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Sample records for unilateral thoracic kidney

  1. Unilateral shunt formation with thoracic aortic dissection in a whippet.

    PubMed

    Cornelis, I; Bosmans, T; Doom, M; Binst, D; Van der Vekens, E; Kromhout, K; Cornillie, P; Van Ham, L

    2014-06-01

    A three-year-old neutered male whippet was presented with intermittent, exercise-induced paraparesis. Femoral pulses were bilaterally absent. Neurologic examination was suggestive of a thoracolumbar myelopathy. Blood pressure measurements revealed hypotension in both pelvic limbs, hypertension in the right thoracic limb and it was immeasurable in the left thoracic limb. Echocardiography was within reference limits. A clear vascular pulsation was palpable on the right ventral abdominal wall. Computed tomographic angiography revealed a dissection of the aortic wall between the left subclavian artery and the brachiocephalic trunk with subsequent thrombus formation. A shunt between the right internal thoracic, cranial and caudal epigastric arteries to preserve blood flow to the pelvic limbs was visualized. Necropsy was declined by the owner. This is the first case report describing the formation of a unilateral vascular shunt following a thoracic aortic occlusion, which presented as exercise-induced paraparesis. PMID:24602076

  2. Percutaneous nephrolithotomy: Effect of unilateral procedure on contralateral kidney function

    PubMed Central

    Sichani, Mehrdad Mohammadi; Behnamfar, Amir; Khorami, Mohammad Hatef; Nourimahdavi, Kia; Alizadeh, Farshid; Izadpanahi, Mohammad Hossein

    2014-01-01

    Background: Although long-term effects of percutaneous nephrolithotomy (PCNL) on renal function and structure have been evaluated, knowledge regarding the immediate effects of surgery on renal function is limited. We conducted this study to evaluate the impact of unilateral PCNL on bilateral renal function during immediate post-operative period. Materials and Methods: From April to September 2012, 40 eligible patients were enrolled in this study and underwent unilateral PCNL. During the post-operative period, creatinine clearances (CrCl) of treated and untreated sides were estimated separately and pattern of changes in bilateral renal function following this procedure was evaluated. Results: Following the operation, CrCl of both kidneys showed a similar pattern of changes, of course more dramatic on treated side. We observed progressive decline in CrCl of both sides followed by bilateral improvement in renal function toward pre-operative values. Conclusions: During the early post-operative period following unilateral PCNL, both kidneys experienced a temporary drop in function warranting more intensive post-operative care. PMID:25538913

  3. Pulmonary endothelial dysfunction induced by unilateral as compared to bilateral thoracic irradiation in rats

    SciTech Connect

    Ward, W.F.; Molteni, A.; Ts'Ao, C.H.; Solliday, N.H.

    1987-07-01

    Rats were sacrificed 2 months after a single dose of 10-30 Gy of /sup 60/Co gamma rays delivered to either a right unilateral or a bilateral thoracic port. Four indices of lung endothelial function were measured: the activities of angiotensin-converting enzyme (ACE) and plasminogen activator (PLA) and the production of prostacyclin (PGI2) and thromboxane (TXA2). The number of macrophages recovered by bronchoalveolar lavage (BAL) and the degree of right ventricular hypertrophy (an index of pulmonary hypertension) also were determined. Right lung ACE and PLA activity decreased linearly, and PGI2 and TXA2 production increased linearly with increasing radiation dose. The response curves for right unilateral and bilateral thoracic irradiation were not significantly different. In contrast, bilateral irradiation was more toxic than unilateral, since rats exposed to the former exhibited decreased body weight, an increased incidence of pleural effusions, an increase in the number of macrophages recovered by BAL, and right ventricular hypertrophy. These data demonstrate that pulmonary endothelial dysfunction induced by hemithorax irradiation represents a direct response of the endothelium to radiation injury and is not secondary to other phenomena such as shunting of function to the shielded lung.

  4. Office-Based Intracordal Hyaluronate Injections Improve Quality of Life in Thoracic-Surgery-Related Unilateral Vocal Fold Paralysis.

    PubMed

    Fang, Tuan-Jen; Hsin, Li-Jen; Chung, Hsiu-Feng; Chiang, Hui-Chen; Li, Hsueh-Yu; Wong, Alice M K; Pei, Yu-Chen

    2015-10-01

    Thoracic-surgery-related unilateral vocal fold paralysis (UVFP) may cause severe morbidity and can cause profound functional impairment and psychosocial stress in patients with pre-existing thoracic diseases. In-office intracordal hyaluronate (HA) injections have recently been applied to improve voice and quality of life in patients with vocal incompetence, but their effect on thoracic-surgery-related UVFP remains inconclusive. We therefore conducted a prospective study to clarify the effect of early HA injection on voice and quality of life in patients with thoracic-surgery-related UVFP. Patients with UVFP within 3 months after thoracic surgery who received office-based HA injection were recruited. Quantitative laryngeal electromyography, videolaryngostroboscopy, voice-related life quality (voice outcome survey), laboratory voice analysis, and health-related quality of life (SF-36) were evaluated at baseline, and at 1 month postinjection. A total of 104 consecutive patients accepted office-based HA intracordal injection during the study period, 34 of whom were treated in relation to thoracic surgery and were eligible for inclusion. Voice-related life quality, voice laboratory analysis, and most generic quality of life domains were significantly improved at 1 month after in-office HA intracordal injection. No HA-related complications were reported. Single office-based HA intracordal injection is a safe and effective treatment for thoracic-surgery-related UVFP, resulting in immediate improvements in patient quality of life, voice quality, and swallowing ability. PMID:26448034

  5. Office-Based Intracordal Hyaluronate Injections Improve Quality of Life in Thoracic-Surgery-Related Unilateral Vocal Fold Paralysis

    PubMed Central

    Fang, Tuan-Jen; Hsin, Li-Jen; Chung, Hsiu-Feng; Chiang, Hui-Chen; Li, Hsueh-Yu; Wong, Alice M.K.; Pei, Yu-Chen

    2015-01-01

    Abstract Thoracic-surgery-related unilateral vocal fold paralysis (UVFP) may cause severe morbidity and can cause profound functional impairment and psychosocial stress in patients with pre-existing thoracic diseases. In-office intracordal hyaluronate (HA) injections have recently been applied to improve voice and quality of life in patients with vocal incompetence, but their effect on thoracic-surgery-related UVFP remains inconclusive. We therefore conducted a prospective study to clarify the effect of early HA injection on voice and quality of life in patients with thoracic-surgery-related UVFP. Patients with UVFP within 3 months after thoracic surgery who received office-based HA injection were recruited. Quantitative laryngeal electromyography, videolaryngostroboscopy, voice-related life quality (voice outcome survey), laboratory voice analysis, and health-related quality of life (SF-36) were evaluated at baseline, and at 1 month postinjection. A total of 104 consecutive patients accepted office-based HA intracordal injection during the study period, 34 of whom were treated in relation to thoracic surgery and were eligible for inclusion. Voice-related life quality, voice laboratory analysis, and most generic quality of life domains were significantly improved at 1 month after in-office HA intracordal injection. No HA-related complications were reported. Single office-based HA intracordal injection is a safe and effective treatment for thoracic-surgery-related UVFP, resulting in immediate improvements in patient quality of life, voice quality, and swallowing ability. PMID:26448034

  6. Commentary on the British Thoracic Society guidelines for the investigation of unilateral pleural effusion in adults.

    PubMed

    Lapworth, Ruth; Tarn, Anne C

    2006-01-01

    The publication of guidelines for the investigation of unilateral pleural effusion in adults by the British Thoracic Society has focused attention on this subject which, although comprising only a small proportion of laboratory workload, is a fairly common clinical problem. We critically reviewed the guidance applicable to clinical biochemistry laboratories and found a number of deficiencies. In particular, the need for anaerobic sample collection for pH measurement and preservation of samples for glucose assay is not mentioned and health and safety issues related to the handling of potentially infected fluids are also not considered. There are discrepancies between recommendations in the text and in the accompanying diagnostic algorithm, which require clarification. Measurement of total protein is an essential first step in the analysis of pleural fluid and will usually distinguish transudates from exudates. Measurement of lactate dehydrogenase activity is only required when total protein results are equivocal. There are practical difficulties with measurement of fluid pH as recommended in the guidelines and there is little evidence that such measurements are valuable. Similarly, there is little evidence to support the recommendation for measurement of complement in suspected rheumatoid effusions, and the recommendation for amylase isoenzyme studies if acute pancreatitis is a possibility is not practical. The different nature of pleural fluid demands a good understanding of the handling of these samples, the limitations of the analytical methods and the subsequent result interpretation by laboratory staff. We propose a modified diagnostic algorithm reflecting our criticisms of the original. Dialogue between the laboratory and local clinicians, possibly with the production of local guidelines, informed by these recommendations, should help optimize diagnostic management of patients with pleural effusion. PMID:16390605

  7. Unilateral hypoplastic kidney and ureter associated with diverse mesonephric remnant hyperplasia

    PubMed Central

    Xiao, Guang-Qian; Jerome, Jean-Gilles; Wu, Guan

    2015-01-01

    Mesonephric remnants have been rarely reported in the genitourinary system and sometimes impose a diagnostic challenge both clinically and pathologically. We reported a case of mesonephric remnant hyperplasia with mixed acinar/tubular and epididymis/vas deferens-like morphologies occurring in the renal parenchyma of a unilateral hypoplastic kidney, which has not been previously described. PMID:26309900

  8. Unilateral nephrectomy elongates primary cilia in the remaining kidney via reactive oxygen species.

    PubMed

    Han, Sang Jun; Jang, Hee-Seong; Kim, Jee In; Lipschutz, Joshua H; Park, Kwon Moo

    2016-01-01

    The length of primary cilia is associated with normal cell and organ function. In the kidney, the change of functional cilia length/mass is associated with various diseases such as ischemia/reperfusion injury, polycystic kidney disease, and congenital solitary kidney. Here, we investigate whether renal mass reduction affects primary cilia length and function. To induce renal mass reduction, mice were subjected to unilateral nephrectomy (UNx). UNx increased kidney weight and superoxide formation in the remaining kidney. Primary cilia were elongated in proximal tubule cells, collecting duct cells and parietal cells of the remaining kidney. Mn(III) Tetrakis (1-methyl-4-pyridyl) porphyrin (MnTMPyP), an antioxidant, reduced superoxide formation in UNx-mice and prevented the elongation of primary cilia. UNx increased the expression of phosphorylated ERK, p21, and exocyst complex members Sec8 and Sec10, in the remaining kidney, and these increases were prevented by MnTMPyP. In MDCK, a kidney tubular epithelial cell line, cells, low concentrations of H2O2 treatment elongated primary cilia. This H2O2-induced elongation of primary cilia was also prevented by MnTMPyP treatment. Taken together, these data demonstrate that kidney compensation, induced by a reduction of renal mass, results in primary cilia elongation, and this elongation is associated with an increased production of reactive oxygen species (ROS). PMID:26923764

  9. Unilateral nephrectomy elongates primary cilia in the remaining kidney via reactive oxygen species

    PubMed Central

    Han, Sang Jun; Jang, Hee-Seong; Kim, Jee In; Lipschutz, Joshua H.; Park, Kwon Moo

    2016-01-01

    The length of primary cilia is associated with normal cell and organ function. In the kidney, the change of functional cilia length/mass is associated with various diseases such as ischemia/reperfusion injury, polycystic kidney disease, and congenital solitary kidney. Here, we investigate whether renal mass reduction affects primary cilia length and function. To induce renal mass reduction, mice were subjected to unilateral nephrectomy (UNx). UNx increased kidney weight and superoxide formation in the remaining kidney. Primary cilia were elongated in proximal tubule cells, collecting duct cells and parietal cells of the remaining kidney. Mn(III) Tetrakis (1-methyl-4-pyridyl) porphyrin (MnTMPyP), an antioxidant, reduced superoxide formation in UNx-mice and prevented the elongation of primary cilia. UNx increased the expression of phosphorylated ERK, p21, and exocyst complex members Sec8 and Sec10, in the remaining kidney, and these increases were prevented by MnTMPyP. In MDCK, a kidney tubular epithelial cell line, cells, low concentrations of H2O2 treatment elongated primary cilia. This H2O2-induced elongation of primary cilia was also prevented by MnTMPyP treatment. Taken together, these data demonstrate that kidney compensation, induced by a reduction of renal mass, results in primary cilia elongation, and this elongation is associated with an increased production of reactive oxygen species (ROS). PMID:26923764

  10. Unilateral Renal Ischemia as a Model of Acute Kidney Injury and Renal Fibrosis in Cats.

    PubMed

    Schmiedt, C W; Brainard, B M; Hinson, W; Brown, S A; Brown, C A

    2016-01-01

    The objectives of this study were to define the acute and chronic effects of 1-hour unilateral in vivo renal ischemia on renal function and histology in cats. Twenty-one adult purpose-bred research cats were anesthetized, and 1 kidney underwent renal artery and vein occlusion for 1 hour. Serum creatinine and urea concentrations, urine protein:creatinine ratio, urine-specific gravity, glomerular filtration rate, hematocrit, platelet concentration and function, and white blood cell count were measured at baseline and variable time points after ischemia. Renal histopathology was evaluated on days 3, 6, 12, 21, 42, and 70 postischemia; changes in smooth muscle actin and interstitial collagen were examined. Following ischemia, whole animal glomerular filtration rate was significantly reduced (57% of baseline on day 6; P < .05). At the early time points, the ischemic kidneys exhibited severe acute epithelial necrosis accompanied by evidence of regeneration of tubules predominantly within the corticomedullary junction. At later periods, postischemic kidneys had evidence of tubular atrophy and interstitial inflammation with significantly more smooth muscle actin and interstitial collagen staining and interstitial fibrosis when compared with the contralateral control kidneys. This study characterizes the course of ischemic acute kidney injury in cats and demonstrates that ischemic acute kidney injury triggers chronic fibrosis, interstitial inflammation, and tubular atrophy in feline kidneys. These late changes are typical of those observed in cats with naturally occurring chronic kidney disease. PMID:26319781

  11. A right thoracic kidney with a pulmonary vascular malformation in an adult

    PubMed Central

    Jhun, Byung Woo; Lee, Kyung-Jong

    2013-01-01

    Ectopic thoracic kidneys are rare anomalies, accounting for less than 5% of all renal ectopia. The anomaly is usually found incidentally on a chest radiograph, with no respiratory or systemic symptoms. It usually presents in the left posteroinferior thorax, associated with a congenital diaphragmatic defect or hernia and is more frequent in males than females. Associated anomalies of other organs are rare and inconsistent. We report a case of a 55-year-old female who was referred to our hospital for evaluation of a mass-like lesion in the right chest, identified incidentally on a chest radiograph. Contrast-enhanced chest computed tomography revealed a right ectopic thoracic kidney with a closed diaphragm and an accompanying pulmonary vascular malformation. PMID:25473544

  12. Screening and identification of the differential proteins in kidney with complete unilateral ureteral obstruction

    PubMed Central

    Zhao, Qi; Yang, Yi; Wang, Chang-Lin; Hou, Ying; Chen, Hui

    2015-01-01

    Obstructive nephropathy is a major cause of renal failure, particularly in infants and children, and indications for therapeutic intervention remain highly controversial. There is a great need for the development of new methods to monitor patients, and the biomarker research field is a promising approach for this purpose to be used as prognostic tools for early disease detection and the choice of the optimal treatment and monitoring. Here, we presented our comparative proteomics study of rat kidney with complete unilateral ureteral obstruction (CUUO). Proteins from the groups of CUUO and corresponding sham rat kidney tissues were subjected to 2-D gel electrophoresis, and then protein identification by mass spectrometry. We identified 39 proteins with differential expression between kidney tissues from sham operated group and those with CUUO. These identified proteins were reported to be involved in cell apoptosis, energy metabolism and injuries of mitochondrion and oxidative stress, and so on. We confirmed 3 identified proteins by immunoblot analysis and immunofluorescence staining and assessed their mRNA levels in renal tissues. Our results demonstrate protein alterations that reflect the pathological situation of the obstructed kidneys, which may help understand the relationship between oxidative stress and obstructive nephropathy. PMID:26045767

  13. Adult intra-thoracic kidney: a case report of bochdalek hernia.

    PubMed

    Fiaschetti, Valeria; Velari, Luca; Gaspari, Eleonora; Mastrangeli, Roberta; Simonetti, Giovanni

    2010-01-01

    Introduction. Bochdalek hernia is a congenital posterior lateral diaphragmatic defect that allows abdominal viscera to herniate into the thorax. Intrathoracic kidney is a very rare finding representing less than 5% of all renal ectopias with the least frequency of all renal ectopias. Case Presentation. We report a case of a 62-year-old man who had a left thoracic kidney associated with left Bochdalek hernia. Abdominal X-ray and chest X-ray revealed dilated loops of the colon above left hemidiaphragm. Abdominal ultrasound (US) showed the right kidney with many fluid and esophytic cysts; left kidney was unfeasible to study because of the impossibility to find it. Computed Tomography (CT) basal scan demonstrated a left-sided Bochdalek hernia with dilatated colon loops and the left kidney within the pleural space. Magnetic Resonance (MR) confirmed a defect in left hemidiaphragm with herniation of left kidney, omento, spleen and colon flexure, and intrarotation with posterior hilum on sagittal plane. Conclusion. The association of a Bochdalek hernia and an intrathoracic renal ectopia is very rare, that pose many diagnostic and management dilemmas for clinicians. Our patient has been visualized by CT and MR imaging. A high index of suspicion can result in early diagnosis and prompt intervention with reduced morbidity and mortality. PMID:20862352

  14. Chronic kidney disease induced in mice by reversible unilateral ureteral obstruction is dependent on genetic background

    PubMed Central

    Shakaib, Mohammed I.; Chang, Anthony; Mathew, Liby; Olayinka, Oladunni; Minto, Andrew W. M.; Sarav, Menaka; Hack, Bradley K.; Quigg, Richard J.

    2010-01-01

    Chronic kidney disease (CKD) begins with renal injury; the progression thereafter depends upon a number of factors, including genetic background. Unilateral ureteral obstruction (UUO) is a well-described model of renal fibrosis and as such is considered a model of CKD. We used an improved reversible unilateral ureteral obstruction (rUUO) model in mice to study the strain dependence of development of CKD after obstruction-mediated injury. C57BL/6 mice developed CKD after reversal of three or more days of ureteral obstruction as assessed by blood urea nitrogen (BUN) measurements (>40 mg/dl). In contrast, BALB/c mice were resistant to CKD with up to 10 days ureteral obstruction. During rUUO, C57BL/6 mice exhibited pronounced inflammatory and intrinsic proliferative cellular responses, disruption of renal architecture, and ultimately fibrosis. By comparison, BALB/c mice had more controlled and measured extrinsic and intrinsic responses to injury with a return to normal within several weeks after release of ureteral obstruction. Our findings provide a model that allows investigation of the genetic basis of events during recovery from injury that contribute to the development of CKD. PMID:20089676

  15. Ozonated autohemotherapy: protection of kidneys from ischemia in rats subjected to unilateral nephrectomy

    PubMed Central

    2011-01-01

    Background Ozonated autohemotherapy (OA) has been previously successfully used in the treatment of patients affected by peripheral occlusive arterial disease. OA consists of an intrafemoral reinfusion of autologous blood previously exposed to a mixture of oxygen/ozone (O2/O3). This study analyzes the effects of OA in protecting rat kidney from ischemia and ischemia/reperfusion damage. Methods We performed OA 30 min before the induction of 60 min renal ischemia or at the induction of 60 min postischemic reperfusion in rats subjected to unilateral nephrectomy. In addition, to evidence the possible protection induced by O2/O3 on endothelial functions, the present study analyzes the in vitro effects of O2/O3 on oxygen consumption by human umbilical vein endothelial cells (HUVEC). Results 1) OA preserves rat kidney functions and architecture, as demonstrated by the improved levels of serum creatinine and blood urea nitrogen and by histology; 2) such protection does not correlate with the increase of plasmatic nitric oxide, but is compatible with a focal renal increase of renal ?NADPH-diaphorase; 3) treatment of HUVEC with O2/O3 significantly increases both the rate of oxygen consumption and the mitochondrial activity assessed by confocal microscopy. Conclusion The preservation of the mitochondrial activity of endothelium could in vivo limit the endothelial dysfunction provoked by the Isc or Isc/R processes. PMID:22081953

  16. Chitosan/siRNA Nanoparticles Targeting Cyclooxygenase Type 2 Attenuate Unilateral Ureteral Obstruction-induced Kidney Injury in Mice

    PubMed Central

    Yang, Chuanxu; Nilsson, Line; Cheema, Muhammad Umar; Wang, Yan; Frøkiær, Jørgen; Gao, Shan; Kjems, Jørgen; Nørregaard, Rikke

    2015-01-01

    Cyclooxygenase type 2 (COX-2) plays a predominant role in the progression of kidney injury in obstructive nephropathy. The aim of this study was to test the efficacy of chitosan/small interfering RNA (siRNA) nanoparticles to knockdown COX-2 specifically in macrophages to prevent kidney injury induced by unilateral ureteral obstruction (UUO). Using optical imaging techniques and confocal microscopy, we demonstrated that chitosan/siRNA nanoparticles accumulated in macrophages in the obstructed kidney. Consistent with the imaging data, the obstructed kidney contained a higher amount of siRNA and macrophages. Chitosan-formulated siRNA against COX-2 was evaluated on RAW macrophages demonstrating reduced COX-2 expression and activity after LPS stimulation. Injection of COX-2 chitosan/siRNA nanoparticles in mice subjected to three-day UUO diminished the UUO-induced COX-2 expression. Likewise, macrophages in the obstructed kidney had reduced COX-2 immunoreactivity, and histological examination showed lesser tubular damage in COX-2 siRNA-treated UUO mice. Parenchymal inflammation, assessed by tumor necrosis factor-alpha (TNF-?) and interleukin 6 mRNA expression, was attenuated by COX-2 siRNA. Furthermore, treatment with COX-2 siRNA reduced heme oxygenase-1 and cleaved caspase-3 in UUO mice, indicating lesser oxidative stress and apoptosis. Our results demonstrate a novel strategy to prevent UUO-induced kidney damage by using chitosan/siRNA nanoparticles to knockdown COX-2 specifically in macrophages. PMID:25553102

  17. The Risk Factors and Outcomes of Acute Kidney Injury after Thoracic Endovascular Aortic Repair

    PubMed Central

    Jeon, Yun-Ho; Bae, Chi-Hoon

    2016-01-01

    Background We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). Methods A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. Results Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was 61.2±17.5 years (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. Conclusion Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure. PMID:26889441

  18. Alleviation of Kidney Damage Induced by Unilateral Ureter Obstruction in Rats by Rhodiola rosea

    PubMed Central

    Terzi, E. Hakan; Kemahli, Eray; Gucuk, Adnan; Tosun, Mehmet; Çetinkaya, Ayhan

    2013-01-01

    Abstract Purpose To evaluate the efficacy of Rhodiola rosea extract in terms of alleviating the renal damage induced by unilateral ureter obstruction (UUO) in rats. Material and Methods Thirty Wistar albino male rats were divided into five groups: (I) Control, (II) UUO 7 days, (III) UUO 7 days+extract,(IV) UUO 14 days, and (V) UUO 14 days+extract. Seven or 14 days after the initiation of the experimental procedure, the left kidneys of rats in all five groups were removed for histological examination, and their blood was drawn for biochemical measurements. Result Median malondialdehyde (MDA) and glutathione peroxidase (GPx) levels were, respectively, 39.4 (5.04) nmol/mL and 25.8 (8.01) nmol/minute/mL in group I, 77.9 (12.38) nmol/mL and 5.8 (1.95) nmol/minute/mL in group II, 48.7 (12.1) nmol/mL and 9.1 (2.3) nmol/minute/mL in group III, 58.5 (23.83) nmol/mL and 8.4 (2.1) nmol/minute/mL in group IV, and 44.8 (4.97) nmol/mL and 13.8 (3.73) nmol/minute/mL in group V. There was a statistically significant difference among the groups in terms of MDA and GPx levels (p<0.05 for both). The median numbers of apoptotic cells were 1 (1), 8 (2.25), 3 (1.25), 23.5 (9), and 7 (I) in groups I, II, III, IV, and V, respectively. There was a statistically siginificant difference among the groups in terms of apoptotic cell number (p<0.05). Conclusion R. rosea extract was shown to alleviate the renal damage induced by UUO through its antioxidant effects. The mechanism by which R. rosea extract causes these effects merits further investigation. PMID:23806024

  19. Unilateral Renal Ischemia-Reperfusion as a Robust Model for Acute to Chronic Kidney Injury in Mice

    PubMed Central

    Le Clef, Nathalie; Verhulst, Anja; D’Haese, Patrick C.; Vervaet, Benjamin A.

    2016-01-01

    Acute kidney injury (AKI) is an underestimated, yet important risk factor for development of chronic kidney disease (CKD). Even after initial total recovery of renal function, some patients develop progressive and persistent deterioration of renal function and these patients are more likely to progress to end-stage renal disease (ESRD). Animal models are indispensable for unravelling the mechanisms underlying this progression towards CKD and ESRD and for the development of new therapeutic strategies in its prevention or treatment. Ischemia (i.e. hypoperfusion after surgery, bleeding, dehydration, shock, or sepsis) is a major aetiology in human AKI, yet unilateral ischemia-reperfusion is a rarely used animal model for research on CKD and fibrosis. Here, we demonstrate in C57Bl/6J mice, by both histology and gene expression, that unilateral ischemia-reperfusion without contralateral nephrectomy is a very robust model to study the progression from acute renal injury to long-term tubulo-interstitial fibrosis, i.e. the histopathological hallmark of CKD. Furthermore, we report that the extent of renal fibrosis, in terms of Col I, TGFβ, CCN2 and CCN3 expression and collagen I immunostaining, increases with increasing body temperature during ischemia and ischemia-time. Thus, varying these two main determinants of ischemic injury allows tuning the extent of the long-term fibrotic outcome in this model. Finally, in order to cover the whole practical finesse of ischemia-reperfusion and allow model and data transfer, we provide a referenced overview on crucial technical issues (incl. anaesthesia, analgesia, and pre- and post-operative care) with the specific aim of putting starters in the right direction of implementing ischemia in their research and stimulate them, as well as the community, to have a critical view on ischemic literature data. PMID:27007127

  20. Semicarbazide-sensitive amine oxidase (SSAO) inhibition ameliorates kidney fibrosis in a unilateral ureteral obstruction murine model.

    PubMed

    Wong, May; Saad, Sonia; Zhang, Jie; Gross, Simon; Jarolimek, Wolfgang; Schilter, Heidi; Chen, Jason A; Gill, Anthony J; Pollock, Carol A; Wong, Muh Geot

    2014-10-15

    Semicarbazide-sensitive amine oxidase (SSAO) is an enzyme known for its dual function in mediating inflammation and reactive oxygen species production. However, the role of SSAO inhibitors in limiting kidney fibrosis is unclear. We aimed to determine the effectiveness of a SSAO inhibitor (SSAOi; PXS4728A) as an antifibrotic agent using a 7-day unilateral ureteric obstruction (UUO) model of acute kidney fibrosis in 6- to 8-wk-old mice. The experimental groups were 1) Sham operated; 2) UUO; 3) UUO+SSAOi (2 mg/kg); 4) UUO+telmisartan, an angiotensin receptor blocker (3 mg/kg); and 5) UUO+SSAOi+telmisartan. Kidney tissue was analyzed for histological evidence of tubulointerstitial fibrosis, nitrotyrosine staining, and mRNA expression of markers associated with fibrosis and inflammation. Kidney SSAO activity was determined by radiometric [(14)C]benzylamine methodology. Our results show that SSAOi effectively suppresses UUO-mediated SSAO activity. Extracellular matrix markers, namely, fibronectin, collagen IV protein, and nitrotyrosine staining, were lower in UUO+SSAOi mice compared with untreated UUO mice. This was consistent with the attenuated mRNA expression of collagen IV and fibronectin. SSAOi effectively inhibited transforming growth factor-?1 (TGF-?1) and monocyte chemoattractant protein-1 (MCP-1) expression to a similar extent to that observed with telmisartan. Individually, SSAOi and telmisartan induced a reduction in interstitial leukocyte and macrophage accumulation. However, the combination of SSAOi and telmisartan was more effective at reducing inflammatory cell infiltration. These results demonstrate that SSAO inhibition significantly suppresses profibrotic and proinflammatory cytokine secretion, reduces oxidative stress, and limits inflammatory cell accumulation and extracellular matrix expression in an acute model of renal fibrosis. PMID:25143459

  1. Activating Nrf-2 Signaling Depresses Unilateral Ureteral Obstruction-Evoked Mitochondrial Stress-Related Autophagy, Apoptosis and Pyroptosis in Kidney

    PubMed Central

    Chung, Shue Dong; Lai, Ting Yu; Chien, Chiang Ting; Yu, Hong Jen

    2012-01-01

    Exacerbated oxidative stress and inflammation may induce three types of programmed cell death, autophagy, apoptosis and pyroptosis in unilateral ureteral obstruction (UUO) kidney. Sulforaphane activating NF-E2-related nuclear factor erythroid-2 (Nrf-2) signaling may ameliorate UUO-induced renal damage. UUO was induced in the left kidney of female Wistar rats. The level of renal blood flow, cortical and medullary oxygen tension and reactive oxygen species (ROS) was evaluated. Fibrosis, ED-1 (macrophage/monocyte) infiltration, oxidative stress, autophagy, apoptosis and pyroptosis were evaluated by immunohistochemistry and Western blot in UUO kidneys. Effects of sulforaphane, an Nrf-2 activator, on Nrf-2- and mitochondrial stress-related proteins and renal injury were examined. UUO decreased renal blood flow and oxygen tension and increased renal ROS, 3-nitrotyrosine stain, ED-1 infiltration and fibrosis. Enhanced renal tubular Beclin-1 expression started at 4 h UUO and further enhanced at 3d UUO, whereas increased Atg-5-Atg12 and LC3-II expression were found at 3d UUO. Increased renal Bax/Bcl-2 ratio, caspase 3 and PARP fragments, apoptosis formation associated with increased caspase 1 and IL-1? expression for pyroptosis formation were started from 3d UUO. UUO reduced nuclear Nrf-2 translocation, increased cytosolic and inhibitory Nrf-2 expression, increased cytosolic Bax translocation to mitochondrial and enhanced mitochondrial Cytochrome c release into cytosol of the UUO kidneys. Sulforaphane significantly increased nuclear Nrf-2 translocation and decreased mitochondrial Bax translocation and Cytochrome c release into cytosol resulting in decreased renal injury. In conclusion, sulforaphane via activating Nrf-2 signaling preserved mitochondrial function and suppressed UUO-induced renal oxidative stress, inflammation, fibrosis, autophagy, apoptosis and pyroptosis. PMID:23071780

  2. Effect of stachydrine on endoplasmic reticulum stress-induced apoptosis in rat kidney after unilateral ureteral obstruction.

    PubMed

    Zhang, Cui; Lu, Ying; Tong, Qian-Qian; Zhang, Lan; Guan, Yu-Fei; Wang, Shu-Jing; Xing, Zhi-Hua

    2013-01-01

    Our study aimed at determining the effect of stachydrine on the PERK, CHOP, and caspase-3 in rat kidney with RIF. Rats were randomly divided into control group, model group, enalapril group, high stachydrine group, medium stachydrine group, and low stachydrine group. RIF models of five groups were developed by unilateral ureteral obstruction except the control group. The rats were sacrificed 12 days after surgery and blood samples were collected. Serum creatinine (Scr) and blood urea nitrogen (BUN) levels were detected. Renal tubular damage index was determined by HE staining. The area percentage of RIF was determined by the Masson method. Expressions of PERK, CHOP, and caspase-3 in kidney were determined by immunohistochemistry. Tubulointerstitial injury index, RIF, serum Scr, BUN level, and expressions of PERK, CHOP, and caspase-3 were different between the model and treatment groups (P < 0.05; P < 0.01). The expressions of PERK, CHOP, and caspase-3 in nephridial tissue were reduced (P < 0.05), tubulointerstitial injury and RIF were reduced (P < 0.05), and Scr and BUN were lower (P < 0.05) in the high stachydrine group than those in the enalapril group. The expressions of PERK, CHOP, and caspase-3 were reduced in the endoplasmic reticulum stress-related apoptosis pathway after stachydrine treatment. Consequently, apoptosis was prevented, and RIF was inhibited. PMID:23464629

  3. Perioperative morbidity and long-term outcome of unilateral nephrectomy in feline kidney donors: 141 cases (1998-2013).

    PubMed

    Wormser, Chloe; Aronson, Lilian R

    2016-02-01

    OBJECTIVE To evaluate the outcome associated with unilateral nephrectomy in feline kidney donors. DESIGN Retrospective case series. ANIMALS 141 cats. PROCEDURES Medical records of cats that underwent nephrectomy for renal donation were reviewed for information on signalment, date of renal donation, results of blood and urine analyses, infectious disease history, anesthetic protocols, intra- and postoperative complications, and postoperative analgesic protocols. Long-term follow-up data were obtained via client telephone interview and review of referring veterinarian medical records. RESULTS All donors were healthy young adult cats with a median age of 1.5 years (range, 0.8 to 2 years). No cats died or were euthanized during the perioperative period. Intraoperative complications occurred in 2 cats, and postoperative complications occurred in 17. Median time from nephrectomy to hospital discharge was 3.6 days (range, 2 to 8 days). Long-term follow-up information was available for 99 cats, with a median interval between nephrectomy and follow-up of 10 years (range, 0.25 to 15 years). Six cats had a history of urinary tract disease including stable chronic kidney disease (n = 3), acute kidney injury (2), and cystitis (1). Nine cats were dead at follow-up; death was attributed to chronic renal failure in 2 and acute ureteral obstruction in 4. CONCLUSIONS AND CLINICAL RELEVANCE Feline donor nephrectomy had an acceptably low perioperative morbidity in this series. Most cats (84%) for which follow-up information was available had no associated long-term effects. However, a small subset (7%) developed renal insufficiency or died of urinary tract disease. PMID:26799104

  4. Postobstructive regeneration of kidney is derailed when surge in renal stem cells during course of unilateral ureteral obstruction is halted

    PubMed Central

    Park, H. C.; Yasuda, K.; Ratliff, B.; Stoessel, A.; Sharkovska, Y.; Yamamoto, I.; Jasmin, J.-F.; Bachmann, S.; Lisanti, M. P.; Chander, P.

    2010-01-01

    Unilateral ureteral obstruction (UUO), a model of tubulointerstitial scarring (TIS), has a propensity toward regeneration of renal parenchyma after release of obstruction (RUUO). No information exists on the contribution of stem cells to this process. We performed UUO in FVB/N mice, reversed it after 10 days, and examined kidneys 3 wk after RUUO. UUO resulted in attenuation of renal parenchyma. FACS analysis of endothelial progenitor (EPC), mesenchymal stem (MSC) and hematopoietic stem (HSC) cells obtained from UUO kidneys by collagenase-dispersed single-cell suspension showed significant increase in EPC, MSC, and HSC compared with control. After RUUO cortical parenchyma was nearly restored, and TIS score improved by 3 wk. This reversal process was associated with return of stem cells toward baseline level. When animals were chronically treated with nitric oxide synthase (NOS) inhibitor at a dose that did not induce hypertension but resulted in endothelial dysfunction, TIS scores were not different from control UUO, but EPC number in the kidney decreased significantly; however, parenchymal regeneration in these mice was similar to control. Blockade of CXCR4-mediated engraftment resulted in dramatic worsening of UUO and RUUO. Similar results were obtained in caveolin-1-deficient but not -overexpressing mice, reflecting the fact that activation of CXCR4 occurs in caveolae. The present data show increase in EPC, HSC, and MSC population during UUO and a tendency for these cells to decrease to control level during RUUO. These processes are minimally affected by chronic NOS inhibition. Blockade of CXCR4-stromal cell-derived factor-1 (SDF-1) interaction by AMD3100 or caveolin-1 deficiency significantly reduced the UUO-associated surge in stem cells and prevented parenchymal regeneration after RUUO. We conclude that the surge in stem cell accumulation during UUO is a prerequisite for regeneration of renal parenchyma. PMID:19906947

  5. Matrix Metalloproteinase-2 Knockout and Heterozygote Mice Are Protected from Hydronephrosis and Kidney Fibrosis after Unilateral Ureteral Obstruction

    PubMed Central

    Tveitarås, Maria K.; Skogstrand, Trude; Leh, Sabine; Helle, Frank; Chatziantoniou, Christos; Reed, Rolf K.; Hultström, Michael

    2015-01-01

    Matrix Metalloproteinase-2 (Mmp2) is a collagenase known to be important in the development of renal fibrosis. In unilateral ureteral obstruction (UUO) the obstructed kidney (OK) develops fibrosis, while the contralateral (CL) does not. In this study we investigated the effect of UUO on gene expression, fibrosis and pelvic remodeling in the kidneys of Mmp2 deficient mice (Mmp2-/-), heterozygous animals (Mmp2+/-) and wild-type mice (Mmp2+/+). Sham operated animals served as controls (Cntrl). UUO was prepared under isoflurane anaesthesia, and the animals were sacrificed after one week. UUO caused hydronephrosis, dilation of renal tubules, loss of parenchymal thickness, and fibrosis. Damage was most severe in Mmp2+/+ mice, while both Mmp2-/- and Mmp2+/- groups showed considerably milder hydronephrosis, no tubular necrosis, and less tubular dilation. Picrosirius red quantification of fibrous collagen showed 1.63±0.25% positivity in OK and 0.29±0.11% in CL (p<0.05) of Mmp2+/+, Mmp2-/- OK and Mmp2-/- CL exhibited only 0.49±0.09% and 0.23±0.04% (p<0.05) positivity, respectively. Mmp2+/- OK and Mmp2+/- CL showed 0.43±0.09% and 0.22±0.06% (p<0.05) positivity, respectively. Transcriptomic analysis showed that 26 genes (out of 48 examined) were differentially expressed by ANOVA (p<0.05). 25 genes were upregulated in Mmp2+/+ OK compared to Mmp2+/+ CL: Adamts1, -2, Col1a1, -2, -3a1, -4a1, -5a1, -5a2, Dcn, Fbln1, -5, Fmod, Fn1, Itga2, Loxl1, Mgp, Mmp2, -3, Nid1, Pdgfb, Spp1, Tgfb1, Timp2, Trf, Vim. In Mmp2-/- and Mmp2+/- 18 and 12 genes were expressed differentially between OK and CL, respectively. Only Mmp2 was differentially regulated when comparing Mmp2-/- OK and Mmp2+/- OK. Under stress, it appears that Mmp2+/- OK responds with less Mmp2 upregulation than Mmp2+/+ OK, suggesting that there is a threshold level of Mmp2 necessary for damage and fibrosis to occur. In conclusion, reduced Mmp2 expression during UUO protects mice against hydronephrosis and renal fibrosis. PMID:26673451

  6. Bilateral pneumothorax after unilateral transthoracic puncture.

    PubMed

    Yamaura, Hidekazu; Inaba, Yoshitaka; Sato, Yozo; Najima, Mina; Shimamoto, Hiroshi; Nishiofuku, Hideyuki

    2007-06-01

    Pneumothorax is a common complication following transthoracic interventional procedures. Most often, this occurs unilaterally on the side of the intervention. Bilateral pneumothorax following unilateral puncture is rare, but may mandate emergent chest tube insertion. We describe two cases in which bilateral pneumothorax occurred after unilateral thoracic puncture. One patient had a history of esophageal resection, while the other had no history of thoracic surgery. PMID:17538145

  7. Renal glucose release during hypoglycemia is partly controlled by sympathetic nerves – a study in pigs with unilateral surgically denervated kidneys

    PubMed Central

    Bischoff, Sabine J; Schmidt, Martin; Lehmann, Thomas; Schwab, Matthias; Matziolis, Georg; Saemann, Alexander; Schiffner, René

    2015-01-01

    Catecholamines are known to increase renal glucose release during hypoglycemia. The specific extent of the contribution of different sources of catecholamines, endocrine delivery via circulation or release from autonomous sympathetic renal nerves, though, is unknown. We tested the hypothesis that sympathetic renal innervation plays a major role in the regulation of renal gluconeogenesis. For this purpose, instrumented adolescent pigs had one kidney surgically denervated while the other kidney served as a control. A hypoglycemic clamp with arterial blood glucose below 2 mmol/L was maintained for 75 min. Arteriovenous blood glucose difference, inulin clearance, p-aminohippurate clearance, and sodium excretion were measured in intervals of 15 min separately for both kidneys. Blood glucose was lowered to 0.84 ± 0.33 mmol/L for 75 min. The side-dependent renal net glucose release (SGN) decreased significantly after the unilateral ablation of renal nerves. In the linear mixed model, renal denervation had a significant inhibitory effect on renal net glucose release (P = 0.036). The SGN of the ablated kidney decreased by 0.02 mmol/min and was equivalent to 43.3 ± 23.2% of the control (nonablated) kidney in the pigs. This allows the conclusion that renal glucose release is partly controlled by sympathetic nerves. This may be relevant in humans as well, and could explain the increased risk of severe hypoglycemia of patients with diabetes mellitus and autonomous neuropathy. The effects of denervation on renal glucose metabolism should be critically taken into account when considering renal denervation as a therapy in diabetic patients. PMID:26564063

  8. DIET AND TISSUE GROWTH : V. THE EFFECT OF DIETARY PROTEIN ON THE REMAINING KIDNEY OF ADULT WHITE RATS FOLLOWING A UNILATERAL NEPHRECTOMY.

    PubMed

    Moise, T S; Smith, A H

    1927-06-30

    The effects of the ingestion of diets containing different concentrations of protein on the remaining kidney in adult white rats after a unilateral nephrectomy has been studied. In the animals on the high protein diet (85 per cent casein), actual glomerular and tubular lesions were observed in the kidneys of animals maintained for 90, 120 and 150 days after nephrectomy. In the animals on the standard ration, 18 per cent casein, no significant renal lesions were observed within the experimental period. Spontaneous focal lesions in the kidneys of rats maintained on Sherman's diets "A" and "B" were inconspicuous at the age of 350 days but became progressively more frequent and were commonly observed after 500 days. The animals on the high protein and standard rations were all under 350 days old at the completion of the experiment. It is suggested that the age factor is of importance in that young animals may have greater powers of adaptation in withstanding the injurious effect of high protein rations. The animals on the high protein ration excreted definitely larger quantities of protein in the urine, and showed a higher incidence of casts in periods roughly corresponding to those in which anatomic lesions were observed than did the rats on the standard diet. PMID:19869327

  9. Penetrating trauma to the kidney and Meckel’s Diverticulum in a patient with unilateral renal agenesis

    PubMed Central

    Sobnach, Sanju; Segobin, Rajshree; Nicol, Andrew; Edu, Sorin; Kahn, Delawir; Navsaria, Pradeep

    2015-01-01

    Introduction Emergency laparotomy for abdominal gunshot wounds is frequently performed in South Africa and remains associated with significant morbidity and mortality. The occurrence of congenital anomalies during surgery is an unexpected finding and presents a major challenge. Presentation of case The successful management of a haemodynamically unstable 26-year-old man with unilateral renal agenesis, concomitant right renal and hepatic injuries, and a transected Meckel's Diverticulum following an abdominal gunshot wound is presented. Discussion Intraoperative decision-making is difficult when congenital visceral anomalies form part of the injury complex in trauma. Basic principles of damage control surgery that include initial exploration, secondary resuscitation and definite operation must be adhered to. Repair of complex injuries are delayed until the definitive laparotomy. The presence of one congenital anomaly should alert the surgeon to the possibility of further anomalies. Conclusion Although congenital visceral anomalies are spectacular findings at laparotomy, they should not distract the trauma surgeon. Adhering to damage control surgery principles and careful inspection of the peritoneal cavity for further abnormalities remain the mainstay of successful management. PMID:26624504

  10. Kidney.

    PubMed

    Hart, A; Smith, J M; Skeans, M A; Gustafson, S K; Stewart, D E; Cherikh, W S; Wainright, J L; Boyle, G; Snyder, J J; Kasiske, B L; Israni, A K

    2016-01-01

    Kidney transplant provides significant survival, cost, and quality-of-life benefits over dialysis in patients with end-stage kidney disease, but the number of kidney transplant candidates on the waiting list continues to grow annually. By the end of 2014, nearly 100,000 adult candidates and 1500 pediatric candidates were waiting for kidney transplant. Not surprisingly, waiting times also continued to increase, along with the number of adult candidates removed from the list due to death or deteriorating medical condition. Death censored graft survival has increased after both living and deceased donor transplants over the past decade in adult recipients. The majority of the trends seen over the past 5 years continued in 2014. However, the new allocation system was implemented in late 2014, providing an opportunity to assess changes in these trends in the coming years. PMID:26755262

  11. Unilateral perseveration.

    PubMed

    Acosta, Lealani Mae Y; Goodman, Ira J; Heilman, Kenneth M

    2013-12-01

    The brain's action-intentional ("when") programming system helps to control when to and when not to initiate an action, when to persist at an action, and when to terminate an action. Motor perseveration is a failure to terminate an action. This disengagement disorder most often results from dysfunction of the executive frontal-subcortical networks that control the action-intentional programming system. Reports of unilateral perseveration are unusual. Here we describe a patient with a form of progressive supranuclear palsy (PSP) who exhibited continuous right-hand motor perseveration. This 68-year-old right-handed man had impaired walking and vertical gaze, consistent with PSP. He often repeated words, and on many motor tasks he showed continuous perseveration of his right but not his left hand. Unilateral motor perseveration may be a sign of PSP, the corticobasal syndrome, or a subtype of these disorders. Future studies of patients with both disorders should use tasks that assess for asymmetric hand perseveration. The mechanism of the unilateral perseveration must also be determined. Bilateral perseveration is found most often in patients with unilateral right frontal-subcortical (basal ganglia) or insula dysfunction. Because patients with PSP or corticobasal syndrome have callosal degeneration, their unilateral perseveration might result from a callosal disconnection of the right frontal lobe from the left hemisphere's premotor and motor as well as speech areas. PMID:24366105

  12. Harlequin Syndrome After Thoracic Paravertebral Block.

    PubMed

    Nagasaka, Yasuko; Wasner, Gunnar; Sharma, Balram; Fleischmann, Katharine

    2016-02-01

    Harlequin syndrome is characterized by the sudden onset of unilateral facial flushing and sweating, often preceded by exercise, excessive heat, or, rarely, regional anesthesia. Although the exact mechanism remains unclear, it is often referred to as transient or permanent interruption of the sympathetic nervous system. We present a case of Harlequin syndrome without Horner syndrome in a patient with unilateral right-sided facial flushing that started shortly after a left-sided thoracic paravertebral nerve block for a mastectomy. We discuss the interruption of the sympathetic and parasympathetic nervous system and the levels of spinal nerve block associated with a thoracic paravertebral nerve block. PMID:26513674

  13. Thoracic splenosis.

    PubMed Central

    Madjar, S.; Weissberg, D.

    1994-01-01

    BACKGROUND--Thoracic splenosis is an uncommon side effect of thoracoabdominal trauma involving injury to the diaphragm and spleen. Only 20 patients with a similar problem have been reported previously. METHODS--Two patients with thoracic splenosis were studied. RESULTS--One of the patients had undergone thoracotomy for resection of a "pulmonary nodule". The other remains under observation. CONCLUSION--Presence of a pulmonary nodule in a patient with history of injury to the diaphragm and spleen should arouse suspicion of splenosis. Appropriate investigation may prevent an unnecessary and potentially harmful operation. Images PMID:7974296

  14. Traumatic chylothorax following blunt thoracic trauma: two conservatively treated cases.

    PubMed

    Apostolakis, Efstratios; Akinosoglou, Karolina; Koletsis, Efstratios; Dougenis, Dimitrios

    2009-01-01

    Chylothorax is rare following blunt thoracic trauma; its diagnosis is usually delayed until the puncture or drainage of posttraumatic pleural effusion and its cause is not clear. Mostly, it is attributed to injury or overstretching of major thoracic duct by fractures or other injury of neighboring thoracic spine. We describe of two cases, one unilateral and one bilateral, of chylothorax, both after blunt thoracic trauma. In the first case, there were associated fractures of lower thoracic vertebrae, whereas in the other there was no obvious cause, except striking osteophytic degeneration alongside the thoracic spine. Both cases were successfully treated after 16 and 23 days, respectively, with drainage, starvation, reexpansion of the lung(-s), and total parenteral nutrition. We believe that with the "triad of RST" ("reexpansion, starvation diet, TPN"), conservative treatment will be successful in the majority of cases. PMID:19267837

  15. Thoracic aortic aneurysm

    MedlinePLUS

    Aortic aneurysm - thoracic; Syphilitic aneurysm; Aneurysm - thoracic aortic ... The most common cause of a thoracic aortic aneurysm is hardening of the ... with high cholesterol, long-term high blood pressure, or who ...

  16. Hoarseness as the sole symptom of an impending thoracic aneurysm rupture?

    PubMed

    Jaafar, R; Mohamad, I

    2014-01-01

    Unilateral vocal cord palsy secondary to thoracic aortic aneurysm is a rare occurrence. Direct compression of the enlarging thoracic aneurysm on the left recurrent laryngeal nerve causes neuronal injury of the nerve, which is manifested as hoarseness. We present a rare case of unilateral vocal cord palsy in a 60-year-old healthy gentleman caused by a large thoracic aortic aneurysm. This rare presentation, with a serious underlying pathology might be misdiagnosed or delayed. Therefore, it is important for us to have high index of suspicion in cases with a rare presentation such as this. PMID:25606294

  17. American Thoracic Society

    MedlinePLUS

    ... Infections Nursing Pediatrics Pulmonary Circulation Pulmonary Rehabilitation Respiratory Cell & Molecular Biology Respiratory Structure & Function Sleep & Respiratory Neurobiology Thoracic Oncology ...

  18. Thoracic outlet syndrome.

    PubMed

    Kuhn, John E; Lebus V, George F; Bible, Jesse E

    2015-04-01

    Thoracic outlet syndrome is a well-described disorder caused by thoracic outlet compression of the brachial plexus and/or the subclavian vessels. Neurogenic thoracic outlet syndrome is the most common manifestation, presenting with pain, numbness, tingling, weakness, and vasomotor changes of the upper extremity. Vascular complications of thoracic outlet syndrome are uncommon and include thromboembolic phenomena and swelling. The clinical presentation is highly variable, and no reproducible study exists to confirm the diagnosis; instead, the diagnosis is based on a physician's judgment after a meticulous history and physical examination. Both nonsurgical and surgical treatment methods are available for thoracic outlet syndrome. Whereas nonsurgical management appears to be effective in some persons, surgical treatment has been shown to provide predictable long-term cure rates for carefully selected patients. In addition, physicians who do not regularly treat patients with thoracic outlet syndrome may not have an accurate view of this disorder, its treatment, or the possible success rate of treatment. PMID:25808686

  19. Dual Kidney Transplant.

    PubMed

    Hassan, Ahmed; Halawa, Ahmed

    2015-12-01

    During the past decades, dual kidney transplant has enabled greater use of marginal kidneys and reduced waiting time. Since the first description of dual transplant in 1996, the techniques and outcomes have improved. No clear allocation criteria for donors and suitable candidates have been outlined; however, in general, an older for older approach is followed by many centers. Many centers are hampered by the lack of a clear allocation policy and the fact that decisions for dual kidney transplant are solely clinician based. Unilateral placement of both kidneys is the technique of choice in many centers. En block pediatric dual transplant and several vascular reconstruction methods for dual kidneys have been adopted by surgeons to enable single arterial and venous anastomosis and to reduce complications. Although there is a higher prevalence of vascular complications, mainly in the form of graft thrombosis, the overall complication rate with dual kidney transplant is comparable to single kidney transplant. Kidney survival and function are encouraging and close to results with standard criteria single kidney transplant. Although the technique is well established in many centers, standardized guidelines are lacking. Here, we review the current experience with dual kidney transplant. PMID:26643671

  20. Burned unilateral half-cheek resurfacing techniques.

    PubMed

    Grishkevich, Viktor M

    2012-01-01

    Postburn cheek deformities are a tragedy for patients and pose a great challenge to surgeons due to a limited number of well-matching donor sites. In cases of unilateral half-cheek deformity, the flap's skin should match the contralateral cheek and the residual skin of the deformed cheek. The skin of a distant flap does not match the facial skin and resembles a patch. The most suitable skin type is the neck's skin and residual cheek's skin transposed on the defect with special techniques. Seventy-six patients with unilateral cheek scars covering nearly half of cheek's surface (total cheek deformities are not included in this series) were personally operated. The deformities were divided into four types or forms: lower cheek, lateral, medial, and upper. The flaps and techniques were designed for each type. The cervical skin, residual cheek skin, and periauricular skin (most matching the cheek's skin) was used in form of different flaps, depending on the scar location on the cheek. The basic flap used was the cervical split flap which could include A) a thoracic adipose-cutaneous layer (cervico-thoracic flap); B) periauricular fasciocutaneous layer (cervico-periauricular and cervico-thoraco-periauricular flaps); C) residual healthy facial adipocutaneous layer (cervico-facial, cervico-facio-periauricular, and cervico-thoraco-facioperiauricular flaps). Cervical flap has axial circulation and is elevated without platysma; it is transposed on the cheek with some tension. The lower and lateral cheek deformities were eliminated most successfully with the cervico-thoraco-periauricular flap by one-stage procedure. Medial and upper cheek deformities were eliminated with the cervico-facio-thoraco-periauricular flap. The facial segment can be expanded (usually in cases of upper cheek reconstruction); in such cases, the thoracic region is not included in the flap (cervico-facio-periauricular flap). The cheeks were reconstructed in all patients without serious complications. The flap's skin matched the contralateral cheek and surrounding healthy skin; the donor site's damage was minimal; operation scars' line was maximally shortened. The use of cervical split flap in combination with thoracic, facial, and periauricular adipose-cutaneous layer opens, in author's opinion, a reliable and most successful way for postburn half-cheek resurfacing. PMID:22210070

  1. Follow-up of prenatally diagnosed unilateral hydronephrosis.

    PubMed

    Thorup, J; Lenz, K; Rabol, A; Passalides, A; Nielsen, O H

    1996-12-01

    Based on previous experience with prenatally diagnosed unilateral hydronephrosis, we found that the primary indications for surgical intervention should be symptoms or functional impairment of the hydronephrotic kidney. Nonoperative management of neonates without symptoms and with normal function of the affected kidney was proposed. However, the strategy of treatment after prenatally diagnosed hydronephrosis is still controversial. We studied 28 consecutive children with suspected unilateral pelviureteral junction obstruction and a normal contralateral kidney. The overall follow-up period varied between 2.5 months and 6 years (median 2 years). Eleven children had normal function of the hydronephrotic kidney and were managed nonoperatively throughout the follow-up period. None of these demonstrated any symptoms and the renal function remained normal. A further 4 children with normal function of the affected kidney were managed nonoperatively, but later had a pyeloplasty performed because of either symptoms or deterioration of renal function. Eleven children had a pyeloplasty performed after the first renography showed that the hydronephrotic kidney provided less than 40% of total renal function. The age at pyeloplasty was 3 weeks- 7 months (median 6 weeks). In all cases but 1 the function of the affected kidney improved. Two patients with impaired hydronephrotic renal function were not operated upon. Our results indicate no need to change the strategy of treatment. PMID:24057464

  2. Thoracic Outlet Syndrome

    MedlinePLUS

    ... NINDS Funding Information Research Programs Training & Career Awards Enhancing Diversity Find People About NINDS NINDS Thoracic Outlet ... Funding | News From NINDS | Find People | Training | Research | Enhancing Diversity Careers@NINDS | FOIA | Accessibility Policy | Contact Us | ...

  3. Thoracic Outlet Syndrome

    MedlinePLUS

    Thoracic outlet syndrome (TOS) causes pain in the arm, shoulder, and neck. It happens when the nerves or blood vessels just below your ... vein is compressed, your hand might be sensitive to cold, or turn pale or bluish. Your arm ...

  4. Endoscopic thoracic sympathectomy

    MedlinePLUS

    Endoscopic thoracic sympathectomy (ETS) is surgery to treat sweating that is much heavier than normal. This condition ... hyperhidrosis . Usually the surgery is used to treat sweating in the palms or face. The sympathetic nerves ...

  5. Society of Thoracic Surgeons

    MedlinePLUS

    ... to Content Skip to Navigation Login For Cardiothoracic Surgeons What's New Education Annual Meeting Online Now Available ... Bavaria Elected President of The Society of Thoracic Surgeons Robert A. Guyton Honored for Leadership, Service to ...

  6. Thoracic Malignancy Steering Committee

    Cancer.gov

    The Thoracic Malignancy Steering Committee evaluates and prioritizes concepts for phase 3 and large phase 2 therapeutic clinical trials to be conducted in the NCI National Clinical Trials Network (NCTN).

  7. Thoracic trauma in horses.

    PubMed

    Hassel, Diana M

    2007-05-01

    Thoracic trauma represents an important cause of morbidity in mortality after injury in human beings and animals. After any form of suspected chest wall trauma, initial emergency management should include assurance of a patent airway and adequate ventilation, along with treatment for shock if present. As with any open wound, tetanus prophylaxis should be instituted. Types of trauma to the thoracic region of the horse include pectoral and axillary lacerations, penetrating chest wounds, flail chest, fractures of the ribs, blunt thoracic trauma, and several potential sequelae that include pneumothorax, pneumomediastinum, hemothorax, pleuritis, fistulae of the sternum or ribs, and diaphragmatic hernia. Emergency management of these various forms of thoracic trauma is discussed. PMID:17379110

  8. [Dilemmas in thoracic surgery].

    PubMed

    Orel, J

    1980-01-01

    Advances in ventilation physiology have brought solutions to fundamental problems of thoracic surgery and suggested ways of coping with problems of surgical technique and cilincal pathology. The domain of thoracic surgery should cover all those areas requiring specific surgical approach to endothoracic organs, with particular emphasis on special preoperative and postoperative care of such patients. This applies to thoracic trauma as well. A specialist in general surgery the thoracic surgeon needs additional training in this specific field. Departments of thoracic surgery must be organized as special units of lagre medical centres, each serving an area of no less than one million inhabitants. We are moreover convinced that pediatric cases ought to be dealt with bu a skillful thoracic surgeon regularly working with children. In the field of surgery of lung carcinoma the effects of radicality and the influence of positive mediastinal lymph nodes on surgical outcome, as well as the selection of patients for postoperative radiotherapy are currently under discussion. Operative management of pulmonary tuberculosis is becoming simpler, the disease occurs in atypical forms and secondary complications, above all aspergillosis, are on the increase. The choice of thoracotomy for various intrathoracic interventions calls for greater selectivity. Tracheal resection with primary anastomosis has been fully accepted, whereas prosthetic reconstruction is still subject to major dilemmas. Surgical stabilization of the chest following trauma, as an alternative to internal pneumatic fixation, ought to be considered more often in the future. In the management of gastroesophageal reflux surgery tends to prevail over conservative methods of treatment, wherebu the correct choice of tests for the evaluation of reflux is a matter of great significance. Numerous problems accompanying gastroesophageal resection for carcinoma still await solutions. PMID:7456945

  9. Unilateral radiation pneumonitis in sheep: Physiological changes and bronchoalveolar lavage

    SciTech Connect

    Tillman, B.F.; Loyd, J.E.; Malcolm, A.W.; Holm, B.A.; Brigham, K.L. )

    1989-03-01

    Radiation pneumonitis is a life-threatening result of therapeutic thoracic irradiation, yet its mechanisms are poorly understood. We studied the effects of unilateral lung irradiation (3,000 rad) in sheep from the immediate response to the later development of radiation pneumonitis. We defined radiation pneumonitis by its diagnostic clinical feature, radiographic infiltration of the irradiated zone with a straight margin corresponding to the radiation port. The immediate response in the few hours after irradiation was characterized by cough, labored respiration, hypoxemia (arterial PO{sub 2} decreased 19 Torr), mild pulmonary hypertension (pulmonary arterial pressure increased 20%), and lymphopenia. Hemodynamics and gas exchange returned to normal by day 2 but became abnormal again before or during radiation pneumonitis at 32 +/- 2 days. Respiratory distress, hypoxemia, and pulmonary hypertension recurred during radiation pneumonitis. Bronchoalveolar lavage during radiation pneumonitis contained increased neutrophils (19 +/- 4%, control = 7%), increased protein (0.27 +/- 0.1 g/dl, control = 0.12 +/- 0.03), and severely impaired ability to lower surface tension. Alveolar macrophages from both lungs during unilateral radiation pneumonitis exhibited impaired generation of superoxide after phorbol myristate (only a 30% increase). Normal control alveolar macrophages increased superoxide production after stimulation greater than 400%. We conclude that unilateral lung irradiation in sheep causes a mild immediate response followed by radiation pneumonitis at 1 mo. Unilateral radiation pneumonitis in this model is associated with ipsilateral neutrophilic alveolitis, increased bronchoalveolar lavage protein, and impaired surfactant function, as well as bilateral functional abnormalities of alveolar macrophages.

  10. [Rethoracotomy in thoracic surgery].

    PubMed

    Parshin, V D; Biriukov, Iu V; Gudovski?, A M; Grigor'eva, S P

    2012-01-01

    Technical progress of recent years allowed thoracic surgery to become a safer procedure. Experience of thoracic operations in our institution counts up to 14 962 cases (1963-2009 yy). Of them 223 (1.5%) patients had rethoracotomies on the reason of various operative complications. 112 patients had the intrapleural bleeding, 56 patients were reoperated on the reason of coagulated hemothorax, 57 patients demonstrated the bronchial stump insufficiency, and 11 were reoperated on other reasons. The frequency of rethoracotomy had decreased from 2.5 to 0.2%. The on-time rethoracotomy allows to save the patients' life and do not aggravate the overall result of the treatment. PMID:22810528

  11. Understanding Thoracic Outlet Syndrome

    PubMed Central

    Freischlag, Julie

    2014-01-01

    The diagnosis of thoracic outlet syndrome was once debated in the world of vascular surgery. Today, it is more understood and surprisingly less infrequent than once thought. Thoracic outlet syndrome (TOS) is composed of three types: neurogenic, venous, and arterial. Each type is in distinction to the others when considering patient presentation and diagnosis. Remarkable advances have been made in surgical approach, physical therapy, and rehabilitation of these patients. Dedicated centers of excellence with multidisciplinary teams have been developed and continue to lead the way in future research. PMID:25140278

  12. Spontaneous thoracic duct cyst.

    PubMed

    Ray, J; Braithwaite, D; Patel, P J

    2003-05-01

    Spontaneous and asymptomatic supraclavicular thoracic duct cysts (lymphoceles ) are rare. Only five cases have been reported so far. They are more common after surgery or trauma and have been reported in the abdomen, mediastinum, pelvis and neck. They must be differentiated from other neck cysts as failure to recognise their attachment may result in the disastrous consequence of chylothorax. A high index of suspicion is necessary, and diagnosis usually can be established by fine-needle aspiration and suitable imaging. This case is reported along with a review of the literature and management options, including that of inadvertent damage to the thoracic duct. PMID:12750920

  13. Thoracic ectopia cordis.

    PubMed

    Shad, Jimmy; Budhwani, Keshav; Biswas, Rakesh

    2012-01-01

    Ectopia cordis is defined as complete or partial displacement of the heart outside the thoracic cavity. It is a rare congenital defect in fusion of the anterior chest wall resulting in extra thoracic location of the heart. Its estimated prevalence is 5.5-7.9 per million live births. The authors had one such case of a 15-h-old full-term male neonate weighing 2.25 kg with an externally visible, beating heart over the chest wall. The neonate had difficulty in respiration with peripheral cyanosis. Patient died of cardiorespiratory arrest before any surgical intervention could be undertaken inspite of best possible resuscitative measures. PMID:23035158

  14. Thoracic ectopia cordis

    PubMed Central

    Shad, Jimmy; Budhwani, Keshav; Biswas, Rakesh

    2012-01-01

    Ectopia cordis is defined as complete or partial displacement of the heart outside the thoracic cavity. It is a rare congenital defect in fusion of the anterior chest wall resulting in extra thoracic location of the heart. Its estimated prevalence is 5.5–7.9 per million live births. The authors had one such case of a 15-h-old full-term male neonate weighing 2.25 kg with an externally visible, beating heart over the chest wall. The neonate had difficulty in respiration with peripheral cyanosis. Patient died of cardiorespiratory arrest before any surgical intervention could be undertaken inspite of best possible resuscitative measures. PMID:23035158

  15. Kidney Disease

    MedlinePLUS

    ... How Can I Help a Friend Who Cuts? Kidney Disease KidsHealth > For Teens > Kidney Disease Print A ... Syndrome Coping With Kidney Conditions What Do the Kidneys Do? You might never think much about some ...

  16. Kidney Cysts

    MedlinePLUS

    ... fluid-filled sac. There are two types of kidney cysts. Polycystic kidney disease (PKD) runs in families. In PKD, the ... place of the normal tissue. They enlarge the kidneys and make them work poorly, leading to kidney ...

  17. Kidney Transplant

    MedlinePLUS

    ... Rate Your Risk Quiz Featured Story African Americans & Kidney Disease Did you know that African Americans are ... Health checks Your Kidneys and You Featured Story Kidney Walk The Kidney Walk is the nation's largest ...

  18. Kidney Biopsy

    MedlinePLUS

    ... More Information American Kidney Fund National Kidney Foundation Kidney and Urologic Disease Organizations Many organizations provide support ... Disease Organizations​​ . (PDF, 345 KB) Alternate Language URL Kidney Biopsy Page Content On this page: What is ...

  19. Kidney Failure

    MedlinePLUS

    ... an AKF screening Kidney Action Day Kidney Action Day Learn about our signature outreach event. About AKF ... our Northeast Region. Kidney Action Day Kidney Action Day Our late spring event is an elegant fundraiser ...

  20. Kidney Biopsy

    MedlinePLUS

    ... More Information American Kidney Fund National Kidney Foundation Kidney and Urologic Disease Organizations Many organizations provide support ... Disease Organizations?? . (PDF, 345 KB) Alternate Language URL Kidney Biopsy Page Content On this page: What is ...

  1. Thoracic disc herniations.

    PubMed

    Dietze, D D; Fessler, R G

    1993-01-01

    Because of the protean nature of thoracic disc disease, surgeons should maintain a high order of suspicion of a thoracic disc herniation in the patient with unexplained localized back or torso pain and sensorimotor deficits. These patients should have MR imaging performed as a screening test, and, if suspicious for a thoracic disc herniation, confirmatory myelogram and postmyelogram CT imaging. Though the natural history is anecdotal, there appears to be a tendency for myelopathic symptoms and signs to be progressive, warranting surgical intervention. For radicular dysfunction or localized back pain, a conservative therapeutic plan is recommended. If intractable pain is demonstrated, and the diagnosis is certain, then surgical intervention is recommended. Once surgical intervention is recommended the surgical approach needs to be individualized according to the surgeon's skills and experience and the specifics of the patient's pathology. Appropriate surgical decision-making depends on an understanding of the variety of surgical options and their advantages and disadvantages, and an understanding of the biomechanical factors of the spine of the individual patient. Surgical concepts important to successful thoracic disc removal are (1) minimal spinal cord manipulation, (2) preservation of the neurovascular supply whenever possible, (3) minimal manipulation of the intercostal nerve, and (4) preservation of maximal bony and ligamentous attachments allowable for adequate exposure. Lastly it is recommended that the posterior longitudinal ligament be removed to ensure complete spinal cord decompression. PMID:8428158

  2. Penetrating paediatric thoracic injury.

    PubMed

    Coley, E; Roach, P; Macmillan, A I; West, A T H; Johnston, A M

    2011-09-01

    Paediatric penetrating chest trauma is common in conflict, but rarely seen in peacetime. We describe the successful hospital management of a five year old female civilian casualty with life threatening penetrating thoracic trauma caused by a fragment from an explosive device. PMID:21977715

  3. Unilateral Hydronephrosis and Renal Damage after Acute Leukemia

    PubMed Central

    Simanauskiene, Egle; Daugelaviciene, Valentina; Laurinavicius, Arvydas; Mickys, Ugnius; Simonyte, Vaida; Vaitkeviciene, Goda; Verkauskas, Gilvydas

    2012-01-01

    A 14-year-old boy presented with asymptomatic right hydronephrosis detected on routine yearly ultrasound examination. Previously, he had at least two normal renal ultrasonograms, 4 years after remission of acute myeloblastic leukemia, treated by AML-BFM-93 protocol. A function of the right kidney and no damage on the left was confirmed by a DMSA scan. Right retroperitoneoscopic nephrectomy revealed 3 renal arteries with the lower pole artery lying on the pelviureteric junction. Histologically chronic tubulointerstitial nephritis was detected. In the pathogenesis of this severe unilateral renal damage, we suspect the exacerbation of deleterious effects of cytostatic therapy on kidneys with intermittent hydronephrosis. PMID:22548083

  4. Bochdalek hernia with intrathoracic kidney

    PubMed Central

    Shah, Arti D.; Ajay, Stani; Adalia, Mayur; Rathi, Amar

    2012-01-01

    Bochdalek hernia is a congenital diaphragmatic defect that allows abdominal viscera to herniate into the thorax. Intrathoracic kidney is a very rare finding representing less than 5% of all renal ectopias. A 20 year old female presented with complaints of dry cough since 15 days and intermittent fever of 4 days duration. As part of routine investigation chest X-ray was done which showed a left retro-cardiac homogenous opacity, rest of the lung field appeared normal. Abdominal ultrasound showed the right kidney to be normal, left kidney was not visualized. Computed tomography scan demonstrated left-sided Bochdalek hernia with the left kidney within the thorax. An IVP was done to confirm the diagnosis. Many a times intrathoracic kidney is confused with a thoracic mass and the patient undergoes a battery of unnecessary investigations, surgical interventions and image guided biopsies for the same, hence to avoid this we are reporting this case. PMID:23243354

  5. Unilateral watershed cerebral infarcts.

    PubMed

    Bogousslavsky, J; Regli, F

    1986-03-01

    We studied 51 patients with symptomatic unilateral watershed (WS) cerebral infarct on CT. In 22 patients, the infarct was between the superficial territory of the anterior and middle cerebral arteries, 20 had an infarct between the superficial territory of the middle and posterior cerebral arteries, and 9 had an infarct between the superficial and deep territory of the middle cerebral arteries. Each type had a characteristic neurologic picture. Syncope at onset (37%) and focal limb shaking (12%) were frequent. Thirty-eight patients (75%) had internal carotid artery occlusion or tight stenosis associated with a hemodynamically significant cardiopathy, increased hematocrit, or acute hypotension. Embolic infarction was probable in only two patients (4%) who had only atrial fibrillation. PMID:3951705

  6. Thoracic textilomas: CT findings*

    PubMed Central

    Machado, Dianne Melo; Zanetti, Gláucia; Araujo, Cesar Augusto; Nobre, Luiz Felipe; Meirelles, Gustavo de Souza Portes; Pereira e Silva, Jorge Luiz; Guimarães, Marcos Duarte; Escuissato, Dante Luiz; Souza, Arthur Soares; Hochhegger, Bruno; Marchiori, Edson

    2014-01-01

    OBJECTIVE: The aim of this study was to analyze chest CT scans of patients with thoracic textiloma. METHODS: This was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus. RESULTS: The majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%). CONCLUSIONS: It is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication. PMID:25410842

  7. Mediastinal thoracic duct cyst.

    PubMed Central

    Gowar, F J

    1978-01-01

    A case of mediastinal thoracic duct cyst is described; it is believed to be the first to be reported in Britain. Five surgically treated cases have been reported but in none was the diagnosis made before operation. Symptoms are caused by pressure of the cyst on the trachea and oesophagus and my be aggravted by eating a fatty meal. Differential diagnosis from other mediastinal tumours, especially bronchogenic cyst and neurofibroma, could perhaps be established before operation by lymphangiography. Images PMID:746509

  8. [Thoracic actinomycosis: three cases].

    PubMed

    Herrak, L; Msougar, Y; Ouadnouni, Y; Bouchikh, M; Benosmane, A

    2007-09-01

    Actinomycosis is a rare condition which, in the thoracic localisation, can mimic cancer or tuberculosis. We report a series of three case of thoracic actinomycosis treated in the Ibn Sina University Thoracic Surgery Unit in Rabat, Morocco. CASE N degrees 1: This 45-year-old patient presented a tumefaction on the left anterior aspect of the chest. Physical examination identified a parietal mass with fistulisation to the skin. Radiography demonstrated a left pulmonary mass. Transparietal puncture led to the pathological diagnosis of actinomycosis. The patient was given medical treatment and improved clinically and radiographically. CASE N degrees 2: This 68-year-old patient presented repeated episodes of hemoptysis. The chest x-ray revealed atelectasia of the middle lobe and bronchial fibroscopy demonstrated the presence of a bud in the middle lobar bronchus. Biopsies were negative. The patient underwent surgery and the histology examination of the operative specimen revealed pulmonary actinomycosis. The patient recovered well clinically and radiographically with antibiotic therapy. CASE N degrees 3: This 56-year-old patient presented cough and hemoptysis. Physical examination revealed a left condensation and destruction of the left lung was noted on the chest x-ray. Left pleuropulmonectomy was performed. Histological analysis of the surgical specimen identified associated Aspergillus and Actinomyces. The outcome was favorable with medical treatment. The purpose of this work was to recall the radiological, clinical, histological, therapeutic, outcome aspects of this condition and to relate the problems of differential diagnosis when can suggest other diseases. PMID:17978739

  9. [Surgery for thoracic tuberculosis].

    PubMed

    Kilani, T; Boudaya, M S; Zribi, H; Ouerghi, S; Marghli, A; Mestiri, T; Mezni, F

    2015-01-01

    Tuberculosis is mainly a medical disease. Surgery has been the unique therapeutic tool for a long time before the advent of specific antituberculous drugs, and the role of surgery was then confined to the treatment of the sequelae of tuberculosis and their complications. The resurgence of tuberculosis and the emergence of multidrug-resistant TB combined to immunosuppressed patients represent a new challenge for tuberculosis surgery. Surgery may be indicated for a diagnostic purpose in patients with pulmonary, pleural, mediastinal or thoracic wall involvement, or with a therapeutic purpose (drainage, resection, residual cavity obliteration). Modern imaging techniques and the advent of video-assisted thoracic surgery allowed a new approach of this pathology; the majority of diagnostic interventions and selected cases requiring lung resection can be performed through a mini-invasive approach. Patients proposed for aggressive surgery may be treated with the best results thanks to a good evaluation of the thoracic lesions, of the patients' nutritional, infectious and general status combined with a good coordination between the specialized medical team for an optimal preparation to surgery. PMID:24894967

  10. Kidney Disease

    MedlinePLUS

    ... version of this page please turn Javascript on. Kidney Disease What is Kidney Disease? What the Kidneys Do Click for more information You have two ... damaged, wastes can build up in the body. Kidney Function and Aging Kidney function may be reduced ...

  11. Nonintubated anesthesia for thoracic surgery

    PubMed Central

    Wang, Bei

    2014-01-01

    Nonintubated thoracic surgery has been used in procedures including pleura, lungs and mediastinum. Appropriate anesthesia techniques with or without sedation allow thoracic surgery patients to avoid the potential risks of intubated general anesthesia, particularly for the high-risk patients. However, nonintubated anesthesia for thoracic surgery has some benefits as well as problems. In this review, the background, indication, perioperative anesthetic consideration and management, and advantages and disadvantages are discussed and summarized. PMID:25589994

  12. Kidney Problems

    MedlinePLUS

    ... our e-newsletter! Aging & Health A to Z Kidney Problems Basic Facts & Information The kidneys are two ... the production of red blood cells. What are Kidney Diseases? For about one-third of older people, ...

  13. Kidney School

    MedlinePLUS

    ... copies? Read our licensing agreement Living Successfully with Kidney Disease People with kidney disease can live long ... Listen Printing multiple copies? Read our licensing agreement Kidneys: How They Work, How They Fail, What You ...

  14. Kidney Transplantation

    MedlinePLUS

    ... your body. The transplanted kidney takes over the work of the two kidneys that failed, so you no longer need dialysis. During a transplant, the surgeon places the new kidney in your lower abdomen and ...

  15. Thoracic trauma in horses.

    PubMed

    Sprayberry, Kim A; Barrett, Elizabeth J

    2015-04-01

    Traumatic injuries involving the thorax can be superficial, necessitating only routine wound care, or they may extend to deeper tissue planes and disrupt structures immediately vital to respiratory and cardiac function. Diagnostic imaging, especially ultrasound, should be considered part of a comprehensive examination, both at admission and during follow-up. Horses generally respond well to diligent monitoring, intervention for complications, and appropriate medical or surgical care after sustaining traumatic wounds of the thorax. This article reviews the various types of thoracic injury and their management. PMID:25770070

  16. Thoracic spine x-ray

    MedlinePLUS

    Vertebral radiography; X-ray - spine; Thoracic x-ray; Spine x-ray; Thoracic spine films; Back films ... The test is done in a hospital radiology department or in the health care provider's office. You will lie on the x-ray table in different positions. If the x-ray ...

  17. Right-sided Bochdalek hernia with intrathoracic ectopic kidney in an advanced-age adult: a case report.

    PubMed

    Onuk, Ö; Ta?, T; ?entürk, A B; Sinano?lu, O; Balc?, M B C; Çelik, O; Nuho?lu, B

    2014-01-01

    Ectopic intrathoracic kidney is an extremely rare congenital anomaly and it is often asymptomatic and discovered incidentally on chest radiography. Although congenital thoracic kidney is mostly seen in infants, it can be diagnosed in neonatal age and adults as well. Herein, we present a 72-year-old woman who had a right-sided Bochdalek hernia with intrathoracic ectopic kidney. In contrast to the usually young patients with thoracic hernia, the presented case was the oldest female patient having thoracic kidney accompanied with Bochdalek hernia with clinical symptoms among those reported in the literature. PMID:24642649

  18. Kidney Cysts

    MedlinePLUS

    MENU Return to Web version Kidney Cysts Overview What do the kidneys do? The kidneys remove waste from your blood. They do this by filtering the blood and making urine. What are kidney cysts? As people get older, sacs filled with ...

  19. Solitary Kidney

    MedlinePLUS

    ... Institute, Inc., Kidney School National Kidney Foundation MedlinePlus Kidney and Urologic Disease Organizations Many organizations provide support ... Organizations​​ . (PDF, 345 KB)​​​​​ Alternate Language URL Solitary Kidney Page Content On this page: What is a ...

  20. Compensatory renal growth after unilateral nephrectomy in the new-born rat

    PubMed Central

    Dicker, S. E.; Shirley, D. G.

    1973-01-01

    1. The right kidney in a series of control rats aged between 5 days and 115 days was weighed. The kidney weight/body weight ratio was greater in young than in older rats, but decreased linearly with increasing age. 2. After unilateral nephrectomy of rats 5 days old, the remaining kidney underwent compensatory growth. The rate and extent of this growth were greater than in adult rats. 3. The concentrations of RNA and DNA in the renal cortex and medulla of rats 5 days old were higher than in adult animals. The concentrations of the two nucleic acids fell with age, and reached adult levels after approximately 6 weeks. 4. After unilateral nephrectomy of rats 5 days old, the concentrations of RNA and DNA in the medulla were not significantly different from those in control animals. In the cortex, however, there was a delayed increase in the RNA/DNA ratio, which reached a level some 12% higher than that in control rats. This increase was smaller than that observed in unilaterally nephrectomized adult rats. 5. The cortical QO2 of the remaining kidney of unilaterally nephrectomized new-born rats was elevated by some 20% within 1 day of unilateral nephrectomy. Cortical QO2's remained higher than those of control animals for 3-4 weeks. 6. Since after unilateral nephrectomy, the increase in renal mass in new-borns was greater than that in adults, whereas the degree of cortical cellular hypertrophy (as estimated by the RNA/DNA ratio) was smaller than in adults, it is likely that in new-born animals a significant contribution to compensatory growth comes from cellular hyperplasia. PMID:4686024

  1. [Thoracic findings in neurofibromatosis].

    PubMed

    Camsari, Güngör; Gür, Aygün; Ozkan, Gülcihan; Bakan, Nur Dilek; Zengin, Fatma; Külcü, Ay?e

    2006-01-01

    Neurofibromatosis type 1 (von Recklinghausen' disease) is an autosomal dominant hereditary syndrome. It is characterized with multiple light brown (café-au-lait) spots, Lisch nodules and neurofibromas. Thorax and lungs are affected in various forms. Four cases with symptoms of thoracic involvement were investigated in our clinic. Mean age was 46. All cases had dyspnoea and cough; two of them had chest pain. Skin lesions of neurofibromatosis type 1 (NF 1) were pathologically confirmed in all cases. Moreover, case 3 had diffuse interstitial fibrosis and honeycomb pattern. Case 2 had thorax deformity, kyphoscoliosis and intrathoracic benign mass. Case 1 had two neurofibrosarcoma masses on the right hemithorax. Case 4 had multiple intrathoracic neurofibromas. Cases 1 and 3 died within two years after diagnosis due to malignancy and respiratory failure, respectively. Cases 2 and 4 are still under our control. PMID:17001545

  2. Thoracic Insufficiency Syndrome.

    PubMed

    Mayer, Oscar; Campbell, Robert; Cahill, Patrick; Redding, Gregory

    2016-03-01

    Thoracic insufficiency syndrome (TIS) is a broad grouping of disorders that have a substantial impact on the chest wall, spine, and in many situations, both. While the conditions are varied, they share a potentially substantial impact on respiratory capacity and development over time and a presentation and need for intervention that is often in early childhood. Addressing these conditions has required a new paradigm that involves both deformity correction and a preservation of growth capacity. While there are now a number of options to treat severe spinal deformity early in life, when the deformity causes or is caused by a chest wall deformity, the Vertical Expandable Prosthetic Titanium Rib(VEPTR) is able to support surgical correction of both. The skeletal correction is often quite dramatic, but the functional measurements of quality of life and pulmonary function often do not show as dramatic and improvement, but consistently show a stabilization indicating control of the progressive thoracospinal disorder that produced TIS. PMID:26747620

  3. [Angiography in thoracic outlet syndrome].

    PubMed

    Bogalho, L; Seixas, I; Martins, J M; Pisco, J M

    1998-01-01

    The thoracic outlet syndrome is a changeable clinical syndrome caused by compression of the neurovascular bundle of the upper extremity, within the cervicoaxillary channel. From April 1980 through May 1995, 24 patients with clinical thoracic outlet syndrome were evaluated by selective arteriography. The diagnosis was confirmed in seven patients, in 14 the exam was normal and in the last three cases another arterial pathology was detected--subclavian artery occlusion, subclavian artery kinking and vertebral steal syndrome. The authors' aim is to emphasize arteriography as a diagnostic exam for thoracic outlet syndrome, very useful in the detection and localization of arterial compression. It also allows the diagnosis of other arterial entities. PMID:9542176

  4. Kidney: polycystic kidney disease.

    PubMed

    Paul, Binu M; Vanden Heuvel, Gregory B

    2014-01-01

    Polycystic kidney disease (PKD) is a life-threatening genetic disorder characterized by the presence of fluid-filled cysts primarily in the kidneys. PKD can be inherited as autosomal recessive (ARPKD) or autosomal dominant (ADPKD) traits. Mutations in either the PKD1 or PKD2 genes, which encode polycystin 1 and polycystin 2, are the underlying cause of ADPKD. Progressive cyst formation and renal enlargement lead to renal insufficiency in these patients, which need to be managed by lifelong dialysis or renal transplantation. While characteristic features of PKD are abnormalities in epithelial cell proliferation, fluid secretion, extracellular matrix and differentiation, the molecular mechanisms underlying these events are not understood. Here we review the progress that has been made in defining the function of the polycystins, and how disruption of these functions may be involved in cystogenesis. PMID:25186187

  5. Tests for Kidney Health

    MedlinePLUS

    ... kidney disease Free kidney health screenings Free kidney health screenings The American Kidney Fund offers free health ... blood. Tests for kidney health Tests for kidney health The only way to know if your kidneys ...

  6. Picture preferences of thoracic surgeons.

    PubMed

    Hirsh, K; McConathy, D A

    1986-01-01

    A mail survey instrument assessed whether thoracic surgeons prefer schematic, semi-schematic or realistic surgical illustrations for educational purposes in print media. Respondents, active members of the American Association of Thoracic Surgeons (N = 292), ranked preferences for the illustration treatments and supplied demographic information. Data analysis revealed significant differences between preferences for illustration treatments. The schematic treatment was the least preferable treatment. Realistic and semi-schematic illustrations were preferred about equally. PMID:2423514

  7. The evolution of thoracic anesthesia.

    PubMed

    Brodsky, Jay B

    2005-02-01

    The specialty of thoracic surgery has evolved along with the modem practice of anesthesia. This close relationship began in the 1930s and continues today. Thoracic surgery has grown from a field limited almost exclusively to simple chest wall procedures to the present situation in which complex procedures, such as lung volume reduction or lung transplantation, now can be performed on the most severely compromised patient. The great advances in thoracic surgery have followed discoveries and technical innovations in many medical fields. One of the most important reasons for the rapid escalation in the number and complexity of thoracic surgical procedures now being performed has been the evolution of anesthesia for thoracic surgery. There has been so much progress in this area that numerous books and journals are devoted entirely to this subject. The author has been privileged to work with several surgeons who specialized in noncardiac thoracic surgery. As a colleague of 25 years, the noted pulmonary surgeon James B.D. Mark wrote, "Any operation is a team effort... (but) nowhere is this team effort more important than in thoracic surgery, where near-choreography of moves by all participants is essential. Exchange of information, status and plans are mandatory". This team approach between the thoracic surgeon and the anesthesiologist reflects the history of the two specialties. With new advances in technology, such as continuous blood gas monitoring and the pharmacologic management of pulmonary circulation to maximize oxygenation during one-lung ventilation, in the future even more complex procedures may be able to be performed safely on even higher risk patients. PMID:15707342

  8. Kidney Diseases

    MedlinePLUS

    Your kidneys are two bean-shaped organs, each about the size of your fists. They are located near the ... back, just below the rib cage. Inside each kidney about a million tiny structures called nephrons filter ...

  9. Kidney Failure

    MedlinePLUS

    Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your ... strong and your blood healthy. But if the kidneys are damaged, they don't work properly. Harmful ...

  10. Multicystic dysplastic kidney complicated by pyelonephritis

    PubMed Central

    Cooper, Chad J.; Said, Sarmad; Khalillullah, Sayeed; Salameh, Hasan J.; Hernandez, German T.

    2013-01-01

    Patient: Female, 21 Final Diagnosis: Multicystic Dysplastic Kidney Disease complicated by pyelonephritis Symptoms: Left flank pain (CVAT) • dysuria • fever Medication: Levofloxacin Clinical Procedure: Dimercaptosuccinic acid scan • voiding cystouretrogram Specialty: Nephrology Objective: Rare disease Background: Multicystic dysplastic kidney (MCDK) is a renal dysplasia characterized by the presence of multiple cysts that are non-communicating, separated by dysplastic parenchyma that consumes the renal cortex resulting in a nonfunctional kidney. MCDK has an incidence of 1: 4300 of live births and is usually unilateral, most commonly occurring in the left kidney. Simple MCDK is defined as unilateral dysplasia with a normal contralateral kidney but with compensatory hypertrophy of the contralateral kidney, and no associated genitourinary anomalies. Case Report: A 21 year old Hispanic American female, presented with intermittent, sharp, severe left flank pain, fever and dysuria for two days but had gradually worsened within the last 24 hours prior to presentation. Previous history of multicystic dysplastic kidney, diagnosed four years ago. No pertinent physical examination findings except left costovertebral angle tenderness (CVAT). Urinalysis findings were positive for infection and urine culture grew pan sensitive Escherichia coli. A CT scan of abdominal and pelvis without contrast revealed a normal right kidney and left kidney had multiple non-communicating dilated cystic spaces, but no hydronephrosis, left ureteropelvic junction obstruction and finding were consistent with multicystic dysplastic kidney and also noted perinephric stranding. Conclusions: VUR is the most common renal abnormality in patients with MCDK, occurring in about 25% of contralateral kidney. Infections involving the MCDK are rare. In fact, cases of infections such as pyelonephritis or an infected renal cyst of MCDK are almost non-existent in the current literature. This patient presented with findings consistent with MCDK complicated by pyelonephritis. PMID:24349603

  11. Number of glomeruli in normal and hypertrophied kidneys of mice and guinea-pigs.

    PubMed Central

    Bonvalet, J P; Champion, M; Courtalon, A; Farman, N; Vandewalle, A; Wanstok, F

    1977-01-01

    1. In mice and guinea-pigs, the number of glomeruli was counted in kidneys during normal growth and in hypertrophy induced by unilateral nephrectomy. 2. In mice, the number of glomeruli increased sharply during the first 2 weeks in life, and more slowly afterwards. Unilateral nephrectomy, when performed during this period of natural increase, induced the formation of supplementary nephrons in the contralateral kidney. 3. In guinea-pigs, the number of glomeruli was almost complete at birth. No evidence of a supplementary increase in the number of nephrons was found in hypertrophied kidneys following unilateral nephrectomy. 4. These results, together wit previous data obtained in the rat, suggest that the ability to induce new nephrons after unilateral nephrectomy in different species would depend more on the state of kidney maturity at birth than on differences in the renal mechanisms which lead to hypertrophy. PMID:894607

  12. Cystic lymphangiectasia of the kidneys in an infant with nephrotic syndrome.

    PubMed

    Mattoo, T K; Giangreco, A B; Afzal, M; Akhtar, M

    1990-05-01

    Cystic lymphangiectasia of kidneys is a very rare abnormality. We report a 2-year-old boy with this disorder who also had congenital nephrotic syndrome. Unilateral nephrectomy abated the problems related to heavy proteinuria. PMID:2400649

  13. [Thoracic outlet syndrome].

    PubMed

    Sonoo, Masahiro

    2014-12-01

    Thoracic outlet syndrome (TOS) is a well-known disorder, but its definition has been disputed. TOS is differentiated into five distinct disorders: arterial vascular, venous vascular, traumatic neurovascular, true neurologic (TN-TOS), and nonspecific TOS. TN-TOS is caused by compression of the lower plexus (T1>C8 roots and/or lower trunk) by a fibrous band. The most frequent presenting symptoms are insidious-onset atrophy and weakness of the intrinsic hand muscles, predominantly in the thenar eminence and radial digital flexors. Numbness and sensory loss are usually present, mainly in the ulnar forearm, although severe pain or pain/paresthesia proximal to the elbow can occur; however, sensory symptoms or signs can be absent in some patients. Nerve conduction studies are pathognomonic and show the loss or severe attenuation of the sensory nerve action potential (SNAP) of the medial antebrachial cutaneous nerve. Additionally, they show a severely depressed median compound muscle action potential (CMAP) and, subsequently, a depressed ulnar CMAP and SNAP. TN-TOS is a rare disorder, although its incidence may be higher than previously believed. Hirayama disease is an important differential diagnosis. Nonspecific TOS, which is mainly diagnosed by provocative maneuvers, corresponds to the classical concept of TOS. However, this concept is now challenged and the existence of nonspecific TOS is doubted. PMID:25475030

  14. Kidney Dysplasia

    MedlinePLUS

    ... Dimes National Kidney Foundation Urology Care Foundation MedlinePlus Kidney and Urologic Disease Organizations Many organizations provide support ... Disease Organizations​​ . (PDF, 345 KB)​​​​​ Alternate Language URL Kidney Dysplasia Page Content On this page: What is ...

  15. Renography with captopril. Changes in a patient with hypertension and unilateral renal artery stenosis.

    PubMed

    Geyskes, G G; Oei, H Y; Puylaert, C B; Dorhout Mees, E J

    1986-09-01

    In a 56-year-old man with severe familial hypertension and unilateral renal artery stenosis, captopril induced striking changes in the renograms of the affected kidney. After injection of orthoiodohippurate sodium I 131, the uptake phase was unchanged but the later curve showed continuous accumulation. In contrast, the uptake of technetium Tc 99m diethylenetriamine pentracetic acid was abolished. These changes are compatible with a cessation of filtration and maintenance of renal blood flow. After balloon dilatation of the stenosis, the blood pressure became lower, and these changes could no longer be demonstrated. The captopril renogram may provide useful information on the dependency of hypertension on unilateral renal artery stenosis. PMID:3530163

  16. Renography with captopril. Changes in a patient with hypertension and unilateral renal artery stenosis

    SciTech Connect

    Geyskes, G.G.; Oei, H.Y.; Puylaert, C.B.; Dorhout Mees, E.J.

    1986-09-01

    In a 56-year-old man with severe familial hypertension and unilateral renal artery stenosis, captopril induced striking changes in the renograms of the affected kidney. After injection of orthoiodohippurate sodium I 131, the uptake phase was unchanged but the later curve showed continuous accumulation. In contrast, the uptake of technetium Tc 99m diethylenetriamine pentracetic acid was abolished. These changes are compatible with a cessation of filtration and maintenance of renal blood flow. After balloon dilatation of the stenosis, the blood pressure became lower, and these changes could no longer be demonstrated. The captopril renogram may provide useful information on the dependency of hypertension on unilateral renal artery stenosis.

  17. Noncompliance unilateral maxillary molar distalization:.

    PubMed

    Mavropoulos, Anestis; Sayinsu, Korkmaz; Allaf, Ferdi; Kiliaridis, Stavros; Papadopoulos, Moschos A; Keles, Ahmet Ozlem

    2006-05-01

    The aim of this prospective study was the three-dimensional (3-D) analysis of tooth movements after unilateral upper molar distalization by means of a noncompliance intraoral appliance, the Keles slider. This appliance exerts a distalizing force of 150 g at approximately the level of the center of resistance of the upper first molar. Twelve patients (six girls and six boys with a mean age of 13.1 years) with a unilateral Class II molar relationship participated in the study. Dental casts were taken immediately before placement and after removal of the appliance. The casts were digitized using a 3-D surface laser scanner and superimposed on a predefined area of the palate. The average unilateral upper first molar distal movement was 3.1 mm (range: 2.4 to 5.3 mm). Anchorage loss was expressed by a 2.1 mm (range: 0.8 to 3.8 mm) proclination of the central incisors and a 6.1 degrees mesial inclination of the ipsilateral first premolar (range: 1.7 degrees to 12.3 degrees ). There was approximately 1 mm of midline deviation toward the contralateral side and a 1.6 mm (range: 0.8 to 2.3 mm) buccal displacement of the contralateral first premolar. A substantial variation was observed among patients. Noncompliance unilateral upper molar distalization was an efficient treatment approach. There was, however, a substantial anchorage loss. Case selection is strongly recommended because significant anterior crowding, ectopic canines, or spacing can lead to significant anchorage loss. PMID:16637715

  18. The dying thoracic patient.

    PubMed

    Krishna, G; Raffin, T A

    1998-08-01

    Health care providers should understand that the practice of good medicine includes not only diagnosing and curing diseases, but also effectively communicating with patients and families and helping terminally ill patients die a peaceful and dignified death. Patients in America come from varied backgrounds, and it is important for physicians to consider cultural and religious issues. Physicians should combine their clinical judgment with objective outcome data to provide optimal care for patients. Informed consent should be obtained from patients after offering a detailed plan of care that would include appropriate interventions and the consequences of no intervention. The physician should then assist the patient in making a decision that would provide the best possible future for that individual. The four fundamental principles of biomedical ethics, namely beneficence, nonmaleficence, autonomy, and justice, should be considered when analyzing an ethical problem. Voluntary active euthanasia, which means performing a deliberate act (e.g., administering a lethal injection) to end a patient's life, should not be performed by a physician. Withholding and withdrawing basic and advanced life support constitutes passive euthanasia. Good communication with patients early in the clinical course whenever possible results in an ethically correct decision. A nonconfrontational, sympathetic, and compassionate approach to family members and legal surrogates facing the immediate death of their loved ones leads to the best possible outcome. It is the duty of the physician to assure the patient and the family that he or she will not abandon the patient. Effective communication is the key to solving almost all ethical dilemmas when caring for the dying thoracic patient. PMID:9742345

  19. Chronic Kidney Disease (CKD)

    MedlinePLUS

    ... ago. Kidney Disease About your kidneys About your kidneys Your kidneys are vital organs that remove waste ... long as possible. Kidney-friendly diet for CKD Kidney-friendly diet You may be able to prevent ...

  20. Thoracic radiologic manifestations of melioidosis.

    PubMed

    Burivong, Wanaporn; Wu, Xiaohua; Saenkote, Wipawadee; Stern, Eric J

    2012-01-01

    Melioidosis (Burkholderia pseudomallei) is a gram-negative bacterial infection that is highly endemic in Southeast Asia and Oceania. Pulmonary disease is the most common form of involvement. The clinical-radiologic thoracic manifestations of melioidosis can be classified as acute, subacute, subclinical, and chronic forms. Radiographic findings include nodular, alveolar, or mixed infiltration/consolidation with or without cavities. Pleural effusion, pneumothorax, and pericardial involvement can be seen. Melioidosis can easily be confused with other infections, especially tuberculosis. Suspicion of this disease in the proper clinical radiologic setting is important for early diagnosis and treatment. In this article, we provide a broad clinical overview of melioidosis, review the radiologic thoracic manifestations of melioidosis with appropriate clinical correlation, as well as compare and contrast the imaging findings of thoracic melioidosis with other similar pulmonary infections. PMID:23009770

  1. Isolated Unilateral Absence of the Left Pulmonary Artery: A Case Report

    PubMed Central

    2014-01-01

    We report the case of a 37-year-old man with isolated unilateral absence of the pulmonary artery (UAPA), which was diagnosed upon the occurrence of hemoptysis. Plain chest radiography demonstrated decreased left pulmonary volume. Computed tomography of the chest revealed the complete absence of the left pulmonary artery. Angiography revealed marked dilation of the left bronchial artery, inferior phrenic artery, internal thoracic artery, and the arterial branches of the thyrocervical trunk. These arteries were considered as collateral circulation to the left lung. In cases with UAPA, collateral circulation should be evaluated by angiography to obtain useful information for treatment. PMID:24995067

  2. Opposing changes in thoracic and abdominal aortic biomechanical properties in rodent models of vascular calcification and hypertension.

    PubMed

    Ameer, Omar Z; Salman, Ibrahim M; Avolio, Alberto P; Phillips, Jacqueline K; Butlin, Mark

    2014-07-15

    This study investigated the effects of hypertension on regional aortic biomechanical and structural properties in three rat models of vascular calcification: the hypertensive Lewis polycystic kidney (LPK; n = 13) model of chronic kidney disease, spontaneously hypertensive rats (SHRs; n = 12), and calcification in normotensive Lewis rats induced by vitamin D3 and nicotine (VDN; n = 8). Lewis and Wistar-Kyoto rats were controls. Thoracic and abdominal aortic stiffness parameters were assessed by tensile testing. In models where aortic stiffness differences compared with controls existed in both thoracic and abdominal segments, an additional cohort was quantified by histology for thoracic and abdominal aortic elastin, collagen, and calcification. LPK and VDN animals had higher thoracic breaking strain than control animals (P < 0.01 and P < 0.05, respectively) and lower energy absorption within the tensile curve of the abdominal aorta (P < 0.05). SHRs had a lower abdominal breaking stress than Wistar-Kyoto rats. LPK and VDN rats had more elastic lamellae fractures than control rats (P < 0.001), which were associated with calcium deposition (thoracic R = 0.37, P = 0.048; abdominal: R = 0.40, P = 0.046). LPK rats had higher nuclear density than control rats (P < 0.01), which was also evident in the thoracic but not abdominal aorta of VDN rats (P < 0.01). In LPK and VDN rats, but not in control rats, media thickness and cross-sectional area were at least 1.5-fold greater in thoracic than abdominal regions. The calcification models chronic kidney disease and induced calcification in normotension caused differences in regional aortic stiffness not seen in a genetic form of hypertension. Detrimental abdominal aortic remodeling but lower stiffness in the thoracic aorta with disease indicates possible compensatory mechanisms in the proximal aorta. PMID:24838503

  3. Unilateral ptosis and eye dominance.

    PubMed

    Lyon, D B; Gonnering, R S; Dortzbach, R K; Lemke, B N

    1993-12-01

    We studied the relationship between eye dominance (Scobee test) and upper lid level (MRD) in 54 patients with unilateral ptosis or asymmetric bilateral ptosis (> or = 2 mm difference in MRD) using the phenylephrine test. A contralateral lid drop was measured in 12/54 patients after instillation of 2.5% phenylephrine in the more ptotic eye and occurred in both congenital (3) and acquired (9) ptosis cases. A contralateral lid drop was seen in 7/14 (50%) patients whose ptosis was greater in the dominant eye and in 5/40 (12.5%) patients whose ptosis was greater in the nondominant eye (p = .01). Contralateral lid drops > or = 1 mm were present in 7/54 patients, and 6/14 (43%) of them had greater ptosis on the dominant side and 1/40 (2.5%) on the non-dominant side (p = .001). There was no association between contralateral pseudoretraction and either visual acuity or severity of ptosis. These results suggest that levator muscle tone is influenced by eye dominance when ptosis is present. The preoperative evaluation of unilateral or asymmetrical bilateral ptosis cases should include the Scobee and phenylephrine tests to unmask contralateral upper lid pseudoretraction. PMID:8305369

  4. Ectopic Kidney

    MedlinePLUS

    ... Human Development March of Dimes National Office MedlinePlus Kidney and Urologic Disease Organizations Many organizations provide support ... Organizations​​ . (PDF, 345 KB)​​​​​ Alternate Language URL Ectopic Kidney Page Content On this page: What is an ...

  5. Kidney Cancer

    MedlinePLUS

    You have two kidneys. They are fist-sized organs on either side of your backbone above your waist. The tubes inside filter and ... blood, taking out waste products and making urine. Kidney cancer forms in the lining of tiny tubes ...

  6. Common and uncommon adult unilateral renal masses other than renal cell carcinoma

    PubMed Central

    Le, Ott; Roy, Anjali; Silverman, Paul M.; Kundra, Vikas

    2012-01-01

    Abstract Many different masses can involve the kidney other than the commonly encountered renal cell carcinoma (RCC). The purpose of this article is to review the characteristic clinical and imaging findings of common and uncommon masses that predominantly present unilaterally in the adult patient, other than RCC. Awareness of such lesions and knowing the clinical scenario is important for appropriate diagnosis and management, especially in a multidisciplinary care setting. PMID:22752221

  7. [Minimum quantities from a thoracic surgical standpoint].

    PubMed

    Kaiser, D

    2007-11-01

    The dependence of operation lethality on hospital volume has been scientifically determined for thoracic surgery. Conclusions on the quality of the results are possible based on the structure and quality of the procedure. Minimum quantities for specialized centers in thoracic surgery have been established as 300 resectional operations on thoracic organs without mediastinoscopy, operations with the heart-lung machine, and thoracic drainage. Minimum quantities are necessary to uphold sufficient complication management by appropriate practice and experience and to keep operation lethality down. They are also needed for financing staff (at least two full-time active specialists in thoracic surgery). The concentration of thoracic surgical services at main hospitals (minimum 300 operations per year) and organ centers (minimum 500 resectional operations on thoracic organs per year) is reasonable for the 45,500 operations expected in Germany. PMID:17932631

  8. Phosphatidylinositol 3-kinase signaling determines kidney size

    PubMed Central

    Chen, Jian-Kang; Nagai, Kojiro; Chen, Jianchun; Plieth, David; Hino, Masayo; Xu, Jinxian; Sha, Feng; Ikizler, T. Alp; Quarles, C. Chad; Threadgill, David W.; Neilson, Eric G.; Harris, Raymond C.

    2015-01-01

    Kidney size adaptively increases as mammals grow and in response to the loss of 1 kidney. It is not clear how kidneys size themselves or if the processes that adapt kidney mass to lean body mass also mediate renal hypertrophy following unilateral nephrectomy (UNX). Here, we demonstrated that mice harboring a proximal tubule–specific deletion of Pten (PtenptKO) have greatly enlarged kidneys as the result of persistent activation of the class I PI3K/mTORC2/AKT pathway and an increase of the antiproliferative signals p21Cip1/WAF and p27Kip1. Administration of rapamycin to PtenptKO mice diminished hypertrophy. Proximal tubule–specific deletion of Egfr in PtenptKO mice also attenuated class I PI3K/mTORC2/AKT signaling and reduced the size of enlarged kidneys. In PtenptKO mice, UNX further increased mTORC1 activation and hypertrophy in the remaining kidney; however, mTORC2-dependent AKT phosphorylation did not increase further in the remaining kidney of PtenptKO mice, nor was it induced in the remaining kidney of WT mice. After UNX, renal blood flow and amino acid delivery to the remaining kidney rose abruptly, followed by increased amino acid content and activation of a class III PI3K/mTORC1/S6K1 pathway. Thus, our findings demonstrate context-dependent roles for EGFR-modulated class I PI3K/mTORC2/AKT signaling in the normal adaptation of kidney size and PTEN-independent, nutrient-dependent class III PI3K/mTORC1/S6K1 signaling in the compensatory enlargement of the remaining kidney following UNX. PMID:25985273

  9. Effects of acute and chronic unilateral renal denervation on the tubuloglomerular feedback mechanism.

    PubMed

    Thorup, C; Kurkus, J; Ollerstam, A; Persson, A E

    1996-02-01

    We recently observed a time-dependent resetting of the tubuloglomerular feedback (TGF) sensitivity to a subnormal level after acute unilateral renal denervation (aDNX). The present investigation compares the effects of aDNX with those of chronic unilateral renal denervation (cDNX), i.e one week after aDNX. All experiments were performed in anaesthetized rats prepared for micropuncture. cDNX led to increases in urine, sodium and potassium excretion in denervated kidneys, while contralateral kidneys showed reduced excretion of these parameters. GFR was increased in denervated kidneys, but unchanged on the contralateral side. TGF activity was determined by measuring the maximal stop-flow pressure response (delta Psf) and the tubular flow rate at which 50% of the maximal response occurred (turning point; TP). cDNX decreased TGF sensitivity, as indicated by an increased TP from 19.1 nL/min in sham-DNX to 26.1 nL/min. Concomitantly, TP in contralateral kidneys was significantly decreased to 15.9 nL/min, aDNX led to a greater sensitivity reduction: TP increased from 19.8 to 34.0 nL/min and contralaterally TP decreased to 14.0 nL/min. delta Psf in cDNX increased by 63% compared to sham-DNX, while on the contralateral side this was unchanged. No difference in delta Psf was found between control, DNX and contralateral kidneys in the aDNX group. In summary, these experiments show that the previously reported decrease in TGF sensitivity in aDNX kidneys still persists after one week, although less pronounced. As a result of the decreased TGF sensitivity, GFR is kept on a high level in cDNX kidneys. Contralateral kidneys show reversed resetting. PMID:8868270

  10. Chronic Kidney Diseases

    MedlinePLUS

    ... Skiing, Snowboarding, Skating Crushes What's a Booger? Chronic Kidney Diseases KidsHealth > For Kids > Chronic Kidney Diseases Print ... re talking about your kidneys. What Are the Kidneys? Your kidneys are tucked under your lower ribs ...

  11. Kidney disease - resources

    MedlinePLUS

    Resources - kidney disease ... The following organizations are good resources for information on kidney disease: National Kidney Disease Education Program -- www.nkdep.nih.gov National Kidney Foundation -- www.kidney.org National ...

  12. Unilateral acute idiopathic maculopathy. 1991.

    PubMed

    Yannuzzi, Lawrence A; Jampol, Lee M; Rabb, Maurice F; Sorenson, John A; Beyrer, Charles; Wilcox, Lloyd M

    2012-02-01

    This is a report of nine patients who experienced sudden, severe, unilateral central vision loss following a flulike illness. Each patient had an exudative detachment of the macula. All patients experienced a spontaneous resolution of the acute macular manifestations with near-complete recovery of vision. A characteristic "bull's-eye" appearance in the macula persisted. The acute manifestations of the disorder did not recur in any of the patients during the period of follow-up. The constellation of findings was suggestive of an inflammatory disease of the retinal pigment epithelium, but a specific causative agent could not be identified. The acute clinical and angiographic features, the natural course, and the residual pigment epithelial derangement were not consistent with any previously described disorder. PMID:22451959

  13. Acute unilateral facial nerve palsy.

    PubMed

    Yeong, Siew Swan; Tassone, Peter

    2011-05-01

    Mrs PS, 78 years of age, presented with acute left-sided otalgia, ear swelling and subsequent unilateral facial paralysis (Figure 1). She denied any otorrhoea or hearing loss. Past medical history relevant to the presenting complaint included: * Bell palsy diagnosed 20 years ago with no residual effect * biopsy confirmed benign parotid lump (diagnosed 3 years previously). Histopathology revealed a pleomorphic adenoma. Mrs PS declined surgical intervention at the time * chicken pox as a child * normal fasting blood glucose 1 month previously and no known immune compromise. Examination revealed yellow crusts and small vesicles on the external acoustic meatus (Figure 2). A 10 mm well defined firm and nontender nodule was palpable at the ramus of the mandible. PMID:21597548

  14. Reoperation for thoracic outlet syndrome.

    PubMed

    Sessions, R T

    1989-01-01

    The clinical history and operative findings in a group of 60 patients who underwent reoperation for thoracic outlet syndrome (TOS) are presented. The patients were severely disabled by arm, shoulder, and neck pain and presented with physical findings pointing to scar fixation of the brachial plexus in the neck (upper tract recurrence) or at the thoracic outlet (lower tract recurrence). The causes of recurrence of TOS as discovered at operation are outlined. Basic principles governing the surgical management of recurrent TOS are elimination of the known causes of recurrence, thorough neurolysis of the brachial plexus, and coverage of the nerves with healthy fat. The role of an expanded PTFE surgical membrane (Gortex) as an adjunct to prevent recurrent scarring is discussed. The surgeon who operates on patients with recurrent TOS must be capable of managing the potential intraoperative complications of severe nerve injury and life threatening bleeding. PMID:2745532

  15. Kidney Facts

    MedlinePLUS

    ... the kidneys is to remove waste from the body through the production of urine. They also help to regulate blood pressure, blood volume and the chemical (electrolyte) composition of the blood. Content on this page requires ...

  16. Kidney Failure

    MedlinePLUS

    ... Dialysis or Transplant Paying for Kidney Failure Treatment Contact Us Health Information Center Phone: 1-800-860- ... to share this content freely. October 2, 2013 Contact Us Health Information Center Phone: 1-800-860- ...

  17. Kidney Tumors

    Cancer.gov

    Kidney tumors are rare and generally curable in children. However, there are subsets of patients afflicted with these diseases that do not respond to treatment or eventually relapse. These patients usually have poor clinical outcomes as compared with the majority of children diagnosed with kidney tumors. All patients undergo therapy regimens that can be detrimental later in life. Through genome-wide characterization, TARGET investigators are identifying critical molecular alterations in these tumors, mostly from relapsed patients.

  18. Regulation of compensatory kidney hypertrophy by its own products

    PubMed Central

    Dicker, S. E.; Morris, Christine A.; Shipolini, R.

    1977-01-01

    1. The ligation of blood vessels of one kidney of adult rats resulted in the compensatory hypertrophy of the other kidney. In most animals the rate of hypertrophy was indistinguishable from that observed after unilateral nephrectomy, but in a few cases the onset was retarded when the renal artery alone had been ligated and the collateral circulation increased. 2. When the blood vessels of one kidney of adult rats were ligated and the cortex was excised, the rate of compensatory renal hypertrophy was similar to that observed after unilateral nephrectomy. 3. In animals operated for simultaneous partial hepatectomy and unilateral nephrectomy, there was no sign of compensatory renal hypertrophy while the liver was undergoing regeneration. Renal hypertrophy started after 7 days, when about 98% of the amount of liver removed had been regenerated. 4. Neither aseptic autolysis of one kidney following suppression of its blood supply, nor unilateral nephrectomy affected the rate of liver regeneration after simultaneous partial hepatectomy. 5. Total splenectomy did not affect the rate of compensatory renal hypertrophy following unilateral nephrectomy. 6. The heterotopic graft of renal cortical, but not of medullary, cells inhibited compensatory renal hypertrophy in adult rats. The removal of the graft after 14 days was followed by the resumption of compensatory hypertrophy. 7. The inhibiting action of fractions of renal cortical extracts fractionated on Sephadex G100 resin and DEAE-52 cellulose were assayed on the `growth' of renal explants reared in vitro. The final material, though only partially purified, proved to have an inhibiting activity between 250 and 500 times greater than that of the initial extract. 8. When injected into unilaterally nephrectomized rats, the partially purified extract from the renal cortex had an inhibiting effect on compensatory renal hypertrophy. 9. Immunofluorescence technique showed that the partially purified cortical extract affected the proximal convoluted tubes specifically, irrespective of animal species. PMID:894611

  19. Aggravated Cardiac Remodeling post Aortocaval Fistula in Unilateral Nephrectomized Rats

    PubMed Central

    Gu, Ye; Zou, Wusong; Zhang, Mingjing; Zhu, Pengfei; Hu, Shao

    2015-01-01

    Background Aortocaval fistula (AV) in rat is a unique model of volume-overload congestive heart failure and cardiac hypertrophy. Living donor kidney transplantation is regarded as beneficial to allograft recipients and not particularly detrimental to the donors. Impact of AV on animals with mild renal dysfunction is not fully understood. In this study, we explored the effects of AV in unilateral nephrectomized (UNX) rats. Methods Adult male Sprague-Dawley (SD) rats were divided into Sham (n = 10), UNX (right kidney remove, n = 10), AV (AV established between the levels of renal arteries and iliac bifurcation, n = 18) and UNX+AV (AV at one week after UNX, n = 22), respectively. Renal outcome was measured by glomerular filtration rate, effective renal plasma flow, fractional excretion of sodium, albuminuria, plasma creatinine, and cystatin C. Focal glomerulosclerosis (FGS) incidence was evaluated by renal histology. Cardiac function was measured by echocardiography and hemodynamic measurements. Results UNX alone induced compensatory left kidney enlargement, increased plasma creatinine and cystatin C levels, and slightly reduced glomerular filtration rate and increased FGS. AV induced significant cardiac enlargement and hypertrophy and reduced cardiac function and increased FGS, these changes were aggravated in UNX+AV rats. Conclusions Although UNX only induces minor renal dysfunction, additional chronic volume overload placement during the adaptation phase of the remaining kidney is associated with aggravated cardiac dysfunction and remodeling in UNX rats, suggesting special medical care is required for UNX or congenital monokidney subjects in case of chronic volume overload as in the case of pregnancy and hyperthyroidism to prevent further adverse cardiorenal events in these individuals. PMID:26252578

  20. Thoracic spine sports-related injuries.

    PubMed

    Menzer, Heather; Gill, G Keith; Paterson, Andrew

    2015-01-01

    Although sports-related injuries to the thoracic spine are relatively uncommon, they are among the most feared due to the potential for catastrophic neurologic injury. The increased biomechanical support of the thoracic spine makes injuries in this region particularly rare compared with the cervical and lumbar spine. As a result, thoracic spine injuries can be missed easily, difficult to diagnose, and problematic to treat. Recognition of mechanism and awareness of injury patterns help physicians determine a diagnosis and create an index of suspicion for unstable thoracic spine injuries. Aggressive full-contact sports receive the most attention for spinal injury; however several sports with repetitive loading of the spine can cause severe injuries, including rowing, gymnastics, and golf. The goal of this article was to provide an overview of the unique anatomic and biomechanical features of the thoracic spine and to discuss some of the more common thoracic injuries that can affect athletes. PMID:25574880

  1. Metabolomics of renal venous plasma from individuals with unilateral renal artery stenosis and essential hypertension

    PubMed Central

    Rhee, Eugene P.; Clish, Clary B.; Pierce, Kerry A.; Saad, Ahmed; Lerman, Lilach O.; Textor, Stephen C.

    2015-01-01

    Objective: To compare the metabolite profiles of venous effluent from both kidneys of individuals with unilateral atherosclerotic renal artery stenosis (ARAS) in order to directly examine how impaired renal blood flow impacts small-molecule handling in humans. Methods: We applied liquid chromatography–mass spectrometry based metabolite profiling to venous plasma obtained from the stenotic (STK) and contralateral (CLK) kidneys of ARAS patients (n?=?16), and both the kidneys of essential hypertensive controls (n?=?11). Study samples were acquired during a 3-day protocol that included iothalamate clearance measurements, radiographic kidney phenotyping (Duplex ultrasound, multidetector computed tomography, and blood-oxygen-level-dependent MRI), and controlled sodium and caloric intake and antihypertensive treatment. Results: Partial least squares-discriminant analysis demonstrated clear separation of essential hypertensive kidney metabolite profiles versus STK and CLK metabolite profiles, but no separation between metabolite profiles of STK and CLK samples. All of the discriminating metabolites were similarly elevated in the STK and CLK samples, likely reflecting the lower glomerular filtration rate in the ARAS versus essential hypertensive individuals (mean 66.1 versus 89.2?ml/min per 1.73?m2). In a paired analysis within the ARAS group, no metabolite was significantly altered in STK compared with CLK samples; notably, creatinine was the same in STK and CLK samples (STK/CLK ratio?=?1.0, P?=?0.9). Results were unchanged in an examination of ARAS patients in the bottom half of renal tissue perfusion or oxygenation. Conclusion: Metabolite profiling does not differentiate venous effluent from STKs or CLKs in individuals with unilateral ARAS, despite the measurable loss of kidney volume and blood flow on the affected side. These findings are consistent with the kidney's ability to adapt to ARAS to maintain a range of metabolic functions. PMID:25490710

  2. Aberrent Thoracic Duct Cyst in Postrior Mediastinum

    PubMed Central

    Park, Soo Jin; Park, Seonng Yong; Choi, Ho

    2015-01-01

    Thoracic duct cysts in the upper portion of the diaphragm are mostly found in the neck and are rarely found in the mediastinum. Thoracic duct cysts should be differentiated from other mediastinal tumors or cysts, and surgical treatment is required to avoid the development of chylothorax if the cyst ruptures. Herein, we report the case of a patient with a thoracic cyst located just above the diaphragm that was treated with surgical resection. PMID:26078934

  3. Selective control of sympathetic pathways to the kidney, spleen and intestine by the ventrolateral medulla in rats.

    PubMed Central

    Hayes, K; Weaver, L C

    1990-01-01

    1. Electrical activity of multifibre renal, splenic, mesenteric and greater splanchnic nerves and 13th thoracic white rami was recorded in artificially respired, urethane-anaesthetized rats. Discharge of neurones in the rostral ventrolateral medulla was blocked by unilateral microinjections of the inhibitory amino acid glycine and effects on the electrical activity of these sympathetic nerves were compared. 2. Blockade of the rostral ventrolateral medulla caused greater decreases in discharge of renal than splenic nerves and had no consistent effect on mesenteric nerves. This blockade also decreased the discharge of the preganglionic white rami more than that of the preganglionic splanchnic nerves. 3. Postganglionic responses to rostral ventrolateral medulla blockade were always greater than preganglionic responses. 4. The arterial pressure and renal nerve responses to rostral ventrolateral medulla blockade in urethane-anaesthetized rats were not different from those in rats anaesthetized with alpha-chloralose. 5. These findings demonstrate that pre- and postganglionic sympathetic pathways to the kidney are more dependent upon excitatory drive from the rostral ventrolateral medulla than pathways directed to the spleen and intestine. PMID:2231417

  4. Kidney cancer.

    PubMed

    Linehan, W Marston; Rathmell, W Kimryn

    2012-01-01

    Over 65,000 Americans are diagnosed with kidney cancer each year and nearly 13,000 die of this disease. Kidney cancer is not a single disease, it is made up of a number of different types of cancer, each with a different histology, a different clinical course, responding differently to therapy and caused by a different gene. Study of the 13 genes that are known to cause kidney cancer has led to the understanding that kidney cancer is a metabolic disease. Recent discoveries of chromatin remodeling/histone modifying genes, such as PBRM1 and SETD2, have opened up new areas of intense interest in the study of the fundamental genetic basis of kidney cancer. New approaches to immunotherapy with agents such as the CTLA4 inhibitor, ipilumumab, have opened up promising new directions for clinical trials. A number of new agents targeting of VEGF receptor signaling and the mTOR pathways as well as novel approaches targeting HIF2 will hopefully provide the foundation for the development of effective forms of therapy for this disease. PMID:23218074

  5. Kidney removal - series (image)

    MedlinePLUS

    Nephrectomy may be recommended for: kidney deformities (birth defects: congenital abnormalities) injury (trauma) disease infection hypertension tumor removal of kidney from donor for kidney transplant

  6. 48 CFR 30.603-2 - Unilateral and desirable changes.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... contractor is initiating management actions directly associated with the change that will result in cost... Unilateral and desirable changes. (a) Unilateral changes. (1) The contractor may unilaterally change its... the aggregate, as a result of the unilateral change. (2) Prior to making any contract price or...

  7. 48 CFR 30.603-2 - Unilateral and desirable changes.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... contractor is initiating management actions directly associated with the change that will result in cost... Unilateral and desirable changes. (a) Unilateral changes. (1) The contractor may unilaterally change its... the aggregate, as a result of the unilateral change. (2) Prior to making any contract price or...

  8. Spontaneous Intracranial Hypotension Manifesting as a Unilateral Subdural Hematoma with a Marked Midline Shift

    PubMed Central

    Inamasu, Joji; Moriya, Shigeta; Shibata, Junpei; Kumai, Tadashi; Hirose, Yuichi

    2015-01-01

    Spontaneous intracranial hypotension (SIH) is a syndrome in which hypovolemia of the cerebrospinal fluid (CSF) results in various symptoms. Although its prognosis is usually benign, cases with a rapid neurologic deterioration resulting in an altered mental status have been reported. One of the characteristic radiographic findings in such cases is the presence of bilateral accumulation of subdural fluid (hematoma/hygroma). When SIH-related subdural hematoma is present only unilaterally with a concomitant midline shift, making an accurate diagnosis may be challenging, and inadvertent hematoma evacuation may result in further neurologic deterioration. We report a 58-year-old woman with an altered mental status who had visited a local hospital and in whom a brain CT showed a unilateral subdural hematoma with a marked midline shift. She was referred to our department because of her neurologic deterioration after hematoma evacuation. A CT myelography revealed a massive CSF leakage in the entire thoracic epidural space. She made a full neurologic recovery following blood patch therapy. Our case is unique and educational because the suspicion for SIH as an underlying cause of subdural hematoma is warranted in nongeriatric patients not only with bilateral but also unilateral lesions. An immediate search for CSF leakage may be important in cases with failed hematoma evacuation surgery. PMID:25969682

  9. Postural disturbances resulting from unilateral and bilateral diaphragm contractions: a phrenic nerve stimulation study.

    PubMed

    Hamaoui, Alain; Hudson, Anna L; Laviolette, Louis; Nierat, Marie-Cécile; Do, Manh-Cuong; Similowski, Thomas

    2014-10-15

    Thoracoabdominal breathing movements are a complex source of postural disturbance, but there are contradictory reports in the literature with inspiration described as having either a backward or a forward disturbing effect. To elucidate the mechanisms underlying this phenomenon, the present study studied the postural disturbance caused by isolated contractions of the diaphragm. Eight male and four female healthy subjects followed an original paradigm of phrenic nerve stimulation (bilateral and unilateral) and "diaphragmatic" voluntary sniff maneuvers in the seated and standing postures. Center of gravity (CG) acceleration was calculated from force plate recordings, and respiratory kinematics were assessed with thoracic and abdominal sensor belts. CG and respiratory signals revealed that, while seated, bilateral phrenic stimulation and sniff maneuvers consistently produced expansion of the abdomen associated with a forward peak of CG acceleration. In the standing posture, the direction of the CG peak was reversed and always directed backward. Unilateral phrenic stimulation induced an additional medial-lateral acceleration of the CG, directed toward the nonactive side while seated, but in the opposite direction while standing. These results suggest that isolated diaphragmatic contractions produce a constant disturbing pattern for a given posture, but with opposite effects between standing and seated postures. This could be related to the different biomechanical configuration of the body in each posture, corresponding to distinct kinematic patterns of the osteoarticular chain. In addition, the lateral component of the CG acceleration induced by unilateral diaphragm contractions could be clinically relevant in patients with hemidiaphragm paralysis. PMID:25150226

  10. Kidney function after renal arterial embolism

    PubMed Central

    Fergus, J. N.; Jones, N. F.; Thomas, M. Lea

    1969-01-01

    Seven patients with atrial fibrillation had acute unilateral renal pain associated with suppression of function in the affected kidney. This was ascribed to renal embolism. Arteriography performed in four patients showed abnormalities in the renal arterial tree in three, though thrombus in a main artery was present in only one. Considerable function returned spontaneously to the affected kidney in six patients as judged by intravenous pyelography or renography. In two patients the sole functioning kidney was affected, leading to acute oliguric renal failure, but renal function recovered in each case. The routine use of anticoagulants in persistent atrial fibrillation is justified by such cases. ImagesFig. 1Fig. 2Fig. 3Fig. 1Fig. 2Fig. 3 PMID:5356546

  11. Effect of intravenous sodium loading on renal tubular handling of sodium and water in unilaterally nephrectomized humans.

    PubMed

    Sørensen, S S; Kjaer, T; Amdisen, A; Pedersen, E B

    1987-09-01

    Glomerular filtration rate (GFR), proximal absolute and fractional reabsorption of isotonic fluid (PAR and PFR) and distal absolute and fractional reabsorption of sodium (DARNa and DFRNa) were measured using the lithium clearance technique in nine unilaterally nephrectomized people (UNP) 1-11 years postnephrectomy and in 14 controls before, during and after an intravenous sodium load. Glomerular filtration rate per kidney was 53% higher in UNP and decreased slightly but significantly (p less than 0.01) in both groups during sodium loading. The PAR per kidney was significantly higher in UNP (p less than 0.01) but PFR was the same as in controls. Both groups responded to sodium loading with a significant decrease in both PAR and PFR. In UNP, DARNa per kidney was significantly higher than in controls (p less than 0.01) but DFRNa was the same in the two groups. Sodium loading resulted in a further increase in DARNa and a decrease in DFRNa in both groups. Both groups responded to sodium loading with a similar increase in fractional sodium excretion. It is concluded that unilateral nephrectomy is followed by an increase in GFR, PAR and DARNa but with maintenance of fractional reabsorption in both proximal and distal tubuli. In response to an intravenous sodium load, the remnant kidney is able to respond in a normal way with a further increase in DARNa. The adjustments necessary to maintain sodium balance after unilateral nephrectomy take place in both proximal and distal tubuli. PMID:3116659

  12. About Chronic Kidney Disease

    MedlinePLUS

    ... Rate Your Risk Quiz Featured Story African Americans & Kidney Disease Did you know that African Americans are ... Health checks Your Kidneys and You Featured Story Kidney Walk The Kidney Walk is the nation's largest ...

  13. Pregnancy and Kidney Disease

    MedlinePLUS

    ... Rate Your Risk Quiz Featured Story African Americans & Kidney Disease Did you know that African Americans are ... Health checks Your Kidneys and You Featured Story Kidney Walk The Kidney Walk is the nation's largest ...

  14. Polycystic kidney disease

    MedlinePLUS

    Cysts - kidneys; Kidney - polycystic; Autosomal dominant polycystic kidney disease; ADPKD ... Polycystic kidney disease (PKD) is passed down through families (inherited), usually as an autosomal dominant trait. If one parent ...

  15. Diet and Kidney Stones

    MedlinePLUS

    ... Rate Your Risk Quiz Featured Story African Americans & Kidney Disease Did you know that African Americans are ... Health checks Your Kidneys and You Featured Story Kidney Walk The Kidney Walk is the nation's largest ...

  16. Kidney Stones in Children

    MedlinePLUS

    ... Nephrology American Kidney Fund National Kidney Foundation MedlinePlus Kidney and Urologic Disease Organizations Many organizations provide support ... Disease Organizations​​ . (PDF, 345 KB) Alternate Language URL Kidney Stones in Children Page Content On this page: ...

  17. Kidney Disease Basics

    MedlinePLUS

    ... Links Take the first step Alternate Language URL Kidney Disease Basics Page Content Your kidneys filter extra ... blood pressure are the most common causes of kidney disease. ​These conditions can slowly damage the kidneys ...

  18. Kidney-Pancreas Transplant

    MedlinePLUS

    ... Rate Your Risk Quiz Featured Story African Americans & Kidney Disease Did you know that African Americans are ... Health checks Your Kidneys and You Featured Story Kidney Walk The Kidney Walk is the nation's largest ...

  19. National Kidney Foundation

    MedlinePLUS

    ... Rate Your Risk Quiz Featured Story African Americans & Kidney Disease Did you know that African Americans are ... Health checks Your Kidneys and You Featured Story Kidney Walk The Kidney Walk is the nation's largest ...

  20. Chronic Kidney Disease (CKD)

    MedlinePLUS

    ... an AKF screening Kidney Action Day Kidney Action Day Learn about our signature outreach event. About AKF ... our Northeast Region. Kidney Action Day Kidney Action Day Our late spring event is an elegant fundraiser ...

  1. American Kidney Fund

    MedlinePLUS

    ... an AKF screening Kidney Action Day Kidney Action Day Learn about our signature outreach event. About AKF ... our Northeast Region. Kidney Action Day Kidney Action Day Our late spring event is an elegant fundraiser ...

  2. Segmental thoracic spinal has advantages over general anesthesia for breast cancer surgery

    PubMed Central

    Elakany, Mohamed Hamdy; Abdelhamid, Sherif Ahmed

    2013-01-01

    Background: Thoracic spinal anesthesia has been used for laparoscopic cholecystectomy and abdominal surgeries, but not in breast surgery. The present study compared this technique with general anesthesia in breast cancer surgeries. Materials and Methods: Forty patients were enrolled in this comparative study with inclusion criteria of ASA physical status I-III, primary breast cancer without known extension beyond the breast and axillary nodes, scheduled for unilateral mastectomy with axillary dissection. They were randomly divided into two groups. The thoracic spinal group (S) (n = 20) underwent segmental thoracic spinal anesthesia with bupivacaine and fentanyl at T5-T6 interspace, while the other group (n = 20) underwent general anesthesia (G). Intraoperative hemodynamic parameters, intraoperative complications, postoperative discharge time from post-anesthesia care unit (PACU), postoperative pain and analgesic consumption, postoperative adverse effects, and patient satisfaction with the anesthetic techniques were recorded. Results: Intraoperative hypertension (20%) was more frequent in group (G), while hypotension and bradycardia (15%) were more frequent in the segmental thoracic spinal (S) group. Postoperative nausea (30%) and vomiting (40%) during PACU stay were more frequent in the (G) group. Postoperative discharge time from PACU was shorter in the (S) group (124 ± 38 min) than in the (G) group (212 ± 46 min). The quality of postoperative analgesia and analgesic consumption was better in the (S) group. Patient satisfaction was similar in both groups. Conclusions: Segmental thoracic spinal anesthesia has some advantages when compared with general anesthesia and can be considered as a sole anesthetic in breast cancer surgery with axillary lymph node clearance. PMID:25885990

  3. Biomarkers in descending thoracic aortic dissection.

    PubMed

    Shalhub, Sherene; Dua, Anahita; Brooks, Jared

    2014-12-01

    The clinical application of serum biomarkers (d-dimer, C-reactive protein) to predict the natural history of descending thoracic aortic dissection remains elusive. In this review, our current understanding of biomarkers in descending thoracic aortic dissection detection, predicting complications, and aiding in patient management is discussed. PMID:26073830

  4. Retropancreatic Teratoma with Intra-thoracic Extension

    PubMed Central

    Bakhshi, Girish D.; Wankhede, Kishor R.; Bhadarwar, Ajay H.; Tayade, Mukund B.; Shenoy, Sachin S.; Gore, Sandeep T.

    2013-01-01

    Primary retroperitoneal teratoma is a rare entity in adults. We present a case of 23-yearsold female who presented with complaint of abdominal pain in left upper quadrant. Computed tomography scan revealed a retroperitoneal retropancreatic teratoma near celiac axis with intra thoracic extension. Laparotomy with tumor resection was done. The case report is interesting for intra thoracic extension of retropancreatic teratoma. PMID:24765493

  5. Evolution of thoracic surgery in Canada

    PubMed Central

    Deslauriers, Jean; Griffith Pearson, F; Nelems, Bill

    2015-01-01

    BACKGROUND: Canada’s contributions toward the 21st century’s practice of thoracic surgery have been both unique and multilayered. Scattered throughout are tales of pioneers where none had gone before, where opportunities were greeted by creativity and where iconic figures followed one another. OBJECTIVE: To describe the numerous and important achievements of Canadian thoracic surgeons in the areas of surgery for pulmonary tuberculosis, thoracic oncology, airway surgery and lung transplantation. METHOD: Information was collected through reading of the numerous publications written by Canadian thoracic surgeons over the past 100 years, interviews with interested people from all thoracic surgery divisions across Canada and review of pertinent material form the archives of several Canadian hospitals and universities. RESULTS: Many of the developments occurred by chance. It was the early and specific focus on thoracic surgery, to the exclusion of cardiac and general surgery, that distinguishes the Canadian experience, a model that is now emerging everywhere. From lung transplantation in chimera twin calves to ex vivo organ preservation, from the removal of airways to tissue regeneration, and from intensive care research to complex science, Canadians have excelled in their commitment to research. Over the years, the influence of Canadian thoracic surgery on international practice has been significant. CONCLUSIONS: Canada spearheaded the development of thoracic surgery over the past 100 years to a greater degree than any other country. From research to education, from national infrastructures to the regionalization of local practices, it happened in Canada.

  6. Exposure latitude for thoracic radiography

    NASA Astrophysics Data System (ADS)

    Van Metter, Richard L.; Lemmers, Henri E. A. S. J.; Schultze Kool, Leo J.

    1992-06-01

    The chest PA examination is one of the single most performed studies in radiology today. It can provide a wealth of information in a single examination. As in many other areas of radiology there is a conflict between high contrast, which enables subtle structures to be visualized, and wide latitude, which allows all areas of interest in the chest to be displayed in a single image. In order to optimize the design of receptor systems it is useful to establish and understand the latitude required for thoracic imaging. We have measured the distributions of x-ray transmittance within the lungs, heart, and abdomen for a population of 868 out-patients. The measurements were made with a resolution element approximately 2 X 2 cm, at a single x-ray beam quality, and with a low-scatter slot-beam geometry. Under these conditions, the required receptor latitude for capturing each area of interest in the thorax is derived as a function of body habitus. To capture all three regions the required receptor latitude for the PA examination varies from 11:1 to 81:1 with increasing patient size. The implications of these results for thoracic image-receptor design is discussed.

  7. Bilateral internal thoracic artery grafting

    PubMed Central

    2013-01-01

    The effectiveness of the left internal mammary artery graft to the anterior descending coronary artery as a surgical strategy has been shown to improve the survival rate and decrease the risk of adverse cardiac events in patients undergoing coronary bypass surgery. These clinical benefits appear to be related to the superior short and long-term patency rates of the internal thoracic artery graft. Although the advantages of using of both internal thoracic arteries (ITA) for bypass grafting have taken longer to prove, recent results from multiple data sets now support these findings. The major advantage of bilateral ITA grafting appears to be improved survival rate, while the disadvantages of complex ITA grafting include the increased complexity of operation, and an increased risk of wound complications. While these short-term disadvantages have been mitigated in contemporary surgical practice, they have not eliminated. Bilateral ITA grafting should be considered the procedure of choice for patients undergoing coronary bypass surgery that have a predicted survival rate of longer than ten years. PMID:23977627

  8. Future of thoracic PET scanning.

    PubMed

    Johnson, Geoffrey B; Peller, Patrick J; Kemp, Bradley J; Ryu, Jay H

    2015-01-01

    The advances in PET scanning for thoracic diseases that are deemed most likely to have clinical impact in the near-term future are highlighted in this article. We predict that the current practice of medicine will continue to embrace the power of molecular imaging and specifically PET scanning. 18F-fluorodeoxyglucose-PET scanning will continue to evolve and will expand into imaging of inflammatory disorders. New clinically available PET scan radiotracers, such as PET scan versions of octreotide and amyloid imaging agents, will expand PET imaging into different disease processes. Major improvements in thoracic PET/CT imaging technology will become available, including fully digital silicone photomultipliers and Bayesian penalized likelihood image reconstruction. These will result in significant improvements in image quality, improving the evaluation of smaller lung nodules and metastases and allowing better prediction of prognosis. The birth of clinical PET/MRI scan will add new imaging opportunities, such as better PET imaging of pleural diseases currently obscured by complex patient motion. PMID:25560859

  9. The Thoracic Shape of Hominoids

    PubMed Central

    Chan, Lap Ki

    2014-01-01

    In hominoids, the broad thorax has been assumed to contribute to their dorsal scapular position. However, the dorsoventral diameter of their cranial thorax was found in one study to be longer in hominoids. There are insufficient data on thoracic shape to explain the relationship between broad thorax and dorsal scapular position. The current study presents data on multilevel cross-sectional shape and volume distribution in a range of primates. Biplanar radiographs of intact fluid-preserved cadavers were taken to measure the cross-sectional shape of ten equally spaced levels through the sternum (called decisternal levels) and the relative volume of the nine intervening thoracic segments. It was found that the cranial thorax of hominoids is larger and broader (except in the first two decisternal levels) than that of other primates. The cranial thorax of hominoids has a longer dorsoventral diameter because the increase in dorsoventral diameter caused by the increase in the volume of the cranial thorax overcompensates for the decrease caused by the broadening of the cranial thorax. The larger and broader cranial thorax in hominoids can be explained as a locomotor adaptation for scapular gliding and as a respiratory adaptation for reducing the effects of orthograde posture on ventilation-perfusion inequality. PMID:24818026

  10. Your Kidneys

    MedlinePLUS

    ... jobs of the kidneys is to filter the waste out of the blood . How does the waste get in your blood? Well, your blood delivers ... to break down the nutrients. Some of the waste is the result of these chemical reactions. Some ...

  11. Kidney pain (image)

    MedlinePLUS

    A kidney stone is a solid piece of material that forms in a kidney. Kidney stones may be the size of sand or ... A kidney stone is a solid piece of material that forms in a kidney. Kidney stones may be the ...

  12. Ossification of thoracic ligamenta flava

    SciTech Connect

    Kudo, S.; Minoru, O.; Russell, W.J.

    1983-07-01

    Although ligamentum flavum ossification (LFO) often occurs in normal persons, there are no reports of its detection on lateral chest radiographs made during screening examinations. Review of 1,744 consecutive lateral chest radiographs identified LFO in 6.2% of males and 4.8% of females. LFO occurred mainly at the intervertebral segments from T9-T10 through T12-L1. Most prevalent was the hook-shaped LFO, protruding inferoirly from the inferior facets into the projections of the intervertabral foramina. Though LFO can cause severe neurologic symptoms, none of the affected persons in this study reported such symptoms. LFO was first visualized radiographically when the subjects were 20-40 years old, and it may be a physiologic condition. The LFO in these cases existed independent of thoracic posterior longitudinal ligament ossification, diffuse idiopathic skeletal hyperostosis, and degenerative osteoarthritis.

  13. Thoracic Extraosseous Epidural Cavernous Hemangioma

    PubMed Central

    Asil, Kiyasettin; Ceylan, Davut; Erdem, Sahin

    2015-01-01

    Cavernous hemangiomas were first reported in 1929 by Globus and Doshay, and are defined as benign vascular structures developed between the neural tissues occurring in the central nervous system, consisting of a dilated vascular bed. Cavernous hemangiomas comprise nearly 5-12% of all spinal vascular malformations; however, existence in the epidural space without bone involvement is rare. Only 4% of all cavernous hemangiomas (0.22/1.000.000) are purely epidural cavernous hemangiomas. In this case report, we removed a hemorrhagic thoracic mass presenting with progressive neurological deficits in a 55-year-old male patient. We found this case to be appropriate for presentation due to the rare occurrence of this type of cavernous hemangioma. PMID:25674348

  14. Management of thoracic outlet syndrome.

    PubMed Central

    Dale, W A; Lewis, M R

    1975-01-01

    This overall management program for thoracic outlet compression syndrome is based upon experience with 153 extremities in 149 patients and the results of others. The following conclusions are documented and discussed. 1) Diagnosis is based chiefly upon history; physical signs are inconstant and often absent. 2) Major vascular problems are unusual; angiography is not always necessary. 3) Electromyography is not always critical but does aid in diagnosis of carpal tunnel syndrome. 4) Non-operative treatment relieves most patients; operative decompression is indicated for a minority. 5) Transxillary first rib resection, with removal of cervical rib is the best operation. 6) Carpal tunnel decompression should be done concomitantly when needed. 7) Operation is relatively safe. Images Fig. 2. Fig. 3A. Fig. 3B. Fig. 4. Fig. 6. Fig. 7. Fig. 8. Fig. 9. Fig. 10. PMID:1130876

  15. The thoracic surgical industrial complex.

    PubMed

    Starr, A

    1986-08-01

    The thoracic surgical industrial complex is an industry worth $2 billion per year and is shaped by six dominant forces, three positive and three negative. The three positive forces are technological innovation, entrepreneurial activity, and the flow of capital and the three opposing forces, government regulation, cost-containment, and the excessive costs of product liability insurance. We are now at a critical time in the evolution of this industry, with growth being enhanced in areas of lesser risk, namely, nonimplantable devices, at the expense of high-risk implantable devices. The future of the artificial heart hinges on the balance between the six forces, and this analysis examines the possibilities for timely development of this ultimate implantable device. PMID:3527091

  16. [Thoracic nocardiosis - a clinical report].

    PubMed

    Vale, Artur; Guerra, Miguel; Martins, Daniel; Lameiras, Angelina; Miranda, José; Vouga, Luís

    2014-01-01

    Nocardia genus microorganisms are ubiquitous, Gram positive aerobic bacterias, responsible for disease mainly in immunocompromised hosts, with cellular immune response commitment. Inhalation is the main form of transmition and pulmonary disease is the most frequent presentation. Dissemination may occur by contiguity and also via hematogenous. The clinical and imaging presentation is not specific, and diagnosis is obtained after identification of Nocardia bacteria in biological samples. Since there are no reliable studies that indicate the best therapeutic option, treatment should be individualized and based on antimicrobial susceptibility testing. Surgical drainage should also be considered in all patients. The authors present a clinical case of a patient with thoracic nocardiosis, and make a short literature review on the theme. PMID:25596394

  17. Radiation-induced long thoracic nerve palsy

    SciTech Connect

    Pugliese, G.N.; Green, R.F.; Antonacci, A.

    1987-09-15

    The incidence of long thoracic nerve palsy after radical mastectomy has been documented to be approximately 10%. No cases have been reported after the more recent treatment for breast cancer, lumpectomy with axillary dissection. This more recent surgical procedure is customarily followed by aggressive radiation therapy to the remaining breast tissue. This is the first case report of a patient with radiation-induced long thoracic nerve palsy. The patient was a young woman who underwent left breast quadrantectomy and axillary dissection for breast cancer. After radiation therapy, she had isolated left long thoracic nerve palsy. The diagnosis was confirmed by electrodiagnostic studies. Almost full recovery occurred after 5 months.

  18. Trilateral retinoblastoma with unilateral eye involvement.

    PubMed

    Andrade, Gabriel Costa de; Pinto, Neviçolino Pereira de Carvalho; Motono, Márcia; Chojniak, Martha Motono; Chojniak, Rubens; Bezerra, Stephania Martins

    2015-08-01

    Retinoblastomas (RB) are the main forms of intraocular tumor in childhood, with a worldwide incidence of 1 case per 15,000 to 20,000 live births. Trilateral RB (RBT) is a rare combination of unilateral or bilateral RB with a midline intracranial neoplasm of neuroblastic origin, usually found in the pineal region or the suprasellar region, presenting variable incidence of 0.5% up to 6% among patients with RB. The article reports a case of unilateral RBT in a patient treated at Hospital A.C.Camargo. PMID:26466209

  19. Pregnancy in a unilaterally ovariohysterectomised queen.

    PubMed

    Jurka, Piotr; Kacprzak, Kamil J; Degórska, Beata

    2015-04-01

    A 4-year-old female Russian Blue cat presented with signs of right-sided abdominal distension, anorexia and a mucoid vaginal discharge. On the basis of clinical and ultrasonographical findings a tentative diagnosis of uterine torsion was made. Exploratory coeliotomy revealed a 900º right uterine torsion along the longitudinal axis. Unilateral ovariohysterectomy was performed. Subsequently, the cat had two successful and uneventful pregnancies. To our knowledge this is the first case report of pregnancy in a unilaterally ovariohysterectomised queen. PMID:25414240

  20. Fetal and Postnatal Magnetic Resonance Imaging of Unilateral Cystic Renal Dysplasia in a Neonate with Tuberous Sclerosis.

    PubMed

    Tyagi, Vineet; Bornstein, Eran; Schacht, Robert; Lala, Shailee; Milla, Sarah

    2014-02-01

    Tuberous sclerosis (TS) is an autosomal dominant condition associated with mutations in the TSC1 and/or TSC2 genes. Clinical manifestations are multisystemic, and they often include lesions in the brain, skin, heart, kidneys, and bones. TSC2 gene mutations can be seen concomitantly with autosomal dominant polycystic kidney disease gene mutations. We present a case of a fetus with prenatal diagnosis of TS that had unique asymmetrical distribution of renal cystic disease. We describe the extensive work up with both fetal and neonatal magnetic resonance imaging with correlating images of the unilateral polycystic renal disease in addition to typical TS brain findings. PMID:24495558

  1. Preoperative Statin Use and Postoperative Acute Kidney Injury

    PubMed Central

    Brunelli, Steven M.; Waikar, Sushrut S.; Bateman, Brian T.; Chang, Tara I.; Lii, Joyce; Garg, Amit X.; Winkelmayer, Wolfgang C.; Choudhry, Niteesh K.

    2013-01-01

    BACKGROUND Acute kidney injury is a frequent postoperative complication that confers increased mortality, morbidity, and costs. The purpose of this study was to evaluate whether preoperative statin use is associated with a decreased risk of postoperative acute kidney injury. METHODS We assembled a retrospective cohort of 98,939 patients who underwent a major open abdominal, cardiac, thoracic, or vascular procedure between 2000 and 2010. Statin users were pair-matched to nonusers on the basis of surgery type, baseline kidney function, days from admission until surgery, and propensity score based on demographics, comorbid conditions, and concomitant medications. Acute kidney injury was defined based on changes in serum creatinine measurements applying Acute Kidney Injury Network and Risk-Injury-Failure staging systems, and on the need for renal replacement therapy. Associations between statin use and acute kidney injury were estimated by conditional logistic regression. RESULTS Across various acute kidney injury definitions, statin use was consistently associated with a decreased risk: adjusted odds ratios (95% confidence intervals) varied from 0.74 (0.58–0.95) to 0.80 (0.71–0.90). Associations were similar among diabetics and nondiabetics, and across strata of baseline kidney function. The protective association of statins was most pronounced among patients undergoing vascular surgery and least among patients undergoing cardiac surgery. CONCLUSIONS Preoperative statin use is associated with a decreased risk of postoperative acute kidney injury. Future randomized clinical trials are needed to determine causality. PMID:23062398

  2. The Effectiveness of Preemptive Thoracic Epidural Analgesia in Thoracic Surgery

    PubMed Central

    Erturk, Engin; Aydogdu Kaya, Ferdane; Kutanis, Dilek; Besir, Ahmet; Akdogan, Ali; Geze, Sükran; Tugcugil, Ersagun

    2014-01-01

    Background. The aim of this study is to investigate the effectiveness of preemptive thoracic epidural analgesia (TEA) comparing conventional postoperative epidural analgesia on thoracotomy. Material and Methods. Forty-four patients were randomized in to two groups (preemptive: Group P, control: Group C). Epidural catheter was inserted in all patients preoperatively. In Group P, epidural analgesic solution was administered as a bolus before the surgical incision and was continued until the end of the surgery. Postoperative patient controlled epidural analgesia infusion pumps were prepared for all patients. Respiratory rates (RR) were recorded. Patient's analgesia was evaluated with visual analog scale at rest (VASr) and coughing (VASc). Number of patient's demands from the pump, pump's delivery, and additional analgesic requirement were also recorded. Results. RR in Group C was higher than in Group P at postoperative 1st and 2nd hours. Both VASr and VASc scores in Group P were lower than in Group C at postoperative 1st, 2nd, and 4th hours. Patient's demand and pump's delivery count for bolus dose in Group P were lower than in Group C in all measurement times. Total analgesic requirements on postoperative 1st and 24th hours in Group P were lower than in Group C. Conclusion. We consider that preemptive TEA may offer better analgesia after thoracotomy. PMID:24745020

  3. Interaction between descending input and thoracic reflexes for joint coordination in cockroach: I. descending influence on thoracic sensory reflexes.

    PubMed

    Mu, Laiyong; Ritzmann, Roy E

    2008-03-01

    Tethered cockroaches turn from unilateral antennal contact using asymmetrical movements of mesothoracic (T2) legs (Mu and Ritzmann in J Comp Physiol A 191:1037-1054, 2005). During the turn, the leg on the inside of the turn (the inside T2 leg) has distinctly different motor patterns from those in straight walking. One possible neural mechanism for the transformation from walking to inside leg turning could be that the descending commands alter a few critical reflexes that start a cascade of physical changes in leg movement or posture, leading to further alterations. This hypothesis has two implications: first, the descending activities must be able to influence thoracic reflexes. Second, one should be able to initiate the turning motor pattern without descending signals by mimicking a point farther down in the reflex cascade. We addressed the first implication in this paper by experiments on chordotonal organ reflexes. The activity of depressor muscle (Ds) and slow extensor tibia muscle (SETi) was excited and inhibited by stretching and relaxing the femoral chordotonal organ. However, the Ds responses were altered after eliminating the descending activity, while the SETi responses remain similar. The inhibition to Ds activity by stretching the coxal chordotonal organ was also altered after eliminating the descending activity. PMID:18094976

  4. Genetics Home Reference: Asphyxiating thoracic dystrophy

    MedlinePLUS

    ... with asphyxiating thoracic dystrophy may live only into infancy or early childhood. However, in people who survive ... individuals may live into adolescence or adulthood. After infancy, people with this condition may develop life-threatening ...

  5. Thoracic radiculopathy caused by a myodil cyst.

    PubMed

    Fitzpatrick, M O; Goyal, K; Johnston, R A

    2000-08-01

    We report the case of a myodil cyst causing a thoracic radiculopathy in a patient who had undergone a myelogram 30 years previously. Although myodil is no longer used, sequelae can continue to be seen for many years. PMID:11045204

  6. Modern impact of video assisted thoracic surgery

    PubMed Central

    D’Amico, Thomas A.

    2014-01-01

    With advancement in technology, experience and training over the last two decades, video assisted thoracic surgery (VATS) has become widely accepted and utilized all over the world. VATS started as a diagnostic tool in the early 1990s, technique of VATS lobectomy evolved and became safer over the next 10-15 years and now it is being used for more advanced and hybrid operations. VATS has contributed to the development of minimally invasive surgical interventions for other thoracic disorders like mediastinal tumors and esophageal cancer as well. This article looks at the advantages of VATS, technique advancements and its applications in other thoracic operations and its influence on the present and future of thoracic surgery. PMID:25379201

  7. Anesthesia Management of a 20-Month-Old Patient with Giant Unilateral Wilms Tumor

    PubMed Central

    Matinyan, Nune; Saltanov, Alexander; Martynov, Leonid; Kazantsev, Anatolij

    2015-01-01

    Wilms tumour (WT) (or nephroblastoma) is one of the most common malignant kidney tumors in children. On subsequent stages clinically it is often characterized by abdominal hypertension syndrome, which, in turn, leads to development of respiratory insufficiency. Other symptoms comprise renal deficiency, hypertension, and abnormalities of hemostasis and hemogram. Treatment includes rounds of preoperative chemotherapy and subsequent surgery. We report a case of perioperative management for nephrectomy in 20-month-old patient with a giant unilateral WT. The complexity of anesthesia was determined by the size of tumor, increased intra-abdominal pressure, respiratory deficiency, and hypercoagulation. PMID:25815216

  8. Cellular proliferation in the urinary tract epithelium of the rat following temporary unilateral renal ischaemia.

    PubMed Central

    Dunn, S.; Gibbons, E. M.; Herbertson, B. M.

    1976-01-01

    A study of the effect of temporary unilateral renal ischaemia on the epithelium lining the renal pelvis and the bladder of the rat is described. There is a significant increase in the mitotic index in the pelvic epithelium of the affected kidneys, presenting a well-defined peak approximately 36 h after reflow. A similar but less pronounced cellular proliferation occurs in the bladder epithelium. The increased mitotic index in the renal pelvis and the bladder is not preceded by any detectable cell destruction at either site. It also has a different time course from the tubular regeneration which follows renal ischaemia. PMID:1268042

  9. [Closed thoracic trauma and concomitant diseases].

    PubMed

    Milkov, B O; Tsybyrne, K A; Smirnova, N A; Kulachek, F G; KhmelevskiÄ­, N M; Iatskiv, V V; Slivka, V P

    1989-01-01

    Examined were 340 patients with closed thoracic trauma and posttraumatic pneumonia. Often, this complication was revealed in the elderly and senile. Chronic non-specific diseases of the lungs, pneumothorax predisposed to occurrence of posttraumatic pneumonia. The methods for treatment of a given complication have been developed. Diseases of the heart, vascular system in thoracic trauma can cause the aggravation of a patient's state up to lethal outcome. PMID:2615202

  10. Nonintubated anesthesia in thoracic surgery: general issues

    PubMed Central

    Castillo, Maria

    2015-01-01

    Anesthetic management for awake thoracic surgery (ATS) is more difficult than under general anesthesia (GA), being technically extremely challenging for the anesthesiologist. Therefore, thorough preparation and vigilance are paramount for successful patient management. In this review, important considerations of nonintubated anesthesia for thoracic surgery are discussed in view of careful patient selection, anesthetic preparation, potential perioperative difficulties and the management of its complications. PMID:26046051

  11. Transient visual loss after right unilateral ECT.

    PubMed

    Kurani, Amit P; Kellner, Charles H; Turbin, Roger E; Serodio, Paulo; Sheren, Lorne B; Tannen, Brad

    2005-09-01

    We report a case of transient bilateral visual loss in a 27-year-old patient with a diagnosis of bipolar disorder after right unilateral electroconvulsive therapy that occurred immediately after her first session and resolved within 24 hours. We discuss possible mechanisms for this adverse effect. PMID:16127312

  12. Motor cortex excitability during unilateral muscle activity.

    PubMed

    Christova, M I; Pondev, N G; Christova, L G; Wolf, W; Dengler, R; Kossev, A R

    2006-10-01

    The effect of unilateral tonic muscle activity with and without co-activation of the antagonists on motor cortex excitability has been studied. Motor evoked potentials (MEPs) were recorded from the first dorsal interosseus muscles of both hands in response to transcranial magnetic stimulation (TMS) during relax, isometric index finger abduction and antagonistic co-activation. The intracortical inhibition (ICI) and intracortical facilitation (ICF) were investigated by paired-pulse TMS with interstimulus intervals of 3 and 13 ms. The unilateral tonic activation of the right hand facilitated contralateral and ipsilateral responses (cMEP and iMEP) recorded from both hands with an exception of iMEPs recorded from the left hand. During paired-pulse TMS ICI for cMEPs was not influenced by the unilateral tonic activity in both hands, while ICF was suppressed when MEPs were recorded from the active right hand. The effect of unilateral tonic activity on iMEP in response to paired-pulse TMS was essentially different: generally, ICI was greater for iMEPs and ICF was completely abolished with an exception of iMEPs recorded from the left hand during right finger isometric abduction when a strong ICF was evident. The decreased ICF and/or increased ICI are assumed to reflect mechanisms underlying the co-activation of antagonists. PMID:16275014

  13. Unilateral vestibular loss impairs external space representation.

    PubMed

    Borel, Liliane; Redon-Zouiteni, Christine; Cauvin, Pierre; Dumitrescu, Michel; Devèze, Arnaud; Magnan, Jacques; Péruch, Patrick

    2014-01-01

    The vestibular system is responsible for a wide range of postural and oculomotor functions and maintains an internal, updated representation of the position and movement of the head in space. In this study, we assessed whether unilateral vestibular loss affects external space representation. Patients with Menière's disease and healthy participants were instructed to point to memorized targets in near (peripersonal) and far (extrapersonal) spaces in the absence or presence of a visual background. These individuals were also required to estimate their body pointing direction. Menière's disease patients were tested before unilateral vestibular neurotomy and during the recovery period (one week and one month after the operation), and healthy participants were tested at similar times. Unilateral vestibular loss impaired the representation of both the external space and the body pointing direction: in the dark, the configuration of perceived targets was shifted toward the lesioned side and compressed toward the contralesioned hemifield, with higher pointing error in the near space. Performance varied according to the time elapsed after neurotomy: deficits were stronger during the early stages, while gradual compensation occurred subsequently. These findings provide the first demonstration of the critical role of vestibular signals in the representation of external space and of body pointing direction in the early stages after unilateral vestibular loss. PMID:24523916

  14. Unilateral scrotal angiomas: An expression of underlying varicocele.

    PubMed

    Tromp, Elise E; Kouwenhoven, Stijn T P; Quint, Koen D; Gmelig Meijling, Kevin A; Genders, Roel E

    2016-02-01

    The current casereport describes a 35-year-old man who presented with unilateral scrotal angiomas. The presence of unilateral scrotal angiomas was associated with an underlying varicocele on the ipsilateral side due to increased venous pressure. In case of unilateral scrotal angiomas further examination for underlying pathology is necessary. PMID:26175040

  15. Modification of unilateral otolith responses following spaceflight.

    PubMed

    Clarke, Andrew H; Schönfeld, Uwe

    2015-12-01

    The aim of the study was to resolve the issue of spaceflight-induced, adaptive modification of the otolith system by measuring unilateral otolith responses in a pre- versus post-flight design. The study represents the first comprehensive approach to examining unilateral otolith function following space flight. Ten astronauts participated in unilateral otolith function tests three times preflight and up to four times after Shuttle flights from landing day through the subsequent 10 days. During unilateral centrifugation, utricular function was examined by the perceptual changes reflected by the subjective visual vertical (SVV) and the otolith-mediated ocular counter-roll, designated as utriculo-ocular response (UOR). Unilateral saccular reflexes were recorded by measurement of collic vestibular evoked myogenic potentials (cVEMP). The findings demonstrate a general increase in interlabyrinth asymmetry of otolith responses on landing day relative to preflight baseline, with subsequent reversal in asymmetry within 2-3 days. Recovery to baseline levels was achieved within 10 days. This fluctuation in asymmetry was consistent for the utricle tests (SVV and UOR) while apparently stronger for SVV. A similar asymmetry was observed during cVEMP testing. In addition, the results provide initial evidence of a dominant labyrinth. The findings require reconsideration of the otolith asymmetry hypothesis; in general, on landing day, the response from one labyrinth was equivalent to preflight values, while the other showed considerable discrepancy. The finding that one otolith response can return to one-g level within hours after re-entry while the other takes considerably longer demonstrates the importance of considering the otolith response as a result of both peripheral and associated central neural processing. PMID:26358122

  16. Cytomegalovirus Immunoglobulin After Thoracic Transplantation

    PubMed Central

    Grossi, Paolo; Mohacsi, Paul; Szabolcs, Zoltán; Potena, Luciano

    2016-01-01

    Abstract Cytomegalovirus (CMV) is a highly complex pathogen which, despite modern prophylactic regimens, continues to affect a high proportion of thoracic organ transplant recipients. The symptomatic manifestations of CMV infection are compounded by adverse indirect effects induced by the multiple immunomodulatory actions of CMV. These include a higher risk of acute rejection, cardiac allograft vasculopathy after heart transplantation, and potentially bronchiolitis obliterans syndrome in lung transplant recipients, with a greater propensity for opportunistic secondary infections. Prophylaxis for CMV using antiviral agents (typically oral valganciclovir or intravenous ganciclovir) is now almost universal, at least in high-risk transplants (D+/R−). Even with extended prophylactic regimens, however, challenges remain. The CMV events can still occur despite antiviral prophylaxis, including late-onset infection or recurrent disease, and patients with ganciclovir-resistant CMV infection or who are intolerant to antiviral therapy require alternative strategies. The CMV immunoglobulin (CMVIG) and antiviral agents have complementary modes of action. High-titer CMVIG preparations provide passive CMV-specific immunity but also exert complex immunomodulatory properties which augment the antiviral effect of antiviral agents and offer the potential to suppress the indirect effects of CMV infection. This supplement discusses the available data concerning the immunological and clinical effects of CMVIG after heart or lung transplantation. PMID:26900989

  17. Kidney cell electrophoresis

    NASA Technical Reports Server (NTRS)

    Todd, P.

    1979-01-01

    A kidney cell electrophoresis technique is described in four parts: (1) the development and testing of electrophoresis solutions; (2) optimization of freezing and thawing; (3) procedures for evaluation of separated kidney cells; and (4) electrophoretic mobility characteristics of kidney cells.

  18. Chronic kidney disease

    MedlinePLUS

    Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; Chronic kidney failure; Chronic renal failure ... Chronic kidney disease (CKD) slowly gets worse over months or years. You may not notice any symptoms for some ...

  19. Chronic Kidney Disease

    MedlinePLUS

    You have two kidneys, each about the size of your fist. Their main job is to filter wastes and excess water out of ... help control blood pressure, and make hormones. Chronic kidney disease (CKD) means that your kidneys are damaged ...

  20. Diabetic Kidney Problems

    MedlinePLUS

    ... too high. Over time, this can damage your kidneys. Your kidneys clean your blood. If they are damaged, waste ... in your blood instead of leaving your body. Kidney damage from diabetes is called diabetic nephropathy. It ...

  1. Acute kidney failure

    MedlinePLUS

    Kidney failure; Renal failure; Renal failure - acute; ARF; Kidney injury - acute ... There are many possible causes of kidney damage. They include: ... cholesterol (cholesterol emboli) Decreased blood flow due to very ...

  2. Kidney cell electrophoresis

    NASA Technical Reports Server (NTRS)

    Todd, P.

    1980-01-01

    The following aspects of kidney cell electrophoresis are discussed: (1) the development and testing of electrophoresis solutions; (2) optimization of freezing and thawing; (3) procedures for evaluation of separated kidney cells; and (4) electrophoretic mobility characterization of kidney cells.

  3. Genetics Home Reference: Asphyxiating thoracic dystrophy

    MedlinePLUS

    ... with this condition may develop life-threatening kidney (renal) abnormalities that cause the kidneys to malfunction or ... Center at Nationwide Children's Hospital MedlinePlus Encyclopedia: Chronic Renal Failure MedlinePlus Encyclopedia: Polydactyly You might also find ...

  4. Pomegranate extract attenuates unilateral ureteral obstruction-induced renal damage by reducing oxidative stress

    PubMed Central

    Otunctemur, Alper; Ozbek, Emin; Cakir, Suleyman Sami; Polat, Emre Can; Dursun, Murat; Cekmen, Mustafa; Somay, Adnan; Ozbay, Nurver

    2015-01-01

    Aims: Ureteral obstruction may cause permanent kidney damage at late period. We know that the pomegranate extract (PE) play a strong role on removal of free oxygen radicals and prevention of oxidative stress. In the current study study, we evaluated the effect of PE on kidney damage after unilateral ureteral obstruction (UUO). Settings and Design: A total of 32 rats were divided into four groups. Group 1 was a control, Group 2 was a sham, Group 3 was rats with UUO and Group 4 was rats with UUO that were given PE (oral 100 μL/day). After 14 days, rats were killed and their kidneys were taken and blood analysis was performed. Subjects and Methods: Tubular necrosis, mononuclear cell infiltration, and interstitial fibrosis scoring were determined histopathologically in a part of kidneys; nitric oxide (NO), malondialdehyde (MDA), and reduced glutathione (GSH) levels were determined in the other part of kidneys. Statistical Analysis Used: Statistical analyses were performed by the Chi-square test and one-way analysis of variance. Results: There was no difference significantly for urea-creatinine levels between groups. Pathologically, there was serious tubular necrosis, mononuclear cell infiltration and fibrosis in Group 3, and there was significantly decreasing for tubular necrosis, mononuclear cell infiltration and fibrosis in Group 4 (P < 0.005). Furthermore, there was significantly increasing for NO and MDA levels; decreasing for GSH levels in Group 3 compared the other groups (P < 0.005). Conclusions: We think that the PE prevents kidney damage by decreasing oxidative stress in kidney. PMID:25838069

  5. Rapidly fluctuating anosmia: A clinical sign for unilateral smell impairment.

    PubMed

    Negoias, Simona; Friedrich, Hergen; Caversaccio, Marco D; Landis, Basile N

    2016-02-01

    Reports about fluctuating olfactory deficits are rare, as are reports of unilateral olfactory loss. We present a case of unilateral anosmia with contralateral normosmia, presenting as rapidly fluctuating anosmia. The olfactory fluctuation occurred in sync with the average nasal cycle duration. Examination after nasal decongestion, formal smell testing, and imaging revealed unilateral, left-sided anosmia of sinonasal cause, with right-sided normosmia. We hypothesize that the nasal cycle induced transient anosmia when blocking the normosmic side. Fluctuating olfactory deficits might hide a unilateral olfactory loss and require additional unilateral testing and thorough workup. Laryngoscope, 126:E57-E59, 2016. PMID:26153195

  6. KIDNEY XENOTRANSPLANTATION

    PubMed Central

    Cowan, Peter J.; Cooper, David K.C.; d’Apice, Anthony J.F.

    2013-01-01

    Xenotransplantation using pigs as donors offers the possibility of eliminating the chronic shortage of donor kidneys, but there are several obstacles to be overcome before this goal can be achieved. Preclinical studies have shown that while porcine renal xenografts are broadly compatible physiologically, they provoke a complex rejection process involving preformed and elicited antibodies, heightened innate immune cell reactivity, dysregulated coagulation, and a strong T cell-mediated adaptive response. Furthermore, the susceptibility of the xenograft to pro-inflammatory and pro-coagulant stimuli is probably increased by cross-species molecular defects in regulatory pathways. To balance these disadvantages, xenotransplantation has at its disposal a unique tool to address particular rejection mechanisms and incompatibilities: genetic modification of the donor. This review focuses on the pathophysiology of porcine renal xenograft rejection, and on the significant genetic, pharmacological and technical progress that has been made to prolong xenograft survival. PMID:24088952

  7. Kidney xenotransplantation.

    PubMed

    Cowan, Peter J; Cooper, David K C; d'Apice, Anthony J F

    2014-02-01

    Xenotransplantation using pigs as donors offers the possibility of eliminating the chronic shortage of donor kidneys, but there are several obstacles to be overcome before this goal can be achieved. Preclinical studies have shown that, while porcine renal xenografts are broadly compatible physiologically, they provoke a complex rejection process involving preformed and elicited antibodies, heightened innate immune cell reactivity, dysregulated coagulation, and a strong T cell-mediated adaptive response. Furthermore, the susceptibility of the xenograft to proinflammatory and procoagulant stimuli is probably increased by cross-species molecular defects in regulatory pathways. To balance these disadvantages, xenotransplantation has at its disposal a unique tool to address particular rejection mechanisms and incompatibilities: genetic modification of the donor. This review focuses on the pathophysiology of porcine renal xenograft rejection, and on the significant genetic, pharmacological, and technical progress that has been made to prolong xenograft survival. PMID:24088952

  8. Vitamin D: can you have too much of a good thing in chronic kidney disease?

    PubMed

    Morris, Howard A

    2015-11-01

    Recommendation of vitamin D supplements is common although there is little information regarding the definition of the upper limit of safety. Kusunoki et al. now publish interesting data of a novel mechanism by which excess 25-hydroxyvitamin D exerts adverse effects on the kidney, using unilateral ureteral obstruction in the mouse as a model of kidney disease. Their report provides a new mechanism to be assessed as a surrogate measure of vitamin D toxicity that may be clinically relevant. PMID:26579677

  9. Pregnancy after thoracic organ transplantation.

    PubMed

    Wu, Danny W; Wilt, Jessie; Restaino, Susan

    2007-12-01

    A growing number of heart, heart-lung, or lung transplant recipients are women of reproductive age. Fertility and pregnancy are important issues in this group of patients and often pose complex medical, psychosocial, and ethical problems. Many successful pregnancy outcomes have been reported following heart or lung transplantation. Nevertheless, these patients are at risk of certain maternal, fetal, and neonatal complications, including hypertension, preeclampsia, infection, preterm birth, and low birth weight. The physiological changes that occur in pregnancy are generally well tolerated by patients who have undergone thoracic organ transplant(s). The risk of allograft rejection during and after pregnancy is significant, and it is important to maintain an adequate level of immunosuppression. Pregnancies among lung transplant recipients are at higher risk for certain complications. The rate for graft rejection, independent of pregnancy status, is higher in this population. The long-term graft and patient outcomes citing a 50% 5-year mortality will be critical while counseling these patients regarding the impact of pregnancy on survival, and the ability to participate in raising the child. A multi-disciplinary team, involving specialists in maternal fetal medicine, cardiology or pulmonary medicine, transplant medicine, anesthesiology, high-risk nursing, neonatology, psychology, genetics, and social service, is crucial to the care of these patients. This team approach should be initiated at the time of pretransplant and preconception counseling and be continued through the prenatal and postpartum periods. The management plan should be individualized according to the status of the mother, the fetus, and the allograft. For most cases, given the need for close collaboration and frequent monitoring, these patients are best managed at their primary transplant institution in collaboration with local or referring physicians. PMID:18063119

  10. Percutaneous radiofrequency upper thoracic sympathectomy.

    PubMed

    Wilkinson, H A

    1996-04-01

    Between June 1979 and May 1994, I performed 148 unilateral or bilateral sympathectomies on 247 limbs in 110 patients using a percutaneous radiofrequency technique, usually on an outpatient surgery basis. Patient ages ranged from 10 to 81 years, with 45 male and 65 female patients. Four patients had unsuccessfully undergone prior open surgical sympathectomy. Patients suffered from hyperhidrosis, vascular occlusion, Raynaud's disease or other chronic vasculopathies, painful causalgia or reflex sympathetic dystrophy, or Prinzmetal's angina. The sympathectomy technique has evolved over this 15-year period and is currently in its third phase. Changes in the procedure were based on anatomic and clinical/radiographic correlations and careful patient follow-up. Current modifications have reduced the frequency of both early and late failures. The present technique (Phase III) relies on neuroleptanalgesia with superficial local anesthesia only and does not require general anesthesia, intubation, or lung collapse. Two 18-gauge radiofrequency TIC needle electrodes (Radionics, Burlington, MA) are used. A series of three lesions is rostrocaudally made at each of the ganglion sites selected in an attempt to destroy the entire fusiform ganglion. Lesion sites are targeted by C-arm fluoroscopy and electrical stimulation, which produces a threshold of sensory awareness of > 1.0 V. Lesion effectiveness is monitored by bilateral finger plethysmography and hand skin temperature measurement. With the Phase III technique, the sympathetic activity in 96% of operated limbs after 2 years and in 91% of operated limbs after 3 years continues to be completely or largely interrupted. By comparison, I achieved similar success in 83 and 72% operated limbs with the Phase I technique and in 77 and 71% with the Phase II technique. Symptomatic pneumothorax, in six patients, has been the only serious complication. When necessary, a subsequent operation can easily be performed and is effective. PMID:8692390

  11. Transgenic Expression of Nonclassically Secreted FGF Suppresses Kidney Repair

    PubMed Central

    Kirov, Aleksandr; Duarte, Maria; Guay, Justin; Karolak, Michele; Yan, Cong; Oxburgh, Leif; Prudovsky, Igor

    2012-01-01

    FGF1 is a signal peptide-less nonclassically released growth factor that is involved in angiogenesis, tissue repair, inflammation, and carcinogenesis. The effects of nonclassical FGF export in vivo are not sufficiently studied. We produced transgenic mice expressing FGF1 in endothelial cells (EC), which allowed the detection of FGF1 export to the vasculature, and studied the efficiency of postischemic kidney repair in these animals. Although FGF1 transgenic mice had a normal phenotype with unperturbed kidney structure, they showed a severely inhibited kidney repair after unilateral ischemia/reperfusion. This was manifested by a strong decrease of postischemic kidney size and weight, whereas the undamaged contralateral kidney exhibited an enhanced compensatory size increase. In addition, the postischemic kidneys of transgenic mice were characterized by hyperplasia of interstitial cells, paucity of epithelial tubular structures, increase of the areas occupied by connective tissue, and neutrophil and macrophage infiltration. The continuous treatment of transgenic mice with the cell membrane stabilizer, taurine, inhibited nonclassical FGF1 export and significantly rescued postischemic kidney repair. It was also found that similar to EC, the transgenic expression of FGF1 in monocytes and macrophages suppresses kidney repair. We suggest that nonclassical export may be used as a target for the treatment of pathologies involving signal peptide-less FGFs. PMID:22606265

  12. Protective Effect of RNase on Unilateral Nephrectomy-Induced Postoperative Cognitive Dysfunction in Aged Mice

    PubMed Central

    Gan, Lu; Dong, Yuanlin; Zhu, Tao; Ma, Gang; Li, Tao; Zhang, Xiyang; Li, Qian; Cheng, Xu; Wu, Chaomeng; Yang, Jing; Zuo, Yunxia; Liu, Jin

    2015-01-01

    Postoperative cognitive dysfunction (POCD) is a common complication after surgery, especially for elderly patients. Administration of RNase has been reported to exhibit neuroprotective effects in acute stroke. However, the potential role of RNase on POCD is unknown. Therefore, we sought to investigate whether RNase treatment could mitigate unilateral nephrectomy induced-cognitive deficit in aged mice. In the present study, twelve-month-old mice were administered RNase or an equal amount of normal saline perioperatively. All mice underwent Morris Water Maze (MWM) training 3 times per day for 7 days to acclimatize them to the water maze before surgical operation, and testing on days 1, 3 and 7 after surgery. We found that perioperative administration of RNase: 1) attenuated unilateral nephrectomy-induced cognitive impairment at day 3 after surgery; 2) reduced the hippocampal cytokines mRNA production and serum cytokines protein production at day 1 and day 7 (for MCP-1) after surgery, and; 3) inhibited hippocampal apoptosis as indicated by cleaved caspase-3 western blot and TUNEL staining at day 1 after surgery. In addition, a trend decrease of total serum RNA levels was detected in the RNase treated group after surgery compared with the untreated group. Further, our protocol of RNase administration had no impact on the arterial blood gas analysis right after surgery, kidney function and mortality rate at the observed days postoperatively. In conclusion, perioperative RNase treatment attenuated unilateral nephrectomy-induced cognitive impairment in aged mice. PMID:26225860

  13. Thoracic aortic aneurysm: reading the enemy's playbook.

    PubMed

    Elefteriades, John A

    2008-05-01

    The vast database of the Yale Center for Thoracic Aortic Disease--which includes information on 3000 patients with thoracic aortic aneurysm or dissection, with 9000 catalogued images and 9000 patient-years of follow-up--has, over the last decade, permitted multiple glimpses into the "playbook" of this virulent disease. Understanding the precise behavioral features of thoracic aortic aneurysm and dissection permits us more effectively to combat this disease. In this monograph, we will first review certain fundamentals--in terms of anatomy, nomenclature, imaging, diagnosis, medical, surgical, and stent treatment. After reviewing these fundamentals, we will proceed with a detailed exploration of lessons learned by peering into the operational playbook of thoracic aortic aneurysm and dissection. Among the glimpses afforded in the behavioral playbook of this disease are the following: 1 Thoracic aortic aneurysm, while lethal, is indolent. Mortality usually does not occur until after years of growth. 2 The aneurysmal ascending thoracic aorta grows slowly: about 0.1 cm per year (the descending aorta grows somewhat faster). 3 Over a patient's lifetime, "hinge points" at which the likelihood of rupture or dissection skyrockets are seen at 5.5 cm for the ascending and 6.5 cm for the descending aorta. Intervening at 5 cm diameter for the ascending and 6 cm for the descending prevents most adverse events. 4 Symptomatic aneurysms require resection regardless of size. 5 The yearly rate of rupture, dissection, or death is 14.1% for a patient with a thoracic aorta of 6 cm diameter. 6 The mechanical properties of the aorta deteriorate markedly at 6 cm diameter (distensibility falls, and wall stress rises)--a finding that "dovetails" perfectly with observations of the clinical behavior of the thoracic aorta. 7 Thoracic aortic aneurysm and dissection are largely inherited diseases, with a predominantly autosomal-dominant pattern. The specific genetics are being elucidated at the molecular level. 8 Matrix metalloproteinase overactivity participates in the destructive processes that degrade an aorta in individuals genetically preprogrammed to develop aneurysms. 9 Most dissections are brought on via presumed momentary hypertensive crises by severe exercise or emotion. We look forward to a future in which the aneurysm diathesis can be determined by a genetic test (RNA or DNA based), in which matrix metalloproteinases can be specifically antagonized by medications, in which exercise and emotion can be modulated in susceptible patients, and in which mechanical properties of the aorta (in addition to simple dimension) can be assessed serially to guide the timing of operation more precisely. Genetic-based therapies (eg, development of drugs on the basis of discovered molecular proteomics) will likely become possible to prevent susceptible patients from forming aneurysms over the long term. PMID:18439439

  14. [Possibilities of videothoracoscopy for penetrating thoracic injuries].

    PubMed

    VoskresenskiÄ­, O V; Radchenko, Iu A; Abakumov, M M

    2015-01-01

    It was analyzed the medical reports of 596 victims with thoracic injuries including 360 cases with following conventional therapeutic approach and 236 patients who underwent videothoracoscopy. We estimated condition severity in case of injuries of thoracic wall, lungs, pericardium and heart. Hemodynamic disorders were estimated according to Allgower-Burri shock index. Intrapleural bleeding was calculated using volume of hemothorax and time before injury and operation. Severity of physiological damages was determined using RTS criterion, anatomic--using ISS criterion. We estimated possibility for videothoracoscopy in patients with conventional therapeutic approach comparing severity of injuries, severity of condition in both groups and volume of surgery. Retrospective analysis revealed possibility of videothoracoscopy in 86.7% of victims with pulmonary injury, in 83.3% with bleeding at the muscular vessels of thoracic wall, in 40.3% with intercostal vessels injury, in 31.2% with heart injury, in 27.3% with damage of pericardium and in 18.8% with internal thoracic vessels injury. Our investigation revealed that videothoracoscopy may be used more widely in case of thoracic injury. PMID:26271560

  15. [Unilateral retinal pseudoarteritis after eyeball contusion].

    PubMed

    Arend, N; Thurau, S

    2012-12-01

    This article reports an unusual case of unilateral frosted branch angiitis. Three major groups of this disease are known: secondary frosted branch angiitis due to viral infection or autoimmune diseases, frosted branch-like angiitis related to malignant diseases and the rare entity of idiopathic frosted branch angiitis. A 58-year-old patient presented with strictly unilateral sheathing and partly occluded retinal arteries, vitritis and macular edema and 4 months prior to presentation he suffered a contusion of the eye with traumatic cataract and vitreous hemorrhage followed by cataract extraction and vitrectomy. The general medical history revealed that the contralateral eye and biochemical analyses were unremarkable despite slightly elevated antinuclear antibody (ANA) levels. Under high dose steroid therapy the patient showed slow improvement in all clinical findings. This case does not fit into any of the known groups and can therefore be defined as pseudoarteritis. PMID:22736263

  16. Unilateral Blaschkoid lichen planus in successive pregnancies

    PubMed Central

    Kumar, Shiva; Okade, Rajendra; Rahman, Yasmin Abdul

    2011-01-01

    A number of genetic, congenital and acquired dermatoses have been known to follow Blaschko's lines. A common disorder like lichen planus can very rarely present with pruritic lesions in atypical patterns such as unilateral distribution, painful eruptions and along Blaschko's lines. Various triggering factors varying from viral infections and vaccinations to trauma have been implicated in lichen planus. We describe a female patient in the second trimester of her second pregnancy who developed unilateral lichen planus along Blaschko's lines during both pregnancies. No case of lichen planus along Blaschko's lines recurring during pregnancy is reported so far. Could pregnancy itself be a contributory factor towards onset of lichen planus in this case? PMID:25386287

  17. Kidney Disease: A Silent Problem

    MedlinePLUS

    ... Kidney Disease: A Silent Problem Heath and Aging Kidney Disease: A Silent Problem Kidney Disease Who Is ... hormones that your body needs to stay healthy. Kidney Disease Kidney disease can sometimes develop very quickly, ...

  18. The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases: joint standardization of variable definitions and terminology.

    PubMed

    Fernandez, Felix G; Falcoz, Pierre E; Kozower, Benjamin D; Salati, Michele; Wright, Cameron D; Brunelli, Alessandro

    2015-01-01

    The European Society of Thoracic Surgery (ESTS) and the Society of Thoracic Surgeons (STS) general thoracic surgery databases collect thoracic surgical data from Europe and North America, respectively. Their objectives are similar: to measure processes and outcomes so as to improve the quality of thoracic surgical care. Future collaboration between the two databases and their integration could generate significant new knowledge. However, important discrepancies exist in terminology and definitions between the two databases. The objective of this collaboration between the ESTS and STS is to identify important differences between databases and harmonize terminology and definitions to facilitate future endeavors. PMID:25555970

  19. Paramedian unilateral Le Fort I osteotomy

    PubMed Central

    Tauro, David P.; Uppada, Uday Kiran

    2015-01-01

    A novel maxillary osteotomy is designed which is a technical modification of the standard Le Fort I osteotomy, termed the paramedian unilateral Le Fort I osteotomy. This technique has been used to correct an anterior open bite in a given patient based on the current clinical scenario as described, secondary to post ankylosis surgery. Its use may be extrapolated to various clinical situations to correct occlusal discrepancies including distraction osteogenesis. PMID:26389040

  20. Functioning unilateral adrenocortical carcinoma in a dog

    PubMed Central

    Gójska-Zygner, Olga; Lechowski, Roman; Zygner, Wojciech

    2012-01-01

    An 11-year-old, 24-kg, intact female Siberian husky dog in anestrus had a 2-month history of polyuria and polydipsia. The dog had signs of mineralocorticoid excess such as hypertension and hypokalemia refractory to potassium supplementation. Abdominal ultrasound revealed an irregular mass in the left adrenal gland. The ACTH stimulation test for aldosterone concentration did not reveal hyperaldosteronism. Unilateral adrenalectomy was performed and histopathology identified adrenal cortical carcinoma. All clinical signs of mineralocorticoid excess ceased after surgery. PMID:23204580

  1. Functioning unilateral adrenocortical carcinoma in a dog.

    PubMed

    Gójska-Zygner, Olga; Lechowski, Roman; Zygner, Wojciech

    2012-06-01

    An 11-year-old, 24-kg, intact female Siberian husky dog in anestrus had a 2-month history of polyuria and polydipsia. The dog had signs of mineralocorticoid excess such as hypertension and hypokalemia refractory to potassium supplementation. Abdominal ultrasound revealed an irregular mass in the left adrenal gland. The ACTH stimulation test for aldosterone concentration did not reveal hyperaldosteronism. Unilateral adrenalectomy was performed and histopathology identified adrenal cortical carcinoma. All clinical signs of mineralocorticoid excess ceased after surgery. PMID:23204580

  2. Accommodative Performance of Children With Unilateral Amblyopia

    PubMed Central

    Manh, Vivian; Chen, Angela M.; Tarczy-Hornoch, Kristina; Cotter, Susan A.; Candy, T. Rowan

    2015-01-01

    Purpose. The purpose of this study was to compare the accommodative performance of the amblyopic eye of children with unilateral amblyopia to that of their nonamblyopic eye, and also to that of children without amblyopia, during both monocular and binocular viewing. Methods. Modified Nott retinoscopy was used to measure accommodative performance of 38 subjects with unilateral amblyopia and 25 subjects with typical vision from 3 to 13 years of age during monocular and binocular viewing at target distances of 50, 33, and 25 cm. The relationship between accommodative demand and interocular difference (IOD) in accommodative error was assessed in each group. Results. The mean IOD in monocular accommodative error for amblyopic subjects across all three viewing distances was 0.49 diopters (D) (95% confidence interval [CI], ±1.12 D) in the 180° meridian and 0.54 D (95% CI, ±1.27 D) in the 90° meridian, with the amblyopic eye exhibiting greater accommodative errors on average. Interocular difference in monocular accommodative error increased significantly with increasing accommodative demand; 5%, 47%, and 58% of amblyopic subjects had monocular errors in the amblyopic eye that fell outside the upper 95% confidence limit for the better eye of control subjects at viewing distances of 50, 33, and 25 cm, respectively. Conclusions. When viewing monocularly, children with unilateral amblyopia had greater mean accommodative errors in their amblyopic eyes than in their nonamblyopic eyes, and when compared with control subjects. This could lead to unintended retinal image defocus during patching therapy for amblyopia. PMID:25626970

  3. Concomitant inhibition of renin angiotensin system and Toll-like receptor 2 attenuates renal injury in unilateral ureteral obstructed mice

    PubMed Central

    Chung, Sarah; Jeong, Jin Young; Chang, Yoon Kyung; Choi, Dae Eun; Na, Ki Ryang; Lim, Beom Jin; Lee, Kang Wook

    2016-01-01

    Background/Aims: There has been controversy about the role of Toll-like receptor 2 (TLR2) in renal injury following ureteric obstruction. Although inhibition of the renin angiotensin system (RAS) reduces TLR2 expression in mice, the exact relationship between TLR2 and RAS is not known. The aim of this study was to determine whether the RAS modulates TLR2. Methods: We used 8-week-old male wild type (WT) and TLR2-knockout (KO) mice on a C57Bl/6 background. Unilateral ureteral obstruction (UUO) was induced by complete ligation of the left ureter. Angiotensin (Ang) II (1,000 ng/kg/min) and the direct renin inhibitor aliskiren (25 mg/kg/day) were administrated to mice using an osmotic minipump. Molecular and histologic evaluations were performed. Results: Ang II infusion increased mRNA expression of TLR2 in WT mouse kidneys (p < 0.05). The expression of renin mRNA in TLR2-KO UUO kidneys was significantly higher than that in WT UUO kidneys (p < 0.05). There were no differences in tissue injury score or mRNA expression of monocyte chemotactic protein 1 (MCP-1), osteopontin (OPN), or transforming growth factor β (TGF-β) between TLR2-KO UUO and WT UUO kidneys. However, aliskiren decreased the tissue injury score and mRNA expression of TLR2, MCP-1, OPN, and TGF-β in WT UUO kidneys (p < 0.05). Aliskiren-treated TLR2-KO UUO kidneys showed less kidney injury than aliskiren-treated WT UUO kidneys. Conclusions: TLR2 deletion induced activation of the RAS in UUO kidneys. Moreover, inhibition of both RAS and TLR2 had an additive ameliorative effect on UUO injury of the kidney. PMID:26932402

  4. Medullary Sponge Kidney

    MedlinePLUS

    ... Association of Kidney Patients National Kidney Foundation MedlinePlus Kidney and Urologic Disease Organizations Many organizations provide support ... PDF, 345 KB)​​​​​ Alternate Language URL Medullary Sponge Kidney Page Content On this page: What is Medullary ...

  5. Simple Kidney Cysts

    MedlinePLUS

    ... Information American Kidney Fund National Kidney Foundation MedlinePlus Kidney and Urologic Disease Organizations Many organizations provide support ... Organizations​​ . (PDF, 345 KB)​​​​​ Alternate Language URL Simple Kidney Cysts Page Content On this page: What are ...

  6. Acquired Cystic Kidney Disease

    MedlinePLUS

    ... onset of disease. People with ACKD already have chronic kidney disease when they develop cysts. Kidneys Ureters Bladder What ... kidney failure and finding treatment to stop its progression. The NIDDK’s Division ... Diseases sup ports basic research into normal kidney function ...

  7. Transthoracic endoscopy for upper thoracic chemical sympathectomy.

    PubMed

    Bardaxoglou, E; Reigner, B; Enon, B; Tolstuchow, N; Lescalié, F; Peret, M; Chevalier, J M

    1992-07-01

    Beginning in April 1989, we have performed eight upper thoracic chemical sympathectomies by transthoracic endoscopy. The indications were occlusive arterial disease in four patients and Raynaud's syndrome and palmar hyperhidrosis in two patients each. Transthoracic endoscopy was performed under general anesthesia, through the third costal interspace on the anterior mid-clavicular line. Five ml of phenol were injected into the parietal pleura covering the three proximal thoracic ganglia. The duration of thoracic drainage was 24 hours. The postoperative course was uneventful except for one case of subcutaneous emphysema and transient Horner's syndrome in three instances. There were no initial failures. Because of its simplicity and the short hospitalization period, chemical sympathectomy by transthoracic endoscopy constitutes a valuable alternative to conventional surgery. This technique is, however, limited in the case of antecedent pleuropulmonary disorders. PMID:1390030

  8. Acute shingles after resection of thoracic schwannoma.

    PubMed

    Muesse, Jason L; Blackmon, Shanda H; Harris, Richard L; Kim, Min P

    2012-01-01

    Herpes zoster is relatively uncommon after surgery in immunocompetent patients. To our knowledge, there have been no reports of herpes zoster after the resection of a thoracic schwannoma. We report the case of a 48-year-old woman in whom acute shingles developed after the video-assisted thoracic surgical resection of a posterior mediastinal schwannoma adjacent to the 4th thoracic vertebral body. The patient recovered after receiving timely antiviral therapy. Rash and pain are common in patients who have wound infections and contact dermatitis after surgery, so the possible reactivation of varicella virus might not be prominent in the surgeon's mind. This case serves as a reminder that viral infections such as shingles should be considered in the differential diagnosis of postoperative erythema and pain. PMID:22740749

  9. Acute Shingles after Resection of Thoracic Schwannoma

    PubMed Central

    Muesse, Jason L.; Blackmon, Shanda H.; Harris, Richard L.; Kim, Min P.

    2012-01-01

    Herpes zoster is relatively uncommon after surgery in immunocompetent patients. To our knowledge, there have been no reports of herpes zoster after the resection of a thoracic schwannoma. We report the case of a 48-year-old woman in whom acute shingles developed after the video-assisted thoracic surgical resection of a posterior mediastinal schwannoma adjacent to the 4th thoracic vertebral body. The patient recovered after receiving timely antiviral therapy. Rash and pain are common in patients who have wound infections and contact dermatitis after surgery, so the possible reactivation of varicella virus might not be prominent in the surgeon's mind. This case serves as a reminder that viral infections such as shingles should be considered in the differential diagnosis of postoperative erythema and pain. PMID:22740749

  10. Pleural abnormalities: thoracic ultrasound to the rescue!

    PubMed Central

    Pathmanathan, Sega; Lakshminarayana, Umesh B.; Avery, Gerard R.; Kastelik, Jack A.; Morjaria, Jaymin B.

    2013-01-01

    Diaphragmatic hernias that are diagnosed in adulthood may be traumatic or congenital in nature. Therefore, respiratory specialists need to be aware of the presentation of patients with these conditions. In this report, we describe a case series of patients with congenital and traumatic diaphragmatic hernias and highlight a varied range of their presentations. Abnormalities were noted in the thorax on the chest radiographs, but it was unclear as to the nature of the anomaly. The findings on thoracic ultrasound conducted by a pulmonologist helped to direct appropriate investigations avoiding unnecessary interventions. Instead of pleural effusions, consolidation or collapse, thoracic computed tomography demonstrated diaphragmatic hernias which were managed either conservatively or by surgery. There is increasing evidence that pulmonary specialists should be trained in thoracic ultrasonography to identify pleural pathology as well as safely conducting pleural-based interventions. PMID:23819018

  11. Kidney Stones

    PubMed Central

    Kleeman, Charles R.; Coburn, Jack W.; Brickman, Arnold S.; Lee, David B. N.; Narins, Robert G.; Ehrlich, Richard M.

    1980-01-01

    The prevalence of kidney stones has steadily risen during this century; passage of a calculus and a positive family history increase the probability of recurrence. Findings from recent studies on the cause of renal calculi have stressed crystallization and crystal aggregation of stone minerals from supersaturated urine, rather than excessive organic matrix. Absence of normal urine inhibitors of calcium salts is also stressed. Formation of calcium oxalate stones is the major problem. Therapy with decreased calcium and oxalate intake, thiazides, phosphate salts and allopurinol in various combinations has substantially decreased the prevalence of recurrent stones. The rationale for the use of allopurinol is that uric acid salts enhance the tendency for calcium oxalate to crystallize from supersaturated urine. The hypercalciuria seen in 30 percent to 40 percent of patients with oxalate stones is usually caused by intestinal hyperabsorption of calcium. Although patients with uric acid calculi constitute only a small fraction of those in whom stones form, they represent a group in whom good medical therapy, based on sound physiologic principles, has proved extremely successful. Renal tubular syndromes lead to nephrocalcinosis and lithiasis through hypercalciuria, alkaline urine and hypocitraturia, the latter an inhibitor of calcium salt precipitation. Recent advances in surgical techniques are discussed, including the rationale for removing staghorn calculi. The ileal ureter and coagulum pyelolithotomy deserve special emphasis. ImagesFigure 2.Figure 4.Figure 5.Figure 7. PMID:7385835

  12. Simultaneous Bilateral or Unilateral Carpal Tunnel Release?

    PubMed Central

    Osei, Daniel A.; Calfee, Ryan P.; Stepan, Jeffrey G.; Boyer, Martin I.; Goldfarb, Charles A.; Gelberman, Richard H.

    2014-01-01

    Background: Over 60% of patients with carpal tunnel syndrome present with symptoms and findings of nerve compression in both hands. Our goal was to compare patient-rated difficulties in performing activities of daily living in the early postoperative period between those undergoing bilateral carpal tunnel release and those undergoing unilateral carpal tunnel release. Methods: This prospective cohort study enrolled consecutive patients with bilateral carpal tunnel syndrome undergoing bilateral carpal tunnel release (n = 47) or unilateral carpal tunnel release (n = 41). Patient function and disease severity were measured by an abbreviated form of the Disabilities of the Arm, Shoulder and Hand questionnaire, QuickDASH, and the Boston Carpal Tunnel Questionnaire at baseline, at postoperative visit 1 at a mean time (and standard deviation) of 10 ± 3 days, and at postoperative visit 2 at a mean time (and standard deviation) of 30 ± 6 days. Patients rated their difficulty in completing fifteen activities of daily living each day for the first postoperative week. Patients reported the factors that influenced their choice of surgery. Results: There was no difference in baseline function or disease severity between the two groups with regard to QuickDASH and the Boston Carpal Tunnel Questionnaire. Patients in both groups improved after carpal tunnel release with no difference between groups either at postoperative visit 1 for QuickDASH (p = 0.97) and the Boston Carpal Tunnel Questionnaire (p = 0.86) or at postoperative visit 2 for QuickDASH (p = 0.43) and the Boston Carpal Tunnel Questionnaire (p = 0.34). Patients undergoing bilateral carpal tunnel release had more difficulty only during postoperative days 1 to 2 in opening jars (p = 0.03), cooking (p = 0.008), and doing household chores (p = 0.02). Patients in the two groups did not differ (p > 0.05) in their abilities to perform activities of daily living necessary for personal hygiene or independence on any day during the first seven days following surgery with regard to using the bathroom, bathing, dressing, or eating. Although the most common reason why patients chose bilateral carpal tunnel release was to avoid two surgical procedures (42%), the most common reason why patients chose unilateral carpal tunnel release was concern for self-care (36%). Conclusions: Patients with bilateral carpal tunnel syndrome can anticipate more severe functional impairment during the first few postoperative days with bilateral carpal tunnel release compared with unilateral carpal tunnel release, but limitations beyond postoperative day 2 or 3 are similar for bilateral and unilateral carpal tunnel release. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:24897736

  13. Genetics Home Reference: Familial thoracic aortic aneurysm and dissection

    MedlinePLUS

    ... OMIM Genetic disorder catalog Conditions > Familial thoracic aortic aneurysm and dissection (often shortened to familial TAAD ) On ... 2015 What is familial TAAD? Familial thoracic aortic aneurysm and dissection (familial TAAD) involves problems with the ...

  14. Genetics Home Reference: Familial thoracic aortic aneurysm and dissection

    MedlinePLUS

    ... literature OMIM Genetic disorder catalog Conditions > Familial thoracic aortic aneurysm and dissection (often shortened to familial TAAD ) On ... January 2015 What is familial TAAD? Familial thoracic aortic aneurysm and dissection (familial TAAD) involves problems with the ...

  15. [Impact of combined anesthesia using isoflurane on the development of adaptation mechanisms on changing ventilation conditions in thoracic surgery].

    PubMed

    Vyzhigina, M A; Riabova, O S; Kulagina, T Iu; Zhukova, S G; Parshin, V D; Sandrikov, V A; Buniatian, A A

    2006-01-01

    The paper deals with the effect of isoflurane (IF) as a component of combined anesthesia during thoracic interventions in the lateral position on the development of adaptation mechanisms to a change in artificial ventilation (AV) modes--from ventilation of both lungs to that of one lung (unilateral ventilation, ULV), long exposure to ULV and to a change from ULV to ventilation of both lungs. Eighteen patients at a high operation-anesthetic risk were examined. Measurements were made in 6 steps, including conditions in AV, exposure to ULV for 15-30, 55-60, and 80-120 minutes, AV after 20-min exposure to ULV, and at the end of surgery in the supine position. While analyzing the results, the authors made an important observation that IF has a property of preventing capillary formation in the ventilated portions, without impairing the mechanism of pulmonary hypoxic vasoconstriction in the area of atelectized alveoles. This contributed to the optimization of a ventilation-perfusion relationship and creates conditions for adequate oxygenation. The use of IF as a component of combined anesthesia during thoracic operations associated with a need for artificial unilateral ventilation in patients at a high operation-anesthetic risk created conditions for optimizing gas exchange and blood circulation at all stages of an operation and anesthesia. PMID:17184063

  16. Effect of unilateral ureteral obstruction and anti-angiotensin II treatment on renal tubule cell apoptosis and interstitial fibrosis in rats.

    PubMed

    Radovi?, Nikola; Aralica, Gorana; Ljubanovi?, Danica Galesi?; Jelec, Vjekoslav; Kontek, Mladen

    2014-06-01

    Unilateral ureteral obstruction (UUO) results in a number of pathophysiological and morphological changes in the renal parenchyma, including interstitial inflammation and fibrosis, apoptotic changes of tubular and interstitial cells. Recent studies have indicated an association between renin-angiotensin system and apoptotic alterations in the kidney after unilateral obstructive nephropathy. In this study, the effect of ACE inhibitors and AT1 receptor antagonists on tubular cell apoptosis and interstitial fibrosis in obstructive nephropathy after UUO in rats was investigated. The study was conducted on Wistar rats with unilaterally ligated ureter and sham operated animals (control group). The rats with UUO were treated with ACE inhibitor (cilazapril) or AT1 receptor antagonists (losartan) and control group was treated with H2O. Sham-operated animals were treated in the same way. Tubular and interstitial cell apoptosis was detected morphologically by hematoxylin and eosin (HE) staining and terminal deoxynucleotidyl transferase-mediated nick end-labeling (TUNEL). The area of intersitial fibrosis was determined using computer-assisted image processing after Gomory silver impregnation of paraffin sections. All experimental animal groups with unilateral ureter ligation showed a significantly increased number of apoptotic tubular and interstitial cells in the obstructed kidney compared with the contralateral, unobstructed kidney. Histomorphometric analysis of renal interstitial fibrotic changes in the groups of rats treated with losartan or water showed a statistically significant difference (p < 0.05) between the operated and sham--operated animals. In conclusion, following UUO there is a significantly increased number of apoptotic tubular cells and interstitial fibrosis in the ipsilateral kidney compared with the contralateral kidney. ACE inhibitors and AT1 receptor antagonists could not decrease the extent of renal cells apoptosis and interstitial fibrosis after UUO. PMID:25144992

  17. Mayo Clinic: An Institutional History of General Thoracic Surgery.

    PubMed

    Gillaspie, Erin A; Nichols, Francis C; Allen, Mark S

    2015-01-01

    The Mayo Clinic was started in Rochester, MN after a 1883 tornado disaster. The Mayo brothers, William and Charles began thoracic surgical procedures early in their career. Dr. Samuel Robinson is recognized as the first thoracic surgeon at Mayo. He was followed by Drs. Harrington and Claret who became famous surgeons. Many other notable surgeons have help to build the thoracic surgical practice into what is today a world renown center of excellence in thoracic surgery. PMID:26811041

  18. Trace Element Changes in Thoracic Aortic Dissection.

    PubMed

    Edvinsson, Marie; Ilbäck, Nils-Gunnar; Frisk, Peter; Thelin, Stefan; Nyström-Rosander, Christina

    2016-02-01

    Thoracic aortic dissection is a life-threatening condition with an incompletely understood pathogenesis. Trace elements are essential for the functioning of different processes in the body, including the immune system and associated responses to infection/inflammation. Because inflammation may be part of the pathogenesis of thoracic aortic dissection, we investigated whether trace element changes associated with inflammation occur in serum and tissue samples during the disease. The study included 21 patients undergoing surgery for thoracic aortic dissection, 10 forensic autopsy specimens for tissue controls and 23 healthy blood donors for serum controls. Levels of magnesium (Mg), calcium (Ca), vanadium (V), manganese (Mn), iron (Fe), cobalt (Co), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), cadmium (Cd) and mercury (Hg) were measured in the aortic tissue and serum by inductively coupled plasma-mass spectrometry (ICP-MS). In the serum, Ca, V, Cu and Zn decreased, whereas Fe increased. In the tissue, Cu and Zn decreased and Fe tended to increase. The Cu/Zn ratio in the serum, a marker of infection/inflammation, did not change in the patients. Concerning trace element changes in the serum and tissue, our data do not support the hypothesis that inflammation is involved in the pathogenesis of thoracic aortic dissection. PMID:26152852

  19. Thoracic range of motion, stability, and correlation to imaging-determined degeneration.

    PubMed

    Healy, Andrew T; Mageswaran, Prasath; Lubelski, Daniel; Rosenbaum, Benjamin P; Matheus, Virgilio; Benzel, Edward C; Mroz, Thomas E

    2015-08-01

    OBJECT The degenerative process of the spinal column results in instability followed by a progressive loss of segmental motion. Segmental degeneration is associated with intervertebral disc and facet changes, which can be quantified. Correlating this degeneration with clinical segmental motion has not been investigated in the thoracic spine. The authors sought to determine if imaging-determined degeneration would correlate with native range of motion (ROM) or the change in ROM after decompressive procedures, potentially guiding clinical decision making in the setting of spine trauma or following decompressive procedures in the thoracic spine. METHODS Multidirectional flexibility tests with image analysis were performed on thoracic cadaveric spines with intact ib cage. Specimens consisted of 19 fresh frozen human cadaveric spines, spanning C-7 to L-1. ROM was obtained for each specimen in axial rotation (AR), flexion-extension (FE), and lateral bending (LB) in the intact state and following laminectomy, unilateral facetectomy, and unilateral costotransversectomy performed at either T4-5 (in 9 specimens) or T8-9 (in 10 specimens). Image grading of segmental degeneration was performed utilizing 3D CT reconstructions. Imaging scores were obtained for disc space degeneration, which quantified osteophytes, narrowing, and endplate sclerosis, all contributing to the Lane disc summary score. Facet degeneration was quantified using the Weishaupt facet summary score, which included the scoring of facet osteophytes, narrowing, hypertrophy, subchondral erosions, and cysts. RESULTS The native ROM of specimens from T-1 to T-12 (n = 19) negatively correlated with age in AR (Pearson's r coefficient = -0.42, p = 0.070) and FE (r = -0.42, p = 0.076). When regional ROM (across 4 adjacent segments) was considered, the presence of disc osteophytes negatively correlated with FE (r = -0.69, p = 0.012), LB (r = -0.82, p = 0.001), and disc narrowing trended toward significance in AR (r = -0.49, p = 0.107). Facet characteristics, scored using multiple variables, showed minimal correlation to native ROM (r range from -0.45 to +0.19); however, facet degeneration scores at the surgical level revealed strong negative correlations with regional thoracic stability following decompressive procedures in AR and LB (Weishaupt facet summary score: r = -0.52 and r = -0.71; p = 0.084 and p = 0.010, respectively). Disc degeneration was not correlated (Lane disc summary score: r = -0.06, p = 0.861). CONCLUSIONS Advanced age was the most important determinant of decreasing native thoracic ROM, whereas imaging characteristics (T1-12) did not correlate with the native ROM of thoracic specimens with intact rib cages. Advanced facet degeneration at the surgical level did correlate to specimen stability following decompressive procedures, and is likely indicative of the terminal stages of segmental degeneration. PMID:25978074

  20. Assessment of renal function in mice with unilateral ureteral obstruction using 99mTc-MAG3 dynamic scintigraphy

    PubMed Central

    2012-01-01

    Background Renal scintigraphy using 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) is widely used for the assessment of renal function in humans. However, the application of this method to animal models of renal disease is currently limited, especially in rodents. Here, we have applied 99mTc-MAG3 renal scintigraphy to a mouse model of unilateral ureteral obstruction (UUO) and evaluated its utility in studying obstructive renal disease. Methods UUO mice were generated by complete ligation of the left ureter. Sham-operated mice were used as a control. Renal function was investigated on days 0, 1, 3, and 6 post-surgery using dynamic planar imaging of 99mTc-MAG3 activity following retro-orbital injection. Time-activity curves (TACs) were produced for individual kidneys and renal function was assessed by 1) the slope of initial 99mTc-MAG3 uptake (SIU), which is related to renal perfusion; 2) peak activity; and 3) the time-to-peak (TTP). The parameters of tubular excretion were not evaluated in this study as 99mTc-MAG3 is not excreted from UUO kidneys. Results Compared to sham-operated mice, SIU was remarkably (>60%) reduced in UUO kidneys at day 1 post surgery and the TACs plateaued, indicating that 99mTc-MAG3 is not excreted in these kidneys. The plateau activity in UUO kidneys was relatively low (~40% of sham kidney’s peak activity) as early as day1 post surgery, demonstrating that uptake of 99mTc-MAG3 is rapidly reduced in UUO kidneys. The time to plateau in UUO kidneys exceeded 200 sec, suggesting that 99mTc-MAG3 is slowly up-taken in these kidneys. These changes advanced as the disease progressed. SIU, peak activity and TTPs were minimally changed in contra-lateral kidneys during the study period. Conclusions Our data demonstrate that renal uptake of 99mTc-MAG3 is remarkably and rapidly reduced in UUO kidneys, while the changes are minimal in contra-lateral kidneys. The parametric analysis of TACs suggested that renal perfusion as well as tubular uptake is reduced in UUO kidneys. This imaging technique should allow non-invasive assessments of UUO renal injury and enable a more rapid interrogation of novel therapeutic agents and protocols. PMID:23228112

  1. Multiple levels paravertebral block versus morphine patient-controlled analgesia for postoperative analgesia following breast cancer surgery with unilateral lumpectomy, and axillary lymph nodes dissection

    PubMed Central

    Fallatah, Summayah; Mousa, WF

    2016-01-01

    Background: Postoperative pain after breast cancer surgery is not uncommon. Narcotic based analgesia is commonly used for postoperative pain management. However, the side-effects and complications of systemic narcotics is a significant disadvantage. Different locoregional anesthetic techniques have been tried including, single and multiple levels paravertebral block (PVB), which seems to have a significant reduction in immediate postoperative pain with fewer side-effects. The aim of this study was to compare unilateral multiple level PVB versus morphine patient-controlled analgesia (PCA) for pain relief after breast cancer surgery with unilateral lumpectomy and axillary lymph nodes dissection. Materials and Methods: Forty patients scheduled for breast cancer surgery were randomized to receive either preoperative unilateral multiple injections PVB at five thoracic dermatomes (group P, 20 patients) or postoperative intravenous PCA with morphine (group M, 20 patients) for postoperative pain control. Numerical pain scale, mean arterial pressure, heart rate, Time to first analgesic demand, 24-h morphine consumption side-effects and length of hospital stay were recorded. Results: PVB resulted in a significantly more postoperative analgesia, maintained hemodynamic, more significant reduction in nausea and vomiting, and shorter hospital stay compared with PCA patients. Conclusion: Multiple levels PVB is an effective regional anesthetic technique for postoperative pain management, it provides superior analgesia with less narcotics consumption, and fewer side-effects compared with PCA morphine for patients with breast cancer who undergo unilateral lumpectomy, with axillary lymph nodes dissection. PMID:26955304

  2. Continuous paravertebral infusion of ropivacaine with or without fentanyl for pain relief in unilateral multiple fractured ribs

    PubMed Central

    Mohta, Medha; Ophrii, Emeni L; Sethi, Ashok Kumar; Agarwal, Deepti; Jain, Bhupendra Kumar

    2013-01-01

    Background: Continuous thoracic paravertebral block (TPVB) provides effective analgesia for unilateral multiple fractured ribs (MFR). However, prolonged infusion of local anaesthetic (LA) in high doses can predispose to risk of LA toxicity, which may be reduced by using safer drugs or drug combinations. This study was conducted to assess efficacy and safety of paravertebral infusion of ropivacaine and adrenaline with or without fentanyl to provide analgesia to patients with unilateral MFR. Methods: Thirty adults, having ?3 unilateral MFR, with no significant trauma outside chest wall, were studied. All received bolus of 0.5% ropivacaine 0.3 ml/kg through paravertebral catheter, followed by either 0.1-0.2 ml/kg/hr infusion of ropivacaine 0.375% with adrenaline 5 ?g/ml in group RA or ropivacaine 0.2% with adrenaline 5 ?g/ml and fentanyl 2 ?g/ml in group RAF. Rescue analgesia was provided by IV morphine. Results: Statistical analysis was performed using unpaired Student t-test, Chi-square test and repeated measures ANOVA. After TPVB, VAS scores, respiratory rate and PEFR improved in both groups with no significant inter-group differences. Duration of ropivacaine infusion, morphine requirements, length of ICU and hospital stay, incidence of pulmonary complications and opioid-related side-effects were similar in both groups. Ropivacaine requirement was higher in group RA than group RAF. No patient showed signs of LA toxicity. Conclusion: Continuous paravertebral infusion of ropivacaine 0.375% with adrenaline 5 ?g/ml at 0.1-0.2 ml/kg/hr provided effective and safe analgesia to patients with unilateral MFR. Addition of fentanyl 2 ?g/ml allowed reduction of ropivacaine concentration to 0.2% without decreasing efficacy or increasing opioid-related side-effects. PMID:24403614

  3. Ocular Tuberculosis with Progressive Unilateral Corneal Melting

    PubMed Central

    Bayraktutar, Betül N.; Uçakhan-Gündüz, Ömür

    2015-01-01

    Objectives In this case report, we present a patient with ocular tuberculosis presenting with progressive unilateral corneal melting. Patient A 47-year-old female was admitted with melting at the inferior half of the peripheral cornea and inferior subconjunctival nodules. Biopsy material of the nodules was negative for tuberculosis bacillus. However, polymerase chain reaction of the biopsy sample revealed the DNA of the bacillus, and the diagnosis was confirmed. Conclusion In endemic areas, ocular tuberculosis should be kept in mind in the differential diagnosis of patients with chronic and atypical corneal involvement. PMID:26483670

  4. Neurological asymmetries immediately after unilateral ECT.

    PubMed Central

    Kriss, A; Blumhardt, L D; Halliday, A M; Pratt, R T

    1978-01-01

    Twenty-nine right handed patients were examined neurologically before and immediately after each of 62 unilateral ECTs to the dominant and non-dominant hemispheres. Most convulsions were followed by signs of transitory neurological dysfunction referable to the treated hemisphere. These signs included deep tendon reflex asymmetry, hemiparesis, tactile and visual inattention, and homonymous hemianopia. After treatment to the right hemisphere some patients had left visuospatial neglect, while all patients who had dominant hemisphere ECT were transiently dysphasic. All neurological abnormalities tested resolved within 20 minutes of treatment. PMID:731257

  5. Unilateral Molar Distalization: A Nonextraction Therapy

    PubMed Central

    Prasad, M. Bhanu; Sreevalli, S.

    2012-01-01

    In the recent years, nonextraction treatment approaches and noncompliance therapies have become more popular in the correction of space discrepancies. One of the conventional approaches for space gaining in the arches without patient compliance is done by using certain extra oral appliances or intraoral appliance. The greatest advantage of certain appliances like fixed functional and molar distalization appliances is that they minimize the dependence on patient cooperation. Molar distalization appliances like pendulum appliance which distalizes the molar rapidly without the need of head gear can be used in patients as a unilateral space gaining procedure due to buccal segment crowding. PMID:23320203

  6. Management of Children with Unilateral Hearing Loss.

    PubMed

    Lieu, Judith E C

    2015-12-01

    Children with impaired hearing in one ear (unilateral hearing loss [UHL]) and normal hearing in the other ear experience challenges in understanding speech in noisy backgrounds and localizing the source of sounds in 3-dimensional space. They are at a high risk for speech and language delay and need educational help in school. However, definitive evidence of benefit from amplification is currently lacking to recommend placement of hearing aids or cochlear implants in all young children with UHL. Management of UHL in children should be guided by the child's development, performance in school, and personal/family values and preferences. PMID:26443488

  7. Coexisting Papillary and Clear Renal Cell Carcinoma in the Same Kidney

    PubMed Central

    Yaprak, Busra; Teke, Kerem; Ciftci, Seyfettin; Yildiz, Kursat; Culha, Melih

    2014-01-01

    Renal cell carcinoma (RCC) is the most common solid lesion of the kidney. Bilateral synchronous benign and malignant renal tumors have been defined in some reports. However, unilateral concordance of malignant renal tumors is very rare and there are only a few cases that had synchronous different subtypes of malignant renal tumors arising within the same kidney. Herein, we describe a 67-year-old male patient who had clear cell RCC and papillary RCC in his right kidney that were successfully treated with radical nephrectomy. We also reviewed the pertinent literature. PMID:25180117

  8. Coexisting papillary and clear renal cell carcinoma in the same kidney.

    PubMed

    Ustuner, Murat; Yaprak, Busra; Teke, Kerem; Ciftci, Seyfettin; Kart, Mucahit; Yildiz, Kursat; Culha, Melih

    2014-01-01

    Renal cell carcinoma (RCC) is the most common solid lesion of the kidney. Bilateral synchronous benign and malignant renal tumors have been defined in some reports. However, unilateral concordance of malignant renal tumors is very rare and there are only a few cases that had synchronous different subtypes of malignant renal tumors arising within the same kidney. Herein, we describe a 67-year-old male patient who had clear cell RCC and papillary RCC in his right kidney that were successfully treated with radical nephrectomy. We also reviewed the pertinent literature. PMID:25180117

  9. Can thoracic paravertebral block replace thoracic epidural block in pediatric cardiac surgery? A randomized blinded study.

    PubMed

    El-Morsy, Gamal Z; El-Deeb, Alaa; El-Desouky, Tariq; Elsharkawy, Ashraf A; Elgamal, Mohamed Adel F

    2012-01-01

    To compare the outcomes of thoracic epidural block with thoracic paravertebral block for thoracotomy in pediatric patients. A prospective double-blind study. 60 pediatric patients aged 1-24 months, ASA II, III scheduled for thoracotomy were randomly allocated into two groups. After induction of general anesthesia, thoracic epidural catheter was inserted in group E (epidural) patients and thoracic paravertebral catheter was inserted in group P (paravertebral) patients. Post operative pain score was recorded hourly for 24 hours. Plasma cortisol level was recorded at three time points. Tidal breathing analysis was done preoperatively and 6 hours postoperatively. Analgesia, serum cortisol level, and pulmonary function parameters were comparable in the two groups. However, failure rate (incorrect placement of catheter) was significantly higher in epidural group than in paravertebral group (7% versus 0%, respectively). The complications were also significantly higher in epidural group (vomiting 14.8%, urine retention 11.1% and hypotension 14.8%) than paravertebral group (0%, 0%, and 3.6%, respectively). We conclude that both thoracic paravertebral block and thoracic epidural block results in comparable pain score and pulmonary function after thoracotomy in pediatric patients; the paravertebral block is associated with significantly less failure rate and side effects. PMID:23041682

  10. Chronic pain and the thoracic spine.

    PubMed

    Louw, Adriaan; Schmidt, Stephen G

    2015-07-01

    In recent years there has been an increased interest in pain neuroscience in physical therapy.1,2 Emerging pain neuroscience research has challenged prevailing models used to understand and treat pain, including the Cartesian model of pain and the pain gate.2-4 Focus has shifted to the brain's processing of a pain experience, the pain neuromatrix and more recently, cortical reorganisation of body maps.2,3,5,6 In turn, these emerging theories have catapulted new treatments, such as therapeutic neuroscience education (TNE)7-10 and graded motor imagery (GMI),11,12 to the forefront of treating people suffering from persistent spinal pain. In line with their increased use, both of these approaches have exponentially gathered increasing evidence to support their use.4,10 For example, various randomised controlled trials and systematic reviews have shown that teaching patients more about the biology and physiology of their pain experience leads to positive changes in pain, pain catastrophization, function, physical movement and healthcare utilisation.7-10 Graded motor imagery, in turn, has shown increasing evidence to help pain and disability in complex pain states such as complex regional pain syndrome (CRPS).11,12 Most research using TNE and GMI has focussed on chronic low back pain (CLBP) and CRPS and none of these advanced pain treatments have been trialled on the thoracic spine. This lack of research and writings in regards to the thoracic spine is not unique to pain science, but also in manual therapy. There are, however, very unique pain neuroscience issues that skilled manual therapists may find clinically meaningful when treating a patient struggling with persistent thoracic pain. Utilising the latest understanding of pain neuroscience, three key clinical chronic thoracic issues will be discussed - hypersensitisation of intercostal nerves, posterior primary rami nerves mimicking Cloward areas and mechanical and sensitisation issues of the spinal dura in the thoracic spine. PMID:26308707

  11. Non-intubated anesthesia in thoracic surgery—technical issues

    PubMed Central

    2015-01-01

    Performing awake thoracic surgery (ATS) is technically more challenging than thoracic surgery under general anesthesia (GA), but it can result in a greater benefit for the patient. Local wound infiltration and lidocaine administration in the pleural space can be considered for ATS. More invasive techniques are local wound infiltration with wound catheter insertion, thoracic wall blocks, selective intercostal nerve blockade, thoracic paravertebral blockade and thoracic epidural analgesia, offering the advantage of a catheter placement which can also be continued for postoperative analgesia. PMID:26046050

  12. Dry needling for the management of thoracic spine pain.

    PubMed

    Fernández-de-Las-Peñas, César; Layton, Michelle; Dommerholt, Jan

    2015-07-01

    Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars. PMID:26309385

  13. Clinical verification of a unilateral otolith test

    NASA Astrophysics Data System (ADS)

    Wetzig, J.; Hofstetter-Degen, K.; Maurer, J.; von Baumgarten, R. J.

    In a previous study 13 we reported promising results for a new test to differentiate in vivo unilateral otolith functions. That study pointed to a need for further validation on known pathological cases. In this presentation we will detail the results gathered on a group of clinically verified vestibular defectives (verum) and a normal (control) group. The subjects in the verum group were former patients of the ENT clinic of the university hospital. These subjects had usually suffered from neurinoma of the VIIth cranial nerve or inner ear infections. All had required surgical intervention including removal of the vestibular system. The patients were contacted usually two or more years postoperatively. A group of students from the pre- and clinical phase of medical training served as control. Both groups were subjected to standardized clinical tests. These tests served to reconfirm the intra- or postoperative diagnosis of unilateral vestibular loss in the verum group. In the control group they had to establish the normalcy of the responses of the vestibular system. Both groups then underwent testing on our exccentric rotary chair in the manner described before 13. Preliminary results of the trials indicate that this test may indeed for the first time offer a chance to look at isolated otolith apparati in vivo.

  14. [Unilateral spatial and motor neglect in children].

    PubMed

    Laurent-Vannier, A; Pradat-Diehl, P; Chevignard, M; Abada, G

    2001-04-01

    Although unilateral spatial neglect is well documented in adults after a cerebral damage, the description in children is rare and no motor neglect has yet been reported. We report four children age range from three to thirteen years old, in patients in a rehabilitation department. A cancellation task "the Teddy bear test" was used to assess spatial neglect in children. The children were presented a page containing line drawings of usual objects, including fifteen Teddy bears. The children were asked to cross out each Teddy bear. These four children omitted five to eleven teddy bears located on the left space, whereas children of the controlled group never omitted more than one Teddy bear. The four children also exhibited neglect in drawings, and during daily life activities. Moreover, one of them had a motor neglect with no more defects of strength and an under-utilization of his left side. Spatial unilateral neglect and motor neglect should be systematically investigated in children after a cerebral damage, and should be considered during rehabilitation. PMID:11398014

  15. [Spontaneous unilateral adrenal hematomas. 10 cases].

    PubMed

    Hoeffel, C; Legmann, P; Luton, J P; Chapuis, Y; Bonnin, A

    1994-06-11

    Spontaneous unilateral adrenal haematoma is a very rare condition. We report 10 such cases in which the pathological examination confirmed the diagnosis and for which computed tomography (CT) (n = 10) and magnetic resonance imaging (MRI) (n = 5) were performed. The diagnosis of this condition was difficult because there was no specific clinical setting nor any specific functional disorder. CT most often revealed a large mass (> 4 cm) of one of the adrenal glands, most often displaying soft-tissue attenuation and thus not specific. However, MRI suggested the diagnosis, showing foci of hypersignal on T1-weighted images and heterogeneous masses on T2-weighted images, predominantly displaying hypersignal and not enhancing, after Gd-DTPA dynamic perfusion study. Pathologic examination of the surgical specimen confirmed either idiopathic haematoma (n = 5) or haematoma possibly associated with a small benign tumour (n = 5). The diagnosis of adrenal haematoma must be considered when an unilateral isolated large adrenal mass is discovered in an asymptomatic patient. MRI with Gd-DTPA dynamic perfusion study has to be performed and one may suggest waiting and repeat imaging (so as to follow decrease in size or signal changes) in order to avoid surgery. PMID:7971805

  16. Medullary cystic kidney disease

    MedlinePLUS

    ... and diet changes, limiting foods containing phosphorus and potassium. You may need dialysis and a kidney transplant. ... Hyponatremia (low blood sodium level) Hyperkalemia (too much potassium in the blood), especially with end-stage kidney ...

  17. Extraintestinal Complications: Kidney Disorders

    MedlinePLUS

    ... most commonly encountered kidney complications of IBD—particularly oxalate stones. Kidney stones are more common in Crohn's ... of fat malabsorption. Fat binds to calcium, leaving oxalate (a type of salt) free to be absorbed ...

  18. Acute arterial occlusion - kidney

    MedlinePLUS

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidneys need a good blood supply. The main artery to the kidney is called the renal artery. ...

  19. Polycystic Kidney Disease

    MedlinePLUS

    ... and requires immediate medical attention. [ Top ] How do health care providers diagnose autosomal dominant polycystic kidney disease? Health ... when test results are available. [ Top ] How do health care providers treat autosomal dominant polycystic kidney disease? Although ...

  20. Testing for Kidney Disease

    MedlinePLUS

    ... Albumin Children and Kidney Disease Additional Kidney Information Contact Us Health Information Center Phone: 1-800-860- ... to share this content freely. September 17, 2014​​ Contact Us Health Information Center Phone: 1-800-860- ...

  1. Kidney Replacement Therapy

    MedlinePLUS

    ... a way of cleaning the blood with an artificial kidney. There are two types of dialysis: hemodialysis ... keep diabetes under control. Hemodialysis In hemodialysis, an artificial kidney removes waste from the blood. A surgeon ...

  2. Kidney Disease Risks among Hispanics

    MedlinePLUS

    ... an AKF screening Kidney Action Day Kidney Action Day Learn about our signature outreach event. About AKF ... our Northeast Region. Kidney Action Day Kidney Action Day Our late spring event is an elegant fundraiser ...

  3. Sexuality and Chronic Kidney Disease

    MedlinePLUS

    ... Rate Your Risk Quiz Featured Story African Americans & Kidney Disease Did you know that African Americans are ... Health checks Your Kidneys and You Featured Story Kidney Walk The Kidney Walk is the nation's largest ...

  4. At Risk for Kidney Disease?

    MedlinePLUS

    ... or organization Alternate Language URL At Risk for Kidney Disease? Page Content You are at risk for ... failure by treating kidney disease early. Diabetes and Kidney Disease Diabetes is the leading cause of kidney ...

  5. The European educational platform on thoracic surgery.

    PubMed

    Massard, Gilbert; Rocco, Gaetano; Venuta, Federico

    2014-05-01

    As the largest scientific organisation world-wide exclusively dedicated to general thoracic surgery (GTS), the European Society of Thoracic Surgeons (ESTS) recognized that one of its priorities is education. The educational platform designed ESTS addresses not only trainees, but also confirmed thoracic surgeons. The two main aims are (I) to prepare trainees to graduation and to the certification by the European Board of Thoracic Surgery and (II) to offer opportunities for continuous medical education in the perspective of life-long learning and continuous professional development to certified thoracic surgeons. It is likely that recertification will become an obligation during the coming decade. At its inception, the platform differentiated two different events. A 6-day course emphasizing on theoretic knowledge was created in Antalya in 2007. The same year, a 2-day school oriented to practical issues with hands-on in the animal lab was launched in Antalya. These two teaching tracks need further development. In the knowledge track, we intend to organize highly specialized 2-day courses to deepen insight into theoretical questions. The skill track will be implemented by specialized courses for high technology such as tracheal surgery, ECMO, robotics or chest wall reconstruction. In order to promote tomorrows' leadership, we created an academic competence track giving an insight into medical communication, methodology and management. We also had to respond to an increasing demand from the Russian speaking countries, where colleagues may face problems to attend western meetings, and where the language bareer may be a major impediment. We initiated a Russian school with three events yearly in 2012. Contemporary teaching must be completed with an e-learning platform, which is currently under development. The school activities are organized by the educational committee, which is headed by the ESTS Director of Education, assisted by coordinators of the teaching tracks and e-learning platform. Ongoing discussions concern development of contemporary teaching techniques and measure of outcome. The major challenge for the coming years is harmonisation of training and certification in thoracic surgery in the European space. PMID:24868446

  6. Delayed unilateral traumatic brain swelling in a child

    PubMed Central

    Paiva, Wellingson S.; Beer-Furlan, André; Soares, Matheus S.; Teixeira, Manoel J.

    2014-01-01

    Traumatic brain injury is a leading cause of morbidity and death in the pediatric population. In this study, we report a delayed unilateral traumatic brain swelling in a child with initial favorable evolution and sudden neurological deterioration after 4 days; highlighting clinical, physiopathological and radiological aspects of delayed unilateral brain swelling. PMID:25250079

  7. Unilateral external ophthalmoplegia in Miller Fisher syndrome: case report

    PubMed Central

    Smith, Jonathan; Clarke, Lucy; Severn, Philip; Boyce, Robert

    2007-01-01

    Background A description of the diagnostic features of Miller Fisher syndrome. Case presentation The clinical presentation, investigation, and subsequent progress of our patient with clinical unilateral external ophthalmoplegia. Conclusion Our case demonstrates the presentation of clinical unilateral external ophthalmoplegia as part of the full triad of Miller Fisher syndrome. PMID:17439660

  8. Reproducibility of Tactile Assessments for Children with Unilateral Cerebral Palsy

    ERIC Educational Resources Information Center

    Auld, Megan Louise; Ware, Robert S.; Boyd, Roslyn Nancy; Moseley, G. Lorimer; Johnston, Leanne Marie

    2012-01-01

    A systematic review identified tactile assessments used in children with cerebral palsy (CP), but their reproducibility is unknown. Sixteen children with unilateral CP and 31 typically developing children (TDC) were assessed 2-4 weeks apart. Test-retest percent agreements within one point for children with unilateral CP (and TDC) were…

  9. Reproducibility of Tactile Assessments for Children with Unilateral Cerebral Palsy

    ERIC Educational Resources Information Center

    Auld, Megan Louise; Ware, Robert S.; Boyd, Roslyn Nancy; Moseley, G. Lorimer; Johnston, Leanne Marie

    2012-01-01

    A systematic review identified tactile assessments used in children with cerebral palsy (CP), but their reproducibility is unknown. Sixteen children with unilateral CP and 31 typically developing children (TDC) were assessed 2-4 weeks apart. Test-retest percent agreements within one point for children with unilateral CP (and TDC) were…

  10. Transcatheter Arterial Embolization Therapy for a Hypoplastic Pelvic Kidney with a Single Vaginal Ectopic Ureter to Control Incontinence: The Usefulness of Three-Dimensional CT Angiography Using Multidetector-Row Helical CT

    SciTech Connect

    Kudoh, Kouichi Kadota, Masataka; Nakayama, Yoshiharu; Imuta, Masanori; Yasuda, Tsuyoshi; Yamashita, Yasuyuki; Inadome, Akito; Yoshida, Masaki; Ueda, Shouichi

    2003-09-15

    A girl with continuous urinary incontinence was successfully treated by angiographic embolization of a hypoplastic pelvic kidney with a single unilateral vaginal ectopic opening of the ureter. For this intervention, CT angiography was useful for detecting the corresponding renal artery of the hypoplastic kidney.

  11. Video-assisted thoracic surgery and pneumothorax.

    PubMed

    Paliouras, Dimitrios; Barbetakis, Nikolaos; Lazaridis, George; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Kioumis, Ioannis; Pitsiou, Georgia; Papaiwannou, Antonis; Karavergou, Anastasia; Lampaki, Sofia; Katsikogiannis, Nikolaos; Mpakas, Andreas; Tsakiridis, Kosmas; Korantzis, Ipokratis; Fassiadis, Nikolaos; Zarogoulidis, Konstantinos; Zarogoulidis, Paul

    2015-02-01

    Video-assisted thoracoscopic surgery (VATS) is a type of thoracic surgery performed using a small video camera that is introduced into the patient's chest via a scope. It is considered a minimally invasive technique where the surgeon is able to view the instruments that are being used along with the anatomy on which the surgeon is operating. The camera and instruments are inserted through separate holes in the chest wall also known as "ports", depending on the patient and problem there are surgeries with one port "uniport", two or three ports. These small ports have the advantage that fewer infections are observed. This allows for a faster recovery. Traditionally, thoracic surgery performed for diagnosis or treatment of chest conditions has required access to the chest through thoracotomy or sternotomy incisions. Vats minimally invasive technique has replaced in many cases thoracotomy or sternotomy. In our current review we will present this technique in detail. PMID:25774310

  12. Acute Aortic Syndromes and Thoracic Aortic Aneurysm

    PubMed Central

    Ramanath, Vijay S.; Oh, Jae K.; Sundt, Thoralf M.; Eagle, Kim A.

    2009-01-01

    Acute and chronic aortic diseases have been diagnosed and studied by physicians for centuries. Both the diagnosis and treatment of aortic diseases have been steadily improving over time, largely because of increased physician awareness and improvements in diagnostic modalities. This comprehensive review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (and its variants intramural hematoma and penetrating aortic ulcers) and thoracic aortic aneurysms. Literature searches of the PubMed database were conducted using the following keywords: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies performed within the past 20 years were included in the review; however, most data are from the past 15 years. PMID:19411444

  13. [Digital thoracic radiology: devices, image processing, limits].

    PubMed

    Frija, J; de Géry, S; Lallouet, F; Guermazi, A; Zagdanski, A M; De Kerviler, E

    2001-09-01

    In a first part, the different techniques of digital thoracic radiography are described. Since computed radiography with phosphore plates are the most commercialized it is more emphasized. But the other detectors are also described, as the drum coated with selenium and the direct digital radiography with selenium detectors. The other detectors are also studied in particular indirect flat panels detectors and the system with four high resolution CCD cameras. In a second step the most important image processing are discussed: the gradation curves, the unsharp mask processing, the system MUSICA, the dynamic range compression or reduction, the soustraction with dual energy. In the last part the advantages and the drawbacks of computed thoracic radiography are emphasized. The most important are the almost constant good quality of the pictures and the possibilities of image processing. PMID:11567193

  14. Rare thoracic cancers, including peritoneum mesothelioma.

    PubMed

    Siesling, Sabine; van der Zwan, Jan Maarten; Izarzugaza, Isabel; Jaal, Jana; Treasure, Tom; Foschi, Roberto; Ricardi, Umberto; Groen, Harry; Tavilla, Andrea; Ardanaz, Eva

    2012-05-01

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002, registered in 89 population-based cancer registries (CRs) and followed-up to 31st December 2003. Over 17,688 cases of rare thoracic cancers were selected based on the list of the RACECARE project. Mesothelioma was the most common tumour (19 per million per year) followed by epithelial tumours of the trachea and thymus (1.3 and 1.7, respectively). The age standardised incidence rates of epithelial tumours of the trachea was double in Eastern and Southern Europe versus the other European regions: 2 per million per year. Epithelial tumours of the thymus had the lowest incidence in Northern and Eastern Europe and UK and Ireland(1) and somewhat higher incidence in Central and Southern Europe.(2) Highest incidence in mesothelioma was seen in UK and Ireland(23) and lowest in Eastern Europe.(4) Patients with tumours of the thymus had the best prognosis (1-year survival 85%, 66% at 5 years). Five year survival was lowest for the mesothelioma 5% compared to 14% of patients with tumours of the trachea. Mesothelioma was the most prevalent rare cancer (12,000 cases), followed by thymus (7000) and trachea (1400). Cancer Registry (CR) data play an important role in revealing the burden of rare thoracic cancers and monitoring the effect of regulations on asbestos use and smoking related policies. PMID:22406029

  15. [Efficacy of soft coagulation in thoracic surgery].

    PubMed

    Sato, Yukio

    2014-07-01

    The soft coagulation is a novel mode of electrosurgical device which automatically regulates its output voltage to stay below 190 Volts, causing pure coagulation without carbonization. The soft coagulation is available with bipolar and monopolar devices in thoracic surgery. Bipolar scissors can be applied for dissection of pulmonary vessels safely and efficiently without the damage to vessel wall. Monopolar soft coagulation can be applied to shrink bullous change of lung, cease air leakage from lung parenchyme or bleeding from pulmonary vessels. PMID:25138947

  16. Embryology of the Absent Vas Supported by 2 Cases of Congenital Unilateral Absence of Vas With Varied Associations

    PubMed Central

    Shepherd, Gregory; Rajimwale, Ashok

    2014-01-01

    Congenital absence of the vas occurs in up to 1% of men. Congenital unilateral absence of the vas deferens can be related to cystic fibrosis transmembrane conductance regulator mutations or in 79% of cases, renal agenesis. We present a case of each, diagnosed in children at operation for elective inguinal hernia repairs. One patient had associated ipsilateral renal agenesis with a normal cystic fibrosis screen. The other patient had an ipsilateral pelvic kidney and a mutation detected on cystic fibrosis screening. Current understanding of the embryology of the relationship between these defects would seem to be supported by our cases.

  17. The European general thoracic surgery database project

    PubMed Central

    Brunelli, Alessandro

    2014-01-01

    The European Society of Thoracic Surgeons (ESTS) Database is a free registry created by ESTS in 2001. The current online version was launched in 2007. It runs currently on a Dendrite platform with extensive data security and frequent backups. The main features are a specialty-specific, procedure-specific, prospectively maintained, periodically audited and web-based electronic database, designed for quality control and performance monitoring, which allows for the collection of all general thoracic procedures. Data collection is the “backbone” of the ESTS database. It includes many risk factors, processes of care and outcomes, which are specially designed for quality control and performance audit. The user can download and export their own data and use them for internal analyses and quality control audits. The ESTS database represents the gold standard of clinical data collection for European General Thoracic Surgery. Over the past years, the ESTS database has achieved many accomplishments. In particular, the database hit two major milestones: it now includes more than 235 participating centers and 70,000 surgical procedures. The ESTS database is a snapshot of surgical practice that aims at improving patient care. In other words, data capture should become integral to routine patient care, with the final objective of improving quality of care within Europe. PMID:24868445

  18. Thoracic disease in children with AIDS.

    PubMed

    Marks, M J; Haney, P J; McDermott, M P; White, C S; Vennos, A D

    1996-11-01

    Knowledge of common and uncommon thoracic pathologic conditions in children with acquired immunodeficiency syndrome (AIDS) can expedite disease management. Chest radiography, computed tomography (CT), and magnetic resonance (MR) imaging are useful in cases involving possible complications of thoracic AIDS. Lymphocytic interstitial pneumonitis (LIP) is generally seen on plain radiographs and CT scans as a diffuse, symmetric, reticulonodular or nodular pattern, occasionally associated with mediastinal or hilar adenopathy. Chronic consolidations and bronchiectasis may be observed in pediatric AIDS patients with no evidence of previous LIP. Bacterial pneumonia, a frequent initial manifestation of AIDS, appears as lobar or segmental consolidations on radiographs. Radiographic findings of Pneumocystis carinii pneumonia, the most common infection, include rapidly progressive increased air-space opacity with air bronchograms. Lymphoma often appears as a mediastinal or hilar mass, often without involvement of the lung parenchyma. Thoracic smooth muscle tumors have also been observed in children with AIDS. Multilocular thymic cysts have low attenuation on CT scans and increased signal intensity on T2-weighted MR images. Most pediatric AIDS patients with cardiac disease have cardiomegaly, often associated with pulmonary edema, at chest radiography. An esophagogram may show ulceration, plaque formation, mucosal edema, and dysmotility in patients with candidal esophagitis. PMID:8946540

  19. Bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis

    PubMed Central

    Kocak, Nilufer; Ozturk, Taylan A; Kaynak, Suleyman

    2014-01-01

    X-linked juvenile retinoschisis is a rare hereditary retinal disease characterized by a tangential splitting of the neurosensory retina which may cause early-onset visual impairment. Existence of the retinal neurosensory layer splitting on cross-sectional images of optical coherance tomography (OCT) and the absence of leakage on fluorescein angiography (FA) help confirming the diagnosis. Such diagnostic tests are also helpful in determining the management of the disease. However, most of the retinoschisis cavities remain stable and rarely extend to the posterior pole, many authors suggest laser prophylaxis to avoid the potential risk of retinal detachment due to holes in the outer retinal layer. Herein, we report a case with bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis who was evaluated with detailed ophthalmologic examination. Visual acuity, fundoscopy, OCT, and FA remained stable in the second year of follow-up after prophylactic argon laser treatment. PMID:23571248

  20. [Unilateral to bilateral pleurisy: Pleural tuberculosis?].

    PubMed

    Ben Ameur, S; Smaoui, S; Kamoun, F; Chabchoub, I; Kamoun, T; Messaadi, F; Aloulou, H; Hachicha, M

    2016-04-01

    Pleural tuberculosis is the first or second most common form of extrapulmonary tuberculosis as well as the main cause of pleural effusion in many countries. It is rare in young infants and is more common in children over 10 years of age. We report the case of a 19-month-old girl admitted for prolonged fever with unilateral pleural effusion. The mother reported a history of lymph node tuberculosis 6 years previously. Intravenous antibiotics with cefotaxime and vancomycin were started. Thoracocentesis yielded a serosanguinous exudate fluid with a lymphocyte predominance. The tuberculin skin test and PCR GeneXpert(©) on pleural fluid were negative. The initial outcome was favorable, but the chest X-rays 10 days after discharge showed bilateral pleural effusion. Pleural biopsy was proposed but the culture of pleural fluid was positive for Mycobacterium tuberculosis. The child was put under standard treatment for tuberculosis. The outcome was favorable. PMID:26922570

  1. Unilateral condylar hyperplasia: a treatment strategy.

    PubMed

    Ferreira, Sabrina; da Silva Fabris, André Luis; Ferreira, Gabriel Ramalho; Faverani, Leonardo Perez; Francisconi, Giovanna Barbosa; Souza, Francisley Avila; Garcia, Idelmo Rangel

    2014-05-01

    Condylar hyperplasia (CH) is a pathologic condition that causes overdevelopment of the condylar head and neck as well as the mandible. Slowly progressive unilateral enlargement of the head and the neck of the condyle causes crossbite malocclusion, facial asymmetry, and shifting of the midpoint of the chin to the unaffected side. The etiology and the pathogenesis of CH remain uncertain. The diagnosis is made by clinical and radiologic examinations and bone scintigraph. A difference in uptake of 10% or more between condyles is regarded as indicative of CH, and the affected condyles had a relative uptake of 55% or more. When the diagnosis of active CH is established, the treatment consists of removal of the growth center by a partial condylectomy. The authors present the case of a 46-year-old male patient with right active type II CH or hemimandibular hyperplasia who underwent a high condylectomy. PMID:24820728

  2. Distraction osteogenesis of a unilateral hypoplastic mandible.

    PubMed

    Liaqat, Sahrish; Baig, Amir Mushtaq; Bukhari, Syed Gulzar Ali; Ahmed, Waseem

    2011-01-01

    Distraction osteogenesis (DO) is a surgical process in which two bony segments are gradually separated so new soft tissue and bone will form between them by applying tension through a fixation device. There are three phases to this process: latency phase, distraction phase, and consolidation phase. The technique was originally applied to long bones but in recent years the method has been adapted for use in maxillofacial surgery. Distraction osteogenesis is a new variation of more traditional; orthognathic surgical procedures which can be applied for the correction of dento-facial deformities and syndromes of the jaws, treating upper airway obstruction in paediatric patients with mandibualr retrognathia, due to tongue collapse and physical obstruction in the hypopharangeal region. It is an effective and powerful reconstructive surgical technique, which can be performed safely without the need of bone graft or blood transfusion. We present treatment of a child with severe facial asymmetry after unilateral TMJ ankylosis corrected bydistraction osteogenesis. PMID:24800374

  3. Unilateral corneal leukoplakia without limbal involvement

    PubMed Central

    Hirano, Koji; Koide, Mihoko; Mizoguchi, Yoshikazu; Osakabe, Yasuhiro; Sasaki, Kaoru-Araki

    2015-01-01

    Purpose Leukoplakia is the term given to a white patch or plaque that is found mainly on the oral mucus membrane. It can occasionally be seen on the corneal surface. We report our clinical and histopathological findings in a case of unilateral corneal leukoplakia. Methods A 26-year-old woman was referred to our hospital because of a white patch on her right cornea that continued to expand. She first noticed the white patch when she was 20 years old, and the white patch had expanded to cover the pupillary area affecting her vision. After plastic surgery on both eyelids for bilateral entropion to alleviate the pain caused by the eyelashes rubbing the cornea, the white corneal patch decreased in size. Because of this reduction, we performed surgery to remove the patch with microforceps under topical anesthesia. The plaque was removed easily and completely, and submitted for histopathological examination. Results Histopathological examination showed that the specimen had characteristics of epidermis with a basal cell layer, spinous cell layer, granular cell layer, and horny layer with hyperkeratosis. She was diagnosed with leukoplakia of the corneal surface. The basic structure of the squamous cell layer was preserved, and there were no signs of metaplasia. Six months after the removal of the leukoplakia, no recurrence was seen and her corrected decimal visual acuity recovered to 1.0. Conclusion Our case of unilateral corneal leukoplakia without limbal involvement was most likely caused by chronic irritation of the cornea by the eyelashes. Although it was totally removed with good recovery of vision, we continue to follow the patient because of the potential of malignant transformation. PMID:26056494

  4. [High level thoracic epidural analgesia as a special component of anesthesia during thoracic surgeries].

    PubMed

    Kurilova, O A; Vyzhigina, M A; Titov, V A; Kozlov, S P; Zhukova, S G; Parshin, V D

    2011-01-01

    This article is devoted to assessing the adequacy and safety of total intravenous anesthesia based on constant dosed infusion of propofol and high thoracic epidural analgesia in thoracic surgical procedures requiring an artificial one-lung ventilation in patients with concomitant chronic cardiorespiratory disorders compared to TIVA without a high thoracic epidural analgesia. Comparative analysis of gas exchange, metabolic rate, pressor, resistance and volumetric characteristics of pulmonary blood flow, central and intracardiac hemodynamics was conducted. We used high technology invasive monitoring system PICCOplus for transpulmonary thermodilution in combination with VoLEF for pulmonary thermodilution in changing modes of ventilation MV-MSL V-MV. MSL V lasted more than 1.5 hours. PMID:21688654

  5. Concentration of phosphoribosyl pyrophosphate in renal hypertrophy. Contrasting effects of early diabetes and unilateral nephrectomy.

    PubMed Central

    Kunjara, S; Sochor, M; Greenbaum, A L; McLean, P

    1986-01-01

    Studies were made of the renal phosphoribosyl pyrophosphate (PPRibP) content and PPRibP synthetase (EC 2.7.6.1) activity in rats diabetic for 5, 14 or 20 days, or unilaterally nephrectomized (UN) for 5 days, and in doubly lesioned animals. Approximately equal degrees of renal enlargement were found after 5 days diabetes or 5 days UN. In the doubly lesioned animals the increment of growth was additive. Unilateral nephrectomy of 5 days duration, in contrast with diabetes, had no effect on the PPRibP content of the contralateral kidney, nor did it modify the renal PPRibP content when performed on animals diabetic for 5, 14 or 20 days. The activity of PPRibP synthetase was unaffected by diabetes, UN or diabetes +UN. The results pinpoint a stage of nucleotide synthesis which is differentially affected by the two stimuli, in line with evidence for differences in regulation of nucleic acid turnover in the two conditions. PMID:2432888

  6. CT and MRI in the Evaluation of Thoracic Aortic Diseases

    PubMed Central

    2013-01-01

    Computed tomography (CT) and magnetic resonance imaging (MRI) are the most commonly used imaging examinations to evaluate thoracic aortic diseases because of their high spatial and temporal resolutions, large fields of view, and multiplanar imaging reconstruction capabilities. CT and MRI play an important role not only in the diagnosis of thoracic aortic disease but also in the preoperative assessment and followup after treatment. In this review, the CT and MRI appearances of various acquired thoracic aortic conditions are described and illustrated. PMID:24396601

  7. Thoracic region self-mobilization: a clinical suggestion.

    PubMed

    Johnson, Katherine D; Grindstaff, Terry L

    2012-04-01

    Limitations in thoracic spine motion may be due to restrictions in contractile or non-contractile tissues. Joint mobilizations are indicated when hypomobility of a joint (non-contractile tissue) is identified. The ability for a patient to perform self-mobilizations of the thoracic spine and ribs may help maximize intervention outcomes. The purpose of this article is to describe a low cost, portable device which can be used for thoracic spine self-mobilization techniques. PMID:22530198

  8. Generalization of Visuomotor Learning Between Bilateral and Unilateral Conditions

    PubMed Central

    Sainburg, Robert L.

    2009-01-01

    A long history of behavioral and physiological research has suggested that bilateral coordination invokes unique neural processes that are not involved in unilateral movements. This hypothesis predicts that motor learning should show limited transfer between unilateral and bilateral conditions, which is consistent with a recent finding that indicated partial, but not complete, transfer of learning between the two conditions. However, during learning of new motor skills, transformations must also be made between visual and proprioceptive coordinate systems, a process that may occur upstream to the processes that differentiate bilateral from unilateral movements. We now investigate whether visuomotor adaptations are shared between unilateral and bilateral movement conditions. Our results indicate substantial transfer from bilateral to subsequent unilateral conditions for both arms. Interestingly, whereas the nondominant arm never showed complete adaptation to visual rotation under bilateral conditions, this interference, or lack of improvement, in bilateral performance did not disturb the visuomotor adaptation process or transfer, as reflected by superb unilateral performances immediately following the bilateral conditions. These findings unambiguously indicate that visuomotor adaptation can extensively generalize between bilateral and unilateral conditions, thus suggesting a substantial overlap in the neural processes underlying visuomotor transformations between the two movement conditions. Our findings provide support for a two-stage model of motor planning, in which the visuomotor transformation process precedes the processes that convert the visuomotor plan into effector-specific commands that incorporate bilateral synergies and that result in the forces that determine motion. PMID:19759325

  9. Unilateral versus Bilateral Instrumentation in Spinal Surgery: A Systematic Review

    PubMed Central

    Molinari, Robert W.; Saleh, Ahmed; Molinari, Robert; Hermsmeyer, Jeff; Dettori, Joseph R.

    2015-01-01

    Study Design Systematic review. Clinical Questions (1) What is the comparative efficacy of unilateral instrumentation compared with bilateral instrumentation in spine surgery? (2) What is the safety of unilateral instrumentation compared with bilateral instrumentation in spine surgery? Methods Electronic databases and reference lists of key articles were searched up to September 30, 2014, to identify studies reporting the comparative efficacy and safety of unilateral versus bilateral instrumentation in spine surgery. Studies including recombinant human bone morphogenetic protein 2 as adjunct therapy and those with follow-up of less than 2 years were excluded. Results Ten randomized controlled trials met the inclusion criteria: five compared unilateral with bilateral instrumentation using open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF), one used open posterolateral fusion, and four used minimally invasive TLIF/PLIF. There were no significant differences between unilateral and bilateral screw instrumentation with respect to nonunion, low back or leg pain scores, Oswestry Disability Index, reoperation, or complications. Conclusions The existing literature does not identify significant differences in clinical outcomes, union rates, and complications when unilateral instrumentation is used for degenerative pathologic conditions in the lumbar spine. The majority of published reports involve single-level lumbar unilateral instrumentation. PMID:26131385

  10. Expanding upon the unilateral hyperlucent hemithorax in children.

    PubMed

    Dillman, Jonathan R; Sanchez, Ramon; Ladino-Torres, Maria F; Yarram, Sai G; Strouse, Peter J; Lucaya, Javier

    2011-01-01

    Unilateral hyperlucent hemithorax is a common pediatric chest radiographic finding that may also be seen at computed tomography. It may result from congenital or acquired conditions involving the pulmonary parenchyma, airway, pulmonary vasculature, pleural space, and chest wall, as well as from technical factors such as patient rotation. Unilateral hyperlucent hemithorax has a broad differential diagnosis that includes unilateral emphysematous or bullous disease, pneumatocele, foreign body aspiration, Swyer-James syndrome, congenital lobar emphysema, endobronchial mass, unilateral pulmonary agenesis, proximal interruption of the pulmonary artery, scimitar syndrome, diaphragmatic hernia, and Poland syndrome. Although certain causes of unilateral hyperlucent hemithorax are clinically significant and potentially life threatening, others are of minimal or no clinical significance. When evaluating a patient with this finding, it is important to establish whether the apparent unilateral hyperlucent hemithorax is truly too lucent (hypoattenuating) or if the contralateral hemithorax is too opaque (hyperattenuating). It is imperative that radiologists be aware of the various causes of unilateral hyperlucent hemithorax so that they may diagnose the underlying condition and appropriately guide patient management. PMID:21571653

  11. Radiation response of the monkey kidney following contralateral nephrectomy

    SciTech Connect

    Robbins, M.E.C.; Stephens, L.C.; Gray, K.N.

    1994-09-30

    The long-term functional and morphologic responses of the hypertrophied monkey kidney after unilateral nephrectomy to fractionated irradiation were assessed. The right kidney of 13 adult female rhesus monkeys was removed. Twelve weeks after unilateral nephrectomy (UN) the remaining kidney received fractionated doses of {gamma}-rays ranging from 35.2 Gy/16 fractions (F) up to 44 Gy/20 F. Glomerular filtration rate, effective renal plasma flow, blood urea nitrogen, serum creatinine, and hematocrit values were measured up to 107 weeks postirradiation (PI). The monkeys were killed and the remaining kidneys were removed 107 weeks PI or earlier when end-stage renal failure was exhibited. Glomeruli were scored for the presence/absence of several pathologic features including increased intercapillary eosinophilic material (ICE), ecstatic capillaries, and thrombi. The relative proportion of renal cortex occupied by glomeruli, interstitium, normal tubules or abnormal tubules was determined using a Chalkley point grid. These quantal dose response data were analyzed using a logistic regression model. Irradiation of the remaining kidney in UN monkeys resulted in a dose-dependent reduction in renal function and anemia. Glomerular dysfunction preceded tubular dysfunction. Animals receiving 44 Gy all manifested progressive clinical renal failure. Conversely, those receiving {le} 39.6 Gy showed stable, albeit impaired, renal function for the duration of the observation period of 107 weeks. Morphologically, the incidence of ICE, ecstatic glomerular capillaries, thrombi, and periglomerular fibrosis was significantly dose-related (p < 0.005). A significant (p < 0.001) dose-related increase in the relative proportion of renal cortex occupied by abnormal tubules was indicative of tubular injury. A highly significant (p < 0.001) dose-dependent increase in the proportion of abnormal to normal tubules was also seen. 27 refs., 4 figs., 2 tabs.

  12. Estrogen preserves split renal function in a chronic complete unilateral ureteral obstruction animal model.

    PubMed

    Mao, Shanhua; Xu, Hua; Zou, Lujia; Xu, Gang; Wu, Zhong; Ding, Qiang; Jiang, Haowen

    2014-06-01

    Estrogen may help to preserve renal function in chronic kidney disease. This study examined whether estrogen administration or deprivation affected the split renal function in rats subjected to chronic unilateral ureteral obstruction (UUO). Fifteen adult female Sprague-Dawley rats were randomly divided into three groups. Low- and high-estrogen groups were modeled by female castration or estrogen intraperitoneal injection, respectively, and the rats in the normal-estrogen group were untreated. Intermittent split renal function [glomerular filtration rate (GFR)] examination was performed on rats on days 2, 6 and 16 after UUO surgery via single-photon emission computed tomography (SPECT/CT). Routine hematoxylin and eosin (H&E) staining, immunohistochemistry, pathology examination and electron microscopy were performed to compare the histological differences. Low-, normal- and high-estrogen groups were successfully established (P<0.001). In the acute stage, the GFR of the contralateral healthy kidney showed a greater compensatory rise in the normal- and high-estrogen groups than in the low-estrogen group (P<0.05). In the chronic stage, the GFR of the obstructed kidney continued to decrease with the GFR of the high-estrogen group being significantly better preserved than that of the low-estrogen group (P<0.05). The GFR of the contralateral kidney compensated to the greatest extent in the high-estrogen group (P=0.01), and the total GFR was significantly superior (P<0.05). Routine H&E examination showed significant histological changes following surgery. The low-estrogen group had significant renal interstitial fibrosis compared with the normal- and high-estrogen groups (P<0.05), as observed by immunohistochemical (IHC) examination of transforming growth factor-? (TGF-?) and ?-smooth muscle actin (?-SMA). Electron-microscopic (EM) examination also differentiated between groups. In conclusion, estrogen administration and deprivation significantly affected renal function. Estrogen may preserve the split renal function (GFR) in rats with chronic UUO. PMID:24926343

  13. Mast cell chymase protects against renal fibrosis in murine unilateral ureteral obstruction.

    PubMed

    Beghdadi, Walid; Madjene, Lydia C; Claver, Julien; Pejler, Gunnar; Beaudoin, Lucie; Lehuen, Agnès; Daugas, Eric; Blank, Ulrich

    2013-08-01

    Mast cell release of chymase is important in tissue remodeling and may participate in inflammation leading to fibrosis and organ failure. Here we analyzed the function of chymase in unilateral ureteral obstruction, an established accelerated model of renal tubulointerstitial fibrosis. Mice deficient in mouse mast cell protease 4 (mMCP4), the functional counterpart of human chymase, had increased obstruction-induced fibrosis when compared to wild-type mice indicating a protective effect of mMCP4. Engraftment of mast cell-deficient Kit(Wsh/Wsh) mice with wild type, but not mMCP4-deficient mast cells, restored protection confirming the role of mMCP4. Kidneys of mMCP4-deficient mice had higher levels of renal tubular damage, interstitial fibrosis, collagen deposition, increased ?-smooth muscle actin, and decreased E-cadherin expression compared to the kidneys of wild-type mice. Further analysis showed an elevated inflammatory response in mMCP4-deficient mice with increased levels of kidney-infiltrating macrophages and T cells and local profibrotic TGF-?1 and CCL2. Granulated and degranulated mast cells and mMCP4 were mainly found in the kidney capsule, respectively, before and after ureteral obstruction. Analysis of mMCP4 substrates showed that it mediates its anti-fibrotic actions by degrading interstitial deposits of fibronectin, a known promoter of inflammatory cell infiltration and adhesion. Thus, mast cell released mMCP4 has anti-fibrotic potential in acutely induced obstructive nephropathy. PMID:23515052

  14. Nonprogressive Unilateral Intracranial Arteriopathy in Children with Arterial Ischemic Stroke

    PubMed Central

    Yeon, Je Young

    2015-01-01

    The nonprogressive unilateral intracranial arteriopathy known as transient (focal) cerebral arteriopathy is not a well-recognized arteriopathy among practitioners of Korea and Japan, although it cannot be easily differentiated from early moyamoya disease. This review summarizes the nomenclature, pathophysiology, diagnostic evaluation, clinico-radiological features, and management of nonprogressive (reversible or stable) unilateral arteriopathy based on the relevant literature and our own experiences. Nonprogressive unilateral arteriopathy should be strongly suspected in children presenting with basal ganglia infarction and arterial beading. The early identification of patients likely to have nonprogressive or progressive arteriopathy would ensure proper management and guide further research for secondary stroke prevention. PMID:26180606

  15. [New kidney transplants].

    PubMed

    Bergerat, S

    2015-11-01

    Chronic kidney failure and patients that require haemodialysis is increasing, mainly because of the increasing prevalence of diabetic nephropathy. Kidney transplantation is an alternative therapy for chronic renal failure in its terminal stage. Currently, in France and in the world, there is a shortage of kidney transplants. The evolution of the French legislation allows the organ donation from living donor, including awaiting cardiac arrest. PMID:26337224

  16. An extension-distraction injury of the thoracic spine with traumatic partial correction of thoracic kyphosis.

    PubMed

    Culotta, Brad A; Deinlein, Donald A; Theiss, Steven M; Lemons, Jack E

    2013-10-01

    Study Design The study is a case report. Objective The authors aim to report an unusual injury pattern in a patient previously treated for thoracic kyphoscoliosis. Methods A postoperative (computed tomography) CT of a healthy 24-year-old man who underwent posterior instrumentation and fusion for a kyphoscoliosis deformity was compared with a CT performed after a motor vehicle accident (MVA) 1 year later, which resulted in an extension-distraction injury of T8 with no neurologic deficit. Cobb angles of the thoracic sagittal images of both CTs were measured using a digital measuring device and the values were recorded. Results Initial postoperative sagittal CT images demonstrate a 67-degree residual thoracic kyphosis compared with the post-MVA sagittal CT images, which reveal a 54-degree thoracic kyphosis, a 13-degree improvement in sagittal alignment. Conclusion It is unusual for a patient with long posterior instrumentation of the spine to sustain a spinal fracture without breakage of the rods, which were 6-mm nickel-titanium alloy with two crosslinks. Although sustaining plastic deformation, the rods maintained their integrity to the degree that the patient required no subsequent treatment to his spine at 12 months follow-up. It is rare to sustain a vertebral fracture without implant failure, which occurred in this case. PMID:24436710

  17. The reported thoracic injuries in Homer's Iliad.

    PubMed

    Apostolakis, Efstratios; Apostolaki, Georgia; Apostolaki, Mary; Chorti, Maria

    2010-01-01

    Homer's Iliad is considered to be a prominent and representative work of the tradition of the ancient Greek epic poetry. In this poem Homer presents the battles which took place during the last year of the 10-year lasting Trojan War between Achaeans and Trojans. We wanted to examine the chest wounds, especially those which are described in detail, according to their localization, severity and mortality. Finally, there are reported 54 consecutive thoracic injuries in the Iliad. The mostly used weapons were the spear (63%), the stones (7.4%), the arrow (5.5%) and the sword (5.5%). We divided the injuries according to their severity in mild (those which did not cause serious injury to the victim), medium (those which cause the victim to abandon the battlefield), and severe (those which cause death of the victim). According to this classification, the reported injuries were mild in 11.11%, medium in 18.52%, and severe in the last 70.37% of the reported cases. In other words, 89% of the injuries belong to the medium or severe category of thoracic injury. As far as the mortality of the injuries is concerned, 38 out of 54 thoracic injuries include death, which makes the mortality percentage reach 70.37%. Concerning the "allocation of the roles", the Achaean were in 68% perpetrators and the Trojans in only 32%. In terms of gravity, out of 38 mortal injuries 30 involve a Trojan (78.95%) and the remaining 8 an Achaean (21.05%). The excellent and detailed description of the injuries by Homer, as well as of the symptoms, may reveal a man with knowledge of anatomy and medicine who cared for the injured warriors in the battlefield. PMID:21087529

  18. The reported thoracic injuries in Homer's Iliad

    PubMed Central

    2010-01-01

    Homer's Iliad is considered to be a prominent and representative work of the tradition of the ancient Greek epic poetry. In this poem Homer presents the battles which took place during the last year of the 10-year lasting Trojan War between Achaeans and Trojans. We wanted to examine the chest wounds, especially those which are described in detail, according to their localization, severity and mortality. Finally, there are reported 54 consecutive thoracic injuries in the Iliad. The mostly used weapons were the spear (63%), the stones (7.4%), the arrow (5.5%) and the sword (5.5%). We divided the injuries according to their severity in mild (those which did not cause serious injury to the victim), medium (those which cause the victim to abandon the battlefield), and severe (those which cause death of the victim). According to this classification, the reported injuries were mild in 11.11%, medium in 18.52%, and severe in the last 70.37% of the reported cases. In other words, 89% of the injuries belong to the medium or severe category of thoracic injury. As far as the mortality of the injuries is concerned, 38 out of 54 thoracic injuries include death, which makes the mortality percentage reach 70.37%. Concerning the "allocation of the roles", the Achaean were in 68% perpetrators and the Trojans in only 32%. In terms of gravity, out of 38 mortal injuries 30 involve a Trojan (78.95%) and the remaining 8 an Achaean (21.05%). The excellent and detailed description of the injuries by Homer, as well as of the symptoms, may reveal a man with knowledge of anatomy and medicine who cared for the injured warriors in the battlefield. PMID:21087529

  19. The clinical application and efficacy of percutaneous kyphoplasty via unilateral pedicular approach guided by CT image measurement

    PubMed Central

    Zhai, Weifeng; Jia, Yongwei; Wang, Jianjie; Cheng, Liming

    2015-01-01

    This study aimed to investigate the clinical application and efficacy of percutaneous kyphoplasty via unilateral pedicular approach with the reference of preoperative CT image data. 73 cases (a total of 112 vertebrae) with thoracic and lumbar osteoporotic vertebral compression fractures (OVCF) received in our department were collected in this study and underwent percutaneous kyphoplasty via unilateral pedicular approach directed by CT image measurement with the operative time and fluoroscopic times recorded. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess the pain status and functional activity before and after operation and at the last follow-up, while X-ray and CT image were used to measure the height of the injured spinal middle column and kyphotic Cobb angle before and after operation. 73 cases (112 vertebrae) underwent percutaneous kyphoplasty successfully. Cement leakage occurred in 7 cases without obvious neurological symptoms, and they were followed up for 10 to 60 months with the average of 23 months; adjacent vertebral refractures occurred in 3 cases during the follow-up, and their symptoms were relieved after the second surgery. There was significant difference in the height of the injured spinal middle column and kyphotic Cobb angle before and after operation (P<0.05); there was significant difference in preoperative and postoperative VAS score and ODI values (P<0.05). Postoperative CT image data showed that puncture paths of the 110 vertebrae were consistent with preoperative ones sketched using the CT image, and the consistent rate of preoperative and postoperative measurement data was 98%. All patients could ambulate with brace within 2 days after operation without serious complications. In conclusion, percutaneous kyphoplasty via unilateral pedicular approach guided by preoperative CT image data is effective in treatment of osteoporotic vertebral compression fractures, and it is convenient and safe with high puncture accuracy, shorter operative time and less radiation exposure for patients and operators. PMID:26885011

  20. Video-assisted thoracic surgery complications

    PubMed Central

    Kozak, Józef

    2014-01-01

    Video-assisted thoracic surgery (VATS) is a miniinvasive technique commonly applied worldwide. Indications for VATS are very broad and include the diagnosis of mediastinal, lung and pleural diseases, as well as large resection procedures such as pneumonectomy. The most frequent complication is prolonged postoperative air leak. The other significant complications are bleeding, infections, postoperative pain and recurrence at the port site. Different complications of VATS procedures can occur with variable frequency in various diseases. Despite the large number of their types, such complications are rare and can be avoided through the proper selection of patients and an appropriate surgical technique. PMID:25561984

  1. Digital subtraction angiography of the thoracic aorta

    SciTech Connect

    Grossman, L.B.; Buonocore, E.; Modic, M.T.; Meaney, T.F.

    1984-02-01

    Forty-three patients with acquired and congenital abnormalities of the thoracic aorta were studied using digital subtraction angiography (DSA) after an intravenous bolus injection of 40 ml of contrast material. Abnormalities studied included coarctation, pseudocoarctation, Marfan syndrome, cervical aorta, double aortic arch, aneurysm, dissection, and tumor. Twenty-four patients also had conventional angiography. DSA was accurate in 95% of cases; in the other 5%, involving patients with acute type I dissection, the coronary arteries could not be seen. The authors concluded that in 92% of their patients, DSA could have replaced the standard aortogram.

  2. Thoracic Outlet Syndrome Following Breast Implant Rupture

    PubMed Central

    Caplash, Yugesh; Giri, Pratyush; Kearney, Daniel; Wagstaff, Marcus

    2015-01-01

    Summary: We present a patient with bilateral breast implant rupture who developed severe locoregional silicone granulomatous lymphadenopathy. Poly Implant Prothese silicone implants had been used for bilateral breast augmentation 5 years prior. Extracapsular implant rupture and bilateral axillary lymphadenopathy indicated explantation, capsulectomy, and selective lymph node excision. Histology demonstrated silicone lymphadenopathy with no evidence of malignancy. Over the subsequent 12 months, she developed progressive locoregional lymphadenopathy involving bilateral cervical, axillary, and internal mammary groups, resulting in bilateral thoracic outlet syndrome. We report the unusual presentation, progression, and the ultimate surgical management of this patient. PMID:25878942

  3. Papillary Kidney Carcinoma

    Cancer.gov

    The most common type of kidney cancer is called renal cell carcinoma. This cancer forms in the cells lining the small tubules in the kidney that filter waste from the blood and make urine. An estimated 58,240 Americans were expected to have been diagnosed with kidney cancer in 2010 and an estimated 13,040 to have died of this cancer.1 Most people with kidney cancer are usually over 55 years of age and this cancer is more common in men.

  4. Clear Cell Kidney Carcinoma

    Cancer.gov

    The most common type of kidney cancer is called renal cell carcinoma. This cancer forms in the cells lining the small tubules in the kidney that filter waste from the blood and make urine. An estimated 58,240 Americans were expected to have been diagnosed with kidney cancer in 2010 and an estimated 13,040 to have died of this cancer.1 Most people with kidney cancer are usually over 55 years of age and this cancer is more common in men.

  5. HCV and the kidney.

    PubMed

    Corouge, Marion; Vallet-Pichard, Anaïs; Pol, Stanislas

    2016-01-01

    Chronic hepatitis C (CHC) is significantly associated with a risk of renal deterioration over time. Renal impairment, especially stage 4-5 chronic kidney disease, increases the risk of: (i) the prevalence and incidence (in dialysis/transplantation) of hepatitis C virus (HCV) infection; (ii) liver deterioration during kidney transplantation and (iii) allograft failure and patient mortality. HCV-infected dialysis patients have a higher mortality than non-infected dialysis patients and than HCV-infected kidney recipients. The harmful impact of HCV emphasizes the need for oral antiviral therapies in patients with chronic kidney disease. Symptomatic cryoglobulinemic vasculitis and extensive liver fibrosis are already approved indications for early access to oral antiviral treatment. Patients with stage 4-5 chronic kidney disease should also be given priority: dialysis patients (whatever the stage of fibrosis and whether or not they are candidates for kidney transplantation) as well as all kidney recipients. The results of treatment of HCV with direct-acting antiviral (DAAs) drugs in patients with late chronic kidney disease are excellent, similar to those in the general population, although additional clinical trials are definitely needed, particularly to optimize adjustment of treatment to kidney function and determine the risk of drug-drug interactions. PMID:26725894

  6. Obstruction of the Superior Mesenteric Artery Due to Emboli from the Thoracic Aorta in a Patient with Thromboangiitis Obliterans

    PubMed Central

    Kamiya, Chiaki; Kitaoka, Tadashi; Suzuki, Jun; Abe, Keiko; Sato, Osamu

    2014-01-01

    A 48-year-old woman presented at our hospital with acute abdominal pain 3 years after being diagnosed with thromboangiitis obliterans (TAO). Computed tomography revealed occlusion of the superior mesenteric artery (SMA) and multiple kidney infarction with thrombus floating in the thoracic aorta connected with the intercostal artery. Despite emergency embolectomy, further thromboembolism eventually required massive resection of the intestine with jejunostomy and colostomy and permanent intravenous hyper-alimentation therapy. Although TAO rarely involves the large artery, the aorta could be the source of embolization in patients with TAO. PMID:25298837

  7. Unilateral Mydriasis After Mandibular Fracture Fixation Surgery

    PubMed Central

    Nesioonpour, Sholeh; Khiabani, Kazem; Hassanijirdehi, Marzieh

    2014-01-01

    Introduction: Unilateral mydriasis is a seriously significant finding in neurologic examinations indicating life-threatening conditions such as cerebral vascular injuries. Case Presentation: A 24 year old woman with mandibular trauma was referred to our center after five days for a reduction of the right mandibular angle fracture. The patient had no history of any loss of consciousness after the accident. Her physical examination showed no abnormalities, except those related to her mandibular fracture. The laboratory results were normal as well. At 8:30 am a general anesthesia was induced. The patient’s eyes were kept shut throughout the surgical procedure. The operation included an intraoral open reduction and fixation using two miniplates without any complications. After the operation, it was noticed that the left eye was completely dilated with no reaction to light, while the right eye was normal. The management and outcomes in this patient were described in the present case report. Conclusions: Evaluating the size of the patient’s pupils before, during and after the operation, careful history, consult, CT scan and MRI would help to diagnosis. Although no probable cause was found to explain the transient mydriasis in our patient. PMID:24829881

  8. Influence of unilateral weight on bilateral cyclograms

    NASA Astrophysics Data System (ADS)

    Pellicer Costa, Juan José; Dusza, Jacek J.

    2014-11-01

    The paper presents the results of gait parameters as a function of unilateral weight. The object of the research was a woman walking on a stationary surface and carrying in his hand weights from 0 to 15 kg. Her movement was recorded by 6 cameras recording the location of 34 markers placed at appropriate points in the body. 3D reconstruction was performed for each of the reflecting markers. Tested signals were changes in the value the joint angles of ankle, knee and hip. On the basis of about 6 cycles of movement of each load, a model for the average gait cycle was developed. The result of the experiments are graphs of changes the joint angles as a function of time, bilateral cyclograms, synchronized bilateral cyclograms and regression lines. The conclusion of the study is to determine how one-sided load affects gait asymmetry. Simple and easy to interpret method of presentation of results were also shown. Studies were conducted using VICON system.

  9. Pulmonary hypoplasia induced by liquid paraffin injection into fetal thoracic cavity with special reference to renal development in rats.

    PubMed

    Morikawa, Y; Katsumoto, Y; Okada, T; Sasaki, F

    2000-02-01

    The present study was designed to clarify lung-kidney interrelation in fetal rats. On fetal day 20, liquid paraffin (LP) was injected into fetal thoracic cavity to produce pulmonary hypoplasia. No significant difference in body and renal weights were noted between the LP injected and control fetuses. The weight of lung, however, was significantly lower in the LP injected fetuses than in the control ones. Histological examinations on the lung and kidney of the LP injected fetuses revealed that the lung was hypoplastic characterized by rich interstitium and reduced air spaces. In the kidney, mature types of glomeruli and profiles of proximal tubules near them were increased in number. Furthermore, strong expression of EGF immunoreactivity was noted in the apical cytoplasm of epithelium of the proximal tubules in the LP injected fetuses. These findings indicate that lung-kidney interrelation exists in fetal rats during late gestational days, and suggest that interruption of the lung development induces accelerated growth of the kidney in fetal rats. PMID:10720182

  10. Isolated, unilateral, reversible palsy of the hypoglossal nerve.

    PubMed

    Giuffrida, S; Lo Bartolo, M L; Nicoletti, A; Reggio, E; Lo Fermo, S; Restivo, D A; Domina, E; Reggio, A

    2000-05-01

    We report three patients with isolated unilateral hypoglossal nerve palsy who experienced an excellent outcome. In two patients no cause was found. Our study seems to confirm that the occurrence of benign and idiopathic isolated unilateral palsy of the hypoglossal nerve is more frequent than previously reported. We would like to stress that neuroimaging studies remain mandatory in order to exclude other common causes, such as tumour and spontaneous or traumatic vascular lesions, in which a specific treatment is necessary. PMID:10886321

  11. Unilateral Vogt-Koyanagi-Harada Disease: Report of Two Cases

    PubMed Central

    Agrawal, Alok; Biswas, Jyotirmay

    2011-01-01

    In this retrospective report, we present two cases of unilateral Vogt-Koyanagi-Harada (VKH) disease. These patients were evaluated with clinical, ophthalmological and laboratory examinations. Their response following corticosteroid administration was evaluated. Both patients had the characteristic clinical features of VKH involving only one eye, including disc edema, choroidal striae, multiple sub retinal yellow lesions and exudative retinal detachment. These cases indicate that the clinical and angiographic features were typical of VKH disease despite the unilateral involvement. PMID:21572744

  12. Grip Force Coordination during Bimanual Tasks in Unilateral Cerebral Palsy

    ERIC Educational Resources Information Center

    Islam, Mominul; Gordon, Andrew M.; Skold, Annika; Forssberg, Hans; Eliasson, Ann-Christin

    2011-01-01

    Aim: The aim of the study was to investigate coordination of fingertip forces during an asymmetrical bimanual task in children with unilateral cerebral palsy (CP). Method: Twelve participants (six males, six females; mean age 14y 4mo, SD 3.3y; range 9-20y;) with unilateral CP (eight right-sided, four left-sided) and 15 age-matched typically…

  13. Assessment of Renal Function in Patients with Unilateral Ureteral Obstruction Using Whole-Organ Perfusion Imaging with 320-Detector Row Computed Tomography

    PubMed Central

    Yu, Juan; Feng, You-Zhen; Xian, Zhao-Hui; Yang, Wen-Cai; Mo, Xu-Kai

    2015-01-01

    Background Obstructed nephropathy is a common complication of several disease processes. Accurate evaluation of the functional status of the obstructed kidney is important to achieve a good outcome. The purpose of this study was to investigate renal cortical and medullary perfusion changes associated with unilateral ureteral obstruction (UUO) using whole-organ perfusion imaging with 320-detector row computed tomography (CT). Methodology/Principle Findings Sixty-four patients with UUO underwent whole-organ CT perfusion imaging. Patients were divided into 3 groups, mild, moderate, and severe, based on hydronephrosis severity. Twenty sex- and age-matched patients without renal disease, who referred to abdominal CT, were chosen as control subjects. Mean cortical and medullary perfusion parameters of obstructed and contralateral kidneys were compared, and mean perfusion ratios between obstructed and contralateral kidneys were calculated and compared. Mean cortical or medullary blood flow (BF) and blood volume (BV) of the obstructed kidneys in the moderate UUO and BF, BV, and clearance (CL) in the severe UUO were significantly lower than those of the contralateral kidneys (p < 0.05). The mean cortical or medullary BF of the obstructed kidney in the moderate UUO, and BF, BV, and CL in the severe UUO were significantly lower than those of the kidneys in control subjects (p < 0.05). Mean cortical or medullary BF of the non-obstructed kidneys in the severe UUO were statistically greater than that of normal kidneys in control subjects (p < 0.05). An inverse correlation was observed between cortical and medullary perfusion ratios and grades of hydronephosis (p < 0.01). Conclusions/Significance Perfusion measurements of the whole kidney can be obtained with 320-detector row CT, and estimated perfusion ratios have potential for quantitatively evaluating UUO renal injury grades. PMID:25874690

  14. Persistent High Level of Urinary Tumor Marker Carbohydrate Antigen 19-9 in Prenatally Diagnosed Dysplastic Kidney

    PubMed Central

    Ebadi, Maryam; Rahimi Sherbaf, Fatemeh; Kajbafzadeh, Abdol-Mohammad

    2014-01-01

    Tumor marker carbohydrate antigen 19-9 (CA 19-9) level has gained clinical significance in gastrointestinal malignancies and in various solid and cystic diseases. Dysplastic kidney is a congenital abnormality resulting from atresia of the ureteral bud during the embryogenesis which can be unilateral or bilateral. We report unilateral dysplastic kidney with extremely large cyst diagnosed by routine ultrasonography in the 32nd week of gestational age with high levels of CA 19-9 in cystic and amniotic fluid, as well as persistent high urinary levels of this tumor marker during the 1-year follow-up. Persistent high urinary CA 19-9 level even after cyst aspiration may be attributable to remained function of dysplastic kidney due to remained epithelial lining. PMID:25614848

  15. Surgical efficacy of minimally invasive thoracic discectomy.

    PubMed

    Elhadi, Ali M; Zehri, Aqib H; Zaidi, Hasan A; Almefty, Kaith K; Preul, Mark C; Theodore, Nicholas; Dickman, Curtis A

    2015-11-01

    We aimed to determine the clinical indications and surgical outcomes for thoracoscopic discectomy. Thoracic disc disease is a rare degenerative process. Thoracoscopic approaches serve to minimize tissue injury during the approach, but critics argue that this comes at the cost of surgical efficacy. Current reports in the literature are limited to small institutional patient series. We systematically identified all English language articles on thoracoscopic discectomy with at least two patients, published from 1994 to 2013 on MEDLINE, Science Direct, and Google Scholar. We analyzed 12 articles that met the inclusion criteria, five prospective and seven retrospective studies comprising 545 surgical patients. The overall complication rate was 24% (n=129), with reported complications ranging from intercostal neuralgia (6.1%), atelectasis (2.8%), and pleural effusion (2.6%), to more severe complications such as pneumonia (0.8%), pneumothorax (1.3%), and venous thrombosis (0.2%). The average reported postoperative follow-up was 20.5 months. Complete resolution of symptoms was reported in 79% of patients, improvement with residual symptoms in 10.2%, no change in 9.6%, and worsening in 1.2%. The minimally invasive endoscopic approaches to the thoracic spine among selected patients demonstrate excellent clinical efficacy and acceptable complication rates, comparable to the open approaches. Disc herniations confined to a single level, with small or no calcifications, are ideal for such an approach, whereas patients with calcified discs adherent to the dura would benefit from an open approach. PMID:26206758

  16. Women in Thoracic Surgery: 30 Years of History.

    PubMed

    Antonoff, Mara B; David, Elizabeth A; Donington, Jessica S; Colson, Yolonda L; Litle, Virginia R; Lawton, Jennifer S; Burgess, Nora L

    2016-01-01

    Women in Thoracic Surgery was founded in 1986, with 2016 marking its 30th anniversary. Reflecting back on the last 3 decades of history, accomplishments, and enormous strides in our field, we review the past, present, and future of this organization. Although women still constitute a small minority of practicing surgeons in our field today, opportunities currently abound for women in thoracic surgery. Owing much to the early female pioneers in the field and to the support of male sponsors and our national societies, Women in Thoracic Surgery has grown and prospered, as have its members and the global community of female thoracic surgeons as a whole. In celebration of our 30th anniversary, we share with the readership the rich history of Women in Thoracic Surgery and its goals for the future. PMID:26694290

  17. Kidney Surgery Codes

    Cancer.gov

    Kidney, Renal Pelvis, and Ureter Kidney C649, Renal Pelvis C659, Ureter C669 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 10 Local tumor

  18. Amyloidosis and Kidney Disease

    MedlinePLUS

    ... Foundation Genetic and Rare Diseases Information Center MedlinePlus Kidney and Urologic Disease Organizations Many organizations provide support ... PDF, 345 KB)​​​​​ Alternate Language URL Amyloidosis and Kidney Disease Page Content On this page: What is ...

  19. Keep Your Kidneys Healthy

    MedlinePLUS

    ... Albumin Children and Kidney Disease Additional Kidney Information Contact Us Health Information Center Phone: 1-800-860- ... to share this content freely. September 17, 2014​​​​ Contact Us Health Information Center Phone: 1-800-860- ...

  20. Acquired Cystic Kidney Disease

    MedlinePLUS

    ... acquired cystic kidney disease should talk with their health care provider about when to begin screening. [ Top ] Eating, Diet, and Nutrition No specific diet will prevent or delay acquired cystic kidney disease. In general, a diet designed for people on hemodialysis or ...

  1. Prevention of renal interstitial fibrosis via histone deacetylase inhibition in rats with unilateral ureteral obstruction.

    PubMed

    Kinugasa, Fumitaka; Noto, Takahisa; Matsuoka, Hideaki; Urano, Yasuharu; Sudo, Yuji; Takakura, Shoji; Mutoh, Seitaro

    2010-05-01

    Acute rejection following renal transplantation has become manageable with the introduction of calcineurin inhibitors, FK506 and cyclosporine A. However, chronic allograft dysfunction accompanied by renal interstitial fibrosis, which induces graft loss, remains unresolved. Here, we evaluated the effect of FR276457, a pan-histone deacetylase (HDAC) inhibitor, on interstitial fibrosis in the injured kidneys of a rat model of unilateral ureteral obstruction. The injured kidneys, harvested on Day 14 following the operation, showed progression of interstitial fibrosis, increases of hydroxyproline contents, and mRNA expression of collagen type Ialpha1 and monocyte chemotactic protein 1 (MCP-1). However, these changes were found to be prevented with daily oral administration of FR276457. In addition, given that MCP-1 is believed to contribute to progressive fibrosis, we investigated the direct effect of FR276457 on MCP-1 production by activated THP-1 cells in vitro. Results showed that FR276457 administration decreased MCP-1 production in these cells in a concentration-dependent manner. Findings from the present study suggested that a pan-HDAC inhibitor may exert a prophylactic effect against renal interstitial fibrosis by inhibiting MCP-1 production. PMID:20206695

  2. Epigallocatechin-3-gallate attenuates unilateral ureteral obstruction-induced renal interstitial fibrosis in mice.

    PubMed

    Wang, Yanqiu; Wang, Bowen; Du, Feng; Su, Xuesong; Sun, Guangping; Zhou, Guangyu; Bian, Xiaohui; Liu, Na

    2015-04-01

    The severity of tubulointerstitial fibrosis is regarded as an important determinant of renal prognosis. Therapeutic strategies targeting tubulointerstitial fibrosis have been considered to have potential in the treatment of chronic kidney disease. This study aims to evaluate the protective effects of (-)-epigallocatechin-3-gallate (EGCG), a green tea polyphenol, against renal interstitial fibrosis in mice. EGCG was administrated intraperitoneally for 14 days in a mouse model of unilateral ureteral obstruction (UUO). The results of our histological examination showed that EGCG alleviated glomerular and tubular injury and attenuated renal interstitial fibrosis in UUO mice. Furthermore, the inflammatory responses induced by UUO were inhibited, as represented by decreased macrophage infiltration and inflammatory cytokine production. Additionally, the expression of type I and III collagen in the kidney were reduced by EGCG, which indicated an inhibition of extracellular matrix accumulation. EGCG also caused an up-regulation in ?-smooth muscle actin expression and a down-regulation in E-cadherin expression, indicating the inhibition of epithelial-to-mesenchymal transition. These changes were found to be in parallel with the decreased level of TGF-?1 and phosphorylated Smad. In conclusion, the present study demonstrates that EGCG could attenuate renal interstitial fibrosis in UUO mice, and this renoprotective effect might be associated with its effects of inflammatory responses alleviation and TGF-?/Smad signaling pathway inhibition. PMID:25549657

  3. Bioengineering Kidneys for Transplantation

    PubMed Central

    Madariaga, Maria Lucia L.; Ott, Harald C.

    2014-01-01

    One in ten Americans suffer from chronic kidney disease, and close to 90,000 people die each year from causes related to kidney failure. Patients with end-stage renal disease are faced with two options: hemodialysis or transplantation. Unfortunately, the reach of transplantation is limited because of the shortage of donor organs and the need for immunosuppression. Bioengineered kidney grafts theoretically present a novel solution to both problems. Herein we discuss the history of bioengineering organs, the current status of bioengineered kidneys, considerations for the future of the field, and challenges to clinical translation. We hope that by integrating principles of tissue engineering, and stem cell and developmental biology, bioengineered kidney grafts will advance the field of regenerative medicine while meeting a critical clinical need. PMID:25217267

  4. [Promoting Living Kidney Transplantation].

    PubMed

    Lin, Chiu-Chu

    2016-04-01

    Kidney transplantation is the best approach for treating patients with end stage renal disease, offering patients the best chance of returning to normal health. While the techniques used in kidney transplantation surgery are mature and highly successful, there is a severe shortage of donor organs. Statistics show a serious imbalance between organ donations and patients on the waiting list for organ transplantation. Moreover, evidence from empirical studies has shown a better transplantation outcome for patients who receive living donor transplantation than for those who receive organs from cadavers. Although using relatives as donors offers an effective way to reduce the problem of organ shortage, this strategy faces many challenges and many other factors affect the promotion of living donor transplantation. This article elaborates how cultural and psychological factors, kidney transplantation awareness, and ethics and laws impact upon living kidney donations and then proposes coping strategies for promoting living kidney transplantation. PMID:27026555

  5. Partial deletion of the ROCK2 protein fails to reduce renal fibrosis in a unilateral ureteral obstruction model in mice.

    PubMed

    Baba, Itsuko; Egi, Yasuhiro; Suzuki, Kazuo

    2016-01-01

    Renal fibrosis is a well?known cause for the progression of chronic kidney disease. Rho/Rho?associated coiled?coil kinase (ROCK) signaling is involved in renal fibrotic processes. Non?selective ROCK1/2 inhibitors have been reported to reduce renal interstitial fibrosis in a rodent unilateral ureteral obstruction (UUO) model. To clarify the role and contribution of ROCK2 in renal fibrosis, the present study used ROCK2 heterozygous knockout (HKO) mice to assess collagen deposition and fibrosis?associated gene expression in the kidney of the UUO model. In the ROCK2 HKO mice, the expression level of ROCK2 in the normal kidney was half of that in the kidney of wild?type (WT) mice. The expression levels of ROCK1 in the ROCK2 HKO mice and WT mice were equivalent. Furthermore, in the ROCK2 HKO and the WT mice, the hydroxyproline content and the gene expression levels of collagen I and transforming growth factor??1 in the obstructed kidneys were augmented following UUO. By contrast, the mRNA expression of ??smooth muscle actin decreased in the ROCK2 HKO mice, compared with that in the WT mice. The activity of ROCK in the obstructed kidneys, indicated by the phosphorylation of myosin phosphatase target subunit?1, which is a non?selective substrate of ROCK1 and ROCK2, was equivalent among the ROCK2 HKO and WT mice. In conclusion, no differences in renal interstitial fibrosis or UUO?induced ROCK activity were identified between the ROCK2 HKO and WT mice, indicating that the genetic partial disruption of ROCK2 is insufficient for protecting against renal fibrosis. PMID:26572751

  6. History and current status of mini-invasive thoracic surgery

    PubMed Central

    He, Jianxing

    2011-01-01

    Mini-invasive thoracic technique mainly refers to a technique involving the significant reduction of the chest wall access-related trauma. Notably, thoracoscope is the chief representative. The development of thoracoscope technique is characterized by: developing from direct peep to artificial lighting, then combination with image and video technique in equipments; technically developing from diagnostic to therapeutic approaches; developing from simpleness to complexity in application scope; and usually developing together with other techniques. At present, the widely used mini-invasive thoracic surgery refers to the mini-open thoracic surgery performed mainly by using some instruments to control target tissues and organs based on the vision associated with multi-limb coordination, which may be hand-assisted if necessary. The mini-invasive thoracic surgery consists of three approaches including video-assisted thoracic surgery (VATS), video-assisted Hybrid and hand-assisted VATS. So far the mini-invasive thoracic technique has achieved great advances due to the development in instruments of mini-invasive thoracic surgery which has the following features: instruments of mini-invasive thoracic surgery appear to be safe and practical, and have successive improvement and diversification in function; the specific instruments of open surgeries has been successively developed into dedicated instruments of endoscopic surgery; the application of endoscopic mechanical suture device generates faster fragmentation and reconstruction of organ tissues; the specific delicated instruments of endoscopic surgery have rapid development and application; and the simple instruments structurally similar to the conventional instruments are designed according to the mini-incison. In addition, the mini-invasive thoracic technique is widely used in five aspects including diseases of pleura membrane and chest wall, lung diseases, esophageal diseases, mediastinal diseases and heart diseases. However, there remain many problems in specifications and trainings, economic cost, conservation and innovation. Therefore, particular attention should be paid to these problems. Nevertheless, the promotion of thoracic surgery appears promising in the future. PMID:22263074

  7. The impacts of Unilateral Stratospheric Geoengineering

    NASA Astrophysics Data System (ADS)

    Jones, A.; Haywood, J. M.; Bellouin, N.; Stephenson, D.

    2013-12-01

    Stratospheric geoengineering proposals have been suggested on the premise that the cooling impacts of volcanic eruptions could be deliberately mimicked to offset the impacts of increased greenhouse gas concentrations in the future by counterbalance global warming. Here, we examine both the impacts of hemispherically asymmetric volcanoes in the observational record and the impact of prolonged deliberate injection of stratospheric aerosol into either the northern or southern hemisphere stratosphere or into both hemispheres equally to assess the impacts on Sahelian rainfall and agriculture (Haywood et al., 2013). While the frequency of volcanic eruptions during the past 100 years is too sparse for definitive attribution, there is a suggestion that volcanic eruptions that preferentially load the northern hemisphere are the harbinger of Sahelian drought. Simulations are then performed with the HadGEM2 couple atmospheric-ocean model to assess the impacts of these volcanic eruptions and deliberate unilateral stratospheric geoengineering. Figure 1 shows the impacts of the geoengineering simulations which show that stratospheric injection into the northern hemisphere induces a severe and prolonged Sahelian drought with undoubted detrimental consequences for the local population. Conversely injection into the southern hemisphere causes a significant greening of the Sahel with vegetation productivity enhanced by over 100%. On the face of it, this suggests potential advocacy of injection into the southern hemisphere: we will investigate potential other side-effects from such a strategy...... Haywood, J.M., A. Jones, N. Bellouin, and D.B. Stephenson, Asymmetric forcing from stratospheric aerosols impacts Sahelian drought, Nature Climate Change, Vol 3, No 7, 660-665, doi: 10.1038/NCLIMATE1857, 2013.

  8. Saccadic eye movement programming in unilateral neglect.

    PubMed

    Walker, R; Findlay, J M

    1996-06-01

    The present study examined the eye movements made by patients with unilateral neglect under fixation gap and overlap conditions. The prior offset of fixation in a + 100 msec gap condition did not produce an increase in the numbers of contralesional saccades made by 3 out of 4 patients. This finding is incompatible with the view that the deficit in producing contralesional saccades reflects an inability to disengage visual attention from fixation. A significant reduction in saccade latency was, however, obtained in the gap condition ('gap effect'). The latency reduction in the gap condition is consistent with models which attribute the gap effect to warning signal effects and the release of an ocular rather than an attentional disengagement mechanism. Saccade latency was not increased when two targets were presented bilaterally and simultaneously in both hemifields (in contrast to the increase in latency shown by normal subjects). The lack of a normal 'bilateral target effect' in neglect is attributed to an imbalance in the level of activity in the saccadic system. Three patients showed visual 'extinction' and did not make saccades to the contralesional bilateral targets. In contrast R.R. who shows object-based neglect did not show extinction and made saccades to the contralesional bilateral targets. This suggests that visual extinction may be influenced by the form of neglect shown by the patient. The effects on saccade amplitude of presenting two targets in the same hemifield were also examined in a global effect task. One patient showed a much greater global effect than normal when pairs of targets were presented in his ipsilesional hemifield. In contrast R.R. showed a normal magnitude global effect. It appears that the form of neglect shown by a patient is a factor that influences their eye movement behaviour on simple saccade tasks and these eye movement abnormalities cannot be accounted for by a deficit of attentional disengagement. PMID:8736563

  9. Postural Compensation for Unilateral Vestibular Loss

    PubMed Central

    Peterka, Robert J.; Statler, Kennyn D.; Wrisley, Diane M.; Horak, Fay B.

    2011-01-01

    Postural control of upright stance was investigated in well-compensated, unilateral vestibular loss (UVL) subjects compared to age-matched control subjects. The goal was to determine how sensory weighting for postural control in UVL subjects differed from control subjects, and how sensory weighting related to UVL subjects’ functional compensation, as assessed by standardized balance and dizziness questionnaires. Postural control mechanisms were identified using a model-based interpretation of medial–lateral center-of-mass body-sway evoked by support-surface rotational stimuli during eyes-closed stance. The surface-tilt stimuli consisted of continuous pseudorandom rotations presented at four different amplitudes. Parameters of a feedback control model were obtained that accounted for each subject’s sway response to the surface-tilt stimuli. Sensory weighting factors quantified the relative contributions to stance control of vestibular sensory information, signaling body-sway relative to earth-vertical, and proprioceptive information, signaling body-sway relative to the surface. Results showed that UVL subjects made significantly greater use of proprioceptive, and therefore less use of vestibular, orientation information on all tests. There was relatively little overlap in the distributions of sensory weights measured in UVL and control subjects, although UVL subjects varied widely in the amount they could use their remaining vestibular function. Increased reliance on proprioceptive information by UVL subjects was associated with their balance being more disturbed by the surface-tilt perturbations than control subjects, thus indicating a deficiency of balance control even in well-compensated UVL subjects. Furthermore, there was some tendency for UVL subjects who were less able to utilize remaining vestibular information to also indicate worse functional compensation on questionnaires. PMID:21922014

  10. Species diversity regarding the presence of proximal tubular progenitor cells of the kidney.

    PubMed

    Hansson, J; Ericsson, A E; Axelson, H; Johansson, M E

    2016-01-01

    The cellular source for tubular regeneration following kidney injury is a matter of dispute, with reports suggesting a stem or progenitor cells as the regeneration source while linage tracing studies in mice seemingly favor the classical theory, where regeneration is performed by randomly surviving cells. We, and others have previously described a scattered cell population localized to the tubules of human kidney, which increases in number following injury. Here we have characterized the species distribution of these proximal tubular progenitor cells (PTPCs) in kidney tissue from chimpanzee, pig, rat and mouse using a set of human PTPC markers. We detected PTPCs in chimpanzee and pig kidneys, but not in mouse tissue. Also, subjecting mice to the unilateral urethral obstruction model, caused clear signs of tubular injury, but failed to induce the PTPC phenotype in renal tubules. PMID:26972712

  11. Thoracic size-selective sampling of fibres: performance of four types of thoracic sampler in laboratory tests.

    PubMed

    Jones, A D; Aitken, R J; Fabriès, J F; Kauffer, E; Liden, G; Maynard, A; Riediger, G; Sahle, W

    2005-08-01

    The counting of fibres on membrane filters could be facilitated by using size-selective samplers to exclude coarse particulate and fibres that impede fibre counting. Furthermore, the use of thoracic size selection would also remove the present requirement to discriminate fibres by diameter during counting. However, before thoracic samplers become acceptable for sampling fibres, their performance with fibres needs to be determined. This study examines the performance of four thoracic samplers: the GK2.69 cyclone, a Modified SIMPEDS cyclone, the CATHIA sampler (inertial separation) and the IOM thoracic sampler (porous foam pre-selector). The uniformity of sample deposit on the filter samples, which is important when counts are taken on random fields, was examined with two sizes of spherical particles (1 and 10 microm) and a glass fibre aerosol with fibres spanning the aerodynamic size range of the thoracic convention. Counts by optical microscopy examined fields on a set scanning pattern. Hotspots of deposition were detected for one of the thoracic samplers (Modified SIMPEDS with the 10 microm particles and the fibres). These hotspots were attributed to the inertial flow pattern near the port from the cyclone pre-separator. For the other three thoracic samplers, the distribution was similar to that on a cowled sampler, the current standard sampler for fibres. Aerodynamic selection was examined by comparing fibre concentration on thoracic samples with those measured on semi-isokinetic samples, using fibre size (and hence calculated aerodynamic diameter) and number data obtained by scanning electron microscope evaluation in four laboratories. The size-selection characteristics of three thoracic samplers (GK2.69, Modified SIMPEDS and CATHIA) appeared very similar to the thoracic convention; there was a slight oversampling (relative to the convention) for d(ae) < 7 microm, but that would not be disadvantageous for comparability with the cowled sampler. Only the IOM thoracic sampler tended to undersample the fibres relative to the thoracic convention. With the data divided into four classes based on fibre length, the size-selection characteristics appeared to be unaffected by fibre length for GK2.69, Modified SIMPEDS and CATHIA. Only the IOM thoracic sampler (with the foam selector) showed slightly lower selection for longer length classes of fibres. These results indicate that the tested samplers follow the thoracic sampling convention for fibres, and may be used to improve the quality and reliability of samples that are taken when there is likely to be significant background dust. PMID:15790615

  12. Nephron Deficiency and Predisposition to Renal Injury in a Novel One-Kidney Genetic Model.

    PubMed

    Wang, Xuexiang; Johnson, Ashley C; Williams, Jan M; White, Tiffani; Chade, Alejandro R; Zhang, Jie; Liu, Ruisheng; Roman, Richard J; Lee, Jonathan W; Kyle, Patrick B; Solberg-Woods, Leah; Garrett, Michael R

    2015-07-01

    Some studies have reported up to 40% of patients born with a single kidney develop hypertension, proteinuria, and in some cases renal failure. The increased susceptibility to renal injury may be due, in part, to reduced nephron numbers. Notably, children who undergo nephrectomy or adults who serve as kidney donors exhibit little difference in renal function compared with persons who have two kidneys. However, the difference in risk between being born with a single kidney versus being born with two kidneys and then undergoing nephrectomy are unclear. Animal models used previously to investigate this question are not ideal because they require invasive methods to model congenital solitary kidney. In this study, we describe a new genetic animal model, the heterogeneous stock-derived model of unilateral renal agenesis (HSRA) rat, which demonstrates 50%-75% spontaneous incidence of a single kidney. The HSRA model is characterized by reduced nephron number (more than would be expected by loss of one kidney), early kidney/glomerular hypertrophy, and progressive renal injury, which culminates in reduced renal function. Long-term studies of temporal relationships among BP, renal hemodynamics, and renal function demonstrate that spontaneous single-kidney HSRA rats are more likely than uninephrectomized normal littermates to exhibit renal impairment because of the combination of reduced nephron numbers and prolonged exposure to renal compensatory mechanisms (i.e., hyperfiltration). Future studies with this novel animal model may provide additional insight into the genetic contributions to kidney development and agenesis and the factors influencing susceptibility to renal injury in individuals with congenital solitary kidney. PMID:25349207

  13. Unilateral carpal tunnel syndrome caused by an occult palmar lipoma.

    PubMed

    Bagatur, A Erdem; Yalcinkaya, Merter

    2009-10-01

    Carpal tunnel syndrome usually presents bilaterally and space-occupying lesions should be suspected in patients with unilateral symptoms, especially with a long history and when the symptomatic hand shows severe neurophysiologic impairment, while the contralateral hand is neurophysiologically intact. Approximately half of patients with unilateral symptoms have positive electrodiagnostic test results in the asymptomatic, contralateral hand. Space-occupying lesions are known to cause carpal tunnel syndrome and the incidence of space-occupying lesions in unilateral carpal tunnel syndrome is higher than that of bilateral carpal tunnel syndrome. It is easy to detect a mass when it is palpable, but occult lesions may be overlooked easily. Whenever a patient presents with unilateral symptoms and unilateral neurophysiologic impairment, the possibility of a space-occupying lesion compressing the median nerve should be kept in mind in the differential diagnosis. This article presents 2 cases of patients with occult deep palmar lipomas compressing the median nerve and causing unilateral symptoms of carpal tunnel syndrome. We stress the importance of imaging studies in patients with unilateral symptoms that are usually not used in carpal tunnel syndrome. While both patients' symptomatic hands showed severe neurophysiologic impairment, the contralateral hands were totally intact, which is contradictory with a long history. The reported patients were evaluated and magnetic resonance images revealed intra-tunnel lesions. Although lipomas are the most common soft tissue tumor in the body, <5% of the benign tumors of the hand are lipomas. Since the thick palmar fascia is strong, a deep lipoma may not be recognized although nerve compression symptoms may be gross. PMID:19824610

  14. Rictor/mTORC2 signaling mediates TGF?1-induced fibroblast activation and kidney fibrosis

    PubMed Central

    Li, Jianzhong; Ren, Jiafa; Liu, Xin; Jiang, Lei; He, Weichun; Yuan, Weiping; Yang, Junwei; Dai, Chunsun

    2015-01-01

    The mammalian target of rapamycin (mTOR) was recently identified in two structurally distinct multiprotein complexes: mTORC1 and mTORC2. Previously, we found that Rictor/mTORC2 protects against cisplatin-induced acute kidney injury, but the role and mechanisms for Rictor/mTORC2 in TGF?1-induced fibroblast activation and kidney fibrosis remains unknown. To study this, we initially treated NRK-49F cells with TGF?1 and found that TGF?1 could activate Rictor/mTORC2 signaling in cultured cells. Blocking Rictor/mTORC2 signaling with Rictor or Akt1 small interfering RNAs markedly inhibited TGF?1-induced fibronection and ?-smooth muscle actin expression. Ensuing western blotting or immunostaining results showed that Rictor/mTORC2 signaling was activated in kidney interstitial myofibroblasts from mice with unilateral ureteral obstruction. Next, a mouse model with fibroblast-specific deletion of Rictor was generated. These knockout mice were normal at birth and had no obvious kidney dysfunction or kidney morphological abnormality within 2 months of birth. Compared with control littermates, the kidneys of Rictor knockout mice developed less interstitial extracellular matrix deposition and inflammatory cell infiltration at 1 or 2 weeks after ureteral obstruction. Thus our study suggests that Rictor/mTORC2 signaling activation mediates TGF?1-induced fibroblast activation and contributes to the development of kidney fibrosis. This may provide a therapeutic target for chronic kidney diseases. PMID:25970154

  15. Rictor/mTORC2 signaling mediates TGF?1-induced fibroblast activation and kidney fibrosis.

    PubMed

    Li, Jianzhong; Ren, Jiafa; Liu, Xin; Jiang, Lei; He, Weichun; Yuan, Weiping; Yang, Junwei; Dai, Chunsun

    2015-09-01

    The mammalian target of rapamycin (mTOR) was recently identified in two structurally distinct multiprotein complexes: mTORC1 and mTORC2. Previously, we found that Rictor/mTORC2 protects against cisplatin-induced acute kidney injury, but the role and mechanisms for Rictor/mTORC2 in TGF?1-induced fibroblast activation and kidney fibrosis remains unknown. To study this, we initially treated NRK-49F cells with TGF?1 and found that TGF?1 could activate Rictor/mTORC2 signaling in cultured cells. Blocking Rictor/mTORC2 signaling with Rictor or Akt1 small interfering RNAs markedly inhibited TGF?1-induced fibronection and ?-smooth muscle actin expression. Ensuing western blotting or immunostaining results showed that Rictor/mTORC2 signaling was activated in kidney interstitial myofibroblasts from mice with unilateral ureteral obstruction. Next, a mouse model with fibroblast-specific deletion of Rictor was generated. These knockout mice were normal at birth and had no obvious kidney dysfunction or kidney morphological abnormality within 2 months of birth. Compared with control littermates, the kidneys of Rictor knockout mice developed less interstitial extracellular matrix deposition and inflammatory cell infiltration at 1 or 2 weeks after ureteral obstruction. Thus our study suggests that Rictor/mTORC2 signaling activation mediates TGF?1-induced fibroblast activation and contributes to the development of kidney fibrosis. This may provide a therapeutic target for chronic kidney diseases. PMID:25970154

  16. Non-intubated thoracic surgery—A survey from the European Society of Thoracic Surgeons

    PubMed Central

    Sorge, Roberto; Akopov, Andrej; Congregado, Miguel; Grodzki, Tomasz

    2015-01-01

    Background A survey amongst the European Society of Thoracic Surgeons (ESTS) members has been performed to investigate the currents trends, rates of adoption as well as potential for future expansion of non-intubated thoracic surgery (NITS) performed under spontaneous ventilation. Methods A 14-question-based questionnaire has been e-mailed to ESTS members. To facilitate the completion of the questionnaire, questions entailed either quantitative or multiple-choice answers. Investigated issues included previous experience with NITS and number of procedures performed, preferred types of anesthesia protocols (i.e., thoracic epidural anesthesia, intercostal or paravertebral blocks, laryngeal mask, use of additional sedation), type of procedures, ideal candidates for NITS, main advantages and technical disadvantages. Non-univocal answer to multiple-choice questions was permitted. Results Out of 105 responders, 62 reported an experience with NITS. The preferred types of anesthesia were intercostal blocks with (59%) or without (50%) sedation, followed by laryngeal mask with sedation (43%) and thoracic epidural anesthesia with sedation (20%). The most frequently performed procedures included thoracoscopic management of recurrent pleural effusion (98%), pleural decortication for empyema thoracis and lung biopsy for interstitial lung disease (26% each); pericardial window and mediastinal biopsy (20% each). More complex procedures such as lobectomy, lung volume reduction surgery and thymectomy have been performed by a minority of responders (2% each). Poor-risk patients due to co-morbidities (70%) and patients with poor pulmonary function (43%) were considered the ideal candidates. Main advantages included faster, recovery (67%), reduced morbidity (59%) and shorter hospital stay with decreased costs (43% each). Reported technical disadvantages included coughing (59%) and poor maneuverability due to diaphragmatic and lung movements (56%). Overall, 69% of responders indicated that NITS procedures will be likely to increase in the near future. Conclusions Results of this survey, suggest that NITS is already quite widely adopted by ESTS members to perform simple thoracoscopic procedures. A future expanded adoption of this strategy is also hypothesized. PMID:25815298

  17. Vasohibin?1 deficiency enhances renal fibrosis and inflammation after unilateral ureteral obstruction

    PubMed Central

    Watatani, Hiroyuki; Maeshima, Yohei; Hinamoto, Norikazu; Yamasaki, Hiroko; Ujike, Haruyo; Tanabe, Katsuyuki; Sugiyama, Hitoshi; Otsuka, Fumio; Sato, Yasufumi; Makino, Hirofumi

    2014-01-01

    Abstract Tubulointerstitial injuries are known to predict the deterioration of renal function in chronic kidney disease (CKD). We recently reported the protective role of Vasohibin?1(VASH?1), a negative feedback regulator of angiogenesis, in diabetic nephropathy, but its impact on tubulointerstitial injuries remains to be elucidated. In the present study, we evaluated the role of endogenous VASH?1 in regulating the tubulointerstitial alterations induced by unilateral ureteral obstruction (UUO), and assessed its role on fibrogenesis and the activation of Smad3 signaling in renal fibroblasts. UUO was induced in female Vasohibin?1 heterozygous knockout mice (VASH?1+/?) or wild?type (WT) (VASH?1+/+) littermates. Mice were sacrificed on Day 7 after left ureter ligation, and the kidney tissue was obtained. Interstitial fibrosis, the accumulation of type I and type III collagen and monocytes/macrophages infiltration in the obstructed kidneys (OBK) were significantly exacerbated in VASH?1+/? mice compared with WT mice (Day 7). The increases in the renal levels of TGF??1, pSmad3, NF??B pp65, CCL2 mRNA, and the number of interstitial fibroblast?specific protein?1 (FSP?1)+ fibroblasts in the OBK were significantly aggravated in VASH?1+/? mice. In addition, treatment with VASH?1 siRNA enhanced the TGF??1?induced phosphorylation of Smad3, the transcriptional activation of the Smad3 pathway and the production of type I/type III collagen in fibroblasts, in vitro. Taken together, our findings demonstrate a protective role for endogenous VASH?1 on tubulointerstitial alterations via its regulation of inflammation and fibrosis and also show the direct anti?fibrotic effects of VASH?1 on renal fibroblasts through its modulation of TGF??1 signaling. PMID:24973329

  18. Endovascular treatment of thoracic aortic fistulas.

    PubMed

    Léobon, Bertrand; Roux, Daniel; Mugniot, Antoine; Rousseau, Hervé; Cérene, Alain; Glock, Yves; Fournial, Gérard

    2002-07-01

    Aortoesophageal and aortobronchial fistulas constitute a problem in therapy because of the high rates of morbidity and mortality associated with operation. From May 1996 to March 2000, we treated by an endovascular procedure one aortoesophageal and three aortobronchial fistulas. There was no postoperative death. We noted one peripheral vascular complication that required a surgical procedure, one postoperative confusion, and one inflammatory syndrome. In one case, because of a persistent leakage after 21 months, we had to implant a second endovascular stent graft. A few weeks later the reopening of this patient's esophageal fistula led to his death by mediastinitis 25 months after the first procedure. The few cases published seem to bear out the interest, observed in our 4 patients, of an endovascular approach to treat complex lesions such as fistulas of the thoracic aorta especially in emergency or palliative cases. PMID:12118773

  19. Surgery for paediatric thoracic outlet syndrome.

    PubMed

    Teddy, P J; Johnson, R D; Cai, R R; Wallace, D

    2012-02-01

    The effectiveness of operative treatment of paediatric thoracic outlet syndrome (TOS) has been analysed, and an attempt made to improve the definition of the condition in terms of presentation, aetiology and diagnosis. A retrospective review of postoperative pain, functional capability and overall outcome was carried out on 13 patients (<18 years) treated by a single surgeon. In 20 operations, 17 were scalenotomies, and three were transaxillary rib resections (TARRs). Follow-up was 6-96 months post-operatively. Surgery alleviated many TOS symptoms, especially vascular compromise, although pain resolution was inconsistent and that of motor deficit poor. Mean functional improvement was good, and overall operative outcomes excellent. Therefore, surgery was successful for paediatric TOS in this series. Anatomical anomalies and sport participation may be related to early onset of TOS in many paediatric patients. PMID:22051028

  20. [Septic complications of penetrating thoracic injuries].

    PubMed

    Danielian, Sh N; Abakumov, M M; VoskresenskiÄ­, O V; Radchenko, Iu A; Chernen'kaia, T V

    2010-01-01

    224 cases of septic complications after penetrating thoracic injuries were analyzed. Pleura empyem was observed in 105 of 7572 patients (overall number of the injured), lung abscess - in 22 cases, pericarditis was diagnosed in 108 patients, costal and sternal osteomyelitis - in 26 and mediastinitis - in 21 patients. Overall frequency of septic complication was 2,96%. Main reasons of septic complications were: massive blood loss, initial contamination, thoracotomy through the initially infected wound, long -lasting and coagulated hemothorax and late diagnosis and hospitalization. Staphylococcus aureus was the most frequent microbe detected - 29,4%. Lethality rate was 9,8% (22 patients). Adequate drainage of the wound allowed rehabilitation of the majority of patients. Cases with costal osteomyelitis required major surgical dissection in 73,1%. PMID:21169927

  1. [Endovascular interventions of the descending thoracic aorta].

    PubMed

    Doss, Mirko; Wood, Jeffrey P; Balzer, Joern; Thalhammer, Alex; Martens, Sven; Wimmer-Greinecker, Gerhard; Vogl, Thomas; Moritz, Anton

    2006-08-01

    Endovascular interventions of the descending thoracic aorta have been established as an alternative to conventional open surgery. Initially, they were limited to elective patients with a high risk profile for open surgery, but soon their use was extended to emergencies as well. In the elective setting, endovascular interventions significantly lowered short-term morbidity and mortality. These excellent perioperative results were reproducible in the emergency setting, thereby leading to superior outcomes for patients treated by endovascular stent grafts when compared to the conventional open surgical approach. However, some questions regarding long-term durability of these devices remain unanswered. Stent-graft failures at mid and long-term follow-up have been reported in the literature. The progressive nature of stent graft-related mid- and long-term complications stresses the need for continued surveillance of these patients. PMID:16944062

  2. Thoracic Bone Tumors Every Radiologist Should Know.

    PubMed

    Jokerst, Clint; McFarland, William; Swanson, Jonathan; Mohammed, Tan-Lucien H

    2016-01-01

    The thoracic cage provides the structural support that makes respiration possible, provides protection to vital organs such as the lungs, heart, liver, and spleen, and serves as an anchor point for the upper extremities. Neoplasms of the bony thorax are not an uncommon incidental finding at both radiography and cross-sectional imaging. Some tumors have a characteristic appearance and it is important that an accurate differential diagnosis be provided. Misidentification could lead to unnecessary imaging or procedures with associated cost, morbidity, and mortality. The purpose of this article is to serve as a quick review of bone tumors commonly encountered in the thorax and that every radiologist should know. Please note that there are also several non-neoplastic osseous lesions that may mimic bone tumors such as osteomyelitis and eosinophilic granuloma; however, these entities are beyond the scope of this review and would not be discussed. PMID:26254813

  3. Thoracic spine compression fracture after TASER activation.

    PubMed

    Sloane, Christian M; Chan, Theodore C; Vilke, Gary M

    2008-04-01

    The TASER is a less lethal weapon seeing increased use by police jurisdictions across the country. As a result, subjects of TASER use are being seen with increasing frequency in emergency departments across the country. The potential injury patterns of the device are important for emergency physicians to understand. This report describes the case of an officer who complained of back pain after a single 5-s TASER discharge during a routine training exercise. Subsequent evaluation led to the diagnosis of an acute thoracic vertebral compression fracture. We discuss the potential mechanisms of injury in this case. Because we were unable to find any cases like this in our review of TASER-related injuries, we liken it to compression fractures that have been documented after seizures. We recommend that physicians consider obtaining back radiographs to rule out a vertebral compression fracture in any individual who has sustained a TASER discharge and has ongoing or persistent back pain. PMID:18191526

  4. [Fractures of the thoracic and lumbar spine].

    PubMed

    Gonschorek, O; Hauck, S; Weiß, T; Bühren, V

    2015-09-01

    Fractures of the thoracic and lumbar spine result from high velocity trauma, assuming bone density is normal. The main location of fractures is the thoracolumbar junction. Most injuries can be treated conservatively; however, patients transferred to hospitals and spine centers represent a preselection with more severe trauma and a higher incidence of operative treatment. There is a large variety of operative techniques that can be used, which can be principally differentiated by the approach: posterior or anterior. Dorsal approaches are differentiated by the instrumentation for spondylodesis as open or percutaneous techniques. Minimally invasive options are favored more and more. For osteoporotic bone, cement augmented solutions may be used. Correct reduction of mainly kyphotic malalignment is crucial for the long-term outcome. Biomechanically stable reconstruction of the anterior spinal column is important mainly for the thoracolumbar junction. PMID:26307631

  5. Respiratory Displacement of the Thoracic Aorta: Physiological Phenomenon With Potential Implications for Thoracic Endovascular Repair

    SciTech Connect

    Weber, Tim Frederik; Tetzlaff, Ralf; Rengier, Fabian; Geisbuesch, Philipp; Kopp-Schneider, Annette; Boeckler, Dittmar; Eichinger, Monika; Kauczor, Hans-Ulrich; Tengg-Kobligk, Hendrik von

    2009-07-15

    The purpose of this study was to assess the magnitude and direction of respiratory displacement of the ascending and descending thoracic aorta during breathing maneuvers. In 11 healthy nonsmokers, dynamic magnetic resonance imaging was performed in transverse orientation at the tracheal bifurcation during maximum expiration and inspiration as well as tidal breathing. The magnitude and direction of aortic displacement was determined relatively to resting respiratory position for the ascending (AA) and descending (DA) aorta. To estimate a respiratory threshold for occurrence of distinct respiratory aortic motion, the latter was related to the underlying change in anterior-posterior thorax diameter. Compound displacement between maximum expiration and inspiration was 24.3 {+-} 6.0 mm for the AA in the left anterior direction and 18.2 {+-} 5.5 mm for the DA in the right anterior direction. The mean respiratory thorax excursion during tidal breathing was 8.9 {+-} 2.8 mm. The respiratory threshold, i.e., the increase in thorax diameter necessary to result in respiratory aortic displacement, was estimated to be 15.7 mm. The data suggest that after a threshold of respiratory thorax excursion is exceeded, respiration is accompanied by significant displacement of the thoracic aorta. Although this threshold may not be reached during tidal breathing in the majority of individuals, segmental differences during forced respiration impact on aortic geometry, may result in additional extrinsic forces on the aortic wall, and may be of significance for aortic prostheses designed for thoracic endovascular aortic repair.

  6. Keep Your Kidneys Healthy: Catch Kidney Disease Early

    MedlinePLUS

    ... please review our exit disclaimer . Subscribe Keep Your Kidneys Healthy Catch Kidney Disease Early Your kidneys aren’t very big—each is about the ... other substances inside your body. Unfortunately, if your kidneys start to malfunction, you might not realize it ...

  7. National Kidney and Urologic Diseases Information Clearinghouse

    MedlinePLUS

    ... V iew personal stories .??? Alternate Language URL Español Kidney Disease A-Z Page Content Kidney disease topics ... lead to chronic kidney disease Anatomy of the Kidneys The Kidneys and How They Work Anemia and ...

  8. What Is Kidney Cancer (Renal Cell Carcinoma)?

    MedlinePLUS

    ... the key statistics about kidney cancer? What is kidney cancer? Kidney cancer is a cancer that starts ... and spread, see What Is Cancer? About the kidneys To understand more about kidney cancer, it helps ...

  9. A reappraisal of adult thoracic surface anatomy.

    PubMed

    Mirjalili, S Ali; Hale, Samuel J M; Buckenham, Tim; Wilson, Ben; Stringer, Mark D

    2012-10-01

    Accurate surface anatomy is essential for safe clinical practice. Numerous inconsistencies in clinically important surface markings exist between and within anatomical reference texts. The aim of this study was to investigate key thoracic surface anatomical landmarks in vivo using computed tomographic (CT) imaging. High-resolution thoracic CT scans from 153 supine adults (mean age 63, range 19-89 years; 53% female) taken at end tidal inspiration were analyzed by dual consensus reporting to determine the surface anatomy of the sternal angle, central veins, heart, lungs, and diaphragm. Patients with kyphosis/scoliosis, distorting space-occupying lesions, or visceromegaly were excluded. The position of the cardiac apex, formation of the brachiocephalic veins, and vertebral levels of the sternal angle, xiphisternal joint, and aortic hiatus were consistent with commonly accepted surface markings although there was a wide range of normal variation. In contrast, common surface markings were markedly inaccurate for the following: the position of the tracheal bifurcation, aortic arch, and azygos vein termination (below the plane of the sternal angle at T5-T6 vertebral level in most individuals); the superior vena cava/right atrial junction (most often behind the fourth costal cartilage); the lower border of the lung (adjacent to T12 vertebra posteriorly); and the level at which the inferior vena cava and esophagus traverse the diaphragm (T11 in most). Surface anatomy must be reappraised using modern imaging in vivo if it is to be evidence based and fit for purpose. The effects of gender, age, posture, respiration, build, and ethnicity also deserve greater emphasis. PMID:22576938

  10. Breast size, thoracic kyphosis & thoracic spine pain - association & relevance of bra fitting in post-menopausal women: a correlational study

    PubMed Central

    2013-01-01

    Background Menopause would seem to exist as a period of accelerated changes for women and their upper torso mechanics. Whether these anthropometric changes reflect changes in pain states remains unclear. Plausible mechanisms of pain exist for the independent and combined effect of increasing breast size and thoracic kyphosis. Bra fit has the potential to change when the anthropometric measures (chest circumference and bust circumference) used to determine bra size change, such as postmenopausally. Identifying an association between breast size, thoracic kyphosis and thoracic spine pain in postmenopausal women and identifying the relevance of bra fit to this association may be of importance to the future management and education of post-menopausal women presenting clinically with thoracic spine pain. Methods A cross-sectional study design. Fifty-one postmenopausal bra-wearing women were recruited. Measures included breast size (Triumph International), thoracic kyphosis (flexible curve), bra fitted (Y/N) and pain (Short Form McGill Pain Questionnaire) and tenderness on palpation (posteroanterior pressure testing). These measures were collected in one session at a physiotherapy clinic. Results The majority of the women in this study were overweight or obese and wearing an incorrect sized bra. Pain was significantly related to breast size, body weight and BMI at mid thoracic levels (T7-8). In contrast self-reported thoracic pain was not correlated with age or index of kyphosis (thoracic kyphosis). Women with thoracic pain were no more likely to have their bra professionally fitted whereas women with a higher BMI and larger breasts were more likely to have their bra professionally fitted. Conclusion The findings of this study show that larger breasts and increased BMI are associated with thoracic pain in postmenopausal women. This is unrelated to thoracic kyphosis. Increasing breast size and how a bra is worn may have biomechanical implications for the loaded thoracic spine and surrounding musculature. Post-menopause women present with a spectrum of anthropometrical changes that have the potential to contribute to altered biomechanics and affect pain states in the thoracic spine. PMID:23816160

  11. Complications associated with thoracic pedicle screws in spinal deformity

    PubMed Central

    Li, Gang; Lv, Guohua; Passias, Peter; Kozanek, Michal; Metkar, Umesh S.; Liu, Zhongjun; Wood, Kirkham B.; Rehak, Lubos

    2010-01-01

    Thoracic pedicle screws have superior anchoring strength compared with other available fixation techniques. However, these are not universally accepted in many developing countries because of the concerns regarding safety and complications. In addition, there is evidence that pedicle morphology is unique in Chinese patients. The goal of this study was to analyze the complications seen at our institution, while using thoracic pedicle screws for the treatment of thoracic deformity, and to determine the safety of our techniques for the treatment of thoracic deformity in a Chinese population. From 1998 to 2005, there were 208 thoracic deformity patients treated at our institution, 70 of whom were male and 138 were female. Their age ranged from 11 to 55 years (mean of 14.9 years). All of them underwent corrective deformity surgery using posterior pedicle screw systems and follow-up was available for at least 3 years. Etiologic diagnoses included adolescent idiopathic scoliosis in 119 patients, congenital kyphoscoliosis in 38, adult scoliosis in 37 and undetermined in 14. Screw positions were evaluated using intraoperative and postoperative radiographs and a CT scan was performed when a concern for screw malposition was present. All radiographic evaluations were carried out in a double-blinded fashion. A total of 1,123 thoracic pedicle screws were inserted (5.4 thoracic screws/patient). The deformity correction rate was 81, 65 and 62% for idiopathic, congenital and adult scoliosis patients, respectively. The overall complication rate was 16.5% at the final follow-up. Complication rates directly and indirectly related to pedicle screws were 7.2 and 9.3%, respectively. There were no significant screw-related neurologic or visceral complications that adversely affected long-term results. The complications seen with thoracic pedicle screws in a Chinese population were similar to other populations and could be utilized safely for the treatment of thoracic deformity in this population. PMID:20237943

  12. Clinical and surgical management of unilateral prepubertal gynecomastia

    PubMed Central

    Ferraro, Giuseppe Andrea; De Francesco, Francesco; Romano, Tiziana; Grandone, Anna; D’Andrea, Francesco; Miraglia Del Giudice, Emanuele; Perrone, Laura; Nicoletti, Gianfranco

    2014-01-01

    INTRODUCTION Gynecomastia is the benign proliferation of the glandular tissue in the male breast. This condition is thought to be caused by the imbalance between estrogen action relative to androgen action at the breast tissue level. Bilateral gynecomastia is frequently found in the neonatal period, early in puberty, and with increasing age. Prepubertal unilateral gynecomastia in the absence of endocrine abnormalities is extremely rare, with only a few cases in literature. PRESENTATION OF CASE We present an otherwise healthy boy of 12 years old with unilateral breast masses. No abnormalities were found on ultrasonography and on all endocrine parameters. Treatment consisted in a new “modified” Webster technique. DISCUSSION The results confirmed validity of this technique in terms of esthetic and functional results, and patient satisfaction. Atypical presentations of gynecomastia are often not recognized. The main pathophysiology of gynecomastia is alteration in the balance between the stimulatory effect of estrogen and the inhibitory effects of androgens on the development of the breast. If there is no causal treatment, surgical resection is the therapy of first choice. CONCLUSION The exact mechanism of unilateral gynecomastia formation in our case is unclear. The evaluation of unilateral gynecomastia can therefore be complex. In conclusion, the surgical treatment of unilateral gynecomastia requires an individual approach, based on an appropriate diagnostic algorithm. PMID:25437663

  13. Determinants of diaphragm motion in unilateral diaphragmatic paralysis.

    PubMed

    Scillia, Pierre; Cappello, Matteo; De Troyer, André

    2004-01-01

    Cranial displacement of a hemidiaphragm during sniffs is a cardinal sign of unilateral diaphragmatic paralysis in clinical practice. However, we have recently observed that isolated stimulation of one phrenic nerve in dogs causes the contralateral (inactive) hemidiaphragm to move caudally. In the present study, therefore, we tested the idea that, in unilateral diaphragmatic paralysis, the pattern of inspiratory muscle contraction plays a major role in determining the motion of the inactive hemidiaphragm. We induced a hemidiaphragmatic paralysis in six anesthetized dogs and assessed the contour of the diaphragm during isolated unilateral phrenic nerve stimulation and during spontaneous inspiratory efforts. Whereas the inactive hemidiaphragm moved caudally in the first instance, it moved cranially in the second. The parasternal intercostal muscles were then severed to reduce the contribution of the rib cage muscles to inspiratory efforts and to enhance the force generated by the intact hemidiaphragm. Although the change in pleural pressure (DeltaPpl) was unaltered, the cranial displacement of the paralyzed hemidiaphragm was consistently reduced. A pneumothorax was finally induced to eliminate DeltaPpl during unilateral phrenic nerve stimulation, and this enhanced the caudal displacement of the inactive hemidiaphragm. These observations indicate that, in unilateral diaphragmatic paralysis, the motion of the inactive hemidiaphragm is largely determined by the balance between the force related to DeltaPpl and the force generated by the intact hemidiaphragm. PMID:12949010

  14. Right main bronchial fracture resolution by digital thoracic drainage system.

    PubMed

    Cortés Julián, Gildardo; Mier, José M; Iñiguez, Marco A; Guzmán de Alba, Enrique

    2016-03-01

    Tracheobronchial stenosis is common in the thoracic surgery service, and iatrogenic injury of the airway after manipulation is not infrequent. When a digital thoracic drainage system came onto the market, many advantages were evident. A 24-year-old woman with critical right main bronchial stenosis underwent airway dilation that was complicated by a tear with a massive air leak, resulting in a total right pneumothorax. We employed a pleural drain connected to a digital thoracic drainage system. The drain was removed 2 days after successful resolution of the air leak. PMID:26660882

  15. Chronic Thoracic Aortic Aneurysm Presenting 29 Years following Trauma

    PubMed Central

    Miller, Sarah; Kumar, Prashant; Van den Bosch, Rene; Khanafer, Adib

    2015-01-01

    Blunt, nonpenetrating injuries of the thoracic aorta are uncommon and associated with a high mortality rate within the first hour. Aortic injury is missed in 1-2% of patients that survive to hospital, and a chronic thoracic aortic aneurysm may subsequently form. We present a case in which a chronic thoracic aortic aneurysm was diagnosed 29 years following a significant motor vehicle accident. We discuss the epidemiology, presentation, and management of this uncommon consequence of blunt, nonpenetrating aortic injury. Our case illustrates an important clinical lesson; a past medical history of trauma should not be overlooked at any patient assessment. PMID:26351610

  16. Implementing effective and sustainable multidisciplinary clinical thoracic oncology programs

    PubMed Central

    Freeman, Richard K.; Krasna, Mark J.

    2015-01-01

    Three models of care are described, including two models of multidisciplinary care for thoracic malignancies. The pros and cons of each model are discussed, the evidence supporting each is reviewed, and the need for more (and better) research into care delivery models is highlighted. Key stakeholders in thoracic oncology care delivery outcomes are identified, and the need to consider stakeholder perspectives in designing, validating and implementing multidisciplinary programs as a vehicle for quality improvement in thoracic oncology is emphasized. The importance of reconciling stakeholder perspectives, and identify meaningful stakeholder-relevant benchmarks is also emphasized. Metrics for measuring program implementation and overall success are proposed. PMID:26380186

  17. Implementing effective and sustainable multidisciplinary clinical thoracic oncology programs.

    PubMed

    Osarogiagbon, Raymond U; Freeman, Richard K; Krasna, Mark J

    2015-08-01

    Three models of care are described, including two models of multidisciplinary care for thoracic malignancies. The pros and cons of each model are discussed, the evidence supporting each is reviewed, and the need for more (and better) research into care delivery models is highlighted. Key stakeholders in thoracic oncology care delivery outcomes are identified, and the need to consider stakeholder perspectives in designing, validating and implementing multidisciplinary programs as a vehicle for quality improvement in thoracic oncology is emphasized. The importance of reconciling stakeholder perspectives, and identify meaningful stakeholder-relevant benchmarks is also emphasized. Metrics for measuring program implementation and overall success are proposed. PMID:26380186

  18. CT evaluation of thoracic infections after major trauma

    SciTech Connect

    Mirvis, S.E.; Rodriguez, A.; Whitley, N.O.; Tarr, R.J.

    1985-06-01

    Thirty-seven septic patients with major multisystem trauma were evaluated by computed tomography (CT) to identify possible thoracic sources of infection. CT was 72% accurate in the diagnosis of empyema and 95% accurate in the diagnosis of lung abscess. While CT proved useful in demonstrating these sites of thoracic infections in septic trauma victims, the presence of concurrent thoracic pathology, particularly loculated hemothorax or hemopneumothorax and traumatic lung cysts with hemorrhage or surrounding parenchymal consolidation, introduced sources of diagnostic error. CT also proved helpful in guiding appropriate revisions of malpositioned and occluded thoracostomy tubes.

  19. Chimeric Anterolateral Thigh Flap for Total Thoracic Esophageal Reconstruction.

    PubMed

    Ruiz-Moya, Alejandro; Segura-Sampedro, Juan J; Sicilia-Castro, Domingo; Carvajo-Pérez, Francisco; Gómez-Cía, Tomás; Vázquez-Medina, Antonio; Ibáñez-Delgado, Francisco

    2016-01-01

    Gastric pull-up is generally the first choice for a total thoracic esophageal reconstruction. Malfunction of this gastric conduit is uncommon, but devastating when it occurs: it causes marked comorbidity to the patient, preventing oral intake and worsening quality of life. Secondary salvage thoracic esophageal reconstruction surgery is usually performed with free or pedicled jejunum flaps or colon interposition. We present a case of a total thoracic esophageal reconstruction with an externally monitored chimeric anterolateral thigh flap, extending from the cervical esophagus to the retrosternal gastroplasty remnant. Intestinal reconstructive techniques were not an available option for this patient. PMID:26694271

  20. Zinc-?2-Glycoprotein Exerts Antifibrotic Effects in Kidney and Heart.

    PubMed

    Sörensen-Zender, Inga; Bhayana, Sagar; Susnik, Nathan; Rolli, Veronique; Batkai, Sandor; Baisantry, Arpita; Bahram, Siamak; Sen, Payel; Teng, Beina; Lindner, Robert; Schiffer, Mario; Thum, Thomas; Melk, Anette; Haller, Hermann; Schmitt, Roland

    2015-11-01

    Zinc-?2-glycoprotein (AZGP1) is a secreted protein synthesized by epithelial cells and adipocytes that has roles in lipid metabolism, cell cycling, and cancer progression. Our previous findings in AKI indicated a new role for AZGP1 in the regulation of fibrosis, which is a unifying feature of CKD. Using two models of chronic kidney injury, we now show that mice with genetic AZGP1 deletion develop significantly more kidney fibrosis. This destructive phenotype was rescued by injection of recombinant AZGP1. Exposure of AZGP1-deficient mice to cardiac stress by thoracic aortic constriction revealed that antifibrotic effects were not restricted to the kidney but were cardioprotective. In vitro, recombinant AZGP1 inhibited kidney epithelial dedifferentiation and antagonized fibroblast activation by negatively regulating TGF-? signaling. Patient sera with high levels of AZGP1 similarly attenuated TGF-? signaling in fibroblasts. Taken together, these findings indicate a novel role for AZGP1 as a negative regulator of fibrosis progression, suggesting that recombinant AZGP1 may have translational effect for treating fibrotic disease. PMID:25788525

  1. Translational Profiles of Medullary Myofibroblasts during Kidney Fibrosis

    PubMed Central

    Grgic, Ivica; Krautzberger, A. Michaela; Hofmeister, Andreas; Lalli, Matthew; DiRocco, Derek P.; Fleig, Susanne V.; Liu, Jing; Duffield, Jeremy S.; McMahon, Andrew P.; Aronow, Bruce

    2014-01-01

    Myofibroblasts secrete matrix during chronic injury, and their ablation ameliorates fibrosis. Development of new biomarkers and therapies for CKD will be aided by a detailed analysis of myofibroblast gene expression during the early stages of fibrosis. However, dissociating myofibroblasts from fibrotic kidney is challenging. We therefore adapted translational ribosome affinity purification (TRAP) to isolate and profile mRNA from myofibroblasts and their precursors during kidney fibrosis. We generated and characterized a transgenic mouse expressing an enhanced green fluorescent protein (eGFP)–tagged L10a ribosomal subunit protein under control of the collagen1α1 promoter. We developed a one-step procedure for isolation of polysomal RNA from collagen1α1-eGFPL10a mice subject to unilateral ureteral obstruction and analyzed and validated the resulting transcriptional profiles. Pathway analysis revealed strong gene signatures for cell proliferation, migration, and shape change. Numerous novel genes and candidate biomarkers were upregulated during fibrosis, specifically in myofibroblasts, and we validated these results by quantitative PCR, in situ, and Western blot analysis. This study provides a comprehensive analysis of early myofibroblast gene expression during kidney fibrosis and introduces a new technique for cell-specific polysomal mRNA isolation in kidney injury models that is suited for RNA-sequencing technologies. PMID:24652793

  2. HIV and Kidney Disease

    MedlinePLUS

    ... remove the waste in urine. The most important waste products are excess sodium and water. . Each kidney contains about a million filtering units called nephrons. They: eliminate wastes from the body, regulate the volume and pressure ...

  3. Organ Facts: Kidney / Pancreas

    MedlinePLUS

    ... the kidneys is to remove waste from the body through the production of urine. They also help to regulate blood pressure, blood volume and the chemical (electrolyte) composition of the blood. The pancreas is a five ...

  4. Living with Kidney Cancer

    MedlinePLUS

    ... Trials Find A Clinical Trial (EmergingMed) A Patient’s Perspective Live Living With Kidney Cancer Cancer Nutrition Information ( ... Second, many insurance companies have formal claims appeal processes. You can appeal your claim and have it ...

  5. Kidney Disease of Diabetes

    MedlinePLUS

    ... is the most common cause of kidney failure, accounting for nearly 44 percent of new cases. 1 ... health care provider regarding insulin injections, medicines, meal planning, physical activity, and blood glucose monitoring. have their ...

  6. Diabetes and Kidney Disease

    MedlinePLUS

    ... NKF Newsroom Contact Us You are here Home » Diabetes - A Major Risk Factor for Kidney Disease Diabetes ... of your body. Are there different types of diabetes? The most common ones are Type 1 and ...

  7. Kidney Disease and Diabetes

    MedlinePLUS

    ... Blood Pressure Tools & Resources Stroke More Kidney Disease & Diabetes Updated:Jan 26,2016 One of the more ... thereafter.) This content was last reviewed January 2016. Diabetes • Home • About Diabetes • Why Diabetes Matters Introduction Cardiovascular ...

  8. Sulfadiazine for kidney disease

    USGS Publications Warehouse

    Rucker, R.R.; Bernier, A.F.; Whipple, W.J.; Burrows, R.E.

    1951-01-01

    The blueback salmon fingerlings (Oncorhynchus nerka) at the U.S. Fish-Cultural Station at Winthrop, Washington, underwent an infection that was caused by a very short, Gram-positive, nonmotile, rod-shaped bacterium. A further description is impossible at this time, as the organism has not been grown satisfactorily for proper identification. The disease was characterized by white, raised areas of dead tissue mainly in the kidney: for this reason it is referred to as kidney disease. Belding and Merrill (1935) described a disease among the brook, brown, and rainbow trout at a State hatchery in Massachusetts which, from the description, might be the same as kidney disease. J.H. Wales of the California Division of Fish and Game described (unpublished manuscript, 1941) a disease in hatchery trout in California which seems to be identical to kidney disease.

  9. Kidney Stones (For Parents)

    MedlinePLUS

    ... can develop in the urinary tract . Also called calculi or nephrolithiasis, kidney stones form when salts and ... form a stone. Struvite stones: Also called staghorn calculi because they look like a stag's antlers, these ...

  10. Medicines and Kidney Disease

    MedlinePLUS

    ... Dialysis or Transplant Paying for Kidney Failure Treatment Contact Us Health Information Center Phone: 1-800-860- ... to share this content freely. ​​September 17, 2014 Contact Us Health Information Center Phone: 1-800-860- ...

  11. Unusual drainage of the main kidney on accessory kidney

    PubMed Central

    Erdem, Gülnur; U?ra?, Murat; Demiröz, Sevgi

    2014-01-01

    Patients with an accessory kidney are characterized by an excessive number of kidneys. The ureter of the accessory kidney either drains separately into the bladder or merges with the ureter of the main kidney. In our case, interestingly, the ureter of the left main kidney drained directly into the accessory kidney and the ureter of the latter was the common drainage route for both. The drainage of a normal kidney via the ureter of an accessory kidney has not been reported in the literature, so far. The aim of this report is to present the case with radiological findings and to emphasize the effects of this situation on planned surgical procedures. A 62-year-old female patient had an interesting abnormality on the left collecting system, which was revealed on excretory urography (EU), retrograde urography (RU) and multidetector computed tomography (MDCT). A kinky left ureter, which formed a U shape, was revealed on EU. On MDCT, an accessory kidney was revealed at the anterior aspect of the middle zone of left main kidney. The ureter of the main left kidney drained directly into the accessory kidney. The course of this drainage was confirmed by retrograde urography. An accessory kidney is a rare entity associated with horseshoe kidney, ectopic ureter draining into the vagina, bifid collecting system and coarctation of the aorta. In our case, an unusual association between the ureters of the main and accessory kidneys was revealed, which may have an impact on planned surgery in the groin and retroperitoneal areas. PMID:26328163

  12. Kidney cell electrophoresis

    NASA Technical Reports Server (NTRS)

    Todd, P. W.

    1985-01-01

    Tasks were undertaken in support of two objectives. They are: (1) to carry out electrophoresis experiments on cells in microgravity; and (2) assess the feasibility of using purified kidney cells from embryonic kidney cultures as a source of important cell products. Investigations were carried out in the following areas: (1) ground based electrophoresis technology; (2) cell culture technology; (3) electrophoresis of cells; (4) urokinase assay research; (5) zero-g electrophoresis; and (6) flow cytometry.

  13. Prepubertal unilateral gynecomastia in the absence of endocrine abnormalities

    PubMed Central

    Kang, Min; Lee, Chan Jae; Hwang, Il Tae; Lee, Kwanseop

    2014-01-01

    Gynecomastia is defined as the excessive development of breast tissue in males, which can occur as unilateral or bilateral. Although the overall prevalence of gynecomastia is 40%-65%, the prepubertal unilateral gynecomastia in the absence of endocrine abnormalities is unusual, with only a few case reports in literature. Idiopathic gynecomastia in prepuberty is benign but a diagnosis of exclusion. We here report two cases of healthy prepubertal boys aged 8.8 and 9.6 years old, respectively, presented with painful palpable mass in their unilateral breast. Breast tissue with glandular proliferation was confirmed on ultrasonography. Serum levels of estradiol, testosterone, and other laboratory findings were within normal range. They seem to have the prepubertal idiopathic gynecomastia but further follow-up to see their progression is needed. PMID:25346921

  14. Unilateral versus bilateral clubfoot: an analysis of severity and correlation.

    PubMed

    Gray, Kelly; Barnes, Elizabeth; Gibbons, Paul; Little, David; Burns, Joshua

    2014-09-01

    This study compares the severity of unilateral and bilateral clubfoot, and the correlation between right and left feet of bilateral cases. Sixty-six unilateral and 75 bilateral clubfoot patients were assessed for severity using the Pirani score at an average age of 12.9 days (SD 9 days). In bilateral cases, the severity of right and left feet was highly correlated (r=0.68). The odds of being very severe were 2.6 (95% confidence interval 1.3-5.1) times higher in bilateral cases (P=0.007). Bilateral and unilateral clubfeet present with differing severity. Right and left feet from bilateral cases are highly correlated. Researchers need to address these issues during study design and analysis. PMID:24869905

  15. [Unilateral and bilateral shock therapy: mechanism of action (author's transl)].

    PubMed

    Ottosson, J O

    1979-01-01

    The unilateral and bilateral therapy differ in psycho-organic effects but have the same antidepressive efficiency. This is due to the facts that the organic effects are mainly caused by the electrical current whereas the antidepressive effect is dependent on the seizure activity. Compared to the bilateral treatment, unilateral gives reduced confusion, anterograde and retrograde amnesia as well as reduced experience of memory impairment. The difference is explained by a lower density of current in the brain. The unilateral treatment should be the treatment to be chosen. The antidepressive action of ECT fits the amine hypothesis, ECT causes a sustained increase of the synthesis of norepinephrine and of the sensitivity of amine receptors and creates conditions for alleviating both "low-output" and "low-sensitivity" depression. The antidepressive action is probably mediated by release of hypothalamic neurohormones. PMID:44867

  16. Minimally invasive unilateral arytenoid lateralization in dogs: A cadaveric study.

    PubMed

    Shipov, A; Israeli, I; Weiser, M; Kelmer, E; Klainbart, S; Milgram, J

    2015-10-01

    The aim of this study was to develop a minimally invasive thyroarytenoid lateralization technique (MITAL). Eleven unilateral MITAL procedures were performed on 11 canine cadavers. Two hypodermic needles were passed through the skin into the lumen of the larynx, penetrating the thyroid and arytenoid cartilages. Suture material was passed through the needles to lateralize the arytenoid cartilage. A rigid endoscope was used to visualize needle insertion and suture material placement. A key-hole approach to the larynx was performed and the suture material was knotted on the lateral aspect of the thyroid cartilage. The change in the rima glottidis area was recorded as were the duration of the procedure and complications encountered. The landmarks for needle insertion were easily palpated, and a significant increase in the area of the rima glottidis was documented after performing unilateral MITAL. In conclusion, unilateral MITAL is a quick, minimally invasive procedure which increases the area of the rima glottidis in cadaveric dogs. PMID:26412529

  17. Signaling during Kidney Development

    PubMed Central

    Krause, Mirja; Rak-Raszewska, Aleksandra; Pietilä, Ilkka; Quaggin, Susan E.; Vainio, Seppo

    2015-01-01

    The kidney plays an essential role during excretion of metabolic waste products, maintenance of key homeostasis components such as ion concentrations and hormone levels. It influences the blood pressure, composition and volume. The kidney tubule system is composed of two distinct cell populations: the nephrons forming the filtering units and the collecting duct system derived from the ureteric bud. Nephrons are composed of glomeruli that filter the blood to the Bowman’s capsule and tubular structures that reabsorb and concentrate primary urine. The collecting duct is a Wolffian duct-derived epithelial tube that concentrates and collects urine and transfers it via the renal pelvis into the bladder. The mammalian kidney function depends on the coordinated development of specific cell types within a precise architectural framework. Due to the availability of modern analysis techniques, the kidney has become a model organ defining the paradigm to study organogenesis. As kidney diseases are a problem worldwide, the understanding of mammalian kidney cells is of crucial importance to develop diagnostic tools and novel therapies. This review focuses on how the pattern of renal development is generated, how the inductive signals are regulated and what are their effects on proliferation, differentiation and morphogenesis. PMID:25867084

  18. The relative contribution of urine extravasation to elevate plasma creatinine levels in acute unilateral ureteral obstruction

    PubMed Central

    Rosenzweig, Barak; Pinthus, Jehonathan H.; Kleinmann, Nir; Joffe, Erel; Erlich, Tomer; Fridman, Eddie; Winkler, Harry; Mor, Yoram; Ramon, Jacob; Dotan, Zohar A.

    2015-01-01

    Introduction: Rising levels of plasma creatinine in the setting of acute unilateral ureteral obstruction (AUUO) often reflects acute renal failure, mandating kidney drainage. We hypothesize that re-absorption of peri-renal urine extravasation (PUE), a common result of UUO, contributes significantly to the elevation in plasma creatinine, rendering the latter an inaccurate benchmark for renal function. We explored this hypothesis in a rat model of AUUO and PUE. Methods: In total, 20 rats were equally divided into 4 groups. Groups 1 and 2 underwent unilateral ligation of the ureter with infiltration of rat’s urine (index group) or saline (control) into the peri-renal space. Two additional control groups underwent peri-renal injection of either urine or saline without AUUO. Plasma creatinine levels were determined immediately prior to the procedure (T0), and hourly for 3 hours (T1, T2 and T3). Renal histology was investigated after 3 hours. Results: Rats in the index group had a significantly greater increase in plasma creatinine levels over 3 hours compared to all other groups (p < 0.05). At T3, average plasma creatinine levels for the index group increased by 96% (0.49 ± 0.18 mg/dL) compared to 46% (0.23 ± 0.06 mg/dL increase) in the AUUO and saline group, and less than 15% rise in both the non-obstructed control groups. Our study limitations includes lack of spontaneous PUE and intraperitoneal surgical approach. Conclusions: Absorption of peri-renal urine in the presence of AUUO is a significant contributor to rising plasma creatinine levels, beyond those attributable to the obstruction alone, and may overestimate the extent of the true renal functional impairment. PMID:26279711

  19. Unilateral Breast Reconstruction Using Bilateral Inferior Gluteal Artery Perforator Flaps

    PubMed Central

    Muto, Mayu; Ogawa, Marina; Shibuya, Mai; Yasumura, Kazunori; Kobayashi, Shinji; Ishikawa, Takashi; Maegawa, Jiro

    2015-01-01

    Background: For reconstructing moderate-to-high projection breasts in nulliparous patients with insufficient abdominal tissue or prior abdominal surgeries, a unilateral inferior gluteal artery perforator (IGAP) flap is an alternative procedure. In patients with slim hips, however, unilateral gluteal tissue is insufficient and inferior gluteal crease displacement may develop postoperatively. Donor-site asymmetry is also a major disadvantage. In these circumstances, bilateral IGAP flaps provide sufficient tissue without significant gluteal deformity. Methods: We retrospectively reviewed 20 patients who underwent unilateral breast reconstruction using bilateral IGAP flaps by a single surgeon between November 2007 and December 2012. A quantitative outcome assessment was performed and compared with that of 22 unilateral IGAP flap patients operated on by the same surgeon. Results: Twenty patients underwent reconstruction with 40 IGAP flaps. Of the 40 flaps, 39 survived and 1 developed total necrosis due to repeated venous thrombosis. In 15 of 20 patients, the size of reconstructed breast was comparable to that of the contralateral breast. Final inset flap weight was 462.3 g for bilateral flaps and 244.3 g for unilateral flaps. Total operating time was 671.1 minutes (bilateral flaps) and 486.8 minutes (unilateral flaps). Conclusions: Use of bilateral IGAP flaps for breast reconstruction helps to avoid asymmetry of the inferior buttock volume and shape. Bilateral flaps provide sufficient tissue volume and allow for reconstruction of a breast comparable to the unaffected side. In patients with moderate-to-high projection breast whose abdominal tissue cannot be used for reconstruction, IGAP flaps may be a suitable alternative. PMID:25878925

  20. Unilateral Augmented Pedicle Screw Fixation for Foraminal Stenosis

    PubMed Central

    Kim, Jeong-Gyun; Jin, Yong-Jun; Kim, Ki-Jeong; Kim, Hyun-Jib

    2009-01-01

    Objective The purpose of this study is to evaluate the effectiveness of unilateral decompression and pedicle screw fixation for the unilateral symptomatic foraminal stenosis. Methods The study group comprises consecutive 16 patients who underwent unilateral decompression and bone cement augmented pedicle screw fixation from May 2003 to January 2006. The patients were evaluated by visual analog scale (VAS) for pain and the scoring system of the Japanese Orthopedic Association (JOA) for low back pain. The result of surgery was also evaluated with McNab's classification. Excellent or good outcome was considered as successful. The patients were followed at postoperative 1 month, 3 month, 6 month, and 1 year with standing AP and lateral films. Results The average VAS and JOA score of the 16 patients were 7.8 (range, 6-9) and 5.8 (range, 3 - 10) before surgery and 2.2 (range, 0 - 5) and 12.3 (range, 9 - 15) at the time of last follow up. Both VAS and JOA score improved significantly after the surgery (p < 0.05, t-test). All patients improved after the operation and no revision surgery was required. No metal failure or pseudoarthrosis was observed during the follow-up. The success rate was 87.5%. Conclusion Our data suggest that unilateral decompression and pedicle screw fixation for the unilateral symptomatic foraminal stenosis is an effect method for obtaining satisfactory clinical outcome. Its possible advantage is shorter operation time and reduced surgical extent. We believe that the reduced stiffness of unilateral fixation was compensated by pedicle screw augmentation and interbody fusion. PMID:19707487

  1. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation

    PubMed Central

    Demartini Jr., Zeferino; Liebert, Fernando; Gatto, Luana Antunes Maranha; Jung, Thiago Simiano; Rocha Jr., Carlos; Santos, Alex Marques Borges; Koppe, Gelson Luis

    2015-01-01

    Unilateral carotid cavernous fistula presents with ipsilateral ocular findings. Bilateral presentation is only seen in bilateral fistulas, usually associated with indirect (dural) carotid cavernous fistulas. Direct carotid cavernous fistulas are an abnormal communication between the internal carotid artery and the cavernous sinus. They typically begin with a traumatic disruption in the artery wall into the cavernous sinus, presenting with a classic triad of unilateral pulsatile exophthalmos, cranial bruit and episcleral venous engorgement. We report the case of a 38-year-old male with traumatic right carotid cavernous sinus fistula and bilateral ocular presentation successfully treated by interventional neuroradiology.

  2. Cold shivering activity after unilateral destruction of the vestibular apparatus

    NASA Technical Reports Server (NTRS)

    Kuzmina, G. I.

    1980-01-01

    The bioelectric activity of muscles (flexors and extensors of the forelimbs and hindlimbs) during cold shivering after unilateral destruction of the vestibular apparatus. It was found, that unilateral delabyrinthing produces bilateral facilitation of cold shivering in the flexor extremities more pronounced on the ipsilateral side. In the extensor muscles there was an absence of bioelectric activity both before and after delabyrinthing. Enhancement of cold shivering in the flexor extremities following intervention was evidently conditioned by removal of the inhibiting effect of the vestibulary apparatus on the function of special centers.

  3. Unilateral Crystalline Vitreoretinopathy: A Rare Entity Associated with Intraocular Inflammation

    PubMed Central

    Harshey, Kaustubh B.; Srinivasan, Karthik; Rengappa, Ramakrishnan; Ramasamy, Kim

    2015-01-01

    A 31-year-old Indian male presented with floaters and diminution of vision in the right eye. Ocular examination showed features of old anterior uveitis with posterior subcapsular cataract and fine, refractile crystals in the vitreous cavity and on the retinal surface. A thorough workup for all known causes of crystalline retinopathy was inconclusive. Unilateral crystalline retinopathy has been sparingly reported. This is the first report of unilateral, crystalline vitreoretinopathy in the absence of any demonstrable and known cause for intraocular crystals. PMID:26688764

  4. Robotic thoracic surgery: from the perspectives of European chest surgeons

    PubMed Central

    2014-01-01

    Although thoracic surgery is one of the fastest growing programs, the results of robotic thoracic surgery reports are presented very rarely. In this manuscript, the development of robotic thoracic surgery programs in Europe and the initial results are discussed. Several European countries lead the development of robotic surgery in the world, especially for lung cancer surgery and for thymus—thymoma surgery. Yet, we may not recognize any major advantage in the outcome when compared to video-assisted thoracic surgery (VATS). But, certainly, the superior capabilities of the intraoperative instrumentation of robotic surgery will be beneficial. More experience in robotic surgery may provide superior results in oncological, physiological and life quality measurements. PMID:24868438

  5. Segmental thoracic lipomatosis of nerve with nerve territory overgrowth.

    PubMed

    Mahan, Mark A; Amrami, Kimberly K; Howe, B Matthew; Spinner, Robert J

    2014-05-01

    Lipomatosis of nerve (LN), or fibrolipomatous hamartoma, is a rare condition of fibrofatty enlargement of the peripheral nerves. It is associated with bony and soft tissue overgrowth in approximately one-third to two-thirds of cases. It most commonly affects the median nerve at the carpal tunnel or digital nerves in the hands and feet. The authors describe a patient with previously diagnosed hemihypertrophy of the trunk who had a history of large thoracic lipomas resected during infancy, a thoracic hump due to adipose proliferation within the thoracic paraspinal musculature, and scoliotic deformity. She had fatty infiltration in the thoracic spinal nerves on MRI, identical to findings pathognomonic of LN at better-known sites. Enlargement of the transverse processes at those levels and thickened ribs were also found. This case appears to be directly analogous to other instances of LN with overgrowth, except that this case involved axial nerves rather than the typical appendicular nerves. PMID:24506247

  6. Thoracic and respirable particle definitions for human health risk assessment

    EPA Science Inventory

    Provides estimates of the thoracic and respirable fractions, for adults and children during typical activities during both nasal and oral inhalation, that may be used in the design of experimental studies and interpretation of evidence of health effects.

  7. Minimally invasive thoracic surgery: new trends in Italy.

    PubMed

    Pompeo, Eugenio

    2015-10-01

    In Italy there exists quite a long and rich history in minimally invasive thoracic surgery. Pioneer Italian surgeons have been amongst those who first adopted video-assisted thoracic surgery (VATS) to perform procedures such as lobectomy and esophagectomy, respectively and quite many others have provided important contributions related to minimally invasive thoracic surgery and have proposed innovative ideas and creative technical refinements. According to a web search on recent studies published in Italy on minimally invasive thoracic surgery along the last 3 years, uniportal, nonintubated, and robotic VATS as well as VATS lobectomy have been found to represent the most frequently investigated issues. An ongoing active investigation in each of these sub-topics is contributing to a better definition of indications advantages and disadvantages of the various surgical strategies. In addition it is likely that combination strategies including adoption of uniportal and nonintubated approaches will lead to define novel ultra-minimally invasive treatment options. PMID:26605315

  8. Minimally invasive thoracic surgery: new trends in Italy

    PubMed Central

    2015-01-01

    In Italy there exists quite a long and rich history in minimally invasive thoracic surgery. Pioneer Italian surgeons have been amongst those who first adopted video-assisted thoracic surgery (VATS) to perform procedures such as lobectomy and esophagectomy, respectively and quite many others have provided important contributions related to minimally invasive thoracic surgery and have proposed innovative ideas and creative technical refinements. According to a web search on recent studies published in Italy on minimally invasive thoracic surgery along the last 3 years, uniportal, nonintubated, and robotic VATS as well as VATS lobectomy have been found to represent the most frequently investigated issues. An ongoing active investigation in each of these sub-topics is contributing to a better definition of indications advantages and disadvantages of the various surgical strategies. In addition it is likely that combination strategies including adoption of uniportal and nonintubated approaches will lead to define novel ultra-minimally invasive treatment options. PMID:26605315

  9. Ectopic intrapleural thymoma: a rare location in the thoracic cavity

    PubMed Central

    Lopez-Marco, Ana; Al-Zuhir, Naail; Kornaszewska, Malgorzata

    2016-01-01

    We present a patient with a large thymoma on the right thoracic cavity developing from the visceral pleura. This is a rare location for this tumour, and only a few had been reported to date in the literature. PMID:26738510

  10. Clinical pathway for thoracic surgery in the United States

    PubMed Central

    Wei, Benjamin

    2016-01-01

    The paradigm for postoperative care for thoracic surgical patients in the United States has shifted with efforts to reduce hospital length of stay and improve quality of life. The increasing usage of minimally invasive techniques in thoracic surgery has been an important part of this. In this review we will examine our standard practices as well as the evidence behind both general contemporary postoperative care principles and those specific to certain operations. PMID:26941967

  11. Fleischner Society: glossary of terms for thoracic imaging.

    PubMed

    Hansell, David M; Bankier, Alexander A; MacMahon, Heber; McLoud, Theresa C; Müller, Nestor L; Remy, Jacques

    2008-03-01

    Members of the Fleischner Society compiled a glossary of terms for thoracic imaging that replaces previous glossaries published in 1984 and 1996 for thoracic radiography and computed tomography (CT), respectively. The need to update the previous versions came from the recognition that new words have emerged, others have become obsolete, and the meaning of some terms has changed. Brief descriptions of some diseases are included, and pictorial examples (chest radiographs and CT scans) are provided for the majority of terms. PMID:18195376

  12. [The evolution of surgical and functional operability in thoracic oncology].

    PubMed

    Parshin, V D; Belov, Iu V; Komarov, R N; Bazarov, D V; Parshin, V V; Babaev, M A; Podaliak, D G

    2012-01-01

    The authors own the experience of 4157 operations on the reason of malignant lung tumors, of them 429 (10.3%) operations were combined. The extracorporeal membrane oxygenation is considered to be reasonable by extended thoracic resections. Surgical lung volume reduction by emphysema shows good functional results, which allows to use its principles in oncologic patients with low functional repiratory reserves. The overall multidisciplinary approach in thoracic oncology allows better treatment results and gives hope to the earlier inoperable patients. PMID:22968497

  13. An Ectopic Pelvic Kidney

    PubMed Central

    Bhoil, Rohit; Sood, Dinesh; Singh, Yash Paul; Nimkar, Kshama; Shukla, Anurag

    2015-01-01

    Summary Background If a kidney does not ascend as it should in normal fetal development, it remains in the pelvic area and is called a pelvic kidney. Often a person with a pelvic kidney will go through his/her whole life unaware of this condition, unless it is discovered during neonatal kidney ultrasound screening or if complications arise later in life due to this or a completely different reason and the condition is noted during investigations. Generally, this is not a harmful condition but it can lead to complications like in our case. With appropriate testing and treatment, if needed, an ectopic kidney should cause no serious long-term health complications and all that may be required for the patient is reassurance with advice to follow up at regular intervals. Case Report A 28-year-old male presented with recurrent pain in his lower left abdomen for one month and an episode of hematuria 3 days earlier accompanied by an attack of acute pain lasting for 3–4 hours. He gave a history of passing 2 small (about 5 mm each) calculi in his urine after the occurrence of hematuria, following which pain decreased in intensity. No history of fever was present. Conclusions Although a simple ectopic kidney seldom causes symptoms, the association of malrotation of the renal pelvis with calculus increases the risk of hematuria and/or hydronephrosis, presenting with colicky pain as in the present case. The clinician should be aware of these in such a case. If asymptomatic, no treatment is required. However, the patient should be advised to have follow-up ultrasounds at regular intervals to detect complications like calculus, hydronephrosis, etc. With appropriate testing and treatment, if required, an ectopic kidney should not cause serious long-term health complications. PMID:26413178

  14. Digital radiography of crush thoracic trauma in the Sichuan earthquake

    PubMed Central

    Dong, Zhi-Hui; Shao, Heng; Chen, Tian-Wu; Chu, Zhi-Gang; Deng, Wen; Tang, Si-Shi; Chen, Jing; Yang, Zhi-Gang

    2011-01-01

    AIM: To investigate the features of crush thoracic trauma in Sichuan earthquake victims using chest digital radiography (CDR). METHODS: We retrospectively reviewed 772 CDR of 417 females and 355 males who had suffered crush thoracic trauma in the Sichuan earthquake. Patient age ranged from 0.5 to 103 years. CDR was performed between May 12, 2008 and June 7, 2008. We looked for injury to the thoracic cage, pulmonary parenchyma and the pleura. RESULTS: Antero-posterior (AP) and lateral CDR were obtained in 349 patients, the remaining 423 patients underwent only AP CDR. Thoracic cage fractures, pulmonary contusion and pleural injuries were noted in 331 (42.9%; 95% CI: 39.4%-46.4%), 67 and 135 patients, respectively. Of the 256 patients with rib fractures, the mean number of fractured ribs per patient was 3. Rib fractures were mostly distributed from the 3rd through to the 8th ribs and the vast majority involved posterior and lateral locations along the rib. Rib fractures had a significant positive association with non-rib thoracic fractures, pulmonary contusion and pleural injuries (P < 0.001). The number of rib fractures and pulmonary contusions were significant factors associated with patient death. CONCLUSION: Earthquake-related crush thoracic trauma has the potential for multiple fractures. The high number of fractured ribs and pulmonary contusions were significant factors which needed appropriate medical treatment. PMID:22132298

  15. Donor to recipient sizing in thoracic organ transplantation.

    PubMed

    Eberlein, Michael; Reed, Robert M

    2016-03-24

    Donor-to-recipient organ size matching is a critical aspect of thoracic transplantation. In the United States potential recipients for lung transplant and heart transplant are listed with limitations on donor height and weight ranges, respectively. Height is used as a surrogate for lung size and weight is used as a surrogate for heart size. While these measures are important predictors of organ size, they are crude surrogates that fail to incorporate the influence of sex on organ size. Independent of other measures, a man's thoracic organs are approximately 20% larger than a woman's. Lung size can be better estimated using the predicted total lung capacity, which is derived from regression equations correcting for height, sex and age. Similarly, heart size can be better estimated using the predicted heart mass, which adjusts for sex, age, height, and weight. These refined organ sizing measures perform better than current sizing practice for the prediction of outcomes after transplantation, and largely explain the outcome differences observed after sex-mismatch transplantation. An undersized allograft is associated with worse outcomes. In this review we examine current data pertaining to size-matching in thoracic transplantation. We advocate for a change in the thoracic allocation mechanism from a height-or-weight-based strategy to a size-matching process that utilizes refined estimates of organ size. We believe that a size-matching approach based on refined estimates of organ size would optimize outcomes in thoracic transplantation without restricting or precluding patients from thoracic transplantation. PMID:27011913

  16. Normal and abnormal spine and thoracic cage development.

    PubMed

    Canavese, Federico; Dimeglio, Alain

    2013-01-01

    Development of the spine and thoracic cage consists of a complex series of events involving multiple metabolic processes, genes and signaling pathways. During growth, complex phenomena occur in rapid succession. This succession of events, this establishment of elements, is programmed according to a hierarchy. These events are well synchronized to maintain harmonious limb, spine and thoracic cage relationships, as growth in the various body segments does not occur simultaneously at the same magnitude or rate. In most severe cases of untreated progressive early-onset spinal deformities, respiratory insufficiency and pulmonary and cardiac hypertension (cor pulmonale), which characterize thoracic insufficiency syndrome (TIS), can develop, sometimes leading to death. TIS is the inability of the thorax to ensure normal breathing. This clinical condition can be linked to costo-vertebral malformations (e.g., fused ribs, hemivertebrae, congenital bars), neuromuscular diseases (e.g., expiratory congenital hypotonia), Jeune or Jarcho-Levin syndromes or to 50% to 75% fusion of the thoracic spine before seven years of age. Complex spinal deformities alter normal growth plate development, and vertebral bodies become progressively distorted, perpetuating the disorder. Therefore, many scoliotic deformities can become growth plate disorders over time. This review aims to provide a comprehensive review of how spinal deformities can affect normal spine and thoracic cage growth. Previous conceptualizations are integrated with more recent scientific data to provide a better understanding of both normal and abnormal spine and thoracic cage growth. PMID:24147251

  17. Thoracic renal artery: a rare case of the renal artery originating from the thoracic aorta and literature review.

    PubMed

    Ishida, Masanori; Namiki, Yoko; Watanabe, Makoto

    2016-03-01

    We report a very rare case of the right renal artery originating from the thoracic aorta. A 37-year-old man visited our hospital for follow-up regarding a gallbladder polyp that had been detected incidentally via ultrasonography as part of a clinical survey. Contrast-enhanced computed tomography revealed incidentally that the right renal artery originated from the thoracic aorta at the level of the 11th thoracic vertebra. No excess right renal artery was found arising from the abdominal aorta, and a normal left renal artery was observed. Although this anomaly is very rare, urological and thoracic surgeons should be aware of this condition, in order to provide appropriate surgical interventions. PMID:26173984

  18. [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

  19. Cytomegalovirus Immunoglobulin After Thoracic Transplantation: An Overview.

    PubMed

    Grossi, Paolo; Mohacsi, Paul; Szabolcs, Zoltán; Potena, Luciano

    2016-03-01

    Cytomegalovirus (CMV) is a highly complex pathogen which, despite modern prophylactic regimens, continues to affect a high proportion of thoracic organ transplant recipients. The symptomatic manifestations of CMV infection are compounded by adverse indirect effects induced by the multiple immunomodulatory actions of CMV. These include a higher risk of acute rejection, cardiac allograft vasculopathy after heart transplantation, and potentially bronchiolitis obliterans syndrome in lung transplant recipients, with a greater propensity for opportunistic secondary infections. Prophylaxis for CMV using antiviral agents (typically oral valganciclovir or intravenous ganciclovir) is now almost universal, at least in high-risk transplants (D+/R-). Even with extended prophylactic regimens, however, challenges remain. The CMV events can still occur despite antiviral prophylaxis, including late-onset infection or recurrent disease, and patients with ganciclovir-resistant CMV infection or who are intolerant to antiviral therapy require alternative strategies. The CMV immunoglobulin (CMVIG) and antiviral agents have complementary modes of action. High-titer CMVIG preparations provide passive CMV-specific immunity but also exert complex immunomodulatory properties which augment the antiviral effect of antiviral agents and offer the potential to suppress the indirect effects of CMV infection. This supplement discusses the available data concerning the immunological and clinical effects of CMVIG after heart or lung transplantation. PMID:26900989

  20. Molecular Mechanisms of Thoracic Aortic Dissection

    PubMed Central

    Wu, Darrell; Shen, Ying H.; Russell, Ludivine; Coselli, Joseph S.; LeMaire, Scott A.

    2013-01-01

    Thoracic aortic dissection (TAD) is a highly lethal vascular disease. In many patients with TAD, the aorta progressively dilates and ultimately ruptures. Dissection formation, progression, and rupture cannot be reliably prevented pharmacologically because the molecular mechanisms of aortic wall degeneration are poorly understood. The key histopathologic feature of TAD is medial degeneration, a process characterized by smooth muscle cell depletion and extracellular matrix degradation. These structural changes have a profound impact on the functional properties of the aortic wall and can result from excessive protease-mediated destruction of the extracellular matrix, altered signaling pathways, and altered gene expression. Review of the literature reveals differences in the processes that lead to ascending versus descending and sporadic versus hereditary TAD. These differences add to the complexity of this disease. Although tremendous progress has been made in diagnosing and treating TAD, a better understanding of the molecular, cellular, and genetic mechanisms that cause this disease is necessary to developing more effective preventative and therapeutic treatment strategies. PMID:23856125

  1. Endovascular Management of Thoracic Aortic Aneurysms

    SciTech Connect

    Fattori, Rossella Russo, Vincenzo; Lovato, Luigi; Buttazzi, Katia; Rinaldi, Giovanni

    2011-12-15

    The overall survival of patients with thoracic aortic aneurysm (TAA) has improved significantly in the past few years. Endovascular treatment, proposed as an alternative to surgery, has been considered a therapeutic innovation because of its low degree of invasiveness, which allows the treatment of even high-surgical risk patients with limited complications and mortality. A major limitation is the lack of adequate evidence regarding long-term benefit and durability because follow-up has been limited to just a few years even in the largest series. The combination of endovascular exclusion with visceral branch revascularization for the treatment of thoraco-abdominal aortic aneurysms involving the visceral aorta has also been attempted. As an alternative, endografts with branches represent a technological evolution that allows treatment of complex anatomy. Even if only small numbers of patients and short follow-up are available, this technical approach, which has with limited mortality (<10%) and paraplegia rates, to expand endovascular treatment to TAA seems feasible. With improved capability to recognize proper anatomy and select clinical candidates, the choice of endovascular stent-graft placement may offer a strategy to optimize management and improve prognosis.

  2. [Magnetic resonance imaging in thoracic diseases].

    PubMed

    Norès, J M; Monsegu, M H; Bergal, S; Ameille, J; Rémy, J M; Lacrosnière, L

    1994-10-01

    Most all the thoracic structures are visible with magnetic resonance imaging: the mediastin, the myocardium including the endocardium and the pericardium, the pulmonary parenchyma and hile and the pleural walls. In cases of mediastrinal masses, T1 images clearly delimit their relations with neighbouring organs and vessels. The intensity of the signal is compared with that of the muscles on T1 weighted images of the preceding sections and T2 weighted images of fat. Images of aneurysms and chronic dissections can be synchronized with the ECG allowing three-dimensional measurement of the size and thickness of the vessel walls. Thrombi or extension to other vessels can also be recognized. Small hilar tumours can be differentiated from vessels but the scanner is better for analyzing systematization and bronchial lesions. For lung tissue itself, magnetic resonance imaging can detect nodules greater than one centimeter in diameter, but the low proton density and respiratory movements hinder spatial resolution. MRI is indicated for localizing tumours situated anteriorly or posteriorly or at the apex and to identify parietal extension of peripheral cancers. Spinal, vascular, pericardial, diaphragmatic and lymph node metastases can be recognized. MRI is the noninvasive method of choice for evaluating left ventricular masse, intra and paracardiac mass studies and for investigating congenital and acquired cardiomyopathies. Technical advances have made it possible to evaluate myocardial perfusion and heart function. PMID:7984543

  3. Impaction of an intrathoracic kidney acted as a shield against herniation of the abdominal viscera in a case of right congenital diaphragmatic hernia

    PubMed Central

    Jeong, Ba-Da; Ahn, Seo Hee; Song, Ji-Won; Lee, Mi-Young; Won, Hye-Sung; Lee, Pil-Ryang; Kim, Ahm

    2016-01-01

    We describe a case of an intrathoracic kidney combined with right congenital diaphragmatic hernia (CDH) that was diagnosed at 32 weeks of gestation. Although it has been well established that a right CDH shows a poorer outcome than a left CDH, our present case showed a good outcome because there was no herniation of other abdominal viscera, except for the right kidney. Our findings in this case indicate that impaction of the intrathoracic kidney may act as a 'shield' against further herniation of other abdominal viscera into the thoracic cavity. PMID:26866038

  4. AB204. Research on adenosine signal in renal fibrosis originated from unilateral ureteral obstruction

    PubMed Central

    Xia, Bing; Dai, Yingbo

    2014-01-01

    Objective Ischemia and hypoxia are the important cause of chronic kidney disease. Adenosine is an important signaling molecule resulted from ischemia and hypoxia and may function as a main pathogenic factor to CKD. The present study detected the fluctuation of renal adenosine and its relative factor-induced fibrosis expression after the unilateral ureteral obstruction (UUO) procedure. To explore the role of adenosine pathway in renal fibrosis and mechanism of the pathogenesis of chronic kidney. Methods A total of 32 male SD rats were randomly enrolled into two groups: sham-operated group and UUO group. Each group was also randomly divided into 1, 2, 3,4 group in term of the week after surgery (n=4) and killed in the same time point, Prior to sacrifice blood, kidney samples taken after death. In obstructed kidney, histological changes and the deposition of renal interstitial collagen were observed by HE stain and Masson stain, adenosine was separated and using reverse-phase HPLC, blood creatinine level was measured using spectrophotometric kits in accordance with the manufacturer’s instructions, the mRNA of TGF-?1 and procollagen I were measured by real time PCR and its protein was examined by immunohistochemical method. The results of immunohistochemical were analyzed semi-quantitatively with the pathological image analysis system. Results (I) After the UUO procedure, Adenosine concentration in the UUO group was significantly higher compared to the Sham group (P<0.05), and reached a peak after the 1 week of the experiment (P<0.01), H&E and Masson staining exhibited renal damage, accompanied by increased (P<0.05) adenosine concentration, Nephron damage gradually increased, increasing the deposition of renal interstitial collagen; (II) we failed to observe a significantly increased creatinine in UUO groups during four time points (P>0.05). Immunohistochemical analysis showed that in the second week after UUO, its highest expression in renal tubular epithelial cells, and then over time, the expression decreased gradually, and with the extension of UUO time, TGF-?1 in renal tubular epithelial cells from the distribution transfer to renal interstitial, and then spread to the glomeruli; (III) the PCR data and immunohistochemical analysis showed that UUO procedure significantly increased (P<0.05) TGF-?1 and procollagen I expression during four weeks. Conclusions (I) Renal interstitial fibrosis continued presence of renal tissue hypoxia and lead to elevated adenosine levels within the organization; (II) the increased adenosine profile accelerated the renal tubular injury and the occurrence and development of interstitial fibrosis; (III) the adenosine signaling pathway can mediate the development of RIF by regulating the expression of the mRNA of TGF-?1, ?1 (I) procollagen.

  5. Inhibitory effects of fasudil on renal interstitial fibrosis induced by unilateral ureteral obstruction

    PubMed Central

    BABA, ITSUKO; EGI, YASUHIRO; UTSUMI, HIROYUKI; KAKIMOTO, TETSUHIRO; SUZUKI, KAZUO

    2015-01-01

    Renal fibrosis is the major cause of chronic kidney disease, and the Rho/Rho-associated coiled-coil kinase (ROCK) signaling cascade is involved in the renal fibrotic processes. Several studies have reported that ROCK inhibitors attenuate renal fibrosis. However, the mechanism of this process remains to be fully elucidated. The present study assessed the inhibitory effect of fasudil, a ROCK inhibitor using immunohistochemistry, reverse transcription-quantitative polymerase chain reaction and western blot analyses, in vivo and in vitro, to elucidate the mechanisms underlying renal interstitial fibrosis. In mice induced with unilateral ureteral obstruction (UUO), collagen accumulation, the expression of fibrosis-associated genes and the content of hydroxyproline in the kidney increased 3, 7, and 14 days following UUO. Fasudil attenuated the histological changes, and the production of collagen and extracellular matrix in the UUO kidney. The expression of α-smooth muscle actin (α-SMA) and the transforming growth factor-β (TGFβ)-Smad signaling pathway, and macrophage infiltration were suppressed by fasudil in the kidneys of the UUO mice. The present study also evaluated the role of intrinsic renal cells and infiltrated macrophages using NRK-52E, NRK-49F and RAW264.7 cells. The mRNA and protein expression levels of collagen I and α-SMA increased in the NRK-52E and NRK-49F cells stimulated by TGF-β1. Hydroxyfasudil, a bioactive metabolite of fasudil, attenuated the increase in the mRNA and protein expression levles of α-SMA in the two cell types. However, the reduction in the mRNA expression of collagen I was observed in the NRK-49F cells only. Hydroxyfasudil decreased the mRNA expression of monocyte chemoattractant protein-1 (MCP-1) induced by TGF-β1 in the NRK-52E cells, but not in the NRK-49F cells. In the RAW264.7 cells, the mRNA expression levels of MCP-1, interleukin (IL)-1β, IL-6 and tumor necrosis factor α were increased significantly following lipopolysaccharide stimulation, and were not suppressed by hydroxyfasudil. These data suggested that the inhibition of ROCK activity by fasudil suppressed the transformation of renal intrinsic cells into the myofibroblast cells, and attenuated the infiltration of macrophages, without inhibiting the expression or the activation of cytokine/chemokines, in the progression of renal interstitial fibrosis. PMID:26498136

  6. Necroinflammation in Kidney Disease.

    PubMed

    Mulay, Shrikant R; Linkermann, Andreas; Anders, Hans-Joachim

    2016-01-01

    The bidirectional causality between kidney injury and inflammation remains an area of unexpected discoveries. The last decade unraveled the molecular mechanisms of sterile inflammation, which established danger signaling via pattern recognition receptors as a new concept of kidney injury-related inflammation. In contrast, renal cell necrosis remained considered a passive process executed either by the complement-related membrane attack complex, exotoxins, or cytotoxic T cells. Accumulating data now suggest that renal cell necrosis is a genetically determined and regulated process involving specific outside-in signaling pathways. These findings support a unifying theory in which kidney injury and inflammation are reciprocally enhanced in an autoamplification loop, referred to here as necroinflammation. This integrated concept is of potential clinical importance because it offers numerous innovative molecular targets for limiting kidney injury by blocking cell death, inflammation, or both. Here, the contribution of necroinflammation to AKI is discussed in thrombotic microangiopathies, necrotizing and crescentic GN, acute tubular necrosis, and infective pyelonephritis or sepsis. Potential new avenues are further discussed for abrogating necroinflammation-related kidney injury, and questions and strategies are listed for further exploration in this evolving field. PMID:26334031

  7. Horseshoe kidney transplantation

    PubMed Central

    Kanyári, Zsolt; Zádori, Gergely; Zsom, Lajos; Berhés, Mariann; Hamar, Mátyás; Kóbor, Krisztina; Péter, Antal

    2015-01-01

    Horseshoe kidney is a fusion anomaly found in approximately one in 400–600 people. Due to vascular and ureteral variations, transplantation with a horseshoe kidney presents a technical challenge. In our case, the isthmus connected the upper poles and contained parenchyma. It consisted of three renal arteries, five veins collected to the inferior vena cava, and two ureters and pyelons. It was implanted en bloc to the left side retroperitoneally. During the early period, cellular and humoral rejection was confirmed and treated. For a urine leak, double J catheters were implanted into both ureters. Later, the first catheter was removed. Subsequently, urinary sepsis developed, necessitating graftectomy. The uncommon anatomy of ureters and antibody-mediated rejection (AMR) may both be factors for a ureter tip necrosis led to an infected urinoma. After other Hungarian authors, we also report a horseshoe kidney transplantation that was technically successful. However, after an adequately treated but severe acute humoral rejection, the patient developed sepsis, and the kidney had to be removed. We conclude that transplantation with horseshoe kidney is technically feasible but may increase the risk for urinary complications and resultant infections. Careful consideration of risk and benefit is advised when a transplant professional is faced with this option. PMID:26120481

  8. Kidney Failure - Multiple Languages: MedlinePlus

    MedlinePLUS

    ... Arabic (???????) Kidney Failure (Arabic) ????? ?????? - ??????? Bilingual PDF Health Information Translations Bosnian (Bosanski) Kidney Failure Otkazivanje rada bubrega - Bosanski (Bosnian) Bilingual PDF Health Information Translations Chinese - Simplified (????) Kidney ...

  9. Bimanual Force Coordination in Children with Spastic Unilateral Cerebral Palsy

    ERIC Educational Resources Information Center

    Smits-Engelsman, B. C. M.; Klingels, K.; Feys, H.

    2011-01-01

    In this study bimanual grip-force coordination was quantified using a novel "Gripper" system that records grip forces produced while holding a lower and upper unit, in combination with the lift force necessary to separate these units. Children with unilateral cerebral palsy (CP) (aged 5-14 years, n = 12) were compared to age matched typically…

  10. Unilateral Family Therapy for Alcohol Abuse: A Working Conception.

    ERIC Educational Resources Information Center

    Thomas, Edwin J.; Santa, Cathleen A.

    1982-01-01

    Presents unilateral family therapy in which intervention is directed toward changing the behavior of an uncooperative family member through working with a cooperative member as mediator. Applies the approach to the problem of endeavoring to reach and change an uncooperative alcohol abuser. (Author)

  11. The Shoulder Gradient in Patients with Unilateral Shoulder Impingement Syndrome

    PubMed Central

    Kim, Hee-Sang; Lee, Jong Ha; Yun, Dong Hwan; Yun, Jee-Sang; Shin, Yong Won; Chon, Jinmann

    2011-01-01

    Objective To investigate the relationship between the shoulder gradient and acromiohumeral interval of both shoulders in patients with unilateral shoulder impingement syndrome. Method Using the angulometer, we measured the shoulder gradient in patients with unilateral shoulder impingement syndrome in a standing position. Using the radiography, we measured the acromiohumeral interval and the angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapula. Results In patients with unilateral shoulder impingement syndrome, the frequency of shoulder impingement syndrome was 76.2% (16 of 21) on the side of the relatively lower shoulder. The mean acromiohumeral interval on the side of the lower shoulder was 10.03±1.28 mm, compared with 10.46±1.50 mm for the higher shoulder. The angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapular of the side of the lower shoulder was -0.31±3.73 degrees, compared with 3.85±4.42 degrees for the higher shoulder. Conclusion The frequency of shoulder impingement syndrome was significantly higher on the side of the relatively lower shoulder, and there is no significant difference in the acromiohumeral interval between the side of the lower shoulder and that of the higher shoulder. In patients with unilateral shoulder impingement syndrome, the scapular on the side of lower shoulder was more rotated downward than on the side of the higher shoulder. PMID:22506196

  12. IQ Decline Following Early Unilateral Brain Injury: A Longitudinal Study

    ERIC Educational Resources Information Center

    Levine, Susan C.; Kraus, Ruth; Alexander, Erin; Suriyakham, Linda Whealton; Huttenlocher, Peter R.

    2005-01-01

    We examine whether children with early unilateral brain injury show an IQ decline over the course of development. Fifteen brain injured children were administered an IQ test once before age 7 and again several years later. Post-7 IQ scores were significantly lower than pre-7 IQ scores. In addition, pre-7 IQ scores were lower for children with…

  13. Unilateral nevoid acanthosis nigricans: Uncommon variant of a common disease

    PubMed Central

    Das, Anupam; Bhattacharya, Sabari; Kumar, Piyush; Gayen, Tirthankar; Roy, Kunal; Das, Nilay K.; Gharami, Ramesh C.

    2014-01-01

    Acanthosis nigricans (AN) is a fairly common dermatosis characterized by hyperpigmented velvety plaques, having a predilection for the intertriginous areas. We herein present a case of unilateral nevoid acanthosis nigricans over the left lateral chest, in an adult male. The rarity of documentation of this entity in the world literature prompted us to report the case. PMID:25506563

  14. Unilateral maxillary molar distalization with zygoma-gear appliance.

    PubMed

    Kilkis, Dogan; Bayram, Mehmet; Celikoglu, Mevlut; Nur, Metin

    2012-08-01

    The aim of this study was to present the orthodontic treatment of a 15-year-old boy with a unilateral maxillary molar distalization system, called the zygoma-gear appliance. It consisted of a zygomatic anchorage miniplate, an inner bow, and a Sentalloy closed coil spring (GAC International, Bohemia, NY). A distalizing force of 350 g was used during the distalization period. The unilateral Class II malocclusion was corrected in 5 months with the zygoma-gear appliance. The maxillary left first molar showed distalization of 4 mm with an inclination of 3°. The maxillary premolars moved distally with the help of the transseptal fibers. In addition, there were slight decreases in overjet (-0.5 mm) and maxillary incisor inclination (-1°), indicating no anchorage loss from the zygoma-gear appliance. Preadjusted fixed appliances (0.022 × 0.028-in, MBT system; 3M Unitek, Monrovia, Calif) were placed in both arches to achieve leveling and alignment. After 14 months of unilateral distalization with the zygoma-gear appliance and fixed appliances, Class I molar and canine relationships were established with satisfactory interdigitation of the posterior teeth. Acceptable overjet and overbite were also achieved. This article shows that this new system, the zygoma-gear appliance, can be used for unilateral maxillary molar distalization without anchorage loss. PMID:22858341

  15. Unilateral congenital elbow luxation in a Cavalier King Charles Spaniel

    PubMed Central

    2004-01-01

    Abstract A 7-week-old, intact female, Cavalier King Charles Spaniel was evaluated for nonweight bearing lameness of the right forelimb. Type III unilateral congenital elbow luxation was diagnosed radiographically. After surgical reduction, temporary placement of a transarticular pin, and external splinting of the joint, full weight bearing was achieved. Radial head subluxation persisted. PMID:15600161

  16. Unilateral alpha rhythm and Cheyne-Stokes respirations.

    PubMed

    Nowack, W J; Baker, Y; Janati, A

    1988-01-01

    A case of unilateral basal ganglion hemorrhage with Cheyne-Stokes respirations is presented. During the hyperpneic periods there was rhythmic alpha activity in the hemisphere contralateral to the basal ganglion hemorrhage. We postulate that the hemorrhage interrupted the thalamocortical fibers on the involved side. The implications of this clinical evidence are discussed in the light of the theory of cerebral autorhythmicity. PMID:3396202

  17. Bimanual Force Coordination in Children with Spastic Unilateral Cerebral Palsy

    ERIC Educational Resources Information Center

    Smits-Engelsman, B. C. M.; Klingels, K.; Feys, H.

    2011-01-01

    In this study bimanual grip-force coordination was quantified using a novel "Gripper" system that records grip forces produced while holding a lower and upper unit, in combination with the lift force necessary to separate these units. Children with unilateral cerebral palsy (CP) (aged 5-14 years, n = 12) were compared to age matched typically…

  18. Coupling of FM Systems to Individuals with Unilateral Hearing Loss.

    ERIC Educational Resources Information Center

    Kopun, Judy G.; And Others

    1992-01-01

    This study examined the attenuation characteristics of 5 Frequency Modulation system sound delivery options for 25 adults and children (ages 5-13). Degree of ear canal occlusion was a major factor in degree of attenuation. For children with unilateral hearing impairments, the most acoustically appropriate option was the tube-fitting. (Author/JDD)

  19. Traumatic glaucoma with features of unilateral pigment dispersion

    PubMed Central

    Bowler, Gordon; Ellul, Antony; Gouws, Pieter

    2014-01-01

    Summary We report a patient with traumatic glaucoma with features of unilateral pigment dispersion. This rare form of secondary glaucoma has only been reported twice previously, with both patients demonstrating angle recession, indicating associated damage to the trabecular meshwork. To our knowledge, this is the first such case reported in which angle recession was absent. PMID:25097455

  20. Management of Young Children with Unilateral Hearing Loss

    ERIC Educational Resources Information Center

    McKay, Sarah

    2006-01-01

    Children with unilateral hearing loss (UHL) are at risk for academic, speech and language and social-emotional difficulties. To date, most of the evidence documented in the literature has been obtained from school-age children, most of whom were diagnosed with UHL after enrollment in school. Following the widespread institution of universal…

  1. Brain–kidney crosstalk

    PubMed Central

    2014-01-01

    Encephalopathy and altered higher mental functions are common clinical complications of acute kidney injury. Although sepsis is a major triggering factor, acute kidney injury predisposes to confusion by causing generalised inflammation, leading to increased permeability of the blood–brain barrier, exacerbated by hyperosmolarity and metabolic acidosis due to the retention of products of nitrogen metabolism potentially resulting in increased brain water content. Downregulation of cell membrane transporters predisposes to alterations in neurotransmitter secretion and uptake, coupled with drug accumulation increasing the risk of encephalopathy. On the other hand, acute brain injury can induce a variety of changes in renal function ranging from altered function and electrolyte imbalances to inflammatory changes in brain death kidney donors. PMID:25043644

  2. An analytical methodology for magnetic field control in unilateral NMR.

    PubMed

    Marble, Andrew E; Mastikhin, Igor V; Colpitts, Bruce G; Balcom, Bruce J

    2005-05-01

    Traditionally, unilateral NMR systems such as the NMR-MOUSE have used the fringe field between two bar magnets joined with a yoke in a 'U' geometry. This allows NMR signals to be acquired from a sensitive volume displaced from the magnets, permitting large samples to be investigated. The drawback of this approach is that the static field (B0) generated in this configuration is inhomogeneous, and has a large, nonlinear, gradient. As a consequence, the sensitive volume of the instrument is both small and ill defined. Empirical redesign of the permanent magnet array producing the B0 field has yielded instruments with magnetic field topologies acceptable for varying applications. The drawback of current approaches is the lack of formalism in the control of B0. Rather than tailoring the magnet geometry to NMR investigations, measurements must be tailored to the available magnet geometry. In this work, we present a design procedure whereby the size, shape, field strength, homogeneity, and gradients in the sensitive spot of a unilateral NMR sensor can be controlled. Our design uses high permeability pole pieces, shaped according to the contours of an analytical expression, to control B0, allowing unilateral NMR instruments to be designed to generate a controlled static field topology. We discuss the approach in the context of previously published design techniques, and explain the advantages inherent in our strategy as compared to other optimization methods. We detail the design, simulation, and construction of a unilateral magnet array using our approach. It is shown that the fabricated array exhibits a B0 topology consistent with the design. The utility of the design is demonstrated in a sample nondestructive testing application. Our design methodology is general, and defines a class of unilateral permanent magnet arrays in which the strength and shape of B0 within the sensitive volume can be controlled. PMID:15809175

  3. Circling behavior following unilateral kainic acid injections into rat striatum.

    PubMed

    Taylor, R J; Reavill, C; Jenner, P; Marsden, C D

    1981-12-01

    Unilateral injection of kainic acid (2.5-25 nmol) into rat anterior caudate putamen induced dose-related circling behaviour. Kainic acid (10 nmol) consistently caused initial weak ipsiversive circling lasting 1 h followed by prolonged strong contraversive rotation lasting in excess of 10 h. Unilateral intrastriatal administration of L-glutamic acid, or of monosodium L-glutamate, to normal rats, or administration of monosodium L-glutamate to rats with extensive decortication, did not induce circling behaviour. The simultaneous unilateral injection of monosodium L-glutamate (1 mumol) with kainic acid (10 nmol) did not modify circling behaviour induced by kainic acid. However, extensive decortication greatly reduced circling induced by unilateral intrastriatal kainic acid (10 nmol), and effect not reversed by the simultaneous administration of monosodium L-glutamate (1 mumol). Unilateral 6-hydroxydopamine lesions of the left nigrostriatal pathway abolished the initial ipsiversive rotation and potentiated the subsequent contraversive rotation for up to 4 h after intrastriatal injection of kainic acid (10 nmol). Peripheral administration of haloperidol (1 mg/kg i.p.) also abolished initial ipsiversive rotation and decreased the subsequent contraversive rotation. Electro-coagulation of the ipsilateral strio-nigral pathway prolonged the initial ipsiversive rotation produced by kainic acid, but markedly attenuated contraversive rotation. These findings suggest that circling induced by intrastriatal administration of kainic acid depends on intact corticostriate pathways, but it cannot be reproduced or modified by intrastriatal administration of glutamate. Kainic acid circling appears to be mediated via strio-nigral pathways, and to be modulated by dopaminergic function. PMID:7333356

  4. Unilateral Incompatibility in Capsicum (Solanaceae): Occurrence and Taxonomic Distribution

    PubMed Central

    ONUS, A. NACI; PICKERSGILL, BARBARA

    2004-01-01

    • Background and aims Unilateral incompatibility (UI) occurs when pollinations between species are successful in one direction but not in the other. Self-incompatible (SI) species frequently show UI with genetically related, self-compatible (SC) species, as pollen of SI species is compatible on the SC pistil, but not vice versa. Many examples of unilateral incompatibility, and all those which have been studied most intensively, are found in the Solanaceae, particularly Lycopersicon, Solanum, Nicotiana and Petunia. The genus Capsicum is evolutionarily somewhat distant from Lycopersicon and Solanum and even further removed from Nicotiana and Petunia. Unilateral incompatibility has also been reported in Capsicum; however, this is the first comprehensive study of crosses between all readily available species in the genus. • Methods All readily available (wild and domesticated) species in the genus are used as plant material, including the three genera from the Capsicum pubescens complex plus eight other species. Pollinations were made on pot-grown plants in a glasshouse. The number of pistils pollinated per cross varied (from five to 40 pistils per plant), depending on the numbers of flowers available. Pistils were collected 24 h after pollination and fixed for 3–24 h. After staining, pistils were mounted in a drop of stain, squashed gently under a cover slip and examined microscopically under ultra-violet light for pollen tube growth. • Key results Unilateral incompatibility is confirmed in the C. pubescens complex. Its direction conforms to that predominant in the Solanaceae and other families, i.e. pistils of self-incompatible species, or self-compatible taxa closely related to self-incompatible species, inhibit pollen tubes of self-compatible species. • Conclusions Unilateral incompatibility in Capsicum does not seem to have arisen to prevent introgression of self-compatibility into self-incompatible taxa, but as a by-product of divergence of the C. pubescens complex from the remainder of the genus. PMID:15229125

  5. Outcomes After Unilateral Uterine Artery Embolization: A Retrospective Review

    SciTech Connect

    Bratby, M. J.; Hussain, F. F.; Walker, W. J.

    2008-03-15

    Purpose. Bilateral uterine artery embolization (UAE) is considered necessary to provide effective treatment for symptomatic uterine fibroids. Occasionally, only unilateral embolization is performed, and this study evaluates these outcomes. Materials and Methods. As part of a prospective observational study of more than 1600 patients treated with UAE since 1996, there have been 48 patients in whom unilateral embolization has been performed. This study retrospectively reviews clinical response as assessed by our standard questionnaire and radiological response assessed by either magnetic resonance imaging or ultrasound. Results. Two principal groups emerged: the largest, where only the dominant unilateral arterial supply was electively embolized (30 patients); and the second, where there was technical failure to catheterize the second uterine artery as a result of anatomical constraints (12 patients). Favorable clinical response with a reduction in menorrhagia at 1 year was seen in 85.7% (18/21) of those patients with a dominant arterial supply to the fibroid(s). In contrast, in those patients where there was technical failure to embolize one uterine artery, there was a high rate of clinical failure requiring further intervention in 58.3% (7/12). Comparison of the technical failure group with the dominant uterine artery group demonstrated a statistically significant (Fisher's exact test) difference in the proportion of patients with evidence of persistent fibroid vascularity (p < 0.001) and requiring repeat intervention (p < 0.01). Conclusion. We conclude that unilateral UAE can achieve a positive clinical result in the group of patients where there is a dominant unilateral artery supplying the fibroid(s), in contrast to the poor results seen following technical failure.

  6. Zoster sine herpete with thoracic motor paralysis temporally associated with thoracic epidural steroid injection.

    PubMed

    Schuchmann, John A; McAllister, Russell K; Armstrong, Christopher S; Puana, Rudolph

    2008-10-01

    Reactivation of latent varicella-zoster virus can occur when the immune system is weakened leading to the typical presentation seen with herpes zoster or shingles. In a small percentage of these patients, motor paralysis can be seen in the affected myotomal distribution. Zoster sine herpete, or shingles without the typical vesicular rash, is an uncommon variant of zoster. Systemic steroids are known to weaken the immune response. Two previous case reports have implicated epidural steroid injections as a precipitating cause of zoster. We present a case of serologically verified zoster sine herpete producing an abdominal wall bulge, which occurred 1 wk after thoracic epidural steroid injection. Electromyography documented the presence of abdominal wall denervation. Given the low incidence of serologically proven zoster sine herpete--especially with thoracic motor paralysis--and the equally rarely documented incidence of zoster related to epidural steroids, we present what we believe to be the first reported case of zoster sine herpete with a neuropathic abdominal wall bulge occurring in close temporal association to receiving epidural steroids. PMID:18806512

  7. Pharacological prolongation of ischemic tolerance of rat-kidneys by Na-Cu-chlorophyllin.

    PubMed

    Hoelscher, M; Zuehlke, V

    1975-01-01

    This experimental study demonstrated that the warm ischemic tolerance of a rat kidney is about 60 mins, in this model. If the warm ischemic time is 60 mins or longer, in unilateral nephrectomized rats, the animals die of renal insufficiency. After pre-operative treatment with Na-Cu-chlorophyllin we observed a significantly lower increase of serum urea and creatinine levels, caused by a pharmacological effect on the kidneys. The prolongation of warm ischemic tolerance of rat kidneys is about 30 mins in this model; that means 50% more than the normal ischemic tolerance. From our results and from the literature we conclude that Na-Cu-chlorophyllin has a membrane stablilizing and an inhibiting effect on autolytic enzymes. The drug Na-Cu-chlorophyllin has indeed 2 positive effects: the immunosuppressive and organ preseving effect. These effects may play a role in donor and recipient pretreatment and treatment after grafting. PMID:1146042

  8. Exaggerated renal fibrosis in P2X4 receptor-deficient mice following unilateral ureteric obstruction

    PubMed Central

    Kim, Min Jeong; Turner, Clare M.; Hewitt, Reiko; Smith, Jennifer; Bhangal, Gurjeet; Pusey, Charles D.; Unwin, Robert J.; Tam, Frederick W.K.

    2014-01-01

    Background The ATP-sensitive P2X7 receptor (P2X7R) has been shown to contribute to renal injury in nephrotoxic nephritis, a rodent model of acute glomerulonephritis, and in unilateral ureteric obstruction (UUO), a rodent model of chronic interstitial inflammation and fibrosis. Renal tubular cells, endothelial cells and macrophages also express the closely related P2X4 receptor (P2X4R), which is chromosomally co-located with P2X7R and has 40% homology; it is also pro-inflammatory and has been shown to interact with P2X7R to modulate its pro-apoptotic and pro-inflammatory effects. Therefore, we chose to explore the function of P2X4R in the UUO model of renal injury using knockout mice. We hypothesized that UUO-induced tubulointerstitial damage and fibrosis would also be attenuated in P2X4R?/? mice. Method P2X4R?/? and wild-type (WT) mice were subjected to either UUO or sham operation. Kidney samples taken on Days 7 and 14 were evaluated for renal inflammation and fibrosis, and expression of pro-fibrotic factors. Results To our surprise, the obstructed kidney in P2X4R?/? mice showed more severe renal injury, more collagen deposition (picrosirius red staining, increase of 53%; P < 0.05) and more type I collagen staining (increase of 107%; P < 0.01), as well as increased mRNA for TGF-? (increase of 102%, P < 0.0005) and CTGF (increase of 157%; P < 0.05) by Day 14, compared with the UUO WT mice. Conclusion These findings showed that lack of P2X4R expression leads to increased renal fibrosis, and increased expression of TGF-? and CTGF in the UUO model. PMID:24574541

  9. Overexpression of Heme Oxygenase-1 Prevents Renal Interstitial Inflammation and Fibrosis Induced by Unilateral Ureter Obstruction

    PubMed Central

    Li, Jian-Si; Zhang, Qing-Fang; Wang, Yu-Xiao; Zhao, Shi-Lei; Yu, Jing; Wang, Chang; Qin, Ying; Wei, Qiu-Ju; Lv, Gui-Xiang; Li, Bing

    2016-01-01

    Renal fibrosis plays an important role in the onset and progression of chronic kidney diseases. Many studies have demonstrated that heme oxygenase-1 (HO-1) is involved in diverse biological processes as a cytoprotective molecule, including anti-inflammatory, anti-oxidant, anti-apoptotic, antiproliferative, and immunomodulatory effects. However, the mechanisms of HO-1 prevention in renal interstitial fibrosis remain unknown. In this study, HO-1 transgenic (TG) mice were employed to investigate the effect of HO-1 on renal fibrosis using a unilateral ureter obstruction (UUO) model and to explore the potential mechanisms. We found that HO-1 was adaptively upregulated in kidneys of both TG and wild type (WT) mice after UUO. The levels of HO-1 mRNA and protein were increased in TG mice compared with WT mice under normal conditions. HO-1 expression was further enhanced after UUO and remained high during the entire experimental process. Renal interstitial fibrosis in the TG group was significantly attenuated compared with that in the WT group after UUO. Moreover, overexpression of HO-1 inhibited the loss of peritubular capillaries. In addition, UUO-induced activation and proliferation of myofibroblasts were suppressed by HO-1 overexpression. Furthermore, HO-1 restrained tubulointerstitial infiltration of macrophages and regulated the secretion of inflammatory cytokines in UUO mice. We also found that high expression of HO-1 inhibited reactivation of Wnt/β-catenin signaling, which could play a crucial role in attenuating renal fibrosis. In conclusion, these data suggest that HO-1 prevents renal tubulointerstitial fibrosis possibly by regulating the inflammatory response and Wnt/β-catenin signaling. This study provides evidence that augmentation of HO-1 levels may be a therapeutic strategy against renal interstitial fibrosis. PMID:26765329

  10. Lefty1 alleviates renal tubulointerstitial injury in mice with unilateral ureteral obstruction.

    PubMed

    Xu, Changgeng; Xu, Mingwei; Wang, Wei; Zhang, Jie

    2016-01-01

    Lefty is a member of the transforming growth factor (TGF) ? superfamily, which is implicated in left?right patterning during embryogenesis. Previous studies revealed that lefty attenuates the epithelial?mesenchymal transition in tubular epithelial cells. In the present study, the protective effect of lefty1 on renal interstitial injury was further assessed. Mice with a unilateral ureteral obstruction (UUO) were sacrificed on days 3, 5 and 7 following surgery, and the association between the expression of lefty1 and the degree of interstitial fibrosis was investigated. Subsequently, mice with a UUO were administered recombinant lefty1 (300 µg/kg body weight) or vehicle (0.9% saline solution; 100 µl) through tail?vein injection every other day for 6 days. The effects of lefty1 were assessed by measuring the degree of tubulointerstitial fibrosis, tubular injury and atrophy, and also by monitoring the expression levels of ??smooth muscle actin (??SMA), TGF??1, phosphorylated (p)?Smad2/3, kidney injury molecular?1 and endogenous lefty1. The expression of lefty1 in the kidney decreased in a time?dependent manner in mice with a UUO, which was inversely correlated with the degree of renal interstitial fibrosis. Furthermore, compared with vehicle treatment, lefty1 attenuated renal interstitial fibrosis. Ureteral ligation induced increased expression levels of ??SMA, TGF??1 and p?Smad2/3. However, these effects were reduced following treatment with lefty1. The UUO also induced tubular injury and atrophy, whereas lefty1 treatment exerted a marked suppressive effect on tubular injury. In addition, exogenous lefty1 administered to mice restored the endogenous expression levels of lefty1. The present study demonstrated that lefty1 attenuated renal interstitial injury by inhibiting the Smad?dependent TGF??1 signaling pathway. Lefty1 may therefore by a putative therapeutic agent in the treatment of renal injury. PMID:26647776

  11. The internal thoracic artery in human foetuses.

    PubMed

    Wi?niewski, Marcin; Krakowiak-Sarnowska, Elzbieta; Szpinda, Micha?; Sarnowski, Jan

    2004-02-01

    The aim of this study was to examine the internal thoracic artery (ITA) in human foetuses. The research material consisted of 32 human foetuses (18 female, 14 male) from the 21(st) to 24(th) week of intrauterine life. After intravascular injection with white latex LBS 3060, the foetuses were fixed in 10% neutral formalin solution. The whole course of the ITA was prepared. Photographic documentation was performed with a Nikon Coolpix 4500 digital camera, and source pictures of arteries were rendered in a Digital Computer System Analysis. The ITA was evaluated with regard to its origin, length, distance from the edge of the sternum to two intercostal spaces (2(nd), 5(th)) and division into terminal branches. The right ITA (RITA) arose from the ascending (68.7%), arcuate (21.9%) and descending (3.2%) parts of the subclavian artery. In other cases (6.2%) it was a branch of the thyrocervical trunk. The left ITA (LITA) was a branch of the ascending (78.1%) and arcuate (21.9%) parts of the subclavian artery. The ITA was longer in male foetuses. Regardless of sex, the LITA was longer than the RITA. Coefficient correlation between the RITA and LITA was 0.92 (p < 0.001). The distance of the ITA from the edge of sternum in the 2(nd) and 5(th) intercostal spaces on both sides was greater in females. It appeared most frequently in the 6(th) space (43.7% right-sided and 56.3% left-sided). Typical bifurcation of the ITA into the superior epigastric artery and the musculophrenic artery was observed in 78.1% of cases on the right side and in 81.25% of cases on the left side. PMID:15039895

  12. Reduced Renal Methylarginine Metabolism Protects against Progressive Kidney Damage.

    PubMed

    Tomlinson, James A P; Caplin, Ben; Boruc, Olga; Bruce-Cobbold, Claire; Cutillas, Pedro; Dormann, Dirk; Faull, Peter; Grossman, Rebecca C; Khadayate, Sanjay; Mas, Valeria R; Nitsch, Dorothea D; Wang, Zhen; Norman, Jill T; Wilcox, Christopher S; Wheeler, David C; Leiper, James

    2015-12-01

    Nitric oxide (NO) production is diminished in many patients with cardiovascular and renal disease. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthesis, and elevated plasma levels of ADMA are associated with poor outcomes. Dimethylarginine dimethylaminohydrolase-1 (DDAH1) is a methylarginine-metabolizing enzyme that reduces ADMA levels. We reported previously that a DDAH1 gene variant associated with increased renal DDAH1 mRNA transcription and lower plasma ADMA levels, but counterintuitively, a steeper rate of renal function decline. Here, we test the hypothesis that reduced renal-specific ADMA metabolism protects against progressive renal damage. Renal DDAH1 is expressed predominately within the proximal tubule. A novel proximal tubule-specific Ddah1 knockout (Ddah1(PT-/-)) mouse demonstrated tubular cell accumulation of ADMA and lower NO concentrations, but unaltered plasma ADMA concentrations. Ddah1(PT-/-) mice were protected from reduced kidney tissue mass, collagen deposition, and profibrotic cytokine expression in two independent renal injury models: folate nephropathy and unilateral ureteric obstruction. Furthermore, a study of two independent kidney transplant cohorts revealed higher levels of human renal allograft methylarginine-metabolizing enzyme gene expression associated with steeper function decline. We also report an association among DDAH1 expression, NO activity, and uromodulin expression supported by data from both animal and human studies, raising the possibility that kidney DDAH1 expression exacerbates renal injury through uromodulin-related mechanisms. Together, these data demonstrate that reduced renal tubular ADMA metabolism protects against progressive kidney function decline. Thus, circulating ADMA may be an imprecise marker of renal methylarginine metabolism, and therapeutic ADMA reduction may even be deleterious to kidney function. PMID:25855779

  13. NFAT5 is protective against ischemic acute kidney injury.

    PubMed

    Hao, Shoujin; Bellner, Lars; Zhao, Hong; Ratliff, Brian B; Darzynkiewicz, Zbigniew; Vio, Carlos P; Ferreri, Nicholas R

    2014-03-01

    NFAT5 is a transcription factor that protects the kidney from hypertonic stress and also is activated by hypoxia. We hypothesized that NFAT5 mitigates the extent of renal damage induced by ischemia-reperfusion injury (IRI). Mice were subjected to IRI by unilateral clamping of the left renal pedicle for 30 minutes followed by reperfusion. After 3 hours of reperfusion, the level of NFAT5 mRNA was similar in contralateral and clamped kidneys. However, after 48 hours, NFAT5 mRNA accumulation increased ?3-fold in both outer medulla and medullary thick ascending limb tubules. NFAT1 levels were elevated at 3 hours but did not increase further at 48 hours. Mice were then either pretreated for 72 hours with an intrarenal injection of a lentivirus short-hairpin RNA construct to silence NFAT5 (enhanced green fluorescent protein-U6-N5-ex8) or a control vector (enhanced green fluorescent protein-U6) before induction of IRI. Neutrophil gelatinase-associated lipocalin and kidney ischemia molecule-1 mRNA levels increased after IRI and further increased after knockdown of NFAT5, suggesting that silencing of NFAT5 exacerbates renal damage during IRI. In contrast, silencing of NFAT1 had no effect on the levels of neutrophil gelatinase-associated lipocalin or kidney ischemia molecule-1 mRNA. Hematoxylin and eosin staining revealed patchy denudation of renal epithelial cells and tubular dilation when NFAT5 was silenced. The number of TUNEL-positive cells in the outer and inner medulla of the clamped kidney increased nearly 2-fold after knockdown of NFAT5 and was associated with an increase in the number of caspase-3-positive cells. Collectively, the data suggest that NFAT5 is part of a protective mechanism that limits renal damage induced by IRI. PMID:24379188

  14. Diet for Kidney Stone Prevention

    MedlinePLUS

    ... may also help prevent kidney stones, such as citrus drinks. Recommendations based on the specific type of ... do to prevent kidney stones. Some studies suggest citrus drinks like lemonade and orange juice protect against ...

  15. Renal (Kidney) Manifestations in TSC

    MedlinePLUS Videos and Cool Tools

    ... TSC Research Conference Text Size Get Involved RENAL (KIDNEY) MANIFESTATIONS IN TSC Download a PDF of this ... complex (TSC) will develop some form of renal (kidney) disease during their lifetime. There are three particular ...

  16. Kidney Stone Treatment with Lithotripsy

    MedlinePLUS Videos and Cool Tools

    Kidney Stone Treatment with Lithotripsy Broward Health Medical Center Fort Lauderdale, FL November 11, 2011 I'm ... got at least three stones in his left kidney. He's been having pain and blood in his ...

  17. Chronic Kidney Disease and Medicines

    MedlinePLUS

    ... Alternate Language URL Español Chronic Kidney Disease and Medicines: What You Need to Know Page Content What ... pharmacist and provider need to know about your medicine and supplement use Your kidneys do not filter ...

  18. Kidney Failure and Vascular Disease

    MedlinePLUS

    ... with renal failure can be treated with an artificial kidney machine (dialysis) which removes toxins from the blood. Patients requiring ongoing dialysis use the artificial kidney machine up to three times a week ...

  19. Kidney Disease Risks among African-Americans

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    ... an AKF screening Kidney Action Day Kidney Action Day Learn about our signature outreach event. About AKF ... our Northeast Region. Kidney Action Day Kidney Action Day Our late spring event is an elegant fundraiser ...

  20. You, Your Blood Pressure, and Your Kidneys

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    ... an AKF screening Kidney Action Day Kidney Action Day Learn about our signature outreach event. About AKF ... our Northeast Region. Kidney Action Day Kidney Action Day Our late spring event is an elegant fundraiser ...

  1. When Your Child Needs a Kidney Transplant

    MedlinePLUS

    ... for Your Child When Your Child Needs a Kidney Transplant KidsHealth > For Parents > When Your Child Needs ... to monitor their new kidney function. About the Kidneys Kidneys are bean-shaped organs located near the ...

  2. Vitamins and Minerals in Kidney Disease

    MedlinePLUS

    ... Rate Your Risk Quiz Featured Story African Americans & Kidney Disease Did you know that African Americans are ... Health checks Your Kidneys and You Featured Story Kidney Walk The Kidney Walk is the nation's largest ...

  3. Lupus and Kidney Disease (Lupus Nephritis)

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    ... Rate Your Risk Quiz Featured Story African Americans & Kidney Disease Did you know that African Americans are ... Health checks Your Kidneys and You Featured Story Kidney Walk The Kidney Walk is the nation's largest ...

  4. Working with Kidney Disease: Rehabilitation and Employment

    MedlinePLUS

    ... Rate Your Risk Quiz Featured Story African Americans & Kidney Disease Did you know that African Americans are ... Health checks Your Kidneys and You Featured Story Kidney Walk The Kidney Walk is the nation's largest ...

  5. When Your Child Needs a Kidney Transplant

    MedlinePLUS

    ... About Food Allergies When Your Child Needs a Kidney Transplant KidsHealth > For Parents > When Your Child Needs ... to monitor their new kidney function. About the Kidneys Kidneys are bean-shaped organs located near the ...

  6. Kidney stones - what to ask your doctor

    MedlinePLUS

    A kidney stone is a solid piece of material that forms in your kidney. The kidney stone may be stuck in your ureter (the tube that carries urine from your kidneys to your bladder). It also may be stuck ...

  7. A randomized clinical trial to compare the immediate effects of seated thoracic manipulation and targeted supine thoracic manipulation on cervical spine flexion range of motion and pain

    PubMed Central

    Karas, Steve; Olson Hunt, Megan J

    2014-01-01

    Design Randomized clinical trial. Objectives To determine the effectiveness of seated thoracic manipulation versus targeted supine thoracic manipulation on cervical spine pain and flexion range of motion (ROM). There is evidence that thoracic spine manipulation is an effective treatment for patients with cervical spine pain. This evidence includes a variety of techniques to manipulate the thoracic spine. Although each of them is effective, no research has compared techniques to determine which produces the best outcomes. Methods A total of 39 patients with cervical spine pain were randomly assigned to either a seated thoracic manipulation or targeted supine thoracic manipulation group. Pain and flexion ROM measures were taken before and after the intervention. Results Pain reduction (post-treatment–pre-treatment) was significantly greater in those patients receiving the targeted supine thoracic manipulation compared to the seated thoracic manipulation (P<0.05). Although not significant, we did observe greater improvement in flexion ROM in the targeted supine thoracic manipulation group. The results of this study indicate that a targeted supine thoracic manipulation may be more effective in reducing cervical spine pain and improving cervical flexion ROM than a seated thoracic manipulation. Future studies should include a variety of patients and physical therapists (PTs) to validate our findings. PMID:24976754

  8. Oleanolic acid attenuates renal fibrosis in mice with unilateral ureteral obstruction via facilitating nuclear translocation of Nrf2

    PubMed Central

    2014-01-01

    Background Renal interstitial fibrosis is a common final pathological process in the progression of kidney disease. This is primarily due to oxidative stress, which contributes to renal inflammation and fibrosis. Nuclear factor-erythroid-2-related factor 2 (Nrf2) is known to coordinate induction of genes that encode antioxidant enzymes. We investigated the effects of oleanolic acid, a known Nrf2 activator, on oxidative stress-induced renal inflammation and fibrosis. Methods One day before unilateral ureteral obstruction (UUO) performed in C57BL/6 mice, oleanolic acid treatment was initiated and was continued until 3 and 7 days after UUO. Renal inflammation and fibrosis, markers of oxidative stress, and changes in Nrf2 expression were subsequently evaluated. Results In the obstructed kidneys of UUO mice, oleanolic acid significantly attenuated UUO-induced collagen deposition and fibrosis on day 7. Additionally, significantly less inflammatory cell infiltration, a lower ratio of Bax to Bcl-2 expression, and fewer apoptotic cells on TUNEL staining were observed in the obstructed kidneys of oleanolic acid-treated mice. Oleanolic acid increased the expression of nuclear Nrf2, heme oxygenase-1, NAD(P)H:quinone oxidoreductase 1 and heat shock protein 70, and decreased lipid peroxidation in the obstructed kidney of UUO mice. There were no changes in the expression of total Nrf2 and Kelch-like ECH-associated protein 1, indicating that oleanolic acid enhanced nuclear translocation of Nrf2. Conclusions These results suggest that oleanolic acid may exert beneficial effects on renal fibrosis by increasing nuclear translocation of Nrf2 and subsequently reducing renal oxidative stress. PMID:24393202

  9. Kidney Stones (For Parents)

    MedlinePLUS

    ... in urine (pee) become extra concentrated and form crystals. Over a few weeks or months, the crystals can build up and become stones. Kidney stones ... changes the level of a substance in it, crystals can begin to form. The crystals can become ...

  10. Chronic Kidney Disease

    MedlinePLUS

    ... The most common causes of CKD are high blood pressure, diabetes and heart disease. Chronic kidney disease can also ... healthy diet can also help to lower your blood pressure. If you have diabetes, your doctor will tell you what to do ...

  11. Monitoring Your Kidney Health

    MedlinePLUS

    ... Dialysis or Transplant Paying for Kidney Failure Treatment Contact Us Health Information Center Phone: 1-800-860- ... to share this content freely. ​​September 17, 2014​​ Contact Us Health Information Center Phone: 1-800-860- ...

  12. Diet - chronic kidney disease

    MedlinePLUS

    ... the sodium in your diet. Look for these words on food labels: Low-sodium No salt added Sodium-free Sodium-reduced Unsalted Check ... much potassium can build up when the kidneys no longer function ... is found in many food groups, including fruits and vegetables. ...

  13. Vascular complications in autosomal dominant polycystic kidney disease.

    PubMed

    Perrone, Ronald D; Malek, Adel M; Watnick, Terry

    2015-10-01

    Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. Relentless cyst growth substantially enlarges both kidneys and culminates in renal failure. Patients with ADPKD also have vascular abnormalities; intracranial aneurysms (IAs) are found in ?10% of asymptomatic patients during screening and in up to 25% of those with a family history of IA or subarachnoid haemorrhage. As the genes responsible for ADPKD—PKD1 and PKD2—have complex integrative roles in mechanotransduction and intracellular calcium signalling, the molecular basis of IA formation might involve focal haemodynamic conditions exacerbated by hypertension and altered flow sensing. IA rupture results in substantial mortality, morbidity and poor long-term outcomes. In this Review, we focus mainly on strategies for screening, diagnosis and treatment of IAs in patients with ADPKD. Other vascular aneurysms and anomalies—including aneurysms of the aorta and coronary arteries, cervicocephalic and thoracic aortic dissections, aortic root dilatation and cerebral dolichoectasia—are less common in this population, and the available data are insufficient to recommend screening strategies. Treatment decisions should be made with expert consultation and be based on a risk-benefit analysis that takes into account aneurysm location and morphology as well as patient age and comorbidities. PMID:26260542

  14. A reappraisal of adult thoracic and abdominal surface anatomy via CT scan in Chinese population.

    PubMed

    Shen, Xin-Hua; Su, Bai-Yan; Liu, Jing-Juan; Zhang, Gu-Muyang; Xue, Hua-Dan; Jin, Zheng-Yu; Mirjalili, S Ali; Ma, Chao

    2016-03-01

    Accurate surface anatomy is essential for safe clinical practice. There are numerous inconsistencies in clinically important surface markings among and within contemporary anatomical reference texts. The aim of this study was to investigate key thoracic and abdominal surface anatomy landmarks in living Chinese adults using computed tomography (CT). A total of 100 thoracic and 100 abdominal CT scans were examined. Our results indicated that the following key surface landmarks differed from current commonly-accepted descriptions: the positions of the tracheal bifurcation, azygos vein termination, and pulmonary trunk bifurcation (all below the plane of the sternal angle at vertebral level T5-T6 in most individuals); the superior vena cava formation and junction with the right atrium (most often behind the 1st and 4th intercostal spaces, respectively); and the level at which the inferior vena cava and esophagus traverse the diaphragm (T10 and T11, respectively). The renal arteries were most commonly at L1; the midpoint of the renal hila was most frequently at L2; the 11th rib was posterior to the left kidney in only 29% of scans; and the spleen was most frequently located between the 10th and 12th ribs. A number of significant sex- and age-related differences were noted. The Chinese population was also compared with western populations on the basis of published reports. Reappraisal of surface anatomy using modern imaging tools in vivo will provide both quantitative and qualitative evidence to facilitate the clinical application of these key surface landmarks. Clin. Anat. 29:165-174, 2016. © 2015 Wiley Periodicals, Inc. PMID:26032163

  15. Multiatlas segmentation of thoracic and abdominal anatomy with level set-based local search.

    PubMed

    Schreibmann, Eduard; Marcus, David M; Fox, Tim

    2014-01-01

    Segmentation of organs at risk (OARs) remains one of the most time-consuming tasks in radiotherapy treatment planning. Atlas-based segmentation methods using single templates have emerged as a practical approach to automate the process for brain or head and neck anatomy, but pose significant challenges in regions where large interpatient variations are present. We show that significant changes are needed to autosegment thoracic and abdominal datasets by combining multi-atlas deformable registration with a level set-based local search. Segmentation is hierarchical, with a first stage detecting bulk organ location, and a second step adapting the segmentation to fine details present in the patient scan. The first stage is based on warping multiple presegmented templates to the new patient anatomy using a multimodality deformable registration algorithm able to cope with changes in scanning conditions and artifacts. These segmentations are compacted in a probabilistic map of organ shape using the STAPLE algorithm. Final segmentation is obtained by adjusting the probability map for each organ type, using customized combinations of delineation filters exploiting prior knowledge of organ characteristics. Validation is performed by comparing automated and manual segmentation using the Dice coefficient, measured at an average of 0.971 for the aorta, 0.869 for the trachea, 0.958 for the lungs, 0.788 for the heart, 0.912 for the liver, 0.884 for the kidneys, 0.888 for the vertebrae, 0.863 for the spleen, and 0.740 for the spinal cord. Accurate atlas segmentation for abdominal and thoracic regions can be achieved with the usage of a multi-atlas and perstructure refinement strategy. To improve clinical workflow and efficiency, the algorithm was embedded in a software service, applying the algorithm automatically on acquired scans without any user interaction. PMID:25207393

  16. Endovascular Repair versus Open Repair for Isolated Descending Thoracic Aortic Aneurysm

    PubMed Central

    Lee, Hyung Chae; Joo, Hyun-Chel; Lee, Seung Hyun; Lee, Sak; Chang, Byung-Chul; Yoo, Kyung-Jong

    2015-01-01

    Purpose To compare the outcomes of thoracic endovascular aortic repair (TEVAR) with those of open repair for descending thoracic aortic aneurysms (DTAA). Materials and Methods We compared the outcomes of 114 patients with DTAA and proximal landing zones 3 or 4 after TEVAR to those of 53 patients after conventional open repairs. Thirty-day and late mortality were the primary endpoints, and early morbidities, aneurysm-related death, and re-intervention were the secondary endpoints. Results The TEVAR group was older and had more incidences of dissecting aneurysm. The mean follow-up was 36±26 months (follow-up rate, 97.8%). The 30-day mortality in the TEVAR and open repair groups were 3.5% and 9.4% (p=0.11). Perioperative stroke and paraplegia incidences were similar between the groups [5.3% vs. 7.5% (p=0.56) and 7.5% vs. 3.5% (p=0.26), respectively]. Respiratory failure occurred more in the open repair group (1.8% vs. 26.4%, p<0.01). The incidence of acute kidney injury requiring dialysis was higher in the open repair group (1.8% vs. 9.4%, p<0.01). The cumulative survival rate was higher in the TEVAR group at 2 to 5 years (79.6% vs. 58.3%, p=0.03). The free from re-intervention was lower in the TEVAR group (65.3% vs. 100%, p=0.02), and the free from aneurysm-related death in the TEVAR and open repair groups were 88.5% and 86.1% (p=0.45). Conclusion TEVAR is safe and effective for treating DTAAs with improved perioperative and long-term outcomes compared with open repair. PMID:26069110

  17. Prevention of reflex natriuresis after acute unilateral nephrectomy by neonatal administration of MSG

    SciTech Connect

    Lin, S.Y.; Wiedemann, E.; Deschepper, C.F.; Alper, R.H.; Humphreys, M.H.

    1987-02-01

    Acute unilateral nephrectomy (AUN) results in natriuresis from the remaining kidney through reflex pathways involving the central nervous system and requiring an intact pituitary gland. The natriuresis is accompanied by an increase in the plasma concentration of a peptide or peptides derived from the N-terminal fragment (NTF) of proopiomelanocortin. The authors measured plasma immunoreactive NTF-like material (IR-NTF) by radioimmunoassay, before and after AUN in control rats and rats treated neonatally with monosodium glutamate (MSG), a procedure that produces neuroendocrine dysfunction by destroying cell bodies in the hypothalamic arcuate nucleus, median eminence, and other brain regions. In control rats, IR-NTF increased from 85.8 +/- 54.9 (SD) to 207 +/- 98.1 fmol/ml after AUN as sodium excretion (U/sub Na/V) doubled. In MSG-treated rats, AUN produced no change in plasma IR-NTF concentration, nor did U/sub Na/V increase. Tissue content of IR-NTF was reduced in the arcuate nucleus and anterior lobe of pituitaries from MSG-treated rats compared with controls, but was no different in the neurointermediate lobe. These results indicate that the hypothalamic lesion produced by neonatal administration of MSG prevents both the increase in plasma IR-NTF concentration and the natruiuresis after AUN, and therefore lend further support to the concept of a casual relationship between these two consequences of AUN.

  18. Effect of Treatment on Body Fluid in Patients with Unilateral Aldosterone Producing Adenoma: Adrenalectomy versus Spironolactone

    PubMed Central

    Wu, Che-Hsiung; Yang, Ya-Wen; Hung, Szu-Chun; Tsai, Yao-Chou; Hu, Ya-Hui; Lin, Yen-Hung; Chu, Tzong-Shinn; Wu, Kwan-Dun; Wu, Vin-Cent

    2015-01-01

    Aldosterone affects fluid retention in the body by affecting how much salt and water that the kidney retains or excretes. There is limited information about the effect of prolonged aldosterone excess and treatment on body fluid in primary aldosteronism (PA) patients. In this study, body composition changes of 41 PA patients with unilateral aldosterone producing adenoma (APA) were assessed by a bio-impedance spectroscopy device. Patients with APA receiving adrenalectomy, as compared with those treated with spironolactone, had significantly lower relative overhydration (OH) and urine albumin excretion, and significantly higher urine sodium excretion four weeks after treatment. These differences dissipated 12 weeks after the initial treatment. Independent factors to predict decreased relative OH four weeks after treatment were male patients and patients who experienced adrenalectomy. Patients who underwent adrenaelctomy had significantly decreased TNF-α and increased serum potassium level when compared to patients treated with spironolactone 4 and 12 weeks after treatment. In this pilot study, we found that adrenalectomy leads to an earlier increase in renal sodium excretion and decreases in body fluid content, TNF-α, and urine albumin excretion. Adrenalectomy yields a therapeutic effect more rapidly, which has been shown to ameliorate overhydration in PA patients. PMID:26477337

  19. Effect of Treatment on Body Fluid in Patients with Unilateral Aldosterone Producing Adenoma: Adrenalectomy versus Spironolactone.

    PubMed

    Wu, Che-Hsiung; Yang, Ya-Wen; Hung, Szu-Chun; Tsai, Yao-Chou; Hu, Ya-Hui; Lin, Yen-Hung; Chu, Tzong-Shinn; Wu, Kwan-Dun; Wu, Vin-Cent

    2015-01-01

    Aldosterone affects fluid retention in the body by affecting how much salt and water that the kidney retains or excretes. There is limited information about the effect of prolonged aldosterone excess and treatment on body fluid in primary aldosteronism (PA) patients. In this study, body composition changes of 41?PA patients with unilateral aldosterone producing adenoma (APA) were assessed by a bio-impedance spectroscopy device. Patients with APA receiving adrenalectomy, as compared with those treated with spironolactone, had significantly lower relative overhydration (OH) and urine albumin excretion, and significantly higher urine sodium excretion four weeks after treatment. These differences dissipated 12 weeks after the initial treatment. Independent factors to predict decreased relative OH four weeks after treatment were male patients and patients who experienced adrenalectomy. Patients who underwent adrenaelctomy had significantly decreased TNF-? and increased serum potassium level when compared to patients treated with spironolactone 4 and 12 weeks after treatment. In this pilot study, we found that adrenalectomy leads to an earlier increase in renal sodium excretion and decreases in body fluid content, TNF-?, and urine albumin excretion. Adrenalectomy yields a therapeutic effect more rapidly, which has been shown to ameliorate overhydration in PA patients. PMID:26477337

  20. Urinary candidate biomarker discovery in a rat unilateral ureteral obstruction model

    PubMed Central

    Yuan, Yuan; Zhang, Fanshuang; Wu, Jianqiang; Shao, Chen; Gao, Youhe

    2015-01-01

    Urine has the potential to become a better source of biomarkers. Urinary proteins are affected by many factors; therefore, differentiating between the variables associated with any particular pathophysiological condition in clinical samples is challenging. To circumvent these problems, simpler systems, such as animal models, should be used to establish a direct relationship between disease progression and urine changes. In this study, a unilateral ureteral obstruction (UUO) model was used to observe tubular injury and the eventual development of renal fibrosis, as well as to identify differential urinary proteins in this process. Urine samples were collected from the residuary ureter linked to the kidney at 1 and 3 weeks after UUO. Five hundred proteins were identified and quantified by LC-MS/MS, out of which 7 and 19 significantly changed in the UUO 1- and 3-week groups, respectively, compared with the sham-operation group. Validation by western blot showed increased levels of Alpha-actinin-1 and Moesin in the UUO 1-week group, indicating that they may serve as candidate biomarkers of renal tubular injury, and significantly increased levels of Vimentin, Annexin A1 and Clusterin in the UUO 3-week group, indicating that they may serve as candidate biomarkers of interstitial fibrosis. PMID:25791774

  1. Kidneys and How They Work

    MedlinePLUS

    ... Options National Kidney Foundation The NephCure Foundation MedlinePlus Kidney and Urologic Disease Organizations Many organizations provide support ... PDF, 345 KB) Alternate Language URL Español The Kidneys and How They Work Page Content On this ...

  2. Kidney Failure: What to Expect

    MedlinePLUS

    ... Fund National Kidney Foundation Renal Support Network MedlinePlus Kidney and Urologic Disease Organizations Many organizations provide support ... Organizations​​ . (PDF, 345 KB)​​​​​ Alternate Language URL Español Kidney Failure: What to Expect Page Content On this ...

  3. Anemia in Chronic Kidney Disease

    MedlinePLUS

    ... Kidney Foundation U.S. Food and Drug Administration MedlinePlus Kidney and Urologic Disease Organizations Many organizations provide support ... 345 KB)​​​​​ Alternate Language URL Anemia in Chronic Kidney Disease Page Content On this page: What is ...

  4. Congenital anomalies of kidney and hand: a review

    PubMed Central

    Natarajan, Gopalakrishnan; Jeyachandran, Dhanapriya; Subramaniyan, Bala; Thanigachalam, Dineshkumar; Rajagopalan, Arul

    2013-01-01

    ‘Acro-renal syndrome’ refers to co-occurrence of congenital renal and limb anomalies. The term acro-renal syndrome was coined by Curran et al. in 1972 though Dieker and Opitz were the first to report this phenomenon in three male patients in 1969. The common limb defects include oligodactyly, ectrodactyly, syndactyly or brachydactyly anomalies of the carpal and tarsal bones and the common renal anomalies observed are unilateral renal agenesis (URA), bilateral renal hypoplasia, ureteric hypoplasia, hydroureteronephrosis and duplication abnormalities. The acro-renal syndrome as originally described is rare, reported only in ?20 patients in the international literature. We report a 23-year-old male patient with renal anomalies in the form of absent right kidney, left-sided vesicoureteric reflux (VUR) and skeletal anomalies viz short radius, absent first metacarpal ray in left hand and left undescended testis, consistent with Dieker's type acro-renal syndrome. Apart from the classical acro-renal syndrome, several anomalies of acro-renal patterns and the abnormal gene loci involved are described in the literature. This article is a comprehensive review of the development of kidneys, types of acro-renal syndromes, congenital anomalies of the kidney and urinary tract (CAKUT), syndromes associated with combined limb and renal anomalies, and anomalies associated with URA. PMID:26019842

  5. Sodium retention and hypertension after kidney transplantation in rats.

    PubMed

    Graf, C; Maser-Gluth, C; de Muinck Keizer, W; Rettig, R

    1993-05-01

    The present study was designed to investigate the development of blood pressure and renal sodium handling in recipients of renal grafts from adult stroke-prone spontaneously hypertensive rats (SHRSP), normotensive Wistar-Kyoto (WKY) rats, and borderline hypertensive F1 hybrids bred from SHRSP and WKY rats. Unilaterally nephrectomized F1 hybrids served as renal graft recipients. The second native kidney was removed 7 days after transplantation. Starting on the day of transplantation, renal graft recipients were put on a standard diet for 7 days followed by a low salt diet (0.18% salt) for 10 days and a high salt diet (1.8% salt) for another 14 days. In recipients of a renal graft from SHRSP donors, systolic blood pressure rose progressively from 140 +/- 4 mm Hg before to 190 +/- 7 mm Hg 4 weeks after transplantation. In contrast, in recipients of a renal graft from WKY rat donors, blood pressure fell during the same time from 139 +/- 7 mm Hg to 120 +/- 4 mm Hg. Blood pressure did not change significantly in recipients of a renal graft from F1 hybrid donors (132 +/- 4 versus 138 +/- 7 mm Hg). With transition from a low salt to high salt diet, all rats exhibited renal sodium retention. The accumulating amount of sodium retained by the renal graft was significantly higher in recipients of an SHRSP kidney than in recipients of a WKY rat kidney at all days on the high salt diet.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8491507

  6. Dietary phosphate restriction ameliorates endothelial dysfunction in adenine-induced kidney disease rats

    PubMed Central

    Van, Tan Vu; Watari, Eriko; Taketani, Yutaka; Kitamura, Tomoyo; Shiota, Asuka; Tanaka, Terumi; Tanimura, Ayako; Harada, Nagakatsu; Nakaya, Yutaka; Yamamoto, Hironori; Miyamoto, Ken-ichi; Takeda, Eiji

    2012-01-01

    Hyperphosphatemia causes endothelial dysfunction as well as vascular calcification. Management of serum phosphate level by dietary phosphate restriction or phosphate binders is considered to be beneficial to prevent chronic kidney disease patients from cardiovascular disease, but it has been unclear whether keeping lower serum phosphate level can ameliorate endothelial dysfunction. In this study we investigated whether low-phosphate diet can ameliorate endothelial dysfunction in adenine-induced kidney disease rats, one of useful animal model of chronic kidney disease. Administration of 0.75% adenine-containing diet for 21 days induced renal failure with hyperphosphatemia, and impaired acetylcholine-dependent vasodilation of thoracic aortic ring in rats. Then adenine-induced kidney disease rats were treated with either control diet (1% phosphate) or low-phosphate diet (0.2% phosphate) for 16 days. Low-phosphate diet ameliorated not only hyperphosphatemia but also the impaired vasodilation of aorta. In addition, the activatory phosphorylation of endothelial nitric oxide synthase at serine 1177 and Akt at serine 473 in the aorta were inhibited by in adenine-induced kidney disease rats. The inhibited phosphorylations were improved by the low-phosphate diet treatment. Thus, dietary phosphate restriction can improve aortic endothelial dysfunction in chronic kidney disease with hyperphosphatemia by increase in the activatory phosphorylations of endothelial nitric oxide synthase and Akt. PMID:22798709

  7. Transcriptional analysis of infiltrating T cells in kidney ischemia-reperfusion injury reveals a pathophysiological role for CCR5

    PubMed Central

    Ko, Gang Jee; Linfert, Douglas; Jang, Hye Ryoun; Higbee, Elizabeth; Watkins, Tonya; Cheadle, Chris; Liu, Manchang; Racusen, Lorraine; Grigoryev, Dmitry N.

    2012-01-01

    Although T cells have been shown to play a direct role in kidney ischemia-reperfusion injury (IRI), little is known about the underlying mechanisms. We hypothesized that studying the transcriptional responses in kidney-infiltrating T cells would help elucidate novel therapeutic targets for kidney IRI. Unilateral renal pedicle clamping for 45 min was performed in male C57BL/6 mice, and CD3+ T cells were isolated from the kidney and purified. Transcriptional activities of T cell were measured by array-based PCR compared between ischemic kidneys and contralateral nonischemic kidneys. Among total of 89 genes analyzed, 24, 22, 24, and 37 genes were significantly changed at 6 h, day 3, day 10, and day 28 after IRI. Genes associated with cytokines, chemokines, and costimulatory molecules were upregulated. Pathway analysis identified CC motif chemokine receptor 5 (CCR5) as a candidate pathophysiological pathway. CCR5 upregulation was validated at the protein level, and CCR5 blockade improved renal function after kidney IRI. Using discovery techniques to identify transcriptional responses in purified kidney-infiltrating cells enabled the elucidation of novel mechanisms and therapeutic targets for IRI. PMID:22160774

  8. Transcriptional analysis of infiltrating T cells in kidney ischemia-reperfusion injury reveals a pathophysiological role for CCR5.

    PubMed

    Ko, Gang Jee; Linfert, Douglas; Jang, Hye Ryoun; Higbee, Elizabeth; Watkins, Tonya; Cheadle, Chris; Liu, Manchang; Racusen, Lorraine; Grigoryev, Dmitry N; Rabb, Hamid

    2012-03-15

    Although T cells have been shown to play a direct role in kidney ischemia-reperfusion injury (IRI), little is known about the underlying mechanisms. We hypothesized that studying the transcriptional responses in kidney-infiltrating T cells would help elucidate novel therapeutic targets for kidney IRI. Unilateral renal pedicle clamping for 45 min was performed in male C57BL/6 mice, and CD3(+) T cells were isolated from the kidney and purified. Transcriptional activities of T cell were measured by array-based PCR compared between ischemic kidneys and contralateral nonischemic kidneys. Among total of 89 genes analyzed, 24, 22, 24, and 37 genes were significantly changed at 6 h, day 3, day 10, and day 28 after IRI. Genes associated with cytokines, chemokines, and costimulatory molecules were upregulated. Pathway analysis identified CC motif chemokine receptor 5 (CCR5) as a candidate pathophysiological pathway. CCR5 upregulation was validated at the protein level, and CCR5 blockade improved renal function after kidney IRI. Using discovery techniques to identify transcriptional responses in purified kidney-infiltrating cells enabled the elucidation of novel mechanisms and therapeutic targets for IRI. PMID:22160774

  9. Kidney Size Comparison of BEN Victims

    USGS Multimedia Gallery

    Normal size kidney (left) and a Balkan endemic nephropathy (BEN) kidney (right). The BEN kidney is reduced by one third compared to a normal kidney. The collapse of the kidney structure in the BEN kidney causes the organ to cease to function, resulting in uremia (blood poisoning) and requiring dialy...

  10. Preclinical evaluation of erythropoietin administration in a model of radiation-induced kidney dysfunction

    SciTech Connect

    Andratschke, Nicolaus; Schnaitera, Andrea; Weber, Wolfgang A.; Caia, Lu; Schill, Sabine; Wiedenmann, Nicole; Schwaiger, Markus; Molls, Michael; Nieder, Carsten . E-mail: cnied@hotmail.com

    2006-04-01

    Purpose: To test whether the clinically available growth factor erythropoietin (EPO) influences radiation-induced normal-tissue damage in a model of kidney dysfunction. Methods: Animal experiments were conducted to test the role of EPO administration in a C3H mouse model of unilateral kidney irradiation with 6, 8, and 10 Gy and to assess the effects of 2 different dose levels of EPO. The kidney function was assessed before radiotherapy, as well as 19, 25, 31, and 37 weeks thereafter by means of {sup 99m}Tc-dimercaptosuccinat scans (static scintigraphy). Results: Concomitant EPO administration significantly increased the degree of radiation-induced kidney dysfunction. A dose of 2,000 IU/kg body weight per injection tended to cause more damage than the lower dose of 500 IU/kg. Conclusion: Administration of growth factors concomitant to radiotherapy might modify the development of kidney dysfunction. Although insulin-like growth factor-1 has previously been shown to protect the kidney, such an effect could not be demonstrated for EPO. The latter agent even increased the development of nephropathy.

  11. Video-assisted thoracic surgery for cancer after thoracic aortic aneurysm repair.

    PubMed

    Taylor, Lauren J; Adesoye, Taiwo; Maloney, James D

    2016-02-01

    Video-assisted thoracoscopic surgery is increasingly accepted as an alternative to open thoracotomy and has established efficacy in the management of non-small-cell lung cancer, but the presence of extensive intrapleural adhesions has been considered a deterrent to a minimally invasive approach. We report the successful use of video-assisted thoracoscopic surgery in 3 patients with history of open thoracic aortic aneurysm repair who presented with left lower lobe stage I non-small-cell lung cancer. While this approach is feasible, it is technically demanding and thus, at the present time, we recommend that its use be limited to high-volume video-assisted thoracoscopic surgery centers. PMID:26430132

  12. Radiation injury in the human kidney: A prospective analysis using specific scintigraphic and biochemical endpoints

    SciTech Connect

    Dewit, L.; Anninga, J.K.; Hoefnagel, C.A.; Nooijen, W.J. )

    1990-10-01

    Renal function was prospectively analyzed in 26 evaluable patients, irradiated to various doses on their kidneys for neoplastic disease. Glomerular function was assessed by 99mTc-DTPA renography, creatinine clearance, and serum beta 2-microglobulin, whereas tubular function was monitored by 99mTc-DMSA scintigraphy, urine beta 2-microglobulin, urine N-acetyl glucosaminidase, and alanine aminopeptidase and a urine concentration test. In the patients given the highest irradiation dose to the entire left kidney, that is, 40 Gy in 5 1/2 weeks, glomerular and tubular functional impairment, as assessed scintigraphically, progressed at a rate of 2.0 +/- 1.0% (+/- 1 SD) and 2.0 +/- 0.5% per month, respectively, down to 30-40% after 3 to 5 years. The overall glomerular function, as assessed by creatinine clearance, decreased by only 20%. In the patients irradiated unilaterally on the upper pole to 40 Gy in 4 weeks, glomerular and tubular function in the left kidney deteriorated at 0.75 +/- 0.33% and 0.75 +/- 0.20% per month in the first 2 years, down to 75-80% at 5 years. This smaller reduction was due to shielding of a part of the left kidney. No changes were observed, thus far, after bilateral whole kidney irradiation to 17-18 Gy in 3 1/2 weeks. The concentration capacity of the kidney after total volume irradiation was not impaired. There was a trend for an increase in diastolic blood pressure in 3 out of 5 patients given the high dose irradiation to the entire left kidney and in 2 out of 7 patients irradiated on the upper pole of the left kidney. The progressive nature of the radiation nephropathy stresses the need for long term follow-up to determine more accurately the tolerance dose of the human kidney for irradiation.

  13. Thoracic aortic dissection and mycotic pseudoaneurysm in the setting of an unstable upper thoracic type b2 fracture.

    PubMed

    Chaudhary, Saad B; Roselli, Eric; Steinmetz, Michael; Mroz, Thomas E

    2012-09-01

    Thoracic type B2 fractures are high-energy injuries. It is crucial to maintain a high index of suspicion for concomitant visceral injuries. A 33-year-old man presented after a motor vehicle accident with a T4 type B2.3 fracture with an associated sternum fracture. He was treated with a T4 corpectomy and an expandable titanium cage and lateral plate construct at T3-T5. Two months later he developed focal kyphosis and loosening of his screws. This was addressed with an instrumented posterior fusion from T1 to T8 complicated by a wound infection, pneumonia, and fungal esophagitis requiring several debridements and vacuum assisted closure therapy. Worsening back pain prompted a thoracic computed tomography scan, revealing a dissecting thoracic-aortic aneurysm, which was treated with an endovascular stent graft. Few months later, he presented with fevers, chills, and hemoptysis secondary to Staphylococcus aureus bacteremia, endovascular leak, and T3-T5 osteomyelitis. He was transferred to our institution and restented by the cardiothoracic service. Subsequently, he underwent a thoracotomy, evacuation of infected aneurysmal hematoma with removal of instrumentation. A revision corpectomy with iliac crest autograft reconstruction was performed without complications. The patient's infection and thoracic pain resolved. However, there was a significant delay in treatment, resulting in substantial morbidity. Patients with thoracic type B2 fractures require careful evaluation for concomitant aortic and visceral injuries. Missed associated injuries result in increased morbidity and mortality. PMID:24353965

  14. Advanced malignant mesothelioma mimicking acute contained thoracic aortic rupture

    PubMed Central

    Mouawad, Nicolas J.; Daniel, Vincent C.; Starr, Jean E.

    2014-01-01

    In the emergent setting, patients presenting with acute interscapular pain along with haemodynamic instability require immediate evaluation. We describe the case of a patient in which computed tomographic scanning demonstrated a large hyper-dense, periaortic collection on post-contrast imaging. Urgent endovascular repair was performed for descending thoracic aortic rupture. Her postoperative course, however, was atypical with a readmission 1 week after discharge with symptoms similar to her primary presentation. Alternative pathologies were then considered in a more elective setting in which the correct diagnosis of diffuse malignant mesothelioma was ultimately discovered in a patient with no previous exposure to occupational toxins. The tumour burden was advanced and the patient opted for palliative care. Herein, we suggest a consideration for oncological thoracic pathology in patients presenting with signs and symptoms mimicking acute thoracic aortic rupture or dissection, who may demonstrate atypical symptoms. PMID:24174122

  15. Update on anesthetic complications of robotic thoracic surgery.

    PubMed

    Campos, J; Ueda, K

    2014-01-01

    In the last decade, there has been increasing use of the da Vinci® robot surgical system to perform minimally invasive thoracic surgery. The robotic technology can be applied for surgery of the lungs, mediastinum, and esophagus. A number of case reports have been shown steep learning curve, and promising surgical outcome with this new technology. However, anesthesia management of the robotic thoracic surgery can be complex and requires further education. For example, most of the cases require sufficient lung collapse in order to provide adequate surgical field. In addition, a unique operative setting, such as patient positioning and capnothorax can make anesthesia management further challenging. Hence, anesthesiologists should have better awareness of adverse events or complications related to the robotic surgery to accomplish successful anesthesia management. This review will focus on the potential complications of robotic thoracic surgery involving the lungs, mediastinum and esophagus. PMID:23877310

  16. Current Evidence and Insights about Genetics in Thoracic Aorta Disease

    PubMed Central

    Muneretto, Claudio

    2013-01-01

    Thoracic aortic aneurysms have been historically considered to be caused by etiologic factors similar to those implied in abdominal aortic aneurysms. However, during the past decade, there has been increasing evidence that almost 20% of thoracic aortic aneurysms may be associated with a genetic disease, often within a syndromic or familial disorder. Moreover, the presence of congenital anomalies, such as bicuspid aortic valve, may have a unique common genetic underlying cause. Finally, also sporadic forms have been found to be potentially associated with genetic disorders, as highlighted by the analysis of rare variants and expression of specific microRNAs. We therefore sought to perform a comprehensive review of the role of genetic causes in the development of thoracic aortic aneurysms, by analyzing in detail the current evidence of genetic alterations in syndromes such as Marfan, Loeys-Dietz, and Ehler-Danlos, familial or sporadic forms, or forms associated with bicuspid aortic valve. PMID:24453931

  17. A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery

    PubMed Central

    2014-01-01

    Background We aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations. Methods One hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group). In both groups, epidural catheters were administered. Hemodynamic measurements, visual analog scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively. Results The VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2, 4, 8, and 16 hours after surgery (for VAS-R, P?=?0.001, P?=?0.01, P?=?0.008, and P?=?0.029, respectively; and for VAS-C, P?=?0.035, P?=?0.023, P?=?0.002, and P?=?0.037, respectively). Total 24-hour analgesic consumption was different between groups (175 +/- 20 mL versus 185 +/- 31 mL; P?=?0.034). The comparison of postoperative complications revealed that the incidence of hypotension (21/57, 36.8% versus 8/63, 12.7%; P?=?0.002), bradycardia (9/57, 15.8% versus 2/63, 3.2%; P?=?0.017), atelectasis (1/57, 1.8% versus 7/63, 11.1%; P?=?0.04), and the need for intensive care unit (ICU) treatment (0/57, 0% versus 5/63, 7.9%; P?=?0.03) were lower in the TEA group in comparison to the LEA group. Conclusions TEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile. PMID:24885545

  18. Congenital unilateral perisylvian syndrome: radiological basis and clinical correlations.

    PubMed Central

    Sébire, G; Husson, B; Dusser, A; Navelet, Y; Tardieu, M; Landrieu, P

    1996-01-01

    DESIGN--Advances in neuroimaging have allowed correlations between radiological patterns and clinical features of brain malformations. This paper reports clinical, prognosis, and electroencephalographic features of six children with a previously unrecognised neuroimaging picture of unilateral widening and verticalisation of the sylvian fossa associated with an abnormal ipsilateral perisylvian cortex. RESULTS--All children had reduced hemisphere size and thalamostriatal hypoplasia ipsilateral to the cleft and hemiplegia. Cognitive development was mostly impaired. Epilepsy occurred in two patients and was mainly characterised by partial seizures. Studies with EEG showed hemispheric slowing of background activity homolateral to the perisylvian dysplasia. Occurrence of the malformation among their siblings was not found. CONCLUSION--Similar brain malformations occasionally reported in older patients confirm the clinical picture, sporadic occurrence, and prognosis found, allowing the validation of a unilateral perisylvian syndrome. Images PMID:8676160

  19. Unilateral Stance Strategies of Athletes With ACL Deficiency

    PubMed Central

    Di Stasi, Stephanie L.; Hartigan, Erin H.; Snyder-Mackler, Lynn

    2013-01-01

    Aberrant movement strategies are characteristic of ACL-deficient athletes with recurrent knee instability (non-copers), and may instigate premature or accelerate joint degradation. Biomechanical evaluation of kinematic changes over time may elucidate noncopers’ responses to neuromuscular intervention and ACL reconstruction (ACLR). Forty noncopers were randomized into a perturbation group or a strength training only group. We evaluated the effects of perturbation training, and then gender on knee angle and tibial position during a unilateral standing task before and after ACLR. No statistically significant interactions were found. Before surgery, the strength training only group demonstrated knee angle asymmetry, but 6 months after ACLR, both groups presented with similar knee flexion between limbs. Aberrant and asymmetrical tibial position was found only in females following injury and ACLR. Neither treatment group showed distinct unilateral standing strategies following intervention; however, males and female noncopers appear to respond uniquely to physical therapy and surgery. PMID:22983931

  20. Framework Surgery for Treatment of Unilateral Vocal Fold Paralysis

    PubMed Central

    Daniero, James J.; Garrett, C. Gaelyn; Francis, David O.

    2014-01-01

    Laryngeal framework surgery is the current gold standard treatment for unilateral vocal fold paralysis. It provides a permanent solution to glottic insufficiency caused by injury to the recurrent laryngeal nerve. Various modifications to the original Isshiki type I laryngoplasty procedure have been described to improve voice and swallowing outcomes. The success of this procedure is highly dependent on the experience of the surgeon as it epitomizes the intersection of art and science in the field. The following article reviews the evidence, controversies, and complications related to laryngoplasty for unilateral vocal fold paralysis. It also provides a detailed analysis of how and when arytenoid-positioning procedures should be considered, and summarizes the literature on postoperative outcomes. PMID:24883239

  1. Congenital Unilateral Deafness Affects Cerebral Organization of Reading

    PubMed Central

    Adorni, Roberta; Manfredi, Mirella; Proverbio, Alice Mado

    2013-01-01

    It is known that early sensory deprivation modifies brain functional structure and connectivity. The aim of the present study was to investigate the neuro-functional organization of reading in a patient with profound congenital unilateral deafness. Using event-related potentials (ERPs), we compared cortical networks supporting the processing of written words in patient RA (completely deaf in the right ear since birth) and in a group of control volunteers. We found that congenital unilateral hearing deprivation modifies neural mechanisms of word reading. Indeed, while written word processing was left-lateralized in controls, we found a strong right lateralization of the fusiform and inferior occipital gyri activation in RA. This finding goes in the same direction of recent proposals that the ventral occipito-temporal activity in word reading seem to lateralize to the same hemisphere as the one involved in spoken language processing. PMID:24961430

  2. Early-onset unilateral electric cataract: a rare clinical entity.

    PubMed

    Mutlu, Fatih Mehmet; Duman, Haluk; Cil, Yakup

    2004-01-01

    Electrical injury may result in cataracts, which usually occur bilaterally. In this report, we present a rare complication of such an injury presenting as a unilateral cataract in a 33-year-old woman with a painless but gradual worsening of vision in her left eye 3 weeks after sustaining a high-voltage electrical injury. A cataract did not develop in the right eye during 26 months of follow-up. The patient underwent successful cataract surgery with an excellent return of vision. Electrical injuries may result in the formation of a unilateral cataract and therefore an ophthalmic examination should be performed regularly in the early recovery period of such injuries. Cataract surgery with intraocular lens implantation results in an excellent return of vision in patients with electrical cataract who do not have any other ocular damage. PMID:15247836

  3. Offspring of patients treated for unilateral Wilms' tumor in childhood

    SciTech Connect

    Green, D.M.; Fine, W.E.; Li, F.P.

    1982-01-01

    Twenty-seven women and the wives of nine men who survived unilateral Wilms' tumor in childhood had a total of 59 live born offspring. Among the 33 infants born to women who had received orthovoltage abdominal irradiation, ten weighed less than 2500 g at birth and three died during the perinatal period. In addition, one term infant of normal weight died of complications of a breech delivery. Only one of 26 infants born to the wives of Wilms' tumor patients and unirradiated female patients weighed less than 2500 g at birth and none died. The frequency of congenital malformations and spontaneous abortions in this series was not increased, and no offspring has developed cancer. The findings suggest that the risk of Wilms' tumor is low among progeny of survivors of nonfamilial, unilateral lesions. Damage from abdominal irradiation given to girls with Wilms' tumor may predispose them to the subsequent delivery of low birthweight children.

  4. Unilateral Loss of Spontaneous Venous Pulsations in an Astronaut

    NASA Technical Reports Server (NTRS)

    Mader, Thomas H.; Gibson, C. Robert; Lee, Andrew G.; Patel, Nimesh; Hart, Steven; Pettit, Donald R.

    2014-01-01

    Spontaneous venous pulsations seen on the optic nerve head (optic disc) are presumed to be caused by fluctuations in the pressure gradient between the intraocular and retrolaminar venous systems. The disappearance of previously documented spontaneous venous pulsations is a well-recognized clinical sign usually associated with a rise in intracranial pressure and a concomitant bilateral elevation of pressure in the subarachnoid space surrounding the optic nerves. In this correspondence we report the unilateral loss of spontaneous venous pulsations in an astronaut 5 months into a long duration space flight. We documented a normal lumbar puncture opening pressure 8 days post mission. The spontaneous venous pulsations were also documented to be absent 21 months following return to Earth.. We hypothesize that these changes may have resulted from a chronic unilateral rise in optic nerve sheath pressure caused by a microgravity-induced optic nerve sheath compartment syndrome.

  5. Isolated Unilateral Frontosphenoidal Craniosynostosis: A Rare Cause of Anterior Plagiocephaly.

    PubMed

    Pickrell, Brent B; Lam, Sandi K; Monson, Laura A

    2015-09-01

    Isolated unilateral frontosphenoidal synostosis is a rare and often misdiagnosed cause of synostotic frontal plagiocephaly. It is important to distinguish the various synostotic causes of frontal plagiocephaly from deformational frontal plagiocephaly because operative intervention is required in synostotic plagiocephaly to avoid progressive deformity, whereas deformational plagiocephaly typically improves without surgery. This study reports a patient with a unique case of anterior plagiocephaly caused by left-sided frontosphenoidal craniosynostosis. The workup should include a thorough history and clinical examination followed by computed tomography scan with three-dimensional reconstruction. Frontosphenoidal synostosis should be suspected in the absence of a coronal synostosis in a child with anterior unilateral plagiocephaly and treated surgically. Good aesthetic and functional results occur with prompt diagnosis and early surgical correction. PMID:26267563

  6. Hypertension and a missing kidney

    PubMed Central

    Raina, Rupesh; Gulani, Vikas; Mehta, Lina; Jacobs, Gretta H.; Joyce, Kelly; Ponsky, Todd A.; Kenagy, David N.

    2012-01-01

    Standard initial assessment via ultrasound of a 4-year-old girl with hypertension revealed the absence of one kidney. Instead of cross-sectional imaging of the retroperitoneal space, a functional (nuclear) study was performed. This revealed a malformed kidney within the chest. Though systemic levels of renin and aldosterone were not elevated, removal of the malformed kidney normalized the blood pressure. The presence of prominent smooth muscle nodules surrounding the arteries was seen in the malformed kidney. Initial attempts to avert surgery by pharmacologically reducing blood flow to the malformed kidney were unsuccessful. The review of the literature offers little evidence to support such a strategy. PMID:25874090

  7. MAT2A mutations predispose individuals to thoracic aortic aneurysms.

    PubMed

    Guo, Dong-chuan; Gong, Limin; Regalado, Ellen S; Santos-Cortez, Regie L; Zhao, Ren; Cai, Bo; Veeraraghavan, Sudha; Prakash, Siddharth K; Johnson, Ralph J; Muilenburg, Ann; Willing, Marcia; Jondeau, Guillaume; Boileau, Catherine; Pannu, Hariyadarshi; Moran, Rocio; Debacker, Julie; Bamshad, Michael J; Shendure, Jay; Nickerson, Deborah A; Leal, Suzanne M; Raman, C S; Swindell, Eric C; Milewicz, Dianna M

    2015-01-01

    Up to 20% of individuals who have thoracic aortic aneurysms or acute aortic dissections but who do not have syndromic features have a family history of thoracic aortic disease. Significant genetic heterogeneity is established for this familial condition. Whole-genome linkage analysis and exome sequencing of distant relatives from a large family with autosomal-dominant inheritance of thoracic aortic aneurysms variably associated with the bicuspid aortic valve was used for identification of additional genes predisposing individuals to this condition. A rare variant, c.1031A>C (p.Glu344Ala), was identified in MAT2A, which encodes methionine adenosyltransferase II alpha (MAT II?). This variant segregated with disease in the family, and Sanger sequencing of DNA from affected probands from unrelated families with thoracic aortic disease identified another MAT2A rare variant, c.1067G>A (p.Arg356His). Evidence that these variants predispose individuals to thoracic aortic aneurysms and dissections includes the following: there is a paucity of rare variants in MAT2A in the population; amino acids Glu344 and Arg356 are conserved from humans to zebrafish; and substitutions of these amino acids in MAT I? are found in individuals with hypermethioninemia. Structural analysis suggested that p.Glu344Ala and p.Arg356His disrupt MAT II? enzyme function. Knockdown of mat2aa in zebrafish via morpholino oligomers disrupted cardiovascular development. Co-transfected wild-type human MAT2A mRNA rescued defects of zebrafish cardiovascular development at significantly higher levels than mRNA edited to express either the Glu344 or Arg356 mutants, providing further evidence that the p.Glu344Ala and p.Arg356His substitutions impair MAT II? function. The data presented here support the conclusion that rare genetic variants in MAT2A predispose individuals to thoracic aortic disease. PMID:25557781

  8. Prospective Evaluation of Thoracic Ultrasound in the Detection of Pneumothorax

    NASA Technical Reports Server (NTRS)

    Schwarz, K. W.; Hamilton, D. R.; Kirkpatrick, A. W.; Billica, R. D.; Williams, D. R.; Diebel, L. N.; Sargysan, A. E.; Dulchavsky, S. A.

    2000-01-01

    Introduction: Pneumothorax (PTX) occurs commonly in trauma patients and is confirmed by examination and radiography. Thoracic ultrasound (VIS) has been suggested as an alternative method for rapidly diagnosing PTX when X-ray is unavailable as in rural, military, or space flight settings; however, its accuracy and specificity are not known. Methods: We evaluated the accuracy of thoracic U/S detection of PTX compared to radiography in stable, emergency patients with a high suspicion of PTX at a Level-l trauma center over a 6-month period. Following University and NASA Institutional Review Board approval, informed consent was obtained from patients with penetrating or blunt chest trauma, or with a history consistent with PTX. Whenever possible, the presence or absence of the " lung sliding" sign or the "comet tail" artifact were determined by U/S in both hemithoraces by residents instructed in thoracic U/S before standard radiologic verification of PTX. Results were recorded on data sheets for comparison to standard radiography. Results: Thoracic VIS had a 94% sensitivity; two PTX could not be reliably diagnosed due to subcutaneous air; the true negative rate was 100%. In one patient, the VIS exam was positive while X ray did not confirm PTX; a follow-up film 1 hour later demonstrated a small PTX. The average time for bilateral thoracic VIS examination was 2 to 3 minutes. Conclusions: Thoracic ultrasound reliably diagnoses pneumothorax. Presence of the "lung sliding" sign conclusively excludes pneumothorax. Expansion of the FAST examination to include the thorax should be investigated.

  9. Donor to recipient sizing in thoracic organ transplantation

    PubMed Central

    Eberlein, Michael; Reed, Robert M

    2016-01-01

    Donor-to-recipient organ size matching is a critical aspect of thoracic transplantation. In the United States potential recipients for lung transplant and heart transplant are listed with limitations on donor height and weight ranges, respectively. Height is used as a surrogate for lung size and weight is used as a surrogate for heart size. While these measures are important predictors of organ size, they are crude surrogates that fail to incorporate the influence of sex on organ size. Independent of other measures, a man’s thoracic organs are approximately 20% larger than a woman’s. Lung size can be better estimated using the predicted total lung capacity, which is derived from regression equations correcting for height, sex and age. Similarly, heart size can be better estimated using the predicted heart mass, which adjusts for sex, age, height, and weight. These refined organ sizing measures perform better than current sizing practice for the prediction of outcomes after transplantation, and largely explain the outcome differences observed after sex-mismatch transplantation. An undersized allograft is associated with worse outcomes. In this review we examine current data pertaining to size-matching in thoracic transplantation. We advocate for a change in the thoracic allocation mechanism from a height-or-weight-based strategy to a size-matching process that utilizes refined estimates of organ size. We believe that a size-matching approach based on refined estimates of organ size would optimize outcomes in thoracic transplantation without restricting or precluding patients from thoracic transplantation. PMID:27011913

  10. Repair of unilateral cleft lip: a comparison of five techniques.

    PubMed

    Lazarus, D D; Hudson, D A; van Zyl, J E; Fleming, A N; Fernandes, D

    1998-12-01

    Repair of unilateral cleft lip is a challenging procedure with no single technique satisfactory for all types of unilateral cleft deformity. This study compares retrospectively five techniques of unilateral cleft lip repair in 72 children (45 boys, 27 girls). Twenty-two children had a Millard rotation-advancement repair, 5 children had a Davies Z-plasty, 22 had a modified Z-plasty, 10 had a Tennison-Randall triangular flap repair, and 13 had a Nakajima-Yoshimura straight-line repair. Assessment was performed clinically by a plastic surgeon not involved in the original surgery. Repairs were assessed objectively by measurement of the vertical length of both the repaired and normal sides of the lip with calipers. Subjective criteria used to evaluate the repair were the symmetry of Cupid's bow, the quality of scar, the alignment of white roll, the evenness of the vermilion, and the lip pout. The mean follow-up period was 5.4 years (range, 9 months-29 years). Sixty-five of the 72 repairs measured (90%) were within two standard deviations (SDs) of normal and thus were considered to be of "acceptable" length. Seven repairs were unacceptably short (>2 SDs) on measurement, six of which included a rotation-advancement repair for a complete cleft lip. Subjective results paralleled the objective results. The outcome following repair of unilateral cleft lip was similar for all five surgical methods assessed except for complete cleft lips repaired by the rotation-advancement technique, which tended to result in an unacceptably short lip as measured on the repaired side. PMID:9869130

  11. Mirror Therapy in Unilateral Neglect After Stroke (MUST trial)

    PubMed Central

    Arora, Rajni; Kaur, Paramdeep; Sharma, Deepika; Vishwambaran, Dheeraj K.; Arima, Hisatomi

    2014-01-01

    Objective: We explored the effectiveness of mirror therapy (MT) in the treatment of unilateral neglect in stroke patients. Methods: This is an open, blinded endpoint, randomized controlled trial carried out from January 2011 to August 2013. We included stroke patients with thalamic and parietal lobe lesions with unilateral neglect 48 hours after stroke. Patients were randomized to the MT group or the control group (sham MT), and both the groups received limb activation. Patients received treatment for 1–2 hours a day 5 days a week for 4 weeks. The primary outcome was unilateral neglect assessed by a blinded assessor using the star cancellation test, the line bisection test, and a picture identification task at 1, 3, and 6 months. This study was registered at http://clinicaltrials.gov (NCT 01735877). Results: Forty-eight patients were randomized to MT (n = 27) or the control group (n = 21). Improvement in scores on the star cancellation test over 6 months was greater in the MT group (mean difference 23, 95% confidence interval [CI] 19–28; p < 0.0001). Similarly, improvement in the MT group was observed in the scores on the picture identification task (mean difference 3.2, 95% CI 2.4–4.0; p < 0.0001) and line bisection test (mean difference 8.6, 95% CI 2.7–14.6; p = 0.006). Conclusions: In patients with stroke, MT is a simple treatment that improves unilateral neglect. Classification of evidence: This study provides Class I evidence that for patients with neglect from thalamic and parietal lobe strokes, MT improves neglect. PMID:25107877

  12. Unilateral hearing during development: hemispheric specificity in plastic reorganizations

    PubMed Central

    Kral, Andrej; Heid, Silvia; Hubka, Peter; Tillein, Jochen

    2013-01-01

    The present study investigates the hemispheric contributions of neuronal reorganization following early single-sided hearing (unilateral deafness). The experiments were performed on ten cats from our colony of deaf white cats. Two were identified in early hearing screening as unilaterally congenitally deaf. The remaining eight were bilaterally congenitally deaf, unilaterally implanted at different ages with a cochlear implant. Implanted animals were chronically stimulated using a single-channel portable signal processor for two to five months. Microelectrode recordings were performed at the primary auditory cortex under stimulation at the hearing and deaf ear with bilateral cochlear implants. Local field potentials (LFPs) were compared at the cortex ipsilateral and contralateral to the hearing ear. The focus of the study was on the morphology and the onset latency of the LFPs. With respect to morphology of LFPs, pronounced hemisphere-specific effects were observed. Morphology of amplitude-normalized LFPs for stimulation of the deaf and the hearing ear was similar for responses recorded at the same hemisphere. However, when comparisons were performed between the hemispheres, the morphology was more dissimilar even though the same ear was stimulated. This demonstrates hemispheric specificity of some cortical adaptations irrespective of the ear stimulated. The results suggest a specific adaptation process at the hemisphere ipsilateral to the hearing ear, involving specific (down-regulated inhibitory) mechanisms not found in the contralateral hemisphere. Finally, onset latencies revealed that the sensitive period for the cortex ipsilateral to the hearing ear is shorter than that for the contralateral cortex. Unilateral hearing experience leads to a functionally-asymmetric brain with different neuronal reorganizations and different sensitive periods involved. PMID:24348345

  13. Acute Contralateral Radiculopathy after Unilateral Transforaminal Lumbar Interbody Fusion

    PubMed Central

    Jang, Kyoung-Min; Kim, Young-Baeg; Park, Yong-Sook; Nam, Taek-Kyun; Lee, Young-Seok

    2015-01-01

    Objective Cases of contralateral radiculopathy after a transforaminal lumbar interbody fusion with a single cage (unilateral TLIF) had been reported, but the phenomenon has not been explained satisfactorily. The purpose of this study was to determine its incidence, causes, and risk factors. Methods We did retrospective study with 546 patients who underwent a unilateral TLIF, and used CT and MRI to study the causes of contralateral radicular symptoms that appeared within a week postoperatively. Clinical and radiological results were compared by dividing the patients into the symptomatic group and asymptomatic group. Results Contralateral symptoms occurred in 32 (5.9%) of the patients underwent unilateral TLIF. The most common cause of contralateral symptoms was a contralateral foraminal stenosis in 22 (68.8%), screw malposition in 4 (12.5%), newly developed herniated nucleus pulposus in 3 (9.3%), hematoma in 1 (3.1%), and unknown origin in 2 patients (6.3%). 16 (50.0%) of the 32 patients received revision surgery. There was no difference in visual analogue scale and Oswestry disability index between the two groups at discharge. Both preoperative and postoperative contralateral foraminal areas were significantly smaller, and postoperative segmental angle was significantly greater in the symptomatic group comparing to those of the asymptomatic group (p<0.05). Conclusion The incidence rate is not likely to be small (5.9%). If unilateral TLIF is performed for cases when preoperative contralateral foraminal stenosis already exists or when a large restoration of segmental lordosis is required, the probability of developing contralateral radiculopathy is increased and caution from the surgeon is needed. PMID:26587189

  14. Early surgical treatment in unilateral coronoid hyperplasia and facial asymmetry.

    PubMed

    Galiè, Manlio; Consorti, Giuseppe; Tieghi, Riccardo; Denes, Stefano Andrea; Fainardi, Enrico; Schmid, Judith Louisa; Neuschl, Matthias; Clauser, Luigi

    2010-01-01

    Unilateral coronoid hyperplasia is a rare condition in the pediatric age. It may be an unrecognized cause of restricted mouth opening in children.The limited jaw movement is due to the enlargement of the coronoid process of the mandible that impinges on the zygomatic arch during mouth opening. This pathologic condition is still unknown and often misdiagnosed.Although in the past the term osteochondroma has been used to describe most of the unilateral and a few of the bilateral cases, there is no histologic evidence that the process has a neoplastic origin.Microscopic examination of the removed coronoid process has revealed hyperplastic compact bone covered with a thin layer of normal cartilage.There are multiple causes of mandibular hypomobility, each of them associated with different anatomic structures and etiologies, and a large number of cases, mostly bilateral, are idiopathic in nature.Several theories of pathogenesis have been proposed: temporomandibular joint dysfunctions, mandibular hypomobility, temporalis hyperactivity, hormonal stimulus, persistent cartilage growth center, genetic inheritance, and family factors.Unilateral coronoid hyperplasia is usually due to a trauma or a pathologic condition and is associated with facial asymmetry, being more frequently seen in women with histologic chondromatous or neoplastic changes. A thorough clinical history should include information about the onset and progression of pain and other subjective symptoms.In this study, we present a case of unilateral hyperplasia of the coronoid process in a 3 year-old female who, to the best of our knowledge, is the youngest patient so far reported with such anomaly.Our findings support the recommendation that early surgical treatment and aggressive postoperative physical therapy should be taken into account to allow for recovery of morphology and growth function in children. PMID:20072021

  15. Perioperative outcomes after unilateral and bilateral total knee arthroplasty

    PubMed Central

    Memtsoudis, Stavros G.; Ma, Yan; González Della Valle, Alejandro; Mazumdar, Madhu; Gaber-Baylis, Licia K.; MacKenzie, C. Ronald; Sculco, Thomas P.

    2009-01-01

    Background The safety of bilateral total knee arthroplasties (BTKA) during the same hospitalization remains controversial. We sought to study differences in perioperative outcomes between unilateral and BTKA, and further compare BTKAs performed during the same versus different operations during the same hospitalization. Methods Nationwide Inpatient Sample data from 1998 to 2006 were analyzed. Entries for unilateral and BTKA procedures performed on the same day (simultaneous) and separate days (staged) during the same hospitalization were identified. Patient and health-care system related demographics were determined. The incidence of in-hospital mortality and procedure related complications was estimated and compared between groups. Multivariate regression was used to identify independent risk factors for morbidity and mortality. Results Despite younger average age and lower comorbidity burden, procedure related complications and in-hospital mortality were more frequent after BTKA than after unilateral procedures (9.45% vs. 7.07% and 0.30% vs. 0.14%, P<0.0001 each). An increased rate of complications was associated with a staged versus simultaneous approach with no difference in mortality (10.30% vs. 9.15% (P<0.0001) and 0.29% vs. 0.26% (P=0.2875)). Independent predictors for in-hospital mortality included: BTKA (simultaneous: OR 2.23, CI=[1.69; 2.95], P<0.0001; staged: OR 2.01, CI=[1.28; 3.41], P=0.0031), male gender (OR 2.02, CI=[1.75, 2.34], P<0.0001), age above 75 years (OR 3.96 CI=[2.77, 5.66], P<0.0001), and the presence of a number of comorbidities and complications. Conclusion BTKAs carry increased risk of perioperative morbidity and mortality compared to unilateral procedures. Staging BTKA procedures during the same hospitalization offers no mortality benefit, and may even expose patients to increased morbidity. PMID:19934863

  16. Three-Dimensional Reconstruction of Thoracic Structures: Based on Chinese Visible Human

    PubMed Central

    Luo, Na; Tan, Liwen; Fang, Binji; Li, Ying; Xie, Bing; Liu, Kaijun; Chu, Chun; Li, Min

    2013-01-01

    We managed to establish three-dimensional digitized visible model of human thoracic structures and to provide morphological data for imaging diagnosis and thoracic and cardiovascular surgery. With Photoshop software, the contour line of lungs and mediastinal structures including heart, aorta and its ramus, azygos vein, superior vena cava, inferior vena cava, thymus, esophagus, diaphragm, phrenic nerve, vagus nerve, sympathetic trunk, thoracic vertebrae, sternum, thoracic duct, and so forth were segmented from the Chinese Visible Human (CVH)-1 data set. The contour data set of segmented thoracic structures was imported to Amira software and 3D thorax models were reconstructed via surface rendering and volume rendering. With Amira software, surface rendering reconstructed model of thoracic organs and its volume rendering reconstructed model were 3D reconstructed and can be displayed together clearly and accurately. It provides a learning tool of interpreting human thoracic anatomy and virtual thoracic and cardiovascular surgery for medical students and junior surgeons. PMID:24369489

  17. Reasons to participate in European Society of Thoracic Surgeons database

    PubMed Central

    2015-01-01

    The process of data collection inevitably involves costs at various levels. Nevertheless, this effort is essential to base our knowledge and the consequent decision making on solid foundations. The European Society of Thoracic Surgeons (ESTS) database collects a large amount of data on general thoracic surgery derived from about 60 units representative of 11 nations. Since its beginning in 2001, the ESTS database has contributed to increase the knowledge and the quality of care in our specialty. The present paper illustrates the ultimate finalities and the obtained results of this data collection, providing a broad overview of the motivations to participate to the ESTS database. PMID:25984355

  18. Prolapsed thoracic intervertebral disc: the importance of CT assisted myelography.

    PubMed

    Bury, R W; Powell, T

    1989-07-01

    We present six new cases of prolapsed thoracic intervertebral disc (PTIVD), and review the clinical and radiological features, particularly with regard to the role of computed tomography (CT) examination in the diagnosis and management. In patients with atypical lower limb pain, particularly when associated with sphincter disturbances, lumbar myelography is incomplete unless supplemented by an examination of the conus region and lower thoracic cord. The supplementary use of CT in suspected PTIVD is of considerable value to the surgeon in determining the size, position, and volume of the sequestration, and the extent of excavation of the spinal cord by prolapsed disc material. PMID:2758753

  19. Coronary Revascularization Using Bilateral Internal Thoracic Arteries: Safe with Skeletonization?

    PubMed Central

    Wehman, Brody; Taylor, Bradley

    2014-01-01

    Substantial evidence exists to support a long-term survival benefit with bilateral internal thoracic artery (BITA) revascularization in coronary artery bypass grafting. However, this technique remains grossly underutilized worldwide and especially in the United States. In this review, we discuss evidence for the advantages of BITA grafting as well as the associated the risk of sternal wound complications. We then review a growing body of literature that suggests ‘skeletonization’ of the internal thoracic artery during harvest confers a protective benefit against sternal wound infection in patients receiving BITA. PMID:24761259

  20. Choroidal Thickness in Eyes with Unilateral Ocular Ischemic Syndrome

    PubMed Central

    Kim, Dong Yoon; Joe, Soo Geun; Lee, Joo Yong; Kim, June-Gone; Yang, Sung Jae

    2015-01-01

    Aim. To analyze the subfoveal choroid thickness and choroidal volume in unilateral ocular ischemic syndrome (OIS). Methods. A retrospective review was conducted for all patients with unilateral OIS from October 2010 through June 2014. The subfoveal choroidal thickness (SFChT) and choroidal volume of both eyes were compared. Results. 19 unilateral OIS patients were included in this study. The mean SFChT of OIS eyes was significantly lower than that of fellow eyes (OIS eyes: 208.89 ± 82.62??m and fellow eyes: 265.31 ± 82.77??m, P < 0.001). The choroidal volume of OIS eyes was significantly smaller than that of fellow eyes (OIS eyes: 0.16 ± 0.05?mm3 and fellow eyes: 0.21 ± 0.05?mm3, P < 0.001). Conclusion. The choroidal thickness and volume of OIS eyes were smaller than those of unaffected fellow eyes. Decreased choroidal circulation caused by carotid artery stenosis might affect the discordance of choroidal thickness and choroidal volume. PMID:26504596

  1. Intracordal auricular cartilage injection for unilateral vocal fold paralysis.

    PubMed

    Lim, Yun-Sung; Lee, Yoon Se; Lee, Jin-Choon; Lee, Byung-Joo; Wang, Soo-Geun; Park, Hee-June; Nam, Su-Bong; Bae, Yong-Chan

    2015-01-01

    We evaluated the efficacy and outcome of intracordal auricular cartilage injection in patients with unilateral vocal fold paralysis. Our interest developed from findings of a canine model study that reported that histologic characteristics of cartilage were preserved 2 and 3 years after intracordal autologous cartilage injection. Between May 2002 and July 2010, 29 patients with breathy dysphonia caused by unilateral vocal fold paralysis underwent intracordal auricular cartilage injection. Each subject underwent preoperative and postoperative perceptual assessments, acoustical voice analysis, and videostroboscopy. Fourteen patients were male, and the mean age was 52-years old. Patients were tracked for a mean duration of 257 days. Injections were performed through a transoral approach under general anesthesia. Perceptual assessments by GRBAS scale, acoustic parameters of jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time significantly improved at 3, 6, and 12 months after cartilage injection (p?unilateral vocal fold paralysis. Autologous auricular cartilage can be a safe, effective, and alternative material for vocal fold medialization, and can be a long lasting one. PMID:24764320

  2. Reliability of the Melbourne assessment of unilateral upper limb function.

    PubMed

    Randall, M; Carlin, J B; Chondros, P; Reddihough, D

    2001-11-01

    This study examines the reliability of the Melbourne Assessment of Unilateral Upper Limb Function: a quantitative test of quality of movement in children with neurological impairment. The assessment was administered to 20 children aged from 5 to 16 years (mean age 9 years 10 months, SD 2 years 10 months) who had various types and degrees of cerebral palsy (CP). The performances of the 20 children during assessment were videotaped for subsequent scoring by 15 occupational therapists. Scores were analyzed for internal consistency of test items, inter- and intrarater reliability of scorings of the same videotapes, and test-retest reliability using repeat videotaping. Results revealed very high internal consistency of test items (alpha=0.96), moderate to high agreement both within and between raters for all test items (intraclass correlations of at least 0.7) apart from item 16 (hand to mouth and down), and high interrater reliability (0.95) and intrarater reliability (0.97) for total test scores. Test-retest results revealed moderate to high intrarater reliability for item totals (mean of 0.83 and 0.79) for each rater and high reliability for test totals (0.98 and 0.97). These findings indicate that the Melbourne Assessment of Unilateral Upper Limb Function is a reliable tool for measuring the quality of unilateral upper-limb movement in children with CP. PMID:11730151

  3. Hepatitis C and Kidney Transplantation

    PubMed Central

    Carbone, Marco; Cockwell, Paul; Neuberger, James

    2011-01-01

    Hepatitis C virus (HCV) infection is relatively common among patients with end-stage kidney disease (ESKD) on dialysis and kidney transplant recipients. HCV infection in hemodialysis patients is associated with an increased mortality due to liver cirrhosis and hepatocellular carcinoma. The severity of hepatitis C-related liver disease in kidney transplant candidates may predict patient and graft survival after transplant. Liver biopsy remains the gold standard in the assessment of liver fibrosis in this setting. Kidney transplantation, not haemodialysis, seems to be the best treatment for HCV+ve patients with ESKD. Transplantation of kidneys from HCV+ve donors restricted to HCV+ve recipients is safe and associated with a reduction in the waiting time. Simultaneous kidney/liver transplantation (SKL) should be considered for kidney transplant candidates with HCV-related decompensated cirrhosis. Treatment of HCV is more complex in hemodialysis patients, whereas treatment of HCV recurrence in SLK recipients appears effective and safe. PMID:21755059

  4. The Kidney Research Predicament

    PubMed Central

    Bryan, Lisa; Ibrahim, Tod; Fischer, Michael J.

    2014-01-01

    Research funding from public and private sources has reached an all-time low. Economic conditions, sequestration, and a trend of low award success rates have created an imbalance between the supply of highly qualified research investigators and the availability of critically necessary research dollars. This grim environment continues to hinder the success of established investigators and deter potential investigators from joining the research workforce. Without action and support of innovative science, the future of the US health care system is in jeopardy, and its leadership role in medical research will decrease. This work discusses the effects of the decline in research funding, the plight of kidney research, and the impact of the American Society of Nephrology Grants Program on scientists. The ASN also calls on the entire nephrology community to rejuvenate the research environment, improve the lives of millions of people with kidney disease, and ultimately, find a cure. PMID:24652790

  5. Crossed-screw fixation of the unstable thoracic and lumbar spine.

    PubMed

    Benzel, E C; Baldwin, N G

    1995-01-01

    An ideal spinal construct should immobilize only the unstable spinal segments, and thus only the segments fused. Pedicle fixation techniques have provided operative stabilization with the instrumentation of a minimal number of spinal segments; however, some failures have been observed with pedicle instrumentation. These failures are primarily related to excessive preload forces and limitations caused by the size and orientation of the pedicles. To circumvent these problems, a new technique, the crossed-screw fixation method, was developed and is described in this report. This technique facilitates short-segment spinal fixation and uses a lateral extracavitary approach, which provides generous exposure for spinal decompression and interbody fusion. The technique employs two large transverse vertebral body screws (6.5 to 8.5 mm in diameter) to bear axial loads, and two unilateral pedicle screws (placed on the side of the exposure) to restrict flexion and extension deformation around the transverse screws and to provide three-dimensional deformity correction. The horizontal vertebral body and the pedicle screws are connected to rods and then to each other via rigid crosslinking. The transverse vertebral body screws are unloaded during insertion by placing the construct in a compression mode after the interbody bone graft is placed, thus optimizing the advantage gained by the significant "toe-in" configuration provided and further decreasing the chance for instrumentation failure. The initial results of this technique are reported in a series of 10 consecutively treated patients, in whom correction of the deformity was facilitated. Follow-up examination (average 10.1 months after surgery) demonstrated negligible angulation. Chronic pain was minimal. The crossed-screw fixation technique is biomechanically sound and offers a rapid and safe form of short-segment three-dimensional deformity correction and solid fixation when utilized in conjunction with the lateral extracavitary approach to the unstable thoracic and lumbar spine. This approach also facilitates the secure placement of an interbody bone graft. PMID:7815111

  6. Pyelonephritis and obstructive uropathy: a case of acute kidney injury.

    PubMed

    Ashmore, Adam Edward; Thompson, Christopher James

    2016-01-01

    We present a case of a man in his late 50s with a history of metastatic prostate carcinoma requiring bilateral ureteric stenting. He was admitted with increasing confusion and lethargy. He was diagnosed with sepsis and an acute kidney injury (AKI). Clinical suspicions of an obstructive component to his AKI were not confirmed by an ultrasound scan, which showed a unilateral hydronephrosis unchanged from a scan 1?month previously. A nephrostomy was performed, and frank pus aspirated. The patient's clinical state improved steadily thereafter. Patients who are dehydrated, or who have suffered from malignant or fibrotic processes affecting the retroperitoneum, may present with urinary obstruction without a corresponding increase in urinary tract dilation. Additionally, there must be a suspicion of pyonephrosis in a symptomatic patient with known hydronephrosis. Clinicians should be aware that clinical suspicions of urinary obstruction not demonstrated on ultrasound scanning require further investigation. PMID:26733429

  7. Diabetes after Kidney Donation

    PubMed Central

    Ibrahim, H. N.; Kukla, A.; Cordner, G.; Bailey, R.; Gillingham, K.; Matas, A. J.

    2013-01-01

    Kidney donors, similar to the general population, are at risk for development of type 2 diabetes mellitus (T2DM). The course of donors who develop T2DM has not been studied. We surveyed 3777 kidney donors regarding the development of T2DM. Of the 2954 who responded, 154 developed T2DM 17.7 ± 9.0 years after donation. The multivariable risk of development of T2DM was associated with type 1 DM in the recipient, male gender and body mass index >30 kg/m2 at time of donation. Compared to age, gender, duration after donation and body mass index (BMI)-matched non-diabetic donor controls; diabetic donors were more likely to have hypertension (70.8% vs. 36.2%, p = 0.005), proteinuria (18.8% vs. 3.9%, p < 0.0001) but had a similar serum creatinine. eGFR change after T2DM development was ?0.80 ± 0.94 mL/min/year, ?0.70 ± 0.86 in nondiabetic donors with similar duration after donation and ?0.61 ± 0.76 mL/min/year in age, gender, BMI and duration after donation matched nondiabetic donor controls. These preliminary and shor-term data demonstrate that factors associated with T2DM in kidney donors are similar to those in the general population and donors screened carefully at the time of donation do not appear to have an acceleration of diabetic kidney disease. PMID:20041863

  8. Kidney Cell Electrophoresis

    NASA Technical Reports Server (NTRS)

    Todd, P.

    1985-01-01

    Materials and procedures for microgravity electrophoresis of living human embryonic kidney cells were evaluated, ground support in the form of analytical cell electrophoresis and flow cytometry was provided and cells returned from space flight were analyzed. Preflight culture media, electrophoresis buffer, fraction collection media, temperature profiles, and urokinase assay procedures were tested prior to flight. Electrophoretic mobility distributions of aliquots of the cell population to be fractionated in flight were obtained. The protocol established and utilized is given.

  9. Neonatal Acute Kidney Injury.

    PubMed

    Selewski, David T; Charlton, Jennifer R; Jetton, Jennifer G; Guillet, Ronnie; Mhanna, Maroun J; Askenazi, David J; Kent, Alison L

    2015-08-01

    In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described. We put forth and describe the neonatal modified Kidney Diseases: Improving Global Outcomes AKI criteria and provide the rationale for its use as the standardized definition of neonatal AKI. We discuss risk factors for neonatal AKI and suggest which patient populations may warrant closer surveillance, including neonates <1500 g, infants who experience perinatal asphyxia, near term/ term infants with low Apgar scores, those treated with extracorporeal membrane oxygenation, and those requiring cardiac surgery. We provide recommendations for the evaluation and treatment of these patients, including medications and renal replacement therapies. We discuss the need for long-term follow-up of neonates with AKI to identify those children who will go on to develop chronic kidney disease. This review highlights the deficits in our understanding of neonatal AKI that require further investigation. In an effort to begin to address these needs, the Neonatal Kidney Collaborative was formed in 2014 with the goal of better understanding neonatal AKI, beginning to answer critical questions, and improving outcomes in these vulnerable populations. PMID:26169430

  10. Claudins and the kidney.

    PubMed

    Yu, Alan S L

    2015-01-01

    Claudins are tight-junction membrane proteins that function as both pores and barriers in the paracellular pathway in epithelial cells. In the kidney, claudins determine the permeability and selectivity of different nephron segments along the renal tubule. In the proximal tubule, claudins have a role in the bulk reabsorption of salt and water. In the thick ascending limb, claudins are important for the reabsorption of calcium and magnesium and are tightly regulated by the calcium-sensing receptor. In the distal nephron, claudins need to form cation barriers and chloride pores to facilitate electrogenic sodium reabsorption and potassium and acid secretion. Aldosterone and the with-no-lysine (WNK) proteins likely regulate claudins to fine-tune distal nephron salt transport. Genetic mutations in claudin-16 and -19 cause familial hypomagnesemic hypercalciuria with nephrocalcinosis, whereas polymorphisms in claudin-14 are associated with kidney stone risk. It is likely that additional roles for claudins in the pathogenesis of other types of kidney diseases have yet to be uncovered. PMID:24948743

  11. Acute kidney injury

    PubMed Central

    Müller, Gerhard Anton

    2015-01-01

    Abstract: Acute kidney injury is a frequent and serious complication in hospitalized patients. Mortality rates have not substantially been decreased during the last 20 years. In most patients AKI results from transient renal hypoperfusion or ischemia. The consequences include tubular cell dysfunction/damage, inflammation of the organ, and post-ischemic microvasculopathy. The two latter events perpetuate kidney damage in AKI. Clinical manifestations result from diminished excretion of water, electrolytes, and endogenous / exogenous waste products. Patients are endangered by cardiovascular complications such as hypertension, heart failure, and arrhythmia. In addition, the whole organism may be affected by systemic toxification (uremia). The diagnostic approach in AKI involves several steps with renal biopsy inevitable in some patients. The current therapy focuses on preventing further kidney damage and on treatment of complications. Different pharmacological strategies have failed to significantly improve prognosis in AKI. If dialysis treatment becomes mandatory, intermittent and continuous renal replacement therapies are equally effective. Thus, new therapies are urgently needed in order to reduce short- and long-term outcome in AKI. In this respect, stem cell-based regimens may offer promising perspectives. PMID:25618438

  12. Claudins and the Kidney

    PubMed Central

    2015-01-01

    Claudins are tight-junction membrane proteins that function as both pores and barriers in the paracellular pathway in epithelial cells. In the kidney, claudins determine the permeability and selectivity of different nephron segments along the renal tubule. In the proximal tubule, claudins have a role in the bulk reabsorption of salt and water. In the thick ascending limb, claudins are important for the reabsorption of calcium and magnesium and are tightly regulated by the calcium-sensing receptor. In the distal nephron, claudins need to form cation barriers and chloride pores to facilitate electrogenic sodium reabsorption and potassium and acid secretion. Aldosterone and the with-no-lysine (WNK) proteins likely regulate claudins to fine-tune distal nephron salt transport. Genetic mutations in claudin-16 and -19 cause familial hypomagnesemic hypercalciuria with nephrocalcinosis, whereas polymorphisms in claudin-14 are associated with kidney stone risk. It is likely that additional roles for claudins in the pathogenesis of other types of kidney diseases have yet to be uncovered. PMID:24948743

  13. N-Acetyl-seryl-aspartyl-lysyl-proline Alleviates Renal Fibrosis Induced by Unilateral Ureteric Obstruction in BALB/C Mice

    PubMed Central

    Chan, Gary C. W.; Yiu, Wai Han; Wu, Hao Jia; Wong, Dickson W. L.; Lin, Miao; Huang, Xiao Ru; Lan, Hui Yao; Tang, Sydney C. W.

    2015-01-01

    To expand the armamentarium of treatment for chronic kidney disease (CKD), we explored the utility of boosting endogenously synthesized N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP), which is augmented by inhibition of the angiotensin converting enzyme. Male BALB/c mice underwent unilateral ureteral ligation (UUO) or sham operation and received exogenously administered Ac-SDKP delivered via a subcutaneous osmotic minipump or Captopril treatment by oral gavage. Seven days after UUO, there were significant reductions in the expression of both collagen 1 and collagen 3 in kidneys treated with Ac-SDKP or Captopril, and there was a trend towards reductions in collagen IV, ?-SMA, and MCP-1 versus control. However, no significant attenuation of interstitial injury or macrophage infiltration was observed. These findings are in contrary to observations in other models and underscore the fact that a longer treatment time frame may be required to yield anti-inflammatory effects in BALB/c mice treated with Ac-SDKP compared to untreated mice. Finding an effective treatment regimen for CKD requires fine-tuning of pharmacologic protocols. PMID:26508815

  14. Survey of Thoracic CT Protocols and Technical Parameters in Korean Hospitals: Changes before and after Establishment of Thoracic CT Guideline by Korean Society of Thoracic Radiology in 2008

    PubMed Central

    2016-01-01

    We retrospectively reviewed the thoracic CT scan protocols and technical parameters obtained from hospitals in Korea, one group during May 2007 (n = 100) and the other group during January 2012 (n = 173), before and after the establishment of the thoracic CT Guideline in 2008. Each group was also divided into two subgroups according to the health care delivery level, i.e. the “A” subgroup from primary and the “B” subgroup from secondary and tertiary care hospitals. When comparing the data from 2007 and 2012, the tube current decreased from 179.1 mAs to 137.2 mAs. The scan interval decreased from 6.4 mm to 4.8 mm. Also, the insufficient scan range decreased from 19.0% to 8.7%, and the suboptimal quality scans decreased from 33.0% to 5.2%. Between groups A and B, group B had lower tube voltages, smaller scan thicknesses, and smaller scan intervals. However, group B had more phase numbers. In terms of the suboptimal quality scans, a decrease was seen in both groups. In conclusion, during the five-year time period between 2007 and 2012, a reduction in the tube current values was seen. And the overall image quality improved over the same time period. We assume that these changes are attributed to the implementation of the thoracic CT guideline in 2008. PMID:26908985

  15. Chronic abdominal pain caused by thoracic disc herniation.

    PubMed

    Whitcomb, D C; Martin, S P; Schoen, R E; Jho, H D

    1995-05-01

    A patient with 7 yr of severe disabling chronic epigastric abdominal pain attributed to chronic pancreatitis was seen in consultation before a 95% pancreatectomy for pain control. Previous attempts to identify and treat the pain lead to extensive radiographic, pharmacological, endoscopic, and surgical interventions, including a Roux-en-Y pancreaticojejunostomy. Pain control was poor despite implantation of a continuous intrathecal morphine infusion pump. A focused physical examination, however, raised the suspicion of thoracic disc disease, which was confirmed after myelogram with computed tomography. Disruption of the T7-T8 disc with protrusion into the vertebral canal and displacement of the spinal cord with an associated bone spur were identified. A microsurgical thoracic discectomy was performed. Immediately, the pain began resolving, and she was pain free and off her medications within several weeks. To our knowledge, this is the first description of a herniated thoracic disc presenting as the pain of chronic pancreatitis. The diagnosis of thoracic disc syndrome requires a high index of suspicion and should be considered in patients with chronic abdominal pain. PMID:7733103

  16. Transcatheter thoracic duct embolization in the dog. An experimental study.

    PubMed

    Pardo, A D; Bright, R M; Walker, M A; Patton, C S

    1989-01-01

    Thoracic duct embolization was created by injecting an isobutyl 2-cyanoacrylate/iophendylate (IBCA) mixture through a cannulated mesenteric lymphatic vessel in eight normal dogs. Aqueous contrast lymphangiography was repeated at minute 10 and week 6. Six dogs were euthanatized at week 6 and two dogs at month 6. Embolization with 1.5 to 3.9 ml of the mixture resulted in complete obstruction of the thoracic duct in all eight dogs. Results of lymphangiography in six dogs at week 6 showed a persistent, complete obstruction of the thoracic duct in six dogs and alternate lymphaticovenous anastomoses in four dogs. Histologically, there were a sclerosing granulomatous response surrounding the lymphatic embolus, mild congestive changes in the mesenteric lymph nodes, and mild lacteal dilatation in the jejunum. The procedure was well tolerated with only a few complications. One dog suffered partial thrombosis of the cranial vena cava by the injected material with later dislodgement and embolization of a pulmonary artery branch. Modifications have been made in the injection procedure to avoid this complication. This technique for occlusion of the thoracic duct shows potential for clinical use in the management of canine chylothorax. The obstruction appears to be complete and permanent, and surgical/anesthetic time is decreased greatly from previously described procedures. PMID:2773291

  17. [Treatment of thoracic malignancy accompanied with cardiovascular disease].

    PubMed

    Sasai, T; Sakakibara, S; Harada, A; Sasaki, K; Kato, Y; Matsuyama, K; Matsushima, S; Gomibuchi, M; Tanaka, S; Shouji, T

    1993-10-01

    We treated 10 cases of thoracic malignancy accompanied with cardiovascular disease. Among thoracic malignancy, 7 cases were lung cancer and 3 were esophageal cancer. Accompanied cardiovascular diseases were ischemic heart disease (2 cases), valvular disease (3 cases), WPW syndrome (1 case), aortic aneurysm (4 cases). The mean age was 66, ranged from 51 to 79. The simultaneous occurrence of the two lesions were observed in 6 cases and thoracic malignancy was diagnosed after a varying interval of time following surgery of cardiovascular disease in 4 cases. In cases of thoracic malignancy accompanied with heart disease, the treatment of heart disease should precede the operation of malignant disease to reduce the risk of surgery. For the patient with esophageal cancer, posterior mediastinal esophagostomy should be applied who may have heart surgery in future. In cases of coexisting malignancy and aortic aneurysm, the priority of treatment should be determined considering the size of aneurysm. If the transverse diameter of aneurysm is larger than 7 cm, there is a high risk of rupture, so surgery for the aneurysm precedes operation of malignant diseases. It is desirable to avoid concomitant operation of malignancy and cardiovascular disease. PMID:8230901

  18. Renal Damage Frequency in Patients with Solitary Kidney and Factors That Affect Progression

    PubMed Central

    Basturk, T.; Koc, Y.; Ucar, Z.; Sakaci, T.; Ahbap, E.; Kara, E.; Bayraktar, F.; Sevinc, M.; Sahutoglu, T.; Kayalar, A.; Sinangil, A.; Akgol, C.; Unsal, A.

    2015-01-01

    Background. The aim of this study is to assess renal damage incidence in patients with solitary kidney and to detect factors associated with progression. Methods. Medical records of 75 patients with solitary kidney were investigated retrospectively and divided into two groups: unilateral nephrectomy (group 1) and unilateral renal agenesis/dysplasia (group 2). According to the presence of kidney damage, each group was divided into two subgroups: group 1a/b and group 2a/b. Results. Patients in group 1 were older than those in group 2 (p = 0.001). 34 patients who comprise group 1a had smaller kidney size (p = 0.002) and higher uric acid levels (p = 0.028) than those in group 1b at presentation. Uric acid levels at first and last visit were associated with renal damage progression (p = 0.004, 0.019). 18 patients who comprise group 2a were compared with those in group 2b in terms of presence of DM (p = 0.038), HT (p = 0.003), baseline proteinuria (p = 0.014), and uric acid (p = 0.032) levels and group 2a showed higher rates for each. Progression was more common in patients with DM (p = 0.039), HT (p = 0.003), higher initial and final visit proteinuria (p = 0.014, for both), and higher baseline uric acid levels (p = 0.047). Conclusions. The majority of patients with solitary kidney showed renal damage at presentation. Increased uric acid level is a risk factor for renal damage and progression. For early diagnosis of renal damage and reducing the risk of progression, patients should be referred to a nephrologist as early as possible. PMID:26783458

  19. Beneficial effects of antioxidant vitamins on the stenotic kidney.

    PubMed

    Chade, Alejandro R; Rodriguez-Porcel, Martin; Herrmann, Joerg; Krier, James D; Zhu, Xiangyang; Lerman, Amir; Lerman, Lilach O

    2003-10-01

    Renal artery stenosis (RAS) may lead to renal injury, partly mediated through increased oxidative stress. However, the potential effects of chronic oral antioxidant intervention on the stenotic kidney remain unknown. This study was designed to test the hypothesis that chronic antioxidant vitamin supplementation in RAS would preserve renal function and structure. Single-kidney hemodynamics and function were quantified in vivo in pigs using electron-beam CT after 12 weeks of unilateral RAS (n=7), a similar degree of RAS orally supplemented with vitamins C (1 g) and E (100 IU/kg) (RAS+Vitamins, n=7), or controls (normal, n=7). Renal tissue was studied ex vivo using Western blotting and immunohistochemistry. Mean arterial pressure was similarly elevated in both RAS groups, while ischemic renal volume and glomerular filtration rate were similarly reduced. Renal blood flow was decreased in RAS compared with normal (326.5+/-99.9 versus 553.4+/-48.7 mL/min, respectively, P=0.01), but preserved in RAS+Vitamins (485.2+/-104.1 mL/min, P=0.3 versus normal). The marked increase in the expression of the NADPH-oxidase subunits p47phox and p67phox, nitrotyrosine, endothelial and inducible nitric oxide synthase, and nuclear factor-kappaB observed in RAS (P<0.05 versus normal) was normalized in RAS+Vitamins (P>0.1). Furthermore, trichrome staining and the expression of transforming growth factor-beta and tissue inhibitor of matrix-metalloproteinase-1 were also decreased in RAS+Vitamins. In conclusion, chronic blockade of the oxidative stress pathway in RAS using antioxidant vitamins improved renal hemodynamics and decreased oxidative stress, inflammation, and fibrosis in the ischemic kidney. These observations underscore the involvement of oxidative stress in renal injury in RAS and support a role for antioxidant vitamins in preserving the ischemic kidney. PMID:12925565

  20. Akt1-Mediated Fast/Glycolytic Skeletal Muscle Growth Attenuates Renal Damage in Experimental Kidney Disease

    PubMed Central

    Hanatani, Shinsuke; Araki, Satoshi; Rokutanda, Taku; Kimura, Yuichi; Walsh, Kenneth; Ogawa, Hisao

    2014-01-01

    Muscle wasting is frequently observed in patients with kidney disease, and low muscle strength is associated with poor outcomes in these patients. However, little is known about the effects of skeletal muscle growth per se on kidney diseases. In this study, we utilized a skeletal muscle-specific, inducible Akt1 transgenic (Akt1 TG) mouse model that promotes the growth of functional skeletal muscle independent of exercise to investigate the effects of muscle growth on kidney diseases. Seven days after Akt1 activation in skeletal muscle, renal injury was induced by unilateral ureteral obstruction (UUO) in Akt1 TG and wild-type (WT) control mice. The expression of atrogin-1, an atrophy-inducing gene in skeletal muscle, was upregulated 7 days after UUO in WT mice but not in Akt1 TG mice. UUO-induced renal interstitial fibrosis, tubular injury, apoptosis, and increased expression of inflammatory, fibrosis-related, and adhesion molecule genes were significantly diminished in Akt1 TG mice compared with WT mice. An increase in the activating phosphorylation of eNOS in the kidney accompanied the attenuation of renal damage by myogenic Akt1 activation. Treatment with the NOS inhibitor L-NAME abolished the protective effect of skeletal muscle Akt activation on obstructive kidney disease. In conclusion, Akt1-mediated muscle growth reduces renal damage in a model of obstructive kidney disease. This improvement appears to be mediated by an increase in eNOS signaling in the kidney. Our data support the concept that loss of muscle mass during kidney disease can contribute to renal failure, and maintaining muscle mass may improve clinical outcome. PMID:25012168