occur in childhood as a tumor-like systemic disease. Currently, both these forms cannot be morphologically distinguished. In the lungs a nodular proliferation of Langerhans cells occurs in the bronchial mucosa and also peripherally in the alveolar septa with an accompanying infiltration by eosinophilic granulocytes and destruction of the bronchial wall. Langerhans cells can be selectively detected with antibodies against CD1a and langerin. In the reactive isolated pulmonary form, abstinence from tobacco smoking in most patients leads to regression of infiltration and improvement of symptoms. In high-resolution computed tomography (HRCT) the small star-like scars can still be detected even after complete cessation of tobacco smoking. PMID:26289803

  12. Immune potential of lymph node-derived lymphocytes in uncontrolled hemorrhagic shock.

    PubMed

    Dyugovskaya, L; Bashenko, Y; Hirsh, M; Krausz, M M

    2001-02-01

    The state of T cell immunity was evaluated in rats in early (1-4 h) hemorrhagic shock induced by a massive splenic injury. T cell subpopulations from treated and untreated shocked animals were tested by flow cytometry and the results were compared with healthy controls. A fall in CD4+ T lymphocyte and natural killer (NKR-P1+) cell number, marked decline in the T helper (CD4+) to T suppressor (CD8+) ratio, and decrease of interleukin-2 receptor (IL-2R) bearing cells in peripheral blood, mesenteric, and popliteal lymph nodes of rats was found in the early stages of hemorrhagic shock. The same phenotype profile was also revealed in lymphocytes of rats in hemorrhagic shock following massive splenic injury treated with Ringer's lactate. The number of TCRalpha beta and TCR-gamma delta positive cells, as well as the percentage of CD4 and CD8 positive cells in the thymus, was similar in all groups of rats. Culture of lymph node cells taken from rats following hemorrhage in the presence of 100 U/mL hrIL-2 resulted in a marked increase in the number of NKR-PI+ positive cells from 4.2% to 30.5% (P < 0.001). Magnet separated NKR-P1+ fractions lysed the allogeneic fibroblasts in the same manner as IL-2-activated NKR-P1 cells from the control rats. Popliteal lymph node (PLNi) CD8b+ lymphocytes from rats in hemorrhagic shock preinfected into the footpad with cytomegalovirus (CMV) 6 days prior to injury lost their ability to lyse the CMV-infected fibroblasts and protect the monolayer from CMV infection when compared with PLNi cells from control infected rats. The possible mechanisms for the observed cellular dysfunction following hemorrhage are discussed. PMID:11220639

  13. 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.; OConnor, 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

  14. Chronic Obstructive Pulmonary Disease.

    PubMed

    Hattab, Yousef; Alhassan, Sulaiman; Balaan, Marvin; Lega, Mark; Singh, Anil C

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) is a chronic smoking-related lung disease associated with significant mortality and morbidity. It carries an enormous economic burden on the health care system. This results in a significant social impact on affected patients and their families. In this article, we review COPD in general, critical care management of patients presenting with acute exacerbation of COPD, and methods of prevention. PMID:26919673

  15. 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

  16. 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

  17. Idiopathic Pulmonary Fibrosis

    PubMed Central

    Garcia, Christine Kim

    2011-01-01

    Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic disease of the lungs that increases in prevalence with advanced age. Recent evidence indicates that mutations in genes of two different biologic pathways lead to the common phenotype of familial pulmonary fibrosis (FPF) and sporadic IPF. Mutations in the genes encoding the lung surfactant proteins C and A2 (SFTPC and SFTPA2, respectively) cause increased endoplasmic reticulum stress in type II alveolar epithelial cells. Mutations in the genes encoding telomerase (TERT and TERC) cause IPF through shortening of telomere lengths and probable exhaustion of lung stem cells. All of the mutations are individually rare, but, collectively, TERT mutations are the most common genetic defect found in FPF. The overall penetrance of pulmonary fibrosis in TERT mutation carriers is 40% in subjects with a mean age of 51 years. Penetrance increases with advanced age, is greater in males than in females, and is positively associated with fibrogenic environmental exposures. Short telomere lengths are found in patients with FPF and sporadic IPF without mutations in telomerase, suggesting that the biologic pathway of telomerase dysfunction provides a biologic explanation for the age-related prevalence of IPF. The molecular data of two seemingly unrelated biologic pathwaysalveolar epithelial endoplasmic reticulum stress and telomerase dysfunctionare beginning to elucidate the pathogenesis of IPF. These results have potentially predictive and therapeutic value. PMID:21543794

  18. 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

  19. Pulmonary trichomoniasis and Trichomonas tenax.

    PubMed

    Hersh, S M

    1985-08-01

    Pulmonary trichomoniasis is usually caused by aspirated Trichomonas tenax. Adult men with chronic purulent or necrotic pulmonary disease are usually affected. Sixty-eight patients were previously described. A Russian study demonstrated pulmonary trichomoniasis in 19 of 112 patients (17%), mostly in patients with lung cancer, lung abscess, or bronchiectasis. Rarely, pulmonary trichomoniasis may be caused by an intra-abdominal (T. hominis) or genitourinary (T. vaginalis) infection. T. tenax is usually regarded as a harmless commensal of the human mouth. Its prevalence ranges from 4% to 53% and may exceed that of vaginal infection with T. vaginalis in adult females. It is frequently found in patients with poor oral hygiene. Cultural identification is superior to microscopic examination of wet-smear, gram-stained and Papanicolaou-stained preparations. Aspirated pulmonary trichomoniasis is an opportunistic infection. Until the question of possible pathogenicity is resolved, metronidazole should be