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Sample records for airway submucosal gland

  1. Mechanisms of submucosal gland morphogenesis in the airway.

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    Filali, Mohammed; Liu, Xiaoming; Cheng, Ningli; Abbott, Duane; Leontiev, Vladimir; Engelhardt, John F

    2002-01-01

    Submucosal glands (SMGs) are thought to play an important role in the pathogenesis of a number of hypersecretory lung diseases including cystic fibrosis, asthma, and chronic bronchitis. In such diseases, severe SMG hypertrophy and hyperplasia is characteristic of disease progression. Our laboratory has focused efforts on defining both the mechanism of SMG morphogenesis and the identification of SMG stem cells. To this end, we have identified a transcription factor (LEF1) that is temporally and spatially uniquely regulated in SMG progenitors during the initial stages of gland development. LEF1 expression is absolutely required for SMG development in mouse and ferret tracheas, but is insufficient to induce de novo gland development in the absence of other unknown co-factors. In an effort to delineate the transcriptional cascades responsible for inducing LEF1 expression and subsequent SMG development in the airway, we have begun to dissect the regulation of the LEF1 promoter using cell line and transgenic mouse models. Current efforts are focused on defining the cis-acting elements and transcriptional binding factors responsible for Wnt induction of the LEF1 promoter and determining whether the Wnt/beta catenin cascade plays a role in submucosal gland development in vivo.

  2. Wnt Signaling Regulates Airway Epithelial Stem Cells in Adult Murine Submucosal Glands.

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    Lynch, Thomas J; Anderson, Preston J; Xie, Weiliang; Crooke, Adrianne K; Liu, Xiaoming; Tyler, Scott R; Luo, Meihui; Kusner, David M; Zhang, Yulong; Neff, Traci; Burnette, Daniel C; Walters, Katherine S; Goodheart, Michael J; Parekh, Kalpaj R; Engelhardt, John F

    2016-06-24

    Wnt signaling is required for lineage commitment of glandular stem cells (SCs) during tracheal submucosal gland (SMG) morphogenesis from the surface airway epithelium (SAE). Whether similar Wnt-dependent processes coordinate SC expansion in adult SMGs following airway injury remains unknown. We found that two Wnt-reporters in mice (BAT-gal and TCF/Lef:H2B-GFP) are coexpressed in actively cycling SCs of primordial glandular placodes and in a small subset of adult SMG progenitor cells that enter the cell cycle 24 hours following airway injury. At homeostasis, these Wnt reporters showed nonoverlapping cellular patterns of expression in the SAE and SMGs. Following tracheal injury, proliferation was accompanied by dynamic changes in Wnt-reporter activity and the analysis of 56 Wnt-related signaling genes revealed unique temporal changes in expression within proximal (gland-containing) and distal (gland-free) portions of the trachea. Wnt stimulation in vivo and in vitro promoted epithelial proliferation in both SMGs and the SAE. Interestingly, slowly cycling nucleotide label-retaining cells (LRCs) of SMGs were spatially positioned near clusters of BAT-gal positive serous tubules. Isolation and culture of tet-inducible H2B-GFP LRCs demonstrated that SMG LRCs were more proliferative than SAE LRCs and culture expanded SMG-derived progenitor cells outcompeted SAE-derived progenitors in regeneration of tracheal xenograft epithelium using a clonal analysis competition assay. SMG-derived progenitors were also multipotent for cell types in the SAE and formed gland-like structures in xenografts. These studies demonstrate the importance of Wnt signals in modulating SC phenotypes within tracheal niches and provide new insight into phenotypic differences of SMG and SAE SCs. Stem Cells 2016.

  3. Lubiprostone stimulates secretion from tracheal submucosal glands of sheep, pigs, and humans

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    Joo, N. S.; Wine, J. J.; Cuthbert, A. W.

    2009-01-01

    Lubiprostone, a putative ClC-2 chloride channel opener, has been investigated for its effects on airway epithelia (tracheas). Lubiprostone is shown to increase submucosal gland secretion in pigs, sheep, and humans and to increase short-circuit current (SCC) in the surface epithelium of pigs and sheep. Use of appropriate blocking agents and ion-substitution experiments shows anion secretion is the driving force for fluid formation in both glands and surface epithelium. From SCC concentration-r...

  4. Vasoactive intestinal peptide stimulates tracheal submucosal gland secretion in ferret

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    Peatfield, A.C.; Barnes, P.J.; Bratcher, C.; Nadel, J.A.; Davis, B.

    1983-07-01

    We studied the effect of vasoactive intestinal peptide (VIP) on the output of 35S-labeled macromolecules from ferret tracheal explants either placed in beakers or suspended in modified Ussing chambers. In Ussing chamber experiments, the radiolabel precursor, sodium (35S)sulfate, and all drugs were placed on the submucosal side of the tissue. Washings were collected at 30-min intervals from the luminal side and were dialyzed to remove unbound 35S, leaving radiolabeled macromolecules. Vasoactive intestinal peptide at 3 X 10(-7) M stimulated bound 35S output by a mean of + 252.6% (n . 14). The VIP response was dose-dependent with a near maximal response and a half maximal response at approximately 10(-6) M and 10(-8), M, respectively. The VIP effect was not inhibited by a mixture of tetrodotoxin, atropine, I-propranolol, and phentolamine. Vasoactive intestinal peptide had no effect on the electrical properties of the of the tissues. We conclude that VIP stimulates output of sulfated-macromolecules from ferret tracheal submucosal glands without stimulating ion transport. Our studies also suggest that VIP acts on submucosal glands via specific VIP receptors. Vasoactive intestinal peptide has been shown to increase intracellular levels of cyclic AMP, and we suggest that this may be the mechanism for its effect on the output of macromolecules. This mechanism may be important in the neural regulation of submucosal gland secretion.

  5. Lubiprostone stimulates secretion from tracheal submucosal glands of sheep, pigs, and humans.

    Science.gov (United States)

    Joo, N S; Wine, J J; Cuthbert, A W

    2009-05-01

    Lubiprostone, a putative ClC-2 chloride channel opener, has been investigated for its effects on airway epithelia (tracheas). Lubiprostone is shown to increase submucosal gland secretion in pigs, sheep, and humans and to increase short-circuit current (SCC) in the surface epithelium of pigs and sheep. Use of appropriate blocking agents and ion-substitution experiments shows anion secretion is the driving force for fluid formation in both glands and surface epithelium. From SCC concentration-response relations, it is shown that for apical lubiprostone K(d) = 10.5 nM with a Hill slope of 1.08, suggesting a single type of binding site and, from the speed of the response, close to the apical surface, confirmed the rapid blockade by Cd ions. Responses to lubiprostone were reversible and repeatable, responses being significantly larger with ventral compared with dorsal epithelium. Submucosal gland secretion rates following basolateral lubiprostone were, respectively, 0.2, 0.5, and 0.8 nl gl(-1) min(-1) in humans, sheep, and pigs. These rates dwarf any contribution surface secretion adds to the accumulation of surface liquid under the influence of lubiprostone. Lubiprostone stimulated gland secretion in two out of four human cystic fibrosis (CF) tissues and in two of three disease controls, chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis (COPD/IPF), but in neither type of tissue was the increase significant. Lubiprostone was able to increase gland secretion rates in normal human tissue in the continuing presence of a high forskolin concentration. Lubiprostone had no spasmogenic activity on trachealis muscle, making it a potential agent for increasing airway secretion that may have therapeutic utility.

  6. Effect of tobacco smoke exposure on rat tracheal submucosal glands: an ultrastructural study

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    Lewis, D.J.; Jakins, P.R.

    1981-08-01

    The ultrastructural appearance of rat tracheal submucosal glands after exposure to tobacco smoke for up to two years is described. Within the mucous cells many of the rough endoplasmic reticulum cisternae were grossly dilated with an accumulation of amorphous, electron-lucent material. The Golgi zones were prominent, and the secretion granules often contained dense cores, and appeared to have coalesced. Histochemically, increased amounts of sulphated mucus were present in exposed rats. Serous, ciliated, and myoepithelial cells were unaffected by smoke exposure.

  7. HCO3- Transport in Relation to Mucus Secretion from Submucosal Glands

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    Joo NS

    2001-07-01

    Full Text Available The role of HCO(3(- transport in relation to fluid secretion by submucosal glands is being studied in sheep, pigs, cats and humans. Optical methods have been developed to measure secretion rates of mucus volume from single glands with sufficient temporal resolution to detect differences in minute-by-minute secretion rates among glands. The ionic composition and viscoelastic properties of the uncontaminated gland mucus are measured with a combination of ratiometric fluorescent indicators, ion-selective microelectrodes, FRAP, and a miniaturized, magnetic force viscometer. Sheep glands secreted basally at low rates, showed small, transient responses to alpha- and beta-adrenergic agonists, and large responses to a cholinergic agonist, carbachol. Peak rates and temporal patterns of responses to carbachol differed markedly among glands. To assess the contribution of HCO(3(- transport to gland secretion, we either inhibited Na(+/K(+/2Cl(- cotransporter (NKCC with bumetanide or replaced HCO(3(- with HEPES and gassed with O(2. Bumetanide caused a small, non-significant inhibition of basal secretion, but removal of HCO(3(-/CO(2 significantly reduced basal secretion almost by half. Both bumetanide and removal of HCO(3(-/CO(2 reduced carbachol-stimulated secretion significantly, with HCO(3(- removal having the larger effect: a reduction to 33% of control (P less than 0.01. The remaining secretory response to carbachol was nearly eliminated by bumetanide. Sheep mucus pH measured with ion selective electrodes was about 0.4 log more acidic than the bath. In humans, we observed the same pattern of responses to agonists and antagonists as in sheep, and observed a mucus pH of 7.0 using 2',7'-bis(carboxyethyl-5,6-carboxyfluorescein (BCECF. We hypothesize that HCO(3(- transport is important in the formation of mucus secretion, but that most HCO(3(- is scavenged before the final mucus appears at the duct opening. Cystic fibrosis transmembrane conductance regulator

  8. Proteomic analysis of pure human airway gland mucus reveals a large component of protective proteins.

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    Nam Soo Joo

    Full Text Available Airway submucosal glands contribute to innate immunity and protect the lungs by secreting mucus, which is required for mucociliary clearance and which also contains antimicrobial, anti-inflammatory, anti-proteolytic and anti-oxidant proteins. We stimulated glands in tracheal trimmings from three lung donors and collected droplets of uncontaminated mucus as they formed at the gland orifices under an oil layer. We analyzed the mucus using liquid chromatography-tandem mass spectrometry (LC-MS/MS. Analysis identified 5486 peptides and 441 proteins from across the 3 samples (269-319 proteins per subject. We focused on 269 proteins common to at least 2 0f 3 subjects, of which 102 (38% had protective or innate immunity functions. While many of these have long been known to play such roles, for many others their cellular protective functions have only recently been appreciated in addition to their well-studied biologic functions (e.g. annexins, apolipoproteins, gelsolin, hemoglobin, histones, keratins, and lumican. A minority of the identified proteins are known to be secreted via conventional exocytosis, suggesting that glandular secretion occurs via multiple mechanisms. Two of the observed protective proteins, major vault protein and prohibitin, have not been observed in fluid from human epithelial cultures or in fluid from nasal or bronchoalveolar lavage. Further proteomic analysis of pure gland mucus may help clarify how healthy airways maintain a sterile environment.

  9. Ion transport mechanisms linked to bicarbonate secretion in the esophageal submucosal glands.

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    Abdulnour-Nakhoul, Solange; Nakhoul, Hani N; Kalliny, Medhat I; Gyftopoulos, Alex; Rabon, Edd; Doetjes, Rienk; Brown, Karen; Nakhoul, Nazih L

    2011-07-01

    The esophageal submucosal glands (SMG) secrete HCO(3)(-) and mucus into the esophageal lumen, where they contribute to acid clearance and epithelial protection. This study characterized the ion transport mechanisms linked to HCO(3)(-) secretion in SMG. We localized ion transporters using immunofluorescence, and we examined their expression by RT-PCR and in situ hybridization. We measured HCO(3)(-) secretion by using pH stat and the isolated perfused esophagus. Using double labeling with Na(+)-K(+)-ATPase as a marker, we localized Na(+)-coupled bicarbonate transporter (NBCe1) and Cl(-)-HCO(3)(-) exchanger (SLC4A2/AE2) to the basolateral membrane of duct cells. Expression of cystic fibrosis transmembrane regulator channel (CFTR) was confirmed by immunofluorescence, RT-PCR, and in situ hybridization. We identified anion exchanger SLC26A6 at the ducts' luminal membrane and Na(+)-K(+)-2Cl(-) (NKCC1) at the basolateral membrane of mucous and duct cells. pH stat experiments showed that elevations in cAMP induced by forskolin or IBMX increased HCO(3)(-) secretion. Genistein, an activator of CFTR, which does not increase intracellular cAMP, also stimulated HCO(3)(-) secretion, whereas glibenclamide, a Cl(-) channel blocker, and bumetanide, a Na(+)-K(+)-2Cl(-) blocker, decreased it. CFTR(inh)-172, a specific CFTR channel blocker, inhibited basal HCO(3)(-) secretion as well as stimulation of HCO(3)(-) secretion by IBMX. This is the first report on the presence of CFTR channels in the esophagus. The role of CFTR in manifestations of esophageal disease in cystic fibrosis patients remains to be determined.

  10. Necrotizing sialometaplasia-like change of the esophageal submucosal glands is associated with Barrett's esophagus.

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    Braxton, David R; Nickleach, Dana C; Liu, Yuan; Farris, Alton B

    2014-08-01

    The esophageal submucosal glands (SMG) protect the squamous epithelium from insults such as gastroesophageal reflux disease by secreting mucins and bicarbonate. We have observed metaplastic changes within the SMG acini that we have termed oncocytic glandular metaplasia (OGM), and necrotizing sialometaplasia-like change (NSMLC). The aim of this study is to evaluate the associated clinicopathological parameters of, and to phenotypically characterize the SMG metaplasias. Esophagectomy specimens were retrospectively assessed on hematoxylin and eosin sections and assigned to either a Barrett's esophagus (BE) or non-BE control group. Clinicopathologic data was collected, and univariate analysis and multivariate logistic regression models were performed to assess the adjusted associations with NSMLC and OGM. Selected cases of SMG metaplasia were characterized. SMG were present in 82 esophagi that met inclusion criteria. On univariate analysis, NSMLC was associated with BE (p = 0.002). There was no relationship between NSMLC and patient age, sex, tumor size, or treatment history. OGM was associated with BE (p = 0.031). No relationship was found between OGM and patient age, sex, or tumor size. On multivariate analysis, BE was independently associated with NSMLC (odds ratio [OR] 4.95, p = 0.003). Treatment history was also independently associated with OGM (p = 0.029), but not NSMLC. Both NSMLC and OGM were non-mucinous ductal type epithelia retaining a p63-smooth muscle actin co-positive myoepithelial cell layer. NSMLC and OGM were present in endoscopic mucosal resection specimens. Our study suggests that SMG metaplasia is primarily a reflux-induced pathology. NSMLC may pose diagnostic dilemmas in resection specimens or when only partially represented in mucosal biopsies or endoscopic resection specimens.

  11. Necrotizing Sialometaplasia-Like Change of the Esophageal Submucosal Glands is Associated with Barrett’s Esophagus

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    Braxton, David R.; Nickleach, Dana C.; Liu, Yuan; Farris, Alton B.

    2014-01-01

    The esophageal submucosal glands (SMG) protect the squamous epithelium from insults such as gastroesophageal reflux disease by secreting mucins and bicarbonate. We have observed metaplastic changes within the SMG acini that we have termed oncocytic glandular metaplasia (OGM), and necrotizing sialometaplasia-like change (NSMLC). The aim of this study is to evaluate the associated clinicopathological parameters of, and to phenotypically characterize the SMG metaplasias. Esophagectomy specimens were retrospectively assessed on hematoxylin and eosin sections and assigned to either a Barrett’s esophagus (BE) or non-BE control group. Clinicopathologic data was collected, and univariate analysis and multivariate logistic regression models were performed to assess the adjusted associations with NSMLC and OGM. Selected cases of SMG metaplasia were characterized. SMG were present in 82 esophagi that met inclusion criteria. On univariate analysis, NSMLC was associated with BE (p=0.002). There was no relationship between NSMLC and patient age, sex, tumor size, or treatment history. OGM was associated with BE (p=0.031). No relationship was found between OGM and patient age, sex, or tumor size. On multivariate analysis, BE was independently associated with NSMLC (odds ratio [OR] 4.95, p =0.003). Treatment history was also independently associated with OGM (p =0.029), but not NSMLC. Both NSMLC and OGM were non-mucinous ductal type epithelia retaining a p63-smooth muscle actin co-positive myoepithelial cell layer. NSMLC and OGM were present in endoscopic mucosal resection specimens. Our study suggests that SMG metaplasia is primarily a reflux-induced pathology. NSMLC may pose diagnostic dilemmas in resection specimens or when only partially represented in mucosal biopsies or endoscopic resection specimens. PMID:24863247

  12. Defective fluid secretion from submucosal glands of nasal turbinates from CFTR-/- and CFTR (ΔF508/ΔF508 pigs.

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    Hyung-Ju Cho

    Full Text Available BACKGROUND: Cystic fibrosis (CF, caused by reduced CFTR function, includes severe sinonasal disease which may predispose to lung disease. Newly developed CF pigs provide models to study the onset of CF pathophysiology. We asked if glands from pig nasal turbinates have secretory responses similar to those of tracheal glands and if CF nasal glands show reduced fluid secretion. METHODOLOGY/PRINCIPAL FINDINGS: Unexpectedly, we found that nasal glands differed from tracheal glands in five ways, being smaller, more numerous (density per airway surface area, more sensitive to carbachol, more sensitive to forskolin, and nonresponsive to Substance P (a potent agonist for pig tracheal glands. Nasal gland fluid secretion from newborn piglets (12 CF and 12 controls in response to agonists was measured using digital imaging of mucus bubbles formed under oil. Secretion rates were significantly reduced in all conditions tested. Fluid secretory rates (Controls vs. CF, in pl/min/gland were as follows: 3 µM forskolin: 9.2±2.2 vs. 0.6±0.3; 1 µM carbachol: 143.5±35.5 vs. 52.2±10.3; 3 µM forskolin + 0.1 µM carbachol: 25.8±5.8 vs. CF 4.5±0.9. We also compared CF(ΔF508/ΔF508 with CFTR(-/- piglets and found significantly greater forskolin-stimulated secretion rates in the ΔF508 vs. the null piglets (1.4±0.8, n = 4 vs. 0.2±0.1, n = 7. An unexpected age effect was also discovered: the ratio of secretion to 3 µM forskolin vs. 1 µM carbachol was ∼4 times greater in adult than in neonatal nasal glands. CONCLUSIONS/SIGNIFICANCE: These findings reveal differences between nasal and tracheal glands, show defective fluid secretion in nasal glands of CF pigs, reveal some spared function in the ΔF508 vs. null piglets, and show unexpected age-dependent differences. Reduced nasal gland fluid secretion may predispose to sinonasal and lung infections.

  13. "Bronchial Artery Delivery of Viral Vectors for Gene delivery in Cystic Fibrosis; Superior to Airway Delivery?"

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    Coutelle Charles C

    2002-04-01

    Full Text Available Abstract Background Attempts at gene therapy for the pulmonary manifestations of Cystic Fibrosis have relied mainly on airway delivery. However the efficiency of gene transfer and expression in the airway epithelia has not reached therapeutic levels. Access to epithelial cells is not homogenous for a number of reasons and the submucosal glands cannot be reached via the airways. Presentation We propose to inject gene delivery vectors directly into bronchial arteries combined with pre-delivery of vascular endothelial growth factor to increase vascular endothelial permeability and post-delivery flow reduction by balloon occlusion. Thus it may be possible to reach mucous secreting cells of the bronchial luminal epithelium and the submucosal glands in an increased and homogenous fashion. Testing This combination of techniques to the best of our knowledge has not previously been investigated, and may enable us to overcome some of the current limitations to gene therapy for Cystic Fibrosis.

  14. Tiotropium bromide suppresses smoke inhalation and burn injury-induced ERK 1/2 and SMAD 2/3 signaling in sheep bronchial submucosal glands.

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    Jacob, Sam; Zhu, Yong; Asmussen, Sven; Ito, Hiroshi; Herndon, David N; Enkhbaatar, Perenlei; Hawkins, Hal K; Cox, Robert A

    2014-05-01

    The effects of tiotropium bromide on ERK 1/2, SMAD 2/3 and NFκB signaling in bronchial submucosal gland (SMG) cells of sheep after smoke inhalation and burn injury (S + B) were studied. We hypothesized that tiotropium would modify intracellular signaling processes within SMG cells after injury. Bronchial tissues were obtained from uninjured (sham, n = 6), S + B injured sheep 48 h after injury (n = 6), and injured sheep nebulized with tiotropium (n = 6). The percentage (mean ± SD) of cells showing nuclear localization of phosphorylated ERK 1/2, pSMAD 2/3, and NFκB (p65) was determined by immunohistochemistry. Nuclear pERK 1/2 staining was increased in injured animals as compared to sham, (66 ± 20 versus 14 ± 9), p = 0.0022, as was nuclear pSMAD, 84 ± 10 versus 20 ± 10, p = 0.0022. There was a significant decrease in pERK 1/2 labeling in the tiotropium group compared to the injured group (31 ± 20 versus 66 ± 20, p = 0.013), and also a decrease in pSMAD labeling, 62 ± 17 versus 84 ± 10, p = 0.04. A significant increase for NFκB (p65) was noted in injured animals as compared to sham (73 ± 16 versus 7 ± 6, p = 0.0022). Tiotropium-treated animals showed decreased p65 labeling as compared to injured (35 ± 17 versus 74 ± 16, p = 0.02). The decrease in nuclear expression of pERK, pSMAD and NFκB molecules in SMG cells with tiotropium treatment is suggestive that their activation after injury is mediated in part through muscarinic receptors.

  15. Vallecular Cyst: Diverse Clinical Presentation and Airway Management Techniques – A Case Series

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    Jui Lagoo

    2013-08-01

    Full Text Available Vallecular Cysts (VC are laryngeal cysts found most frequently at true vocal cords followed by epiglottis and vallecula, which develops due to obstruction of the submucosal gland. In children, they present with stridor, respiratory distress, feeding difficulty, failure to thrive or as an incidental finding on laryngoscopy. The anaesthesiologist can face the risk of obstructed breathing during mask holding, obscured laryngeal view, loss of airway, rupture of cyst and potential aspiration of cyst contents. Various techniques of airway management have been described in literature. We report a series of three cases with VC where we managed the airway successfully. We also discuss the relevant literature review.

  16. Old dilemma: asthma with irreversible airway obstruction or COPD.

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    Fattahi, Fatemeh; Vonk, Judith M; Bulkmans, Nicole; Fleischeuer, Ruth; Gouw, Annette; Grünberg, Katrien; Mauad, Thais; Popper, Helmut; Felipe-Silva, Aloisio; Vrugt, Bart; Wright, Joanne L; Yang, Hui-Min; Kocks, Janwillem W H; Hylkema, Machteld N; Postma, Dirkje S; Timens, Wim; Ten Hacken, Nick H T

    2015-11-01

    Older asthmatic patients may develop fixed airway obstruction and clinical signs of chronic obstructive pulmonary disease (COPD). We investigated the added value of pathological evaluation of bronchial biopsies to help differentiate asthma from COPD, taking into account smoking, age, and inhaled corticosteroid (ICS) use. Asthma and COPD patients (24 of each category) were matched for ICS use, age, FEV(1), and smoking habits. Five pulmonary and five general pathologists examined bronchial biopsies using an interactive website, without knowing patient information. They were asked to diagnose asthma or COPD on biopsy findings in both a pairwise and randomly mixed order of cases during four different phases, with intervals of 4-6 weeks, covering a maximal period of 36 weeks. Clinically concordant diagnoses of asthma or COPD varied between 63 %-73 %, without important differences between pairwise vs randomly mixed examination or between general vs pulmonary pathologists. The highest percentage of concordant diagnoses was in young asthmatic patients without ICS use and in COPD patients with ICS use. In non ICS users with fixed airway obstruction, a COPD diagnosis was favored if abnormal presence of glands, squamous metaplasia, and submucosal infiltrate was present and an asthma diagnosis in case of abnormal presence of goblet cells. In ICS users with fixed airway obstruction, abnormal presence of submucosal infiltrates, basement membrane thickening, eosinophils, and glands was associated with asthma. Histological characteristics in bronchial biopsies are reproducibly recognized by pathologists, yet the differentiation by histopathology between asthma and COPD is difficult without information about ICS use.

  17. [Submucosal lingual schwannoma].

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    Ulusoy, Bülent; Bozdemir, Kazım; Ersoy Çallıoğlu, Elif; Kutluhan, Ahmet; Korkmaz, Mehmet Hakan

    2015-01-01

    Schwannoma or neurilemmoma is a slow growing, solitary, and encapsulated benign tumor originating from Schwann cells of the peripheral nerves. Lingual schwannomas are rare. A 46-year-old male patient admitted with a complaint of swelling on the right half of the tongue for one year. An approximately 1x1 cm submucosal mass was detected on the right side of the tongue. The submucosal mass was totally excised under local anesthesia. Pathological examination was consistent with schwannoma. Lingual schwannomas should be considered in the differential diagnosis of tongue masses.

  18. Airway mucus, mucins and their secretory regulations%气道粘液、粘蛋白及其分泌调节

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    黄建民; 何韶衡; 赵卫华

    2003-01-01

    Mucus secreted mainly by epithelial goblet cells and submucosal glands coveting the respi-ratory tract plays an important role in the protection from external aggressions, such as solid particles,pathogens and chemical agents by mucocilialy clearance, The viscoelastic properties of mucus are mainly deter-mined by the presence of extensively - glycosylated high molecular weight mucins. A lot of factors influence the expression and secretion of mucins in airway, lead to mucus overproduction, which is a distinguishing feature of chronic obstructive pulmonaly disease (COPD) and causes disruption of the mucocilialy clearance function,resulting in airway block, chronic infection and death.

  19. CFTR and calcium-activated chloride channels in primary cultures of human airway gland cells of serous or mucous phenotype.

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    Fischer, Horst; Illek, Beate; Sachs, Lorne; Finkbeiner, Walter E; Widdicombe, Jonathan H

    2010-10-01

    Using cell culture models, we have investigated the relative importance of cystic fibrosis transmembrane conductance regulator (CFTR) and calcium-activated chloride channels (CaCC) in Cl secretion by mucous and serous cells of human airway glands. In transepithelial recordings in Ussing chambers, the CFTR inhibitor CFTR(inh)-172 abolished 60% of baseline Cl secretion in serous cells and 70% in mucous. Flufenamic acid (FFA), an inhibitor of CaCC, reduced baseline Cl secretion by ∼20% in both cell types. Methacholine and ATP stimulated Cl secretion in both cell types, which was largely blocked by treatment with 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid (BAPTA) and partially by mucosal FFA or CFTR(inh)-172 with the exception of methacholine responses in mucous cells, which were not blocked by FFA and partially (∼60%) by CFTR(inh)-172. The effects of ionomycin on short-circuit current (I(sc)) were less than those of ATP or methacholine. Forskolin stimulated Cl secretion only if Cl in the mucosal medium was replaced by gluconate. In whole cell patch-clamp studies of single isolated cells, cAMP-induced Cl currents were ∼3-fold greater in serous than mucous cells. Ionomycin-induced Cl currents were 13 times (serous) or 26 times (mucous) greater than those generated by cAMP and were blocked by FFA. In serous cells, mRNA for transmembrane protein 16A (TMEM16A) was ∼10 times more abundant than mRNA for CFTR. In mucous cells it was ∼100 times more abundant. We conclude: 1) serous and mucous cells both make significant contributions to gland fluid secretion; 2) baseline Cl secretion in both cell types is mediated predominantly by CFTR, but CaCC becomes increasingly important after mediator-induced elevations of intracellular Ca; and 3) the high CaCC currents seen in patch-clamp studies and the high TMEM16A expression in intact polarized cells sheets are not reflected in transepithelial current recordings.

  20. Endoscopic submucosal dissection

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    Pimentel-Nunes, Pedro; Dinis-Ribeiro, Mário; Ponchon, Thierry

    2015-01-01

    UNLABELLED: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system 1 2 was adopted to define the strength of recommendations and the quality of evidence. MAIN...... of colonic and rectal lesions with high suspicion of limited submucosal invasion that is based on two main criteria of depressed morphology and irregular or nongranular surface pattern, particularly if the lesions are larger than 20 mm; or ESD can be considered for colorectal lesions that otherwise cannot...

  1. Submucosal tunneling techniques: current perspectives

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    Kobara H

    2014-04-01

    Full Text Available Hideki Kobara,1 Hirohito Mori,1 Kazi Rafiq,2 Shintaro Fujihara,1 Noriko Nishiyama,1 Maki Ayaki,1 Tatsuo Yachida,1 Tae Matsunaga,1 Johji Tani,1 Hisaaki Miyoshi,1 Hirohito Yoneyama,1 Asahiro Morishita,1 Makoto Oryu,1 Hisakazu Iwama,3 Tsutomu Masaki1 1Department of Gastroenterology and Neurology, 2Department of Pharmacology, 3Life Science Research Center, Faculty of Medicine, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan Abstract: Advances in endoscopic submucosal dissection include a submucosal tunneling technique, involving the introduction of tunnels into the submucosa. These tunnels permit safer offset entry into the peritoneal cavity for natural orifice transluminal endoscopic surgery. Technical advantages include the visual identification of the layers of the gut, blood vessels, and subepithelial tumors. The creation of a mucosal flap that minimizes air and fluid leakage into the extraluminal cavity can enhance the safety and efficacy of surgery. This submucosal tunneling technique was adapted for esophageal myotomy, culminating in its application to patients with achalasia. This method, known as per oral endoscopic myotomy, has opened up the new discipline of submucosal endoscopic surgery. Other clinical applications of the submucosal tunneling technique include its use in the removal of gastrointestinal subepithelial tumors and endomicroscopy for the diagnosis of functional and motility disorders. This review suggests that the submucosal tunneling technique, involving a mucosal safety flap, can have potential values for future endoscopic developments. Keywords: submucosal endoscopy, submucosal tunneling method, natural orifice transluminal endoscopic surgery, peroral endoscopic myotomy, gastrointestinal subepithelial tumor, functional and motility disorders

  2. Submucosal Hemangioma of the Trachea in an Infant: Diagnosis and Follow-Up with 3D-CT/Bronchoscopy

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    Jungwha Choi

    2016-01-01

    Full Text Available Introduction: Infantile hemangiomas of the airway are diagnosed at bronchoscopy as part of the investigation of stridor or other respiratory symptoms. Here, we present three-dimensional computed tomography (3D-CT/bronchoscopy findings of submucosal subglottic hemangioma missed at bronchoscopy. Case Presentation: We report on the clinical usefulness of 3D-CT/bronchoscopy as the primary diagnostic tool and follow-up method in the evaluation of suspected airway infantile hemangiomas, especially when the hemangioma is the submucosal type. Conclusions: 3D-CT/bronchoscopy will reduce the need for invasive laryngoscopic studies and help to diagnose submucosal hemangiomas undetected on laryngoscope. Additionally, 3D-CT/bronchoscopy will help evaluating the extent of the lesion, degree of airway narrowing, and treatment response.

  3. Analysis of airway epithelial regeneration and repair following endobronchial brush biopsy in sheep.

    Science.gov (United States)

    Yahaya, B; Baker, A; Tennant, P; Smith, S H; Shaw, D J; McLachlan, G; Collie, D D S

    2011-11-01

    Understanding the fundamental processes involved in repairing the airway wall following injury is fundamental to understanding the way in which these processes are perturbed during disease pathology. Indeed complex diseases such as asthma and chronic obstructive pulmonary disease (COPD) have at their core evidence of airway wall remodeling processes that play a crucial functional role in these diseases. The authors sought to understand the dynamic cellular events that occur during bronchial airway epithelial repair in sheep. The injury was induced by endobronchial brush biopsy (BBr), a process that causes epithelial débridement and induces a consequential repair process. In addition, the current experimental protocol allowed for the time-dependent changes in airway wall morphology to be studied both within and between animals. The initial débridement was followed by evidence of dedifferentiation in the intact epithelium at the wound margins, followed by proliferation of cells both within the epithelium and in the deeper wall structures, notably in association with the submucosal glands and smooth muscle bundles. Seven days after injury, although the airway wall was thickened at the site of damage, the epithelial layer was intact, with evidence of redifferentiation. These studies, in demonstrating broad agreement with previous studies in small animals, indicate the wider relevance of this system as a comparative model and should provide a solid basis upon which to further characterize the critical cellular and molecular interactions that underlie both effective restitution and pathological repair.

  4. Effects of ozone on the cholinergic secretory responsiveness of ferret tracheal glands

    Energy Technology Data Exchange (ETDEWEB)

    McBride, R.K.; Oberdoerster, G.; Marin, M.G. (Univ. of Rochester School of Medicine and Dentistry, NY (USA))

    1991-06-01

    Oxidant air pollutants exacerbate several pulmonary diseases. Inhalation of ozone has been shown to induce airway smooth muscle hyperresponsiveness. Oxidant injury could also affect airway secretory mechanisms. The authors postulated that oxidant exposure would alter the glycoconjugate secretory function of airway submucosal glands. To test this hypothesis they examined the effects of in vivo ozone exposure on the in vitro secretory responsiveness of ferret tracheal glands. Ferrets were exposed to 1 ppm ozone, 24 hr/day for 3 or 7 days. Following exposure, glandular explants, denuded of surface epithelial cells, were prepared and incubated in medium containing 3H-glucosamine for 18 hr. Basal secretion of labeled glycoconjugates was significantly increased 31% following 3 days of ozone exposure (P less than or equal to 0.05) and remained elevated 11% after 7 days of exposure compared to the air-exposed group. After 3 or 7 days of exposure to ozone, tracheal gland responsiveness to carbachol was increased as indicated by significantly lower EC50 values (log molar concentration) of -6.43 {plus minus} 0.04 (n = 6) and -6.50 {plus minus} 0.11 (n = 5), respectively; compared to -6.20 {plus minus} 0.08 (n = 6) for the air-exposed group. There was no difference in carbachol EC50 values for air and 7-day ozone-exposed animals treated with dexamethasone. Dexamethasone did not attenuate the ozone-induced increase in basal secretion. Tracheal gland responsiveness to {alpha}- or {beta}-adrenergic agonists was not changed by oxidant exposure. These experiments suggest that oxidant injury not only increases basal secretion of respiratory glycoconjugates but also increases tracheal gland sensitivity to a cholinergic agonist.

  5. Enhanced Edar signalling has pleiotropic effects on craniofacial and cutaneous glands.

    Directory of Open Access Journals (Sweden)

    Shie Hong Chang

    Full Text Available The skin carries a number of appendages, including hair follicles and a range of glands, which develop under the influence of EDAR signalling. A gain of function allele of EDAR is found at high frequency in human populations of East Asia, with genetic evidence suggesting recent positive selection at this locus. The derived EDAR allele, estimated to have reached fixation more than 10,000 years ago, causes thickening of hair fibres, but the full spectrum of phenotypic changes induced by this allele is unknown. We have examined the changes in glandular structure caused by elevation of Edar signalling in a transgenic mouse model. We find that sebaceous and Meibomian glands are enlarged and that salivary and mammary glands are more elaborately branched with increased Edar activity, while the morphology of eccrine sweat and tracheal submucosal glands appears to be unaffected. Similar changes to gland sizes and structures may occur in human populations carrying the derived East Asian EDAR allele. As this allele attained high frequency in an environment that was notably cold and dry, increased glandular secretions could represent a trait that was positively selected to achieve increased lubrication and reduced evaporation from exposed facial structures and upper airways.

  6. MRI Findings of Rectal Submucosal Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hon Soul; Kim, Joo Hee; Lim, Joon Seok; Choi, Jin Young; Chung, Yong Eun; Park, Mi Suk; Kim, Myeong Jin; Kim, Ki Whang; Kim, Sang Kyum [Yonsei University Health System, Seoul (Korea, Republic of)

    2011-08-15

    Rectal submucosal lesions encompass a wide variety of benign and malignant tumors involving the rectum. With optical colonoscopy, any mass-like protrusion covered by normal mucosa, whether the underlying process is intramural or extramural in origin, may be reported as a submucosal lesion. Whereas the assessment of submucosal lesions may be limited with performing optical colonoscopy, cross-sectional imaging such as CT, transrectal ultrasonography and MRI allows the evaluation of perirectal tissues and pelvic organs in addition to the entire thickness of the rectum, and so this is advantageous for the assessment of rectal submucosal tumors. Among these, MRI is the best investigative modality for soft tissue characterization. Therefore, knowledge of the MRI features of rectal submucosal tumors can help achieve accurate preoperative diagnoses and facilitate the appropriate management.

  7. Vitronectin Expression in the Airways of Subjects with Asthma and Chronic Obstructive Pulmonary Disease

    Science.gov (United States)

    Salazar-Peláez, Lina M.; Abraham, Thomas; Herrera, Ana M.; Correa, Mario A.; Ortega, Jorge E.; Paré, Peter D.; Seow, Chun Y.

    2015-01-01

    Vitronectin, a multifunctional glycoprotein, is involved in coagulation, inhibition of the formation of the membrane attack complex (MAC), cell adhesion and migration, wound healing, and tissue remodeling. The primary cellular source of vitronectin is hepatocytes; it is not known whether resident cells of airways produce vitronectin, even though the glycoprotein has been found in exhaled breath condensate and bronchoalveolar lavage from healthy subjects and patients with interstitial lung disease. It is also not known whether vitronectin expression is altered in subjects with asthma and COPD. In this study, bronchial tissue from 7 asthmatic, 10 COPD and 14 control subjects was obtained at autopsy and analyzed by immunohistochemistry to determine the percent area of submucosal glands occupied by vitronectin. In a separate set of experiments, quantitative colocalization analysis was performed on tracheobronchial tissue sections obtained from donor lungs (6 asthmatics, 4 COPD and 7 controls). Vitronectin RNA and protein expressions in bronchial surface epithelium were examined in 12 subjects who undertook diagnostic bronchoscopy. Vitronectin was found in the tracheobronchial epithelium from asthmatic, COPD, and control subjects, although its expression was significantly lower in the asthmatic group. Colocalization analysis of 3D confocal images indicates that vitronectin is expressed in the glandular serous epithelial cells and in respiratory surface epithelial cells other than goblet cells. Expression of the 65-kDa vitronectin isoform was lower in bronchial surface epithelium from the diseased subjects. The cause for the decreased vitronectin expression in asthma is not clear, however, the reduced concentration of vitronectin in the epithelial/submucosal layer of airways may be linked to airway remodeling. PMID:25768308

  8. Vitronectin expression in the airways of subjects with asthma and chronic obstructive pulmonary disease.

    Directory of Open Access Journals (Sweden)

    Lina M Salazar-Peláez

    Full Text Available Vitronectin, a multifunctional glycoprotein, is involved in coagulation, inhibition of the formation of the membrane attack complex (MAC, cell adhesion and migration, wound healing, and tissue remodeling. The primary cellular source of vitronectin is hepatocytes; it is not known whether resident cells of airways produce vitronectin, even though the glycoprotein has been found in exhaled breath condensate and bronchoalveolar lavage from healthy subjects and patients with interstitial lung disease. It is also not known whether vitronectin expression is altered in subjects with asthma and COPD. In this study, bronchial tissue from 7 asthmatic, 10 COPD and 14 control subjects was obtained at autopsy and analyzed by immunohistochemistry to determine the percent area of submucosal glands occupied by vitronectin. In a separate set of experiments, quantitative colocalization analysis was performed on tracheobronchial tissue sections obtained from donor lungs (6 asthmatics, 4 COPD and 7 controls. Vitronectin RNA and protein expressions in bronchial surface epithelium were examined in 12 subjects who undertook diagnostic bronchoscopy. Vitronectin was found in the tracheobronchial epithelium from asthmatic, COPD, and control subjects, although its expression was significantly lower in the asthmatic group. Colocalization analysis of 3D confocal images indicates that vitronectin is expressed in the glandular serous epithelial cells and in respiratory surface epithelial cells other than goblet cells. Expression of the 65-kDa vitronectin isoform was lower in bronchial surface epithelium from the diseased subjects. The cause for the decreased vitronectin expression in asthma is not clear, however, the reduced concentration of vitronectin in the epithelial/submucosal layer of airways may be linked to airway remodeling.

  9. Activated nuclear factor kappa B and airway inflammation after smoke inhalation and burn injury in sheep.

    Science.gov (United States)

    Cox, Robert A; Burke, Ann S; Jacob, Sam; Oliveras, Gloria; Murakami, Kazunori; Shimoda, Katsumi; Enkhbaatar, Perenlei; Traber, Lillian D; Herndon, David N; Traber, Daniel L; Hawkins, Hal K

    2009-01-01

    In a recent study, we have shown a rapid inflammatory cell influx across the glandular epithelium and strong proinflammatory cytokine expression at 4 hours after inhalation injury. Studies have demonstrated a significant role of nuclear factor kappa B in proinflammatory cytokine gene transcription. This study examines the acute airway inflammatory response and immunohistochemical detection of p65, a marker of nuclear factor kappa B activation, in sheep after smoke inhalation and burn injury. Pulmonary tissue from uninjured sheep and sheep at 4, 8, 12, 24, and 48 hours after inhalation and burn injury was included in the study. Following immunostaining for p65 and myeloperoxidase, the cell types and the percentage of bronchial submucosal gland cells staining for p65 and the extent of myeloperoxidase stained neutrophils in the bronchial submucosa were determined. Results indicate absence of detection of P65 before 12 hours after injury. At 12 hours after injury, strong perinuclear staining for p65 was evident in bronchial gland epithelial cells, macrophages, and endothelial cells. Bronchial submucosal gland cells showed a significant increase in the percentage of cells stained for p65 compared with uninjured animals and earlier times after injury, P macrophages, and endothelial cells. Quantitation of the neutrophil influx into the bronchial submucosa showed a significant increase compared with uninjured tissue at 24 and 48 hours after injury, P < .05. In conclusion, immunohistochemical detection of activated p65 preceded the overall inflammatory response measured in the lamina propria. However, detection of p65 did not correlate with a recent study showing rapid emigration of neutrophils at 4 hours postinjury. Together, these results suggest that p65 immunostaining may identify cells that are activated to produce proinflammatory cytokines after injury; however, the immunoexpression may not adequately reflect the temporal activation of gene transcription that may

  10. Polyethylene glycol submucosal irrigation: a novel approach to improve visibility during endoscopic submucosal dissection

    Science.gov (United States)

    Arantes, Vitor; Toyonaga, Takashi; Piñeros, Elias Alfonso Forero

    2014-01-01

    In order to expand the availability of endoscopic submucosal dissection (ESD), measures to facilitate the procedure are necessary. When bleeding occurs, the examiner’s field of vision is critically impaired, and ESD becomes less efficient and more hazardous because of the presence of submucosal hematoma and covered blood clot. We propose the use of polyethylene glycol (PEG) irrigation as a simple and effective measure to improve visibility during submucosal dissection, particularly when bleeding occurs. PEG irrigation facilitates further dissection by allowing a better recognition of the submucosal fibers and muscularis propria layer. PMID:26134968

  11. Endoscopically removed giant submucosal lipoma

    Directory of Open Access Journals (Sweden)

    Jovanović Ivan

    2007-01-01

    Full Text Available Background. Although uncommon, giant submucosal colon lipomas merit attention as they are often presented with dramatic clinical features such as bleeding, acute bowel obstruction, perforation and sometimes may be mistaken for malignancy. There is a great debate in the literature as to how to treat them. Case report. A patient, 67-year old, was admitted to the Clinic due to a constipation over the last several months, increasing abdominal pain mainly localized in the left lower quadrant accompanied by nausea, vomiting and abdominal distension. Physical examination was unremarkable and the results of the detailed laboratory tests and carcinoembryonic antigen remained within normal limits. Colonoscopy revealed a large 10 cm long, and 4 to 5 cm in diameter, mobile lesion in his sigmoid colon. Conventional endoscopic ultrasound revealed 5 cm hyperechoic lesion of the colonic wall. Twenty MHz mini-probe examination showed that lesion was limited to the submucosa. Since polyp appeared too large for a single transaction, it was removed piecemeal. Once the largest portion of the polyp has been resected, it was relatively easy to place the opened snare loop around portions of the residual polyp. Endoscopic resection was carried out safely without complications. Histological examination revealed the common typical histological features of lipoma elsewhere. The patient remained stable and eventually discharged home. Four weeks later he suffered no recurrent symptoms. Conclusion. Colonic lipomas can be endoscopically removed safely eliminating unnecessary surgery.

  12. Gastric inverted hyperplasic polyp composed only of pyloric glands: a rare case report and review of the literature.

    Science.gov (United States)

    Jung, Minsun; Min, Kyueng-Whan; Ryu, Young-Joon

    2015-06-01

    Inverted hyperplastic polyp (IHP) in stomach is a rare benign gastric polypoid lesion, characterized by downward growth of hyperplastic mucosal glands into the submucosal layer. In most previous reported cases, gastric IHP showed mixtures of fundic-type gland, pyloric-type gland, and foveolar-type epithelium. Also, a case of IHP composed of only one type of gland is extremely rare. This report describes a case of a 70-year-old man with gastric IHP, composed only of pyloric-type gland. It was removed completely by endoscopic submucosal dissection, and patient showed no recurrence over 2 years after treatment.

  13. Submucosal Hemangioma of the Trachea in an Infant: Diagnosis and Follow-Up with 3D-CT/Bronchoscopy

    OpenAIRE

    Jungwha Choi; Soo Ah Im; Jee Young Kim

    2016-01-01

    Introduction: Infantile hemangiomas of the airway are diagnosed at bronchoscopy as part of the investigation of stridor or other respiratory symptoms. Here, we present three-dimensional computed tomography (3D-CT)/bronchoscopy findings of submucosal subglottic hemangioma missed at bronchoscopy. Case Presentation: We report on the clinical usefulness of 3D-CT/bronchoscopy as the primary diagnostic tool and follow-up method in the e...

  14. Retrotracheal thymoma masquerading as esophageal submucosal tumor

    Institute of Scientific and Technical Information of China (English)

    Sheung-Fat Ko; Yuan-Hsiung Tsai; Hsuan-Ying Huang; Shu-Hang Ng; Fu-Ming Fang; Yeh Tang; Ming-Tse Sung; Ming-Jang Hsieh

    2005-01-01

    A 42-year-old man presented with a two-year history of progressive dysphagia and hoarseness. Esophagogram and endoscopy revealed submucosal mass effect on the upper esophagus. Computed tomography and magnetic resonance imaging revealed an elongated mass in the retrotracheal region of the lower neck with extension to the posterior mediastinum. Partial tumor resection and histopathological evaluation revealed a WHO type B2 thymoma. Adjuvant radiation and chemotherapy were subsequently administered resulting in complete tumor regression. To our knowledge, this is the first report of ectopic retrotracheal thymoma with clinical and imaging manifestations mimicking those for esophageal submucosal tumor.

  15. MR imaging of the lingual thyroid. Comparison to other submucosal lesions

    Energy Technology Data Exchange (ETDEWEB)

    Takashima, S.; Ueda, M.; Shibata, A.; Takayama, F.; Momose, M.; Yamashita, K. [Shinshu Univ. School of Medicine, Matsumoto (Japan). Dept. of Radiology

    2001-03-01

    Purpose: To study MR findings for clues to the diagnosis of lingual thyroid. Material and methods: MR findings and clinical and scintigraphic data of 5 cases of lingual thyroid were reviewed and the MR findings were compared to those of 16 cases of other submucosal lesions in the base of the tongue. Results: Four of the 5 patients with lingual thyroid were women and all had hypothyroidism. MR imaging depicted lingual thyroid in the midline in the base of the tongue (n=5) and additional ectopic thyroid glands in the floor of the mouth (n=2) or between the right and left sternohyoid muscles (n=1). Ectopic thyroid glands appeared isointense or hyperintense relative to muscle tissue on T1-weighted images and showed slight or fair contrast enhancement. All glands had low to intermediate T2 signal, which was also seen in 1 case of non-Hodgkin's lymphoma and 1 case of adenoid cystic carcinoma. All ectopic thyroid glands had well-defined margins, whereas malignant tumors tended to have ill-defined margins and to invade the surrounding structures. All but the 5 cases of lingual thyroid had an MR-demonstrable thyroid gland in the normal cervical position. Conclusion: A well-defined mass of low-intermediate T2 signal in the midline base of the tongue, neither with invasive tendency nor with a cervical thyroid gland in the normal site on MR imaging, may strongly indicate lingual thyroid.

  16. Gastric carcinoma originating from the heterotopicsubmucosal gastric gland treated by laparoscopy andendoscopy cooperative surgery

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Gastric carcinoma is derived from epithelial cells inthe gastric mucosa. We reported an extremely rarecase of submucosal gastric carcinoma originating fromthe heterotopic submucosal gastric gland (HSG) thatwas safely diagnosed by laparoscopy and endoscopycooperative surgery (LECS). A 66-year-old manunderwent gastrointestinal endoscopy, which detected asubmucosal tumor (SMT) of 1.5 cm in diameter on thelesser-anterior wall of the upper gastric body. The tumorcould not be diagnosed histologically, even by endoscopicultrasound-guided fine-needle aspiration biopsy. Localresection by LECS was performed to confirm a diagnosis.Pathologically, the tumor was an intra-submucosal welldifferentiated adenocarcinoma invading 5000 μm into the submucosal layer. The resected tumor had negativelateral and vertical margins. Based on the Japanesetreatment guidelines, additional laparoscopic proximalgastrectomy was curatively performed. LECS is a lessinvasive and safer approach for the diagnosis of SMT,even in submucosal gastric carcinoma originating fromthe HSG.

  17. Tissue engineering and the use of stem/progenitor cells for airway epithelium repair

    Directory of Open Access Journals (Sweden)

    GM Roomans

    2010-06-01

    Full Text Available Stem/progenitor cells can be used to repair defects in the airway wall, resulting from e.g., tumors, trauma, tissue reactions following long-time intubations, or diseases that are associated with epithelial damage. Several potential sources of cells for airway epithelium have been identified. These can be divided into two groups. The first group consists of endogenous progenitor cells present in the respiratory tract. This group can be subdivided according to location into (a a ductal cell type in the submucosal glands of the proximal trachea, (b basal cells in the intercartilaginous zones of the lower trachea and bronchi, (c variant Clara cells (Clarav-cells in the bronchioles and (d at the junctions between the bronchioles and the alveolar ducts, and (e alveolar type II cells. This classification of progenitor cell niches is, however, controversial. The second group consists of exogenous stem cells derived from other tissues in the body. This second group can be subdivided into: (a embryonic stem (ES cells, induced pluripotent stem (iPS cells, or amniotic fluid stem cells, (b side-population cells from bone marrow or epithelial stem cells present in bone marrow or circulation and (c fat-derived mesenchymal cells. Airway epithelial cells can be co-cultured in a system that includes a basal lamina equivalent, extracellular factors from mesenchymal fibroblasts, and in an air-liquid interface system. Recently, spheroid-based culture systems have been developed. Several clinical applications have been suggested: cystic fibrosis, acute respiratory distress syndrome, chronic obstructive lung disease, pulmonary fibrosis, pulmonary edema, and pulmonary hypertension. Clinical applications so far are few, but include subglottic stenosis, tracheomalacia, bronchiomalacia, and emphysema.

  18. Endoscopic submucosal dissection for small submucosal tumors of the rectum compared with endoscopic submucosal resection with a ligation device

    Science.gov (United States)

    Harada, Hideaki; Suehiro, Satoshi; Murakami, Daisuke; Nakahara, Ryotaro; Shimizu, Takanori; Katsuyama, Yasushi; Miyama, Yasunaga; Hayasaka, Kenji; Tounou, Shigetaka

    2017-01-01

    AIM To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for small rectal submucosal tumors (SMTs). METHODS Between August 2008 and March 2016, 39 patients were treated with endoscopic submucosal resection with a ligation device (ESMR-L) (n = 21) or ESD (n = 18) for small rectal SMTs in this study. Twenty-five lesions were confirmed by histological evaluation of endoscopic biopsy prior to the procedure, and 14 lesions were not evaluated by endoscopic biopsy. The results for the ESMR-L group and the ESD group were retrospectively compared, including baseline characteristics and therapeutic outcomes. RESULTS The rate of en bloc resection was 100% in both groups. Although the rate of complete endoscopic resection was higher in the ESD group than in the ESMR-L group (100% vs 95.2%), there were no significant differences between the two groups (P = 0.462). In one patient in the ESMR-L group with a previously biopsied tumor, histological complete resection with a vertical margin involvement of carcinoid tumor could not be achieved, whereas there was no incomplete resection in the ESD group. The mean length of the procedure was significantly greater in the ESD group than in the ESMR-L group (14.7 ± 6.4 min vs 5.4 ± 1.7 min, P < 0.05). The mean period of the hospitalization was also significantly longer in the ESD group than in the ESMR-L group (3.7 ± 0.9 d vs 2.8 ± 1.5 d, P < 0.05). Postoperative bleeding was occurred in one patient in the ESMR-L group. CONCLUSION Both ESMR-L and ESD were effective for treatment of small rectal SMTs. ESMR-L was simpler to perform than ESD and took less time. PMID:28250899

  19. Radiologic findings of submucosal tumors of gastrointestinal tract

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Ja; Ahn, In Oak; You, Jin Jong [College of Medicine, Gyeongsang National University, Chinju (Korea, Republic of)

    2000-05-01

    Gastrointestinal submucosal tumors originate from submucosal histologic structures such as muscles, lymph nodes, nerves, fibers and vessels. Most patients are asymptomatic. Lesions that are large or ulcerated may cause abdominal pain or upper gastrointestinal bleeding, and those that grow intraluminally sometimes become pedunculated and occasionally prolapse to cause intussusception. Adenocarcinoma is the most common primary gastrointestinal tumor, accounting for approximately 90-95% of such lesions, while submucosal tumors account for approximately 2-6% of all gastrointestinal tumors. Because their overlying mucosa appears normal, submucosal tumors age after difficult to visualize endoscopically, and for this reason, barium studies or CT scans are helpful for diagnosis. In this paper, variable CT and barium study findings of the different types of gastrointestinal submucosal tumor are demonstrated, and a brief discussion of the respective disease entities is included. (author)

  20. Diagnostic procedures for submucosal tumors in the gastrointestinal tract

    Institute of Scientific and Technical Information of China (English)

    Laura Graves Ponsaing; Katalin Kiss; Annika Loft; Lise Ingemann Jensen; Mark Berner Hansen

    2007-01-01

    This review is part one of three, which will present an update on diagnostic procedures for gastrointestinal (GI) submucosal tumors (SMTs). Part two identifies the classification and part three the therapeutic methods regarding GI SMTs. Submucosal tumors are typically asymptomatic and therefore encountered incidentally.Advances in diagnostic tools for gastrointestinal submucosal tumors have emerged over the past decade.The aim of this paper is to provide the readers with guidelines for the use of diagnostic procedures, when a submucosal tumor is suspected. Literature searches were performed to find information on diagnostics for gastrointestinal submucosal tumors. Based on the searches, the optimal diagnostic procedures and specific features of the submucosal tumors could be outlined.Standard endoscppy, capsule endoscopy and push-and-pull enteroscopy (PPE) together with barium contrast X-ray do not alone provide sufficient information, when examining submucosal tumors. Endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI) and fiuorodeoxyglucose-labeled positron emission tomography (FDG-PET) are recommended as supplementary tools.

  1. Evolution of Brunner gland hamartoma associated with Helicobacter pylori infection.

    Science.gov (United States)

    Kurella, Ravi R; Ancha, Hanumantha R; Hussain, Sanam; Lightfoot, Stan A; Harty, Richard

    2008-06-01

    The pathogenesis of Brunner gland hamartoma of the duodenum is unknown. This case report describes the chronology of the development of Brunner gland hamartoma from Brunner gland hyperplasia over a 12-year interval. The study subject, a 64-year-old man with chronic iron deficiency anemia, underwent serial upper endoscopies during this period. Repeated endoscopies demonstrated the evolution of Brunner gland hyperplasia, as manifest endoscopically by a submucosal mass, to a pedunculated polyp with histologic features of Brunner gland hamartoma. The duodenal polypoid mass was removed by snare polypectomy. The patient also had a chronic Helicobacter pylori infection of the stomach. This report details the time-dependent evolution of Brunner gland hyperplasia to hamartoma in association with chronic gastric H. pylori infection.

  2. Endoscopic submucosal dissection for gastrointestinal neoplasms

    Institute of Scientific and Technical Information of China (English)

    Naomi Kakushima; Mitsuhiro Fujishiro

    2008-01-01

    Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it:injecting fluid into the submucosa to elevate the lesion,cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of enbloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms.Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects: (1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operator's skill, and (3) organ characteristics.

  3. Endoscopic submucosal dissection for stomach neoplasms

    Institute of Scientific and Technical Information of China (English)

    Mitsuhiro Fujishiro

    2006-01-01

    Recent advances in techniques of therapeutic endoscopy for stomach neoplasms are rapidly achieved. One of the major topics in this field is endoscopic submucosal dissection (ESD). ESD is a new endoscopic technique using cutting devices to remove the tumor by thefollowing three steps: injecting fluid into the submucosa to elevate the tumor from the muscle layer, pre-cutting the surrounding mucosa of the tumor, and dissecting the connective tissue of the submucosa beneath the tumor. So the tumors are resectable in an en bloc fashion, regardless of the size, shape, coexisting ulcer,and location. Indication for ESD is strictly confined by two aspects: the possibility of nodal metastases and technical difficulty, which depends on the operators. Although long-term outcome data are still lacking, short-term outcomes of ESD are extremely favourable and laparotomy with gastrectomy is replaced with ESD in some parts of therapeutic strategy for early gastric cancer.

  4. Counter traction makes endoscopic submucosal dissection easier.

    Science.gov (United States)

    Oyama, Tsuneo

    2012-11-01

    Poor counter traction and poor field of vision make endoscopic submucosal dissection (ESD) difficult. Good counter traction allows dissections to be performed more quickly and safely. Position change, which utilizes gravity, is the simplest method to create a clear field of vision. It is useful especially for esophageal and colon ESD. The second easiest method is clip with line method. Counter traction made by clip with line accomplishes the creation of a clear field of vision and suitable counter traction thereby making ESD more efficient and safe. The author published this method in 2002. The name ESD was not established in those days; the name cutting endoscopic mucosal resection (EMR) or EMR with hook knife was used. The other traction methods such as external grasping forceps, internal traction, double channel scope, and double scopes method are introduced in this paper. A good strategy for creating counter traction makes ESD easier.

  5. Diagnostic value of dynamic contrast-enhanced MRI for submucosal palatal tumors

    Energy Technology Data Exchange (ETDEWEB)

    Matsuzaki, Hidenobu, E-mail: hidenobu@md.okayama-u.ac.jp [Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama 700-8525 (Japan); Yanagi, Yoshinobu, E-mail: ya7@md.okayama-u.ac.jp [Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama 700-8525 (Japan); Hara, Marina, E-mail: hara-m@cc.okayama-u.ac.jp [Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama 700-8525 (Japan); Katase, Naoki, E-mail: katase-n@cc.okayama-u.ac.jp [Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama 700-8525 (Japan); Hisatomi, Miki, E-mail: tomi@md.okayama-u.ac.jp [Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama 700-8525 (Japan); Unetsubo, Teruhisa, E-mail: gmd17107@s.okadai.jp [Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama 700-8525 (Japan); Konouchi, Hironobu, E-mail: kono@md.okayama-u.ac.jp [Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama 700-8525 (Japan); Takenobu, Toshihiko, E-mail: takenobu@kcgh.gr.jp [Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama 700-8525 (Japan); and others

    2012-11-15

    Objectives: To evaluate the diagnostic value of dynamic contrast-enhanced MRI (DCE-MRI) for differentiating between benign and malignant tumors in the palate. Materials and methods: 26 patients with submucosal palatal tumors were preoperatively examined using DCE-MRI. Their maximum contrast index (CImax), time of CImax (Tmax), and washout ratios (WR300 and WR600) were determined from contrast index curves. The submucosal palatal tumors were divided into two groups according to their Tmax values: the early enhancement group (Tmax < 300 s) consisted of 9 malignant tumors and 6 benign tumors, while the late enhancement group (Tmax {>=} 300 s) included one malignant tumor and 10 benign tumors. We compared the following DCE-MRI parameters between the benign and malignant tumors: CImax and Tmax in all cases and CImax, Tmax, and the washout ratios in the early enhancement group. In addition, we performed a regression analysis of the relationships between tumor size and DCE-MRI parameters; i.e., CImax, Tmax, and washout ratios, among the malignant salivary gland tumors and pleomorphic adenomas. Results: In all cases and the early enhancement group, significant differences in Tmax were detected between the benign and malignant tumors (P < 0.001 and P < 0.05, respectively), and the optimal Tmax cutoff value for differentiating between them was found to be 165 s. None of the other parameters displayed significant differences between the benign and malignant tumors. Only the WR600 of the pleomorphic adenomas was significantly correlated with tumor size (R{sup 2} = 0.92, P < 0.001). Conclusions: Tmax is a useful parameter for distinguishing between benign and malignant submucosal palatal tumors.

  6. Submucosal endoscopy: from ESD to POEM and beyond.

    Science.gov (United States)

    Inoue, Haruhiro; Santi, Esperanza Grace; Onimaru, Manabu; Kudo, Shin-ei

    2014-04-01

    Peroral endoscopic myotomy (POEM) is an evolving minimally invasive endoscopic surgical procedure, with no skin incision, intended for long-term recovery from symptoms of esophageal achalasia. POEM was developed based on both the already established surgical principles of esophageal myotomy and the advanced techniques of endoscopic submucosal dissection. This article relates how POEM was developed, and its use in practice is reported and discussed. As an extension of the POEM technique, submucosal endoscopic tumor resection is introduced.

  7. Classification of submucosal tumors in the gastrointestinal tract

    Institute of Scientific and Technical Information of China (English)

    Laura Graves Ponsaing; Katalin Kiss; Mark Berner Hansen

    2007-01-01

    This review is part two of three, which will present an update on the classification of gastrointestinal submucosal tumors. Part one treats of the diagnosis and part three of the therapeutic methods regarding gastrointestinal submucosal tumors. In the past there has been some confusion as to the classification of gastrointestinal submucosal tumors. Changes in classifications have emerged due to recent advances in mainly immunohistochemistry and electron microscopy.The aim of this paper is to update the reader on the current classification. Literature searches were performed to find information related to classification of gastrointestinal submucosal tumors. Based on these searches the twelve most frequent submucosal tumor types were chosen for description of their classification.The factors that indicate whether tumors are benign or malignant are mainly size and number of mitotic counts.Gastrointestinal stromal tumors are defined mainly by their CD117 positivity. In the future, there should be no more confusion between gastrointestinal stromal tumors and other types of submucosal tumors.

  8. Brunner's gland hyperplasia in the sand rat (Psammomys obesus).

    Science.gov (United States)

    Steinbach, T J; Kane, J D

    2013-07-01

    Brunner's glands are submucosal glands located in the proximal duodenum. Hyperplasia of the Brunner's gland has been reported rarely in humans and animals. We examined sections of the Brunner's gland from 63 sand rats submitted for necropsy over 2 years. Of the 63 animals necropsied, 45 (71%) had evidence of hyperplasia defined as nodular expansion, dilated ducts, or intraductal papillary proliferation. The hyperplasia was graded as mild in 22 (49%) of the cases, moderate in 15 (33%), and marked in 8 (18%). We found an association with both increased age and evidence of gastric ulceration and hyperplasia of the Brunner's gland. In sand rats with marked hyperplasia, 8 of 8 (100%) had evidence of gastric ulceration, compared to 13 of 18 (72%) in animals with no hyperplasia. Animals with marked hyperplasia were, on average, 8.4 months older than animals with no hyperplasia. There was no association with gender. The lesion in sand rats is histologically similar to that in humans.

  9. Mucocele of the glands of Blandin-Nuhn after lingual frenectomy.

    Science.gov (United States)

    Santos, Thiago de Santana; Filho, Paulo Ricardo Saquete Martins; Piva, Marta Rabello; Khalil Karam, Frederick

    2012-11-01

    Mucoceles are the most common lesions of the minor salivary glands and typically appear as a fluctuant, bluish, nontender, submucosal swelling with a normal overlying mucosa. Mucoceles of the glands of Blandin-Nuhn (in the anterior portion of the ventral surface of the tongue) have been considered to be uncommon. This article reports an unusual case of a large extravasation mucocele involving the ventral surface of the tongue, which appeared after a lingual frenectomy.

  10. Endocrine glands

    Science.gov (United States)

    ... Diabetes Gigantism Diabetes insipidus Cushing Disease Watch this video about: Pituitary gland Testes and ovaries: Lack of sex development (unclear genitalia) Thyroid: Congenital hypothyroidism Myxedema Goiter ...

  11. The Dolichoarteriopathia of Common Carotid Artery Narrowing the Airway

    Directory of Open Access Journals (Sweden)

    Erkan Eski

    2013-01-01

    Full Text Available Tortuousity of the common carotid artery is rarely seen in otorinolaryngologic  practice. In this report, a case of tortuous common carotid artery narrowing the airway and indenting the epiglottis is presented. In endoscopic examination, pulsating bulge at the level of right lateral farengeal wall, pyriform sinus and larynx was found in a 73 year-old female. Computerized tomographic scan showed tortuous  right common carotid artery bulging the submucosal area of the oropharynx and pyriform sinus. Awareness of the tortuous common carotid artery before any  laryngologic surgical intervention is very important to prevent serious complications.

  12. Gastric adenocarcinoma of fundic gland type: Endoscopicand clinicopathological features

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Gastric adenocarcinoma of fundic gland type (GA-FG)with chief cell differentiation was recently proposed asan extremely rare type of gastric adenocarcinoma. Here,we report 4 cases of GA-FG with chief cell differentiation.Endoscopic features included a submucosal tumor shapeor a flat shape, whitish discolorationand dilated vesselson the surface. The tumors were located in the upper ormiddle third of the stomach. All cases were preoperativelydiagnosed as GA-FG by biopsy, and endoscopic submucosaldissection was performed. Resected specimensrevealed well-differentiated adenocarcinomas resemblingchief cells. Tumor cells were diffusely positive for pepsinogen-Ⅰ,but partially positive for H+/K+-ATPase inscattered locations around the tumor margin. Despitethe presence of minimal invasion of the carcinoma intothe submucosal layer, which was observed in two cases,neither lymphatic nor venous invasion was detected inany of the cases. Finally, all cases showed less aggressiveclinical behavior with low grade malignancy.

  13. Airway management in trauma

    Directory of Open Access Journals (Sweden)

    Rashid M Khan

    2011-01-01

    Full Text Available Trauma has assumed epidemic proportion. 10% of global road accident deaths occur in India. Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients. Objective signs of airway compromise include agitation, obtundation, cyanosis, abnormal breath sound and deviated trachea. If time permits, one should carry out a brief airway assessment prior to undertaking definitive airway management in these patients. Simple techniques for establishing and maintaining airway patency include jaw thrust maneuver and/or use of oro- and nas-opharyngeal airways. All attempts must be made to perform definitive airway management whenever airway is compromised that is not amenable to simple strategies. The selection of airway device and route- oral or -nasal, for tracheal intubation should be based on nature of patient injury, experience and skill level.

  14. An Unusual Endoscopic Image of a Submucosal Angiodysplasia

    Directory of Open Access Journals (Sweden)

    Rita Carvalho

    2012-01-01

    Full Text Available Obscure gastrointestinal bleeding is responsible for 2–10% of the cases of digestive bleeding. Angiodysplasia is the most common cause. The authors report a case of a 70-year-old female patient admitted to our Gastrointestinal Intensive Care Unit with a significant digestive bleeding. Standard upper and lower endoscopy showed no abnormalities, and we decided to perform a capsule enteroscopy that revealed a submucosal nodule with active bleeding in the jejunum. An intraoperative enteroscopy confirmed the presence of a small submucosal lesion with a central ulceration, and subsequently a segmental enterectomy was performed. Surprisingly, the histopathological diagnosis was angiodysplasia. The patient remains well after a two-year period of follow-up. We present this case of obscure/overt gastrointestinal bleeding to emphasize the role of capsule and intraoperative enteroscopy in the evaluation of these situations, and because of the unusual endoscopic appearance of the angiodysplasia responsible for the hemorrhage.

  15. Expulsion of dominant submucosal fibroids after uterine artery embolization

    Energy Technology Data Exchange (ETDEWEB)

    Radeleff, Boris, E-mail: Boris_radeleff@med.uni-heidelberg.d [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Eiers, Michael; Bellemann, Nadine; Ramsauer, Stefanie [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Rimbach, Stefan [Department of Gynecology, University of Konstanz (Germany); Kauczor, Hans-Ulrich [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Richter, Goetz M. [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Clinic of Diagnostic and Interventional Radiology, Katharinenhospital, Stuttgart (Germany)

    2010-07-15

    Purpose: Purpose of this study was to evaluate the frequency, probability, and factors associated with expulsion of submucosal fibroids after uterine artery embolization (UAE) in addition to the technical and clinical results at 1-year follow-up. Materials and methods: We determined the preinterventional volume of each dominant submucosal fibroid using the commonly used ellipsoid formula and a 3D volumetry in the MRI to define a threshold value in milliliters that indicates the probability for a fibroid expulsion. Assessment of fibroid expulsion was done by MRI at 3-month intervals for a year. Assessment of clinical mid term success was achieved by applying questionnaires at 1-year follow-up. Results: Technical success was observed in all 20 patients (mean age of 41.4 {+-} 5.6 years; range: 29.2-51.1 years). Two (10%) minor and one (5%) major complications occurred. 10/20 dominant submucosal fibroids were completely expelled during the follow-up. Using 3D MRI volumetry the preinterventional mean volume of the later expelled fibroids was 56.8 {+-} 57.0 ml (range 2.3-198.0 ml) and the mean volume of non-expelled fibroids was 123.8 {+-} 147.3 ml (range 24.0-531.8 ml). This difference was statistically significant, but weak (p = 0.0494). Fibroids with a volume equal or less than the threshold value (66.0 ml) were 73% likely to be expelled and fibroids larger than 66.0 ml were 78% likely not to be expelled. All 20 patients demonstrated a significant reduction in the fibroid related symptoms. Conclusion: In our study the complication rate was low despite increased rates of fibroid expulsion (50%); simultaneously the rate of treatment satisfaction was very high. Patients with a dominant submucosal fibroid under 66.0 ml should be informed about the probability of fibroid expulsion and the accompanying symptoms.

  16. Endoscopic submucosal dissection in Spain: outcomes and development possibilities

    Directory of Open Access Journals (Sweden)

    Juan J. Vila

    2013-10-01

    Full Text Available Endoscopic submucosal dissection (ESD allows endoscopic, curative, en-bloc resection of superficial malignant or premalignant lesions. This procedure was conceived over 10 years ago in Japan, but has not experienced great expansion in Western countries for different reasons. This article reviews ESD indications and outcomes, and reflects on the reasons that prevent ESD from becoming common clinical practice in Western hospitals. Finally, recommendations on ESD training in our setting are made.

  17. Airway distensibility in Chronic Obstructive Airway Disease

    DEFF Research Database (Denmark)

    Winkler Wille, Mathilde Marie; Pedersen, Jesper Holst; Dirksen, Asger

    2013-01-01

    -20% (mild), 20%-30% (moderate) or >30% (severe). Spirometry was performed annually and participants were divided into severity groups according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Data were analysed in a mixed effects regression model with log(airway lumen diameter......Rationale – Chronic Obstructive Pulmonary Disease (COPD) is a combination of chronic bronchitis and emphysema, which both may lead to airway obstruction. Under normal circumstances, airway dimensions vary as a function of inspiration level. We aim to study the influence of COPD and emphysema...... in causing airway narrowing, the latter most likely due to loss of elastic recoil of surrounding tissue....

  18. Congenital salivary gland anlage tumor - in utero and postnatal imaging

    Energy Technology Data Exchange (ETDEWEB)

    Radhakrishnan, Rupa; Calvo-Garcia, Maria A.; Koch, Bernadette L. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Lim, Foong-Yen [Cincinnati Children' s Hospital Medical Center, Division of Pediatric Surgery, Cincinnati, OH (United States); Elluru, Ravindhra G. [Cincinnati Children' s Hospital Medical Center, Division of Pediatric Otolaryngology, Cincinnati, OH (United States)

    2015-03-01

    We present a case of an infant with congenital salivary gland anlage tumor, with fetal and postnatal imaging. To the best of our knowledge, this is the first case describing the in utero imaging findings of salivary gland anlage tumor. A fetal MRI was performed secondary to the clinical finding of polyhydramnios, which identified a nasopharyngeal mass. Because findings were concerning for airway obstruction, the fetus was delivered by ex utero intrapartum treatment (EXIT) to airway procedure. A postnatal CT confirmed the findings of the fetal MRI. The lesion was resected when the baby was 4 days old and recovery was uneventful. (orig.)

  19. Congenital salivary gland anlage tumor - in utero and postnatal imaging.

    Science.gov (United States)

    Radhakrishnan, Rupa; Calvo-Garcia, Maria A; Lim, Foong-Yen; Elluru, Ravindhra G; Koch, Bernadette L

    2015-03-01

    We present a case of an infant with congenital salivary gland anlage tumor, with fetal and postnatal imaging. To the best of our knowledge, this is the first case describing the in utero imaging findings of salivary gland anlage tumor. A fetal MRI was performed secondary to the clinical finding of polyhydramnios, which identified a nasopharyngeal mass. Because findings were concerning for airway obstruction, the fetus was delivered by ex utero intrapartum treatment (EXIT) to airway procedure. A postnatal CT confirmed the findings of the fetal MRI. The lesion was resected when the baby was 4 days old and recovery was uneventful.

  20. Brunner's Gland Adenoma – A Rare Cause of Gastrointestinal Bleeding: Case Report and Systematic Review

    Science.gov (United States)

    Sorleto, Michele; Timmer-Stranghöner, Annette; Wuttig, Helge; Engelhard, Oliver; Gartung, Carsten

    2017-01-01

    Brunner's gland adenoma is an extremely rare benign small bowel neoplasm, often discovered incidentally during upper gastrointestinal endoscopy or radiological diagnostics. In few cases, it tends to cause gastrointestinal hemorrhage or intestinal obstruction. We report here our experience with a 47-year-old woman with a Brunner's gland adenoma of more than 6 cm in size, located in the first part of the duodenum and causing gastrointestinal bleeding. Initially, we performed a partial endoscopic resection using endoloop and snare alternatively to prevent severe bleeding. A rest endoscopic polypectomy with the submucosal dissection technique was planned. However, on request of the patient, an elective surgical duodenotomy with submucosal resection of the remaining small duodenal tumor was performed. To better define the patient's characteristics and treatment options of such lesions, we performed a systematic review of the available literature in PubMed. Recently, an endoscopic removal is being increasingly practiced and is considered as a safe treatment modality of such lesions. PMID:28203131

  1. Management of the complications of endoscopic submucosal dissection

    Institute of Scientific and Technical Information of China (English)

    Seong Hwan Kim; Jeong Seop Moon; Young Hoon Youn; Ki Myung Lee; Sung Joon Lee

    2011-01-01

    Endoscopic submucosal dissection (ESD) is currently widely accepted as a standard treatment option for early gastrointestinal neoplasms in Korea. However, ESD has technical difficulties and a longer procedure time than conventional endoscopic resection. So it may have a higher risk of complications than conventional endoscopic resection techniques. We, the ESD study group of Korean Society of Gastrointestinal Endoscopy, have experienced many complications, mostly treated by endoscopic or conservative management. Here, we introduce and share our experiences for management of post ESD complications and review published papers on the topic.

  2. Worldwide experiences of endoscopic submucosal dissection: Not just Eastern acrobatics

    Institute of Scientific and Technical Information of China (English)

    Kwang Bum Cho; Won Joong Jeon; Jae J Kim

    2011-01-01

    The high incidence of gastric cancer has led to the initiation of cancer screening programs. As a result, the number of early gastric cancer cases has increased and consequentially, the cancer mortality rate has decreased. Moreover, the development of minimally invasive endoscopic treatment has been introduced for these early lesions. Endoscopic submucosal dissection (ESD) is now recognized as one of the preferred treatment modalities for premalignant gastrointestinal epithelial lesions and early gastric cancer without lymph node metastasis. We review the results of ESD including experiences in Japan and Korea, as well as western countries.

  3. Adrenal Gland Tumors: Statistics

    Science.gov (United States)

    ... Gland Tumor: Statistics Request Permissions Adrenal Gland Tumor: Statistics Approved by the Cancer.Net Editorial Board , 03/ ... primary adrenal gland tumor is very uncommon. Exact statistics are not available for this type of tumor ...

  4. Salivary Gland Cancer Treatment

    Science.gov (United States)

    ... and Oropharyngeal Cancer Screening Research Salivary Gland Cancer Treatment (PDQ®)–Patient Version General Information About Salivary Gland ... in diagnosing salivary gland cancer. Certain factors affect treatment options and prognosis (chance of recovery). The treatment ...

  5. Thymus Gland Anatomy

    Science.gov (United States)

    ... historical Searches are case-insensitive Thymus Gland, Adult, Anatomy Add to My Pictures View /Download : Small: 720x576 ... Large: 3000x2400 View Download Title: Thymus Gland, Adult, Anatomy Description: Anatomy of the thymus gland; drawing shows ...

  6. COMPARISON OF PARTIAL INFERIOR TURBINECTOMY AND SUBMUCOSAL DIATHERMY FOR HYPERTROPHIED INFERIOR TURBINATE IN ALLERGIC RHINITIS PATIENTS

    Directory of Open Access Journals (Sweden)

    Smitha Chandra

    2015-07-01

    Full Text Available BACKGROUND : The inferior turbinate is the first point of contact of allergen in the nose. In patients with allergic rhinitis the turbinate hypertrophies and its mucosa becomes purplish edematous. This leads to significant obstruction of airway. Hence reduction of this hypertrophied inferior turbinate is essential. AIM: To analyze & evaluate the efficacy of sub mucosal diathermy and partial inferior turbinectomy in the treatment of symptomatic hypertrophied inferior turbinates in allergic rhinitis patients in a rural setup. METHODS AND MATERIAL S: A prospective clinical study of 132 patients between age group of 15 - 55 years of eith er sex were enrolled in the study with bilateral Inferior. Turbinate Hypertrophy who had history of failed medical line of treatment. After informing , the patients were randomized into two groups to eliminate bias byallotting them alternately into the groups. Patients in Group I underwent. Submucosal diathermy and Group II patients underwent Partial Inferior. Turbinectomy. Postoperative follow up was done at regular intervals by objective& subjective assessment. STATISTICAL ANALYSIS USED: Friedman test and Ch i Square test were used for statistical analysis. RESULTS: In group I significant improvement of nasal airflow was seen in 14% patients & 85.9% had moderate improvement. In group II 41.3% of patients had significant improvement & 58.6% had moderate i mprovement. Statistically by analyzing the ranks of subjective nasal obstruction and objective nasal obstruction of Group - I & Group - IIwe conclude that Group - II subjects showed more improvement than Group I. CONCLUSIONS: Various surgical methods have been t ried for enlarged inferior turbinate secondary to allergic rhinitis. Of them the well - known techniques are s ubmucosal Diathermy & Partial Inferior Turbinectomy. In this study Partial Inferior Turbinectomy was found to be more effective in relieving nasal ob structionin allergic rhinitis patients for

  7. Parathyroid gland removal

    Science.gov (United States)

    Removal of parathyroid gland; Parathyroidectomy; Hyperparathyroidism - parathyroidectomy; PTH - parathyroidectomy ... and pain-free) for this surgery. Usually the parathyroid glands are removed using a 2- to 4- ...

  8. Postoperative Submandibular Gland Swelling following Craniotomy under General Anesthesia

    Directory of Open Access Journals (Sweden)

    Haruka Nakanishi

    2015-01-01

    Full Text Available Objective. Reporting of a rare case of postoperative submandibular gland swelling following craniotomy. Case Report. A 33-year-old male underwent resection for a brain tumor under general anesthesia. The tumor was resected via a retrosigmoid suboccipital approach and the patient was placed in a lateral position with his face down and turned to the right. Slight swelling of the right submandibular gland was observed just after the surgery. Seven hours after surgery, edematous change around the submandibular gland worsened and he required emergent reintubation due to airway compromise. The cause of submandibular gland swelling seemed to be an obstruction of the salivary duct due to surgical positioning. Conclusion. Once submandibular swelling and edematous change around the submandibular gland occur, they can worsen and compromise the air way within several hours after operation. Adequate precaution must be taken for any predisposing skull-base surgery that requires strong cervical rotation and flexion.

  9. Engineering Airway Epithelium

    Directory of Open Access Journals (Sweden)

    John P. Soleas

    2012-01-01

    Full Text Available Airway epithelium is constantly presented with injurious signals, yet under healthy circumstances, the epithelium maintains its innate immune barrier and mucociliary elevator function. This suggests that airway epithelium has regenerative potential (I. R. Telford and C. F. Bridgman, 1990. In practice, however, airway regeneration is problematic because of slow turnover and dedifferentiation of epithelium thereby hindering regeneration and increasing time necessary for full maturation and function. Based on the anatomy and biology of the airway epithelium, a variety of tissue engineering tools available could be utilized to overcome the barriers currently seen in airway epithelial generation. This paper describes the structure, function, and repair mechanisms in native epithelium and highlights specific and manipulatable tissue engineering signals that could be of great use in the creation of artificial airway epithelium.

  10. Therapeutic procedures for submucosal tumors in the gastrointestinal tract

    Institute of Scientific and Technical Information of China (English)

    Laura Graves Ponsaing; Mark Berner Hansen

    2007-01-01

    This review is part three of three and will present an update on the therapeutic options and procedures concerning gastrointestinal (GI) submucosal tumors (SMTs). The aim of this paper is to investigate the treatments of GI SMTs and to present a case of a gastrointestinal stromal tumor (GIST). Literature searches were performed to find information on therapy for GI SMTs. Based on these searches, the optimal therapeutic procedures could be outlined. The choice of treatment of localized tumors is endoscopic resection if possible or, alternatively, laparoscopic resection or surgical resection by an open procedure. However,benign SMTs should only be excised if symptoms are present, and GISTs should be treated with particular precautions. Irresectable or recurrent GISTs may be successfully treated with the tyrosine kinase inhibitor,imatinib.

  11. Severe splenic rupture after colorectal endoscopic submucosal dissection

    Science.gov (United States)

    Herreros de Tejada, Alberto; Giménez-Alvira, Luis; Van den Brule, Enrique; Sánchez-Yuste, Rosario; Matallanos, Pilar; Blázquez, Esther; Calleja, Jose L; Abreu, Luis E

    2014-01-01

    Splenic rupture (SR) after colonoscopy is a very rare but potentially serious complication. Delayed diagnosis is common, and may increase morbidity and mortality associated. There is no clear relation between SR and difficult diagnostic or therapeutic procedures, but it has been suggested that loop formation and excessive torquing might be risk factors. This is a case of a 65-year-old woman who underwent endoscopic submucosal dissection (ESD) for lateral spreading tumor in the descending colon, and 36 h afterwards presented symptoms and signs of severe hypotension due to SR. Standard splenectomy was completed and the patient recovered uneventfully. Colorectal ESD is usually a long and position-demanding technique, implying torquing and loop formation. To our knowledge this is the first case of SR after colorectal ESD reported in the literature. Endoscopists performing colorectal ESD in the left colon must be aware of this potential complication. PMID:25071360

  12. Airway management in trauma

    Directory of Open Access Journals (Sweden)

    Rao B

    2004-01-01

    Full Text Available Airway Management for the victims of major trauma is the first priority in the care of the trauma victim and is a core skill in emergency medicine and critical care. Endotracheal intubation remains the gold standard for trauma airway management. Airway management in trauma patients is not just the capability to insert an oral/nasal airway or endotracheal tube beyond the vocal cords. The five components integral to modern, sophisticated airway management in trauma patients include equipment, pharmacologic adjuncts, manual techniques, physical circumstances, and patient profile. A trauma patient may require airway management in a variety of physical circumstances. Whereas, the commonly used airway management algorithms may not suffice in all these situations, the construction of a truly complete decision tree is also virtually impossible. There is consensus that it is not the intervention per se but rather the conditions, skills, and performance that might be the possible variables that affect outcome. Paramedics have only limited experience and on-the-job skills for invasive airway management. Difficult airway management is best left for the experienced physicians to handle.

  13. Airway surface liquid volume expansion induces rapid changes in amiloride-sensitive Na+ transport across upper airway epithelium-Implications concerning the resolution of pulmonary edema

    Science.gov (United States)

    Azizi, Fouad; Arredouani, Abdelilah; Mohammad, Ramzi M

    2015-01-01

    During airway inflammation, airway surface liquid volume (ASLV) expansion may result from the movement of plasma proteins and excess liquid into the airway lumen due to extravasation and elevation of subepithelial hydrostatic pressure. We previously demonstrated that elevation of submucosal hydrostatic pressure increases airway epithelium permeability resulting in ASLV expansion by 500 μL cm−2 h−1. Liquid reabsorption by healthy airway epithelium is regulated by active Na+ transport at a rate of 5 μL cm−2 h−1. Thus, during inflammation the airway epithelium may be submerged by a large volume of luminal liquid. Here, we have investigated the mechanism by which ASLV expansion alters active epithelial Na+ transport, and we have characterized the time course of the change. We used primary cultures of tracheal airway epithelium maintained under air interface (basal ASLV, depth is 7 ± 0.5 μm). To mimic airway flooding, ASLV was expanded to a depth of 5 mm. On switching from basal to expanded ASLV conditions, short-circuit current (Isc, a measure of total transepithelial active ion transport) declined by 90% with a half-time (t1/2) of 1 h. 24 h after the switch, there was no significant change in ATP concentration nor in the number of functional sodium pumps as revealed by [3H]-ouabain binding. However, amiloride-sensitive uptake of 22Na+ was reduced by 70% upon ASLV expansion. This process is reversible since after returning cells back to air interface, Isc recovered with a t1/2 of 5–10 h. These results may have important clinical implications concerning the development of Na+ channels activators and resolution of pulmonary edema. PMID:26333829

  14. Indirect airway challenges

    NARCIS (Netherlands)

    Joos, GF; O'Connor, B; Anderson, SD; Chung, F; Cockcroft, DW; Dahlen, B; DiMaria, G; Foresi, A; Hargreave, FE; Holgate, ST; Inman, M; Lotvall, J; Magnussen, H; Polosa, R; Postma, DS; Riedler, J

    2003-01-01

    Indirect challenges act by causing the release of endogenous mediators that cause the airway smooth muscle to contract. This is in contrast to the direct challenges where agonists such as methacholine or histamine cause airflow limitation predominantly via a direct effect on airway smooth muscle. Di

  15. Pediatric airway nightmares.

    Science.gov (United States)

    D'Agostino, James

    2010-02-01

    Pediatric disorders that involve actual or potential airway compromise are among the most challenging cases that emergency department providers face. This article discusses the diagnosis and management of common and uncommon conditions in infants and children who may present with airway obstruction.

  16. A laser-induced pulsed water jet for layer-selective submucosal dissection of the esophagus.

    Science.gov (United States)

    Nakano, T; Sato, C; Yamada, M; Nakagawa, A; Yamamoto, H; Fujishima, F; Tominaga, T; Satomi, S; Ohuchi, N

    2016-10-01

    Background and aims: Conventional water jet devices have been used for injecting fluid to lift up lesions during endoscopic submucosal dissection or endoscopic mucosal resection procedures. However, these devices cannot dissect the submucosal layer effectively. Here we aim to elucidate the dissection capability of a laser-induced pulsed water jet and to clarify the mechanism of dissection with layer selectivity. Materials (Subjects) and methods: Pulsed water jets were ejected from a stainless nozzle by accelerating saline using the energy of a pulsed holmium: yttrium-aluminum-garnet laser. The impact force (strength) of the jet was evaluated using a force meter. Injection of the pulsed jet into the submucosal layer was documented by high-speed imaging. The physical properties of the swine esophagus were evaluated by measuring the breaking strength. Submucosal dissection of the swine esophagus was performed and the resection bed was evaluated histologically. Results: Submucosal dissection of the esophagus was accomplished at an impact force of 1.11-1.47 N/pulse (laser energy: 1.1-1.5 J/pulse; standoff distance: 60 mm). Histological specimens showed clear dissection at the submucosal layer without thermal injury. The mean static breaking strength of the submucosa (0.11 ± 0.04 MPa) was significantly lower than that of the mucosa (1.32 ± 0.18 MPa), and propria muscle (1.45 ± 0.16 MPa). Conclusions: The pulsed water jet device showed potential for achieving selective submucosal dissection. It could achieve mucosal, submucosal, and muscle layer selectivity owing to the varied breaking strengths.

  17. Hyaline vascular-type castleman disease presenting as an esophageal submucosal tumor: case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ki Nam; Lee, Ki Nam; Kang, Myong Jin; Roh, Mee Sook; Choi, Pil Jo; Yang, Doo Kyung [Donga University, Pusan (Korea, Republic of)

    2006-03-15

    Castleman disease is a relatively rare disorder of lymphoid tissue that involves the gastrointestinal tract in a variety of clinical and pathologic manifestation. A submucosal location has never been described in the medical literature. We report a case of esophageal Castleman disease involving the submucosal layer in a 62-year-old man, which was confirmed on pathology. Esophagography and CT demonstrated an intramural tumor, and a leiomyoma or leiomyosarcoma was suspected based on the known incidence of such tumors.

  18. Basal Secretion of Lysozyme from Human Airways in Vitro

    Directory of Open Access Journals (Sweden)

    Patricia Roger

    1999-01-01

    Full Text Available The aim of this study was to examine the basal release of lysozyme from isolated human lung tissues. Measurements of lysozyme in the fluids derived from lung preparations were performed using a rate-of-lysis assay subsequent to acidification of the biological samples. Lysozyme released from bronchial preparations into fluids was greater than that observed for parenchymal tissues. The lysozyme quantities detected in bronchial fluids were not modified by removal of the surface epithelium. Furthermore, the quantities of lysozyme in bronchial fluids was correlated with the size of the bronchial preparations. These results suggest that the lysozyme was principally secreted by the human bronchi (submucosal layer rather than by parenchyma tissues and that a greater release was observed in the proximal airways.

  19. Parathyroid glands (image)

    Science.gov (United States)

    The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce pararthyroid hormone (PTH). Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within ...

  20. Adrenal Gland Cancer

    Science.gov (United States)

    ... either benign or malignant. Benign tumors aren't cancer. Malignant ones are. Most adrenal gland tumors are ... and may not require treatment. Malignant adrenal gland cancers are uncommon. Types of tumors include Adrenocortical carcinoma - ...

  1. Microbial Population Differentials between Mucosal and Submucosal Intestinal Tissues in Advanced Crohn's Disease of the Ileum.

    Directory of Open Access Journals (Sweden)

    Rodrick J Chiodini

    Full Text Available Since Crohn's disease is a transmural disease, we hypothesized that examination of deep submucosal tissues directly involved in the inflammatory disease process may provide unique insights into bacterial populations transgressing intestinal barriers and bacterial populations more representative of the causes and agents of the disease. We performed deep 16s microbiota sequencing on isolated ilea mucosal and submucosal tissues on 20 patients with Crohn's disease and 15 non-inflammatory bowel disease controls with a depth of coverage averaging 81,500 sequences in each of the 70 DNA samples yielding an overall resolution down to 0.0001% of the bacterial population. Of the 4,802,328 total sequences generated, 98.9% or 4,749,183 sequences aligned with the Kingdom Bacteria that clustered into 8545 unique sequences with <3% divergence or operational taxonomic units enabling the identification of 401 genera and 698 tentative bacterial species. There were significant differences in all taxonomic levels between the submucosal microbiota in Crohn's disease compared to controls, including organisms of the Order Desulfovibrionales that were present within the submucosal tissues of most Crohn's disease patients but absent in the control group. A variety of organisms of the Phylum Firmicutes were increased in the subjacent submucosa as compared to the parallel mucosal tissue including Ruminococcus spp., Oscillospira spp., Pseudobutyrivibrio spp., and Tumebacillus spp. In addition, Propionibacterium spp. and Cloacibacterium spp. were increased as well as large increases in Proteobacteria including Parasutterella spp. and Methylobacterium spp. This is the first study to examine the microbial populations within submucosal tissues of patients with Crohn's disease and to compare microbial communities found deep within the submucosal tissues with those present on mucosal surfaces. Our data demonstrate the existence of a distinct submucosal microbiome and ecosystem

  2. Emergency airway puncture - slideshow

    Science.gov (United States)

    ... presentations/100113.htm Emergency airway puncture - series—Normal anatomy To ... larynx is a tubular structure in the neck, through which air passes to the lungs. The thryoid and cricoid cartilage form the narrowest ...

  3. Emergency airway puncture

    Science.gov (United States)

    ... inserted into the throat, just below the Adam's apple (cricoid cartilage), into the airway. In a hospital, ... Choking Browse the Encyclopedia A.D.A.M., Inc. is accredited by URAC, also known as the ...

  4. Airway management in trauma.

    Science.gov (United States)

    Langeron, O; Birenbaum, A; Amour, J

    2009-05-01

    Maintenance of a patent and prevention of aspiration are essential for the management of the trauma patient, that requires experienced physicians in airway control techniques. Difficulties of the airway control in the trauma setting are increased by the vital failures, the risk of aspiration, the potential cervical spine injury, the combative patient, and the obvious risk of difficult tracheal intubation related to specific injury related to the trauma. Endotracheal intubation remains the gold standard in trauma patient airway management and should be performed via the oral route with a rapid sequence induction and a manual in-line stabilization maneuver, to decrease the risks previously mentioned. Different techniques to control the airway in trauma patients are presented: improvement of the laryngoscopic vision, lighted stylet tracheal intubation, retrograde technique for orotracheal intubation, the laryngeal mask and the intubating laryngeal mask airways, the combitube and cricothyroidotomy. Management of the airway in trauma patients requires regular training in these techniques and the knowledge of complementary techniques allowing tracheal intubation or oxygenation to overcome difficult intubation and to prevent major complications as hypoxemia and aspiration.

  5. Neuropeptide release from airways of young and fully-grown rabbits.

    Science.gov (United States)

    Larsen, Gary L; Fratelli, Cori; Loader, Joan; Kang, June-Ku Brian; Dakhama, Azzeddine

    2006-12-01

    Nerve growth factor (NGF), a neurotrophin that regulates neuronal development, enhances production of neuropeptides that control airway caliber including substance P (SP). Little is known about the developmental interplay between neurotrophins and neuropeptides. Our goal was to assess release of NGF, SP, and vasoactive intestinal peptide (VIP) from tracheal segments of young (2-week-old) and fully-grown (13-week-old) rabbits, and ascertain location of neuropeptides in airways with mechanical denudation of epithelium and immunohistochemistry. After electrical field stimulation of nerves, bath solutions were collected and immunoassays performed to quantify NGF, SP, and VIP release. There were significant decreases in NGF, SP, and VIP release from airways in 13- versus 2-week-old rabbits. There were also significant decreases in SP and VIP release from denuded versus normal tissues at 2 weeks of age. A similar pattern for SP was seen in 13-week-old rabbits. Immunohistochemistry demonstrated increased neuropeptides in airways from younger rabbits. Although SP was seen in the epithelium and submucosal nerves in the younger group, it was localized to the latter location in fully-grown rabbits. VIP was seen in only submucosal nerves at both ages. Thus, release of NGF, SP, and VIP with neural stimulation decreases in rabbit tracheal segments with age. Decreases in SP with maturation and epithelial denudation appear related in part to decreases in epithelial SP with growth. However, decreases in VIP that occur normally and with epithelial denudation are not explained by location of VIP within the epithelium. The epithelium may be a source of factors that inhibit release of neuropeptides.

  6. Clinicopathological Characteristics as Predictive Factrs for Lymph Node Metastasis in Submucosal Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    OBJECTIVE To identify clinicopathological characteristics as predictive factors for lymph node metastasis in submucosal gastric cancer, and in addition to establish objective criteria as indications for endoscopic submucosal dissection (ESD).METHODS Data from 130 patients with submucosal gastric cancer were collected, and the relationship between their clinicopathological characteristics and the presence of lymph node metastasis was retrospectively analyzed by multivariate analysis.RESULTS In the multivariate logistic regression model, a tumor size of 2 cm or more and an undifferentiated histologic type were found to be independent risk clinicopathological characteristics for lymph node metastasis.Among 130 patients with submucosal carcinoma, no lymph node metastases were observed in 17 patients who showed neither of the two risk clinicopathological characteristics. Lymph node metastasis occurred in 61.1% (22/36) of the patients who had both risk clinicopathological characteristics.CONCLUSION A tumor size of 2 cm or more and an undifferentiated histologic type were significantly and independently related to lymph node metastasis in submucosal gastric cancer. It is rational for the paitients with neither of these two independent risk clinicopathological characteristics to undergo an ESD.

  7. Submucosal tunnel endoscopy: Peroral endoscopicmyotomy and peroral endoscopic tumor resection

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Peroral endoscopic myotomy (POEM) is an innovative,minimally invasive, endoscopic treatment for esophagealachalasia and other esophageal motility disorders,emerged from the natural orifice transluminal endoscopicsurgery procedures, and since the first human caseperformed by Inoue in 2008, showed exciting results ininternational level, with more than 4000 cases globallyup to now. POEM showed superior characteristics thanthe standard 100-year-old surgical or laparoscopic Hellermyotomy (LHM), not only for all types of esophagealachalasia [classical (Ⅰ), vigorous (Ⅱ), spastic (Ⅲ),Chicago Classification], but also for advanced sigmoidtype achalasia (S1 and S2), failed LHM, or other esophagealmotility disorders (diffuse esophageal spasm,nutcracker esophagus or Jackhammer esophagus). POEMstarts with a mucosal incision, followed by submucosaltunnel creation crossing the esophagogastric junction(EGJ) and myotomy. Finally the mucosal entry is closedwith endoscopic clip placement. POEM permittedrelatively free choice of myotomy length and localization.Although it is technically demanding procedure, POEMcan be performed safely and achieves very goodcontrol of dysphagia and chest pain. Gastroesophagealreflux is the most common troublesome side effect,and is well controllable with proton pump inhibitors.Furthermore, POEM opened the era of submucosal tunnelendoscopy, with many other applications. Based onthe same principles with POEM, in combination withnew technological developments, such as endoscopicsuturing, peroral endoscopic tumor resection (POET), issafely and effectively applied for challenging submucosalesophageal, EGJ and gastric cardia tumors (submucosaltumors), emerged from muscularis propria. POET showedup to know promising results, however, it is restricted tospecialized centers. The present article reviews the recentdata of POEM and POET and discussed controversialissues that need further study and future perspectives.

  8. Multidrug-Resistant Tuberculous Mediastinal Lymphadenitis, with an Esophagomediastinal Fistula, Mimicking an Esophageal Submucosal Tumor.

    Science.gov (United States)

    Kim, Dongwuk; Kim, Juwon; Lee, Daegeun; Chang, Ha Sung; Joh, Hyunsung; Koh, Won-Jung; Lee, Jun Haeng

    2016-11-01

    Mediastinal tuberculous lymphadenitis rarely mimics esophageal submucosal tumor, particularly in the case of multidrug-resistant tuberculosis (MDR-TB). Herein, we report the case of a 61-year-old woman who visited a local hospital complaining of odynophagia. An initial esophagogastroduodenoscopy revealed an esophageal submucosal tumor, and subsequent chest computed tomography showed subcarinal lymphadenopathy with an esophagomediastinal fistula. The patient was then referred to Samsung Medical Center, and a second esophagogastroduodenoscopy showed deep central ulceration, as well as a suspicious fistula in the esophageal submucosal tumor-like lesion. A biopsy examination of the ulcerative lesion confirmed focal inflammation only. Next, an endobronchial, ultrasound-guided lymph node biopsy was performed, and TB was confirmed. The patient initially began a course of isoniazid, rifampicin, ethambutol, and pyrazinamide. However, after a drug sensitivity test, she was diagnosed with MDR-TB, and second-line anti-TB medications were prescribed. She recovered well subsequently.

  9. Histopathological and genetic differences between polypoid and non-polypoid submucosal colorectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    Ichiro Hirata; Fang-Yu Wang; Mitsuyuki Murano; Takuya Inoue; Ken Toshina; Takashi Nishikawa; Kentaro Maemura

    2007-01-01

    AIM: To investigate the histopathological and geneticdifferences between polypoid growth (PG) and nonpolypoid growth (NPG) submucosal invasive colorectal carcinoma (CRC).METHODS: A total of 96 cases of submucosal CRC were divided into two groups according to their growth type;60 cases of PG and 36 cases of NPG. The size, histological degree of dysplasia, depth of submucosal invasion and lymph node metastasis were compared between the two groups. Furthermore, expression of p53 was detected by immunohistochemical staining, and K-ras gene mutation was examined by polymerase chain reaction based single-strand conformation polymorphism (SSCP).RESULTS: The average size of the lesions in the NPG group was significantly smaller than those in the PG group (7.5 mm vs 13.8 mm, P < 0.001). The histological degree of dysplasia tended to be more severe in NPG group, while the incidence of submucosal massive invasion and the lymph node metastasis were both significantly higher in the NPG type than in the PG group (64.3% vs 43.3%, P = 0.004; 43% vs 7%, P =0.008, respectively). In addition, K-ras gene mutations were detected in 67% of lesions in the PG group, but none in the NPG group, while no difference in p53immunohistochemical expression was found between the two groups.CONCLUSION: Compared with PG submucosal CRC,NPG type demonstrates more frequent submucosal massive invasion, more lymph node metastasis and a higher degree dysplasia. Genetically, NPG type shows much less frequent K-ras mutation.

  10. Granulomatosis with Polyangiitis Presenting as a Parotid Gland Abscess

    Directory of Open Access Journals (Sweden)

    Blenda Dias

    2015-01-01

    Full Text Available Granulomatosis with polyangiitis (GPA is a small-vessel vasculitis consisting of necrotizing granulomatous lesions in airways and focal necrotizing glomerulonephritis. However, it may affect other sites such as the skin, central nervous system, eyes, heart, gastrointestinal tract, and liver. We describe a rare case of GPA in which the initial manifestation was the involvement of the parotid gland mimicking a pyogenic abscess.

  11. Integrated care pathways for airway diseases (AIRWAYS-ICPs)

    NARCIS (Netherlands)

    Bousquet, J.; Addis, A.; Adcock, I.; Agache, I.; Agusti, A.; Alonso, A.; Annesi-Maesano, I.; Anto, J. M.; Bachert, C.; Baena-Cagnani, C. E.; Bai, C.; Baigenzhin, A.; Barbara, C.; Barnes, P. J.; Bateman, E. D.; Beck, L.; Bedbrook, A.; Bel, E. H.; Benezet, O.; Bennoor, K. S.; Benson, M.; Bernabeu-Wittel, M.; Bewick, M.; Bindslev-Jensen, C.; Blain, H.; Blasi, F.; Bonini, M.; Bonini, S.; Boulet, L. P.; Bourdin, A.; Bourret, R.; Bousquet, P. J.; Brightling, C. E.; Briggs, A.; Brozek, J.; Buh, R.; Bush, A.; Caimmi, D.; Calderon, M.; Calverley, P.; Camargos, P. A.; Camuzat, T.; Canonica, G. W.; Carlsen, K. H.; Casale, T. B.; Cazzola, M.; Sarabia, A. M. Cepeda; Cesario, A.; Chen, Y. Z.; Chkhartishvili, E.; Chavannes, N. H.; Chiron, R.; Chuchalin, A.; Chung, K. F.; Cox, L.; Crooks, G.; Crooks, M. G.; Cruz, A. A.; Custovic, A.; Dahl, R.; Dahlen, S. E.; De Blay, F.; Dedeu, T.; Deleanu, D.; Demoly, P.; Devillier, P.; Didier, A.; Dinh-Xuan, A. T.; Djukanovic, R.; Dokic, D.; Douagui, H.; Dubakiene, R.; Eglin, S.; Elliot, F.; Emuzyte, R.; Fabbri, L.; Wagner, A. Fink; Fletcher, M.; Fokkens, W. J.; Fonseca, J.; Franco, A.; Frith, P.; Furber, A.; Gaga, M.; Garces, J.; Garcia-Aymerich, J.; Gamkrelidze, A.; Gonzales-Diaz, S.; Gouzi, F.; Guzman, M. A.; Haahtela, T.; Harrison, D.; Hayot, M.; Heaney, L. G.; Heinrich, J.; Hellings, P. W.; Hooper, J.; Humbert, M.; Hyland, M.; Iaccarino, G.; Jakovenko, D.; Jardim, J. R.; Jeandel, C.; Jenkins, C.; Johnston, S. L.; Jonquet, O.; Joos, G.; Jung, K. S.; Kalayci, O.; Karunanithi, S.; Keil, T.; Khaltaev, N.; Kolek, V.; Kowalski, M. L.; Kull, I.; Kuna, P.; Kvedariene, V.; Le, L. T.; Carlsen, K. C. Lodrup; Louis, R.; MacNee, W.; Mair, A.; Majer, I.; Manning, P.; Keenoy, E. de Manuel; Masjedi, M. R.; Meten, E.; Melo-Gomes, E.; Menzies-Gow, A.; Mercier, G.; Mercier, J.; Michel, J. P.; Miculinic, N.; Mihaltan, F.; Milenkovic, B.; Molimard, M.; Mamas, I.; Montilla-Santana, A.; Morais-Almeida, M.; Morgan, M.; N'Diaye, M.; Nafti, S.; Nekam, K.; Neou, A.; Nicod, L.; O'Hehir, R.; Ohta, K.; Paggiaro, P.; Palkonen, S.; Palmer, S.; Papadopoulos, N. G.; Papi, A.; Passalacqua, G.; Pavord, I.; Pigearias, B.; Plavec, D.; Postma, D. S.; Price, D.; Rabe, K. F.; Pontal, F. Radier; Redon, J.; Rennard, S.; Roberts, J.; Robine, J. M.; Roca, J.; Roche, N.; Rodenas, F.; Roggeri, A.; Rolland, C.; Rosado-Pinto, J.; Ryan, D.; Samolinski, B.; Sanchez-Borges, M.; Schunemann, H. J.; Sheikh, A.; Shields, M.; Siafakas, N.; Sibille, Y.; Similowski, T.; Small, I.; Sola-Morales, O.; Sooronbaev, T.; Stelmach, R.; Sterk, P. J.; Stiris, T.; Sud, P.; Tellier, V.; To, T.; Todo-Bom, A.; Triggiani, M.; Valenta, R.; Valero, A. L.; Valiulis, A.; Valovirta, E.; Van Ganse, E.; Vandenplas, O.; Vasankari, T.; Vestbo, J.; Vezzani, G.; Viegi, G.; Visier, L.; Vogelmeier, C.; Vontetsianos, T.; Wagstaff, R.; Wahn, U.; Wallaert, B.; Whalley, B.; Wickman, M.; Williams, D. M.; Wilson, N.; Yawn, B. P.; Yiallouros, P. K.; Yorgancioglu, A.; Yusuf, O. M.; Zar, H. J.; Zhong, N.; Zidarn, M.; Zuberbier, T.

    2014-01-01

    The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will ad

  12. 内镜黏膜下挖除术治疗消化道黏膜下肿瘤108例分析%Analysis of 108 cases of submucosal tumor treated by endoscopic submucosal excavation

    Institute of Scientific and Technical Information of China (English)

    张明黎; 王业涛; 宋继中; 丁西平; 王巧民; 盛明伶; 卫梅枝

    2013-01-01

    ).The endoscopic treatment was converted to laparoscopic operation in three cases because the submucosal tumors of gastric body growing towards outside the lumen,or adhesive to muscular layer tightly and or perforation too big to be sutured.Three cases of submucosal tumor of fundus were failed to excavate,the other 102 cases (94.44%) of lesions were completely removed.Perforation occurred in 19 cases (17.59%).The procedure was converted to laparoscopic operation in one case.Effective endoscopic suture was complered in 18 cases.The volume of haemorrhage during operation was about 0 to 50 mL and no post-operational bleeding was found.Eight cases had cervical subcutaneous emphysema.Nine cases had pneumoperitoneum.Left parotid gland swollen was found in one case.Nine cases were lost to follow up.The left 99 cases were followed up for one to 24 months and no recurrence.Conclusion ndoscopic submucosal excavation safety and effectively achieve once complete removed of the big submucosal tumor which grows towards inside the lumen,and provide complete pathologic data.

  13. Endoscopic Sealing of Bronchopleural Fistulas with Submucosal Injection of a Tissue Expander: A Novel Technique

    Directory of Open Access Journals (Sweden)

    Cayo García-Polo

    2010-01-01

    Full Text Available The occurrence of a bronchopleural fistula (BPF continues to represent a challenging management problem, and is associated with high morbidity and mortality. A novel and successful technique that uses submucosal injection of a tissue expander for bronchoscopic occlusion of BPFs has been designed. This method may be used either alone or in combination with bronchoscopic instillation of n-butyl-cyanoacrylate glue. The occlusion technique is described, with a presentation of two patients who were successfully treated with this method. The submucosal injection of a tissue expander is an effective, economical and minimally invasive technique for managing BPFs.

  14. [Submucosal gastric tumour: heterotopic pancreas. A case report and review of the literature].

    Science.gov (United States)

    Esquivel, Carlos; Ballario, Federico; García, Sebastián; Giraudo, Pedro; Esteban Granero, Lucas

    2011-09-01

    Heterotopic pancreas is the presence of pancreatic tissue outside the anatomical location of the pancreas. It is a rare condition and can occur anywhere in the gastrointestinal tract with the stomach and small bowel as the most common sites. It is usually asymptomatic but may become clinically evident when complicates by pathologic changes such as inflammation, bleeding, obstruction and malignant transformation. We report the case of a 49-year-old man who presented with recurrent epigastric pain. The upper gastrointestinal endoscopy revealed a submucosal tumour in the antrum. The histopathology study after surgery showed a heterotopic pancreatic tissue. Ectopic pancreas should be considered in the differential diagnosis of a submucosal gastric tumour.

  15. Submucosal Abscess of the Esophagus Caused by Piriform Sinus Fistula Treated with Transoral Video Laryngoscopic Surgery.

    Science.gov (United States)

    Koyama, Satoshi; Fujiwara, Kazunori; Morisaki, Tsuyoshi; Fukuhara, Takahiro; Kawamoto, Katsuyuki; Kitano, Hiroya; Takeuchi, Hiromi

    2016-01-01

    Piriform sinus fistula (PSF) is a rare branchial anomaly that causes repetitive acute suppurative thyroiditis or deep neck abscess. The definitive treatment of PSF is open neck surgery. However, such surgery has a cosmetic problem and a high risk of recurrence. Furthermore, identifying the fistula is difficult due to previous repetitive infections. We report a case of esophageal submucosal abscess caused by PSF treated with endoscopic mucosal incision. The patient underwent transoral video laryngoscopic surgery (TOVS), and endoscopy as well as fluoroscopy revealed complete closure of PSF without any complication. TOVS is a novel surgical technique for the definitive treatment of PSF with esophageal submucosal abscess.

  16. Diffuse intestinal submucosal lipomatosis with incidental epidermal inclusion cyst of caecum clinically masquerading as carcinoma caecum.

    Science.gov (United States)

    Thakur, Brijesh; Kishore, Sanjeev; Bhardwaj, Aparna; Kudesia, Sandip

    2014-07-30

    Symptomatic diffuse submucosal intestinal lipomatosis is a rare entity. Also few cases of epidermal inclusion cyst of caecum have been reported in literature. Here, we are presenting a rare case of intestinal submucosal lipomatosis with coincidence of epidermal inclusion cyst of caecum and presumptively diagnosed as carcinoma of ileocaecal region during surgery in a 55 years old male. Both are rare entity considering the location even they should be kept as a differential diagnosis in unusual cases of intestinal perforations with inconclusive radiological findings or clinical uncertainity.

  17. Diffuse intestinal submucosal lipomatosis with incidental epidermal inclusion cyst of caecum clinically masquerading as carcinoma caecum

    Directory of Open Access Journals (Sweden)

    Brijesh Thakur

    2014-08-01

    Full Text Available Symptomatic diffuse submucosal intestinal lipomatosis is a rare entity. Also few cases of epidermal inclusion cyst of caecum have been reported in literature. Here, we are presenting a rare case of intestinal submucosal lipomatosis with coincidence of epidermal inclusion cyst of caecum and presumptively diagnosed as carcinoma of ileocaecal region during surgery in a 55 years old male. Both are rare entity considering the location even they should be kept as a differential diagnosis in unusual cases of intestinal perforations with inconclusive radiological findings or clinical uncertainity.

  18. Inhibition of airway epithelial-to-mesenchymal transition and fibrosis by kaempferol in endotoxin-induced epithelial cells and ovalbumin-sensitized mice.

    Science.gov (United States)

    Gong, Ju-Hyun; Cho, In-Hee; Shin, Daekeun; Han, Seon-Young; Park, Sin-Hye; Kang, Young-Hee

    2014-03-01

    Chronic airway remodeling is characterized by structural changes within the airway wall, including smooth muscle hypertrophy, submucosal fibrosis and epithelial shedding. Epithelial-to-mesenchymal transition (EMT) is a fundamental mechanism of organ fibrosis, which can be induced by TGF-β. In the in vitro study, we investigated whether 1-20 μM kaempferol inhibited lipopolysaccharide (LPS)-induced bronchial EMT in BEAS-2B cells. The in vivo study explored demoting effects of 10-20 mg/kg kaempferol on airway fibrosis in BALB/c mice sensitized with ovalbumin (OVA). LPS induced airway epithelial TGF-β1 signaling that promoted EMT with concurrent loss of E-cadherin and induction of α-smooth muscle actin (α-SMA). Nontoxic kaempferol significantly inhibited TGF-β-induced EMT process through reversing E-cadherin expression and retarding the induction of N-cadherin and α-SMA. Consistently, OVA inhalation resulted in a striking loss of epithelial morphology by displaying myofibroblast appearance, which led to bronchial fibrosis with submucosal accumulation of collagen fibers. Oral administration of kaempferol suppressed collagen deposition, epithelial excrescency and goblet hyperplasia observed in the lung of OVA-challenged mice. The specific inhibition of TGF-β entailed epithelial protease-activated receptor-1 (PAR-1) as with 20 μM kaempferol. The epithelial PAR-1 inhibition by SCH-79797 restored E-cadherin induction and deterred α-SMA induction, indicating that epithelial PAR-1 localization was responsible for resulting in airway EMT. These results demonstrate that dietary kaempferol alleviated fibrotic airway remodeling via bronchial EMT by modulating PAR1 activation. Therefore, kaempferol may be a potential therapeutic agent targeting asthmatic airway constriction.

  19. Airway reconstruction in children

    Directory of Open Access Journals (Sweden)

    Rao Sanjay

    2009-01-01

    Full Text Available Aim/Background : Airway anomalies are infrequent but potentially life threatening in children. A program to care for these difficult children was set up at our institution, and this paper summarizes our experience. Methods: A total of 34 children were enrolled in the program over a period of three years. These children were evaluated as per the standard protocols. Treatment was individualized. Results: Of these 34 children, 28 had their airways restored and are doing well. Four children continue to remain on tracheostomy and two will require long term tracheostomy. There were two deaths. All children are under surveillance as there is a risk of recurrence. Conclusions: Airway anomalies are complex problems with significant morbidity and mortality. Current therapeutic modalities allow for good results. Most children were successfully decannulated and did well.

  20. Paediatric airway management: basic aspects

    DEFF Research Database (Denmark)

    Holm-Knudsen, R J; Rasmussen, L S

    2009-01-01

    . Airway obstruction can be avoided by paying close attention to the positioning of the head of the child and by keeping the mouth of the child open during mask ventilation. The use of oral and nasopharyngeal airways, laryngeal mask airways, and cuffed endotracheal tubes is discussed with special reference...... to the circumstances in infants. A slightly different technique during laryngoscopy is suggested. The treatment of airway oedema and laryngospasm is described....

  1. Pituitary Gland Disorders Overview

    Science.gov (United States)

    ... hormone ( TSH) - TSH stimulates the thyroid gland to produce thyroid hormones, which regulate the body's metabolism, energy balance, growth, and nervous system activity. Read about TSH-secreting ...

  2. cAMP Stimulation of HCO3- Secretion Across Airway Epithelia

    Directory of Open Access Journals (Sweden)

    Welsh MJ

    2001-07-01

    Full Text Available To test for the presence of HCO(3(- transport across airway epithelia, we measured short-circuit current in primary cultures of canine and human airway epithelia bathed in a Cl(--free, HCO(3(-/CO(2-buffered solution. cAMP agonists stimulated a secretory current that was likely carried by HCO(3(- because it was absent in HCO(3(--free solutions. In addition, the cAMP-stimulated current was inhibited by the carbonic anhydrase inhibitor, acetazolamide, and by the apical addition of a blocker of cystic fibrosis transmembrane conductance regulator (CFTR, diphenylamine-2-carboxylate. The current was dependent on Na(+ because it was inhibited by removing Na(+ from the submucosal solution and by inhibition of the Na(+-K(+-ATPase with ouabain. The cAMP-stimulated current was absent in cystic fibrosis (CF airway epithelia. These data suggest that cAMP agonists can stimulate HCO(3(- secretion across airway epithelia and that CFTR may provide a conductive pathway for HCO(3(- movement across the apical membrane.

  3. Distinct PKA and Epac compartmentalization in airway function and plasticity

    NARCIS (Netherlands)

    Dekkers, Bart G. J.; Racke, Kurt; Schmidt, Martina

    2013-01-01

    Asthma and chronic obstructive pulmonary disease (COPD) are obstructive lung diseases characterized by airway obstruction, airway inflammation and airway remodelling. Next to inflammatory cells and airway epithelial cells, airway mesenchymal cells, including airway smooth muscle cells and (myo)fibro

  4. Acute airway obstruction due to spontaneous intrathyroid hemorrhage precipitated by anticoagulation therapy

    Directory of Open Access Journals (Sweden)

    Laxmi Kokatnur

    2014-01-01

    Full Text Available Acute airway compromise due to hemorrhage in of thyroid gland is a rare life-hreating condition. The increasing use of anticoagulants for various reasons is likely increased the occurrence of this this complication. We describe an elderly patient on anticoagulation for atrial fibrillation, which developed swelling on the right side of neck causing acute airway obstruction requiring emergency intubation for airway protection. Computed tomographic scan showed massive intrathyroid hemorrhage along with substernal extension. She had supratherapeutic INR which was appropriately corrected emergently. She underwent resection of the thyroid gland which showed multinodular goiter without any evidence of malignancy. Our case illustrates the rare but lethal bleeding complication of anticoagulants in critical anatomical area and we request physicians should be wary of similar conditions.

  5. Airway management and morbid obesity

    DEFF Research Database (Denmark)

    Kristensen, Michael S

    2010-01-01

    airway and the function of the lungs (decreased residual capacity and aggravated ventilation perfusion mismatch) worse than in lean patients. Proper planning and preparation of airway management is essential, including elevation of the patient's upper body, head and neck. Preoxygenation is mandatory...... solely on whether morbid obesity is present or not. It is important to ensure sufficient depth of anaesthesia before initiating manipulation of the airway because inadequate anaesthesia depth predisposes to aspiration if airway management becomes difficult. The intubating laryngeal mask airway is more...... pressure, noninvasive ventilation and physiotherapy....

  6. Adrenal Gland Disorders

    Science.gov (United States)

    ... t live without, including sex hormones and cortisol. Cortisol helps you respond to stress and has many other important functions. With adrenal gland disorders, your glands make too much or not enough hormones. In Cushing's ... too much cortisol, while with Addison's disease, there is too little. ...

  7. Salivary Gland Cancer

    Science.gov (United States)

    ... contains antibodies that can kill germs. Salivary gland cancer is a type of head and neck cancer. It is rare. It may not cause any ... pain in your face Doctors diagnose salivary gland cancer using a physical exam, imaging tests, and a ...

  8. Salivary Gland Secretion.

    Science.gov (United States)

    Dorman, H. L.; And Others

    1981-01-01

    Describes materials and procedures for an experiment utilizing a live dog to demonstrate: (1) physiology of the salivary gland; (2) parasympathetic control of the salivary gland; (3) influence of varying salivary flow rates on sodium and potassium ions, osmolarity and pH; and (4) salivary secretion as an active process. (DS)

  9. Technique of endoscopic biopsy of islet allografts transplanted into the gastric submucosal space in pigs

    NARCIS (Netherlands)

    T. Fujita (Tetsuji); K.M. McGrath (Kevin); R. Bottino (Rita); E.M. Dons (Eefje); C. Long (Cassandra); G. Kumar (Goutham); B. Ekser; G.J. Echeverri (Gabriel); A. Hata (Akira); K. Haruma (Ken); D.K.C. Cooper (David); H. Hara (Hidetaka)

    2013-01-01

    textabstractCurrently, islet cells are transplanted into the liver via portal vein infusion. One disadvantage of this approach is that it is not possible to adequately biopsy the islets in the liver to assess for rejection. Islet transplantation (Tx) into the gastric submucosal space (GSMS) can be p

  10. Advances in prehospital airway management.

    Science.gov (United States)

    Jacobs, Pe; Grabinsky, A

    2014-01-01

    Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome. In studies demonstrating poor outcomes related to prehospital-attempted endotracheal intubation (ETI), both training and skill level of the provider are usually often low. Research supports a relationship between the number of intubation experiences and ETI success. National standards for certification of emergency medicine provider are in general too low to guarantee good success rate in emergency airway management by paramedics and physicians. Some paramedic training programs require more intense airway training above the national standard and some EMS systems in Europe staff their system with anesthesia providers instead. ETI remains the cornerstone of definitive prehospital airway management, However, ETI is not without risk and outcomes data remains controversial. Many systems may benefit from more input and guidance by the anesthesia department, which have higher volumes of airway management procedures and extensive training and experience not just with training of airway management but also with different airway management techniques and adjuncts.

  11. Upper airway imaging and its role in preoperative airway evaluation

    Directory of Open Access Journals (Sweden)

    Jagadish G Sutagatti

    2016-01-01

    Full Text Available Ultrasonography (USG is well-known as a fast, safe, and noninvasive technique. Its application for imaging of the airway is now gaining momentum. The upper airway has a complex anatomy, and its assessment forms a vital part of every preanesthetic evaluation. Ultrasound (US imaging can help in upper airway assessment in the preoperative period. There are various approaches to upper airway USG. The technique has its own advantages, disadvantages, and limitations. This simple yet challenging imaging technique is all set to become an important part of routine preoperative airway evaluation. This article reviews the various approaches to upper airway US imaging, interpretation of the images, limitations, and disadvantages of the technique and its varied clinical applications in the preoperative period. The scientific material presented here was hand searched from textbooks and journals, electronically from PubMed, and Google scholar using text words.

  12. Relationship between airway pathophysiology and airway inflammation in older asthmatics

    DEFF Research Database (Denmark)

    Porsbjerg, Celeste M; Gibson, Peter G; Pretto, Jeffrey J;

    2013-01-01

    BACKGROUND AND OBJECTIVE: Asthma-related morbidity is greater in older compared with younger asthmatics. Airway closure is also greater in older asthmatics, an observation that may be explained by differences in airway inflammation. We hypothesized that in older adult patients with asthma......: Mean patient age was 67 years (confidence interval: 63-71) with a mean FEV1 of 78 % predicted (confidence interval: 70-85%). AHR correlated with sputum eosinophils (r = 0.68, P = 0.005) and eNO (r = 0.71, P ... or eNO. CONCLUSIONS: In older patients with asthma, airway inflammatory cells are linked to abnormal airway physiology. Eosinophilic airway inflammation is associated with AHR while neutrophilic inflammation may be an important determinant of airflow limitation at rest and airway closure during...

  13. Integrated care pathways for airway diseases (AIRWAYS-ICPs)

    DEFF Research Database (Denmark)

    Bousquet, J; Addis, A; Adcock, I

    2014-01-01

    The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy....... AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers)....

  14. Biomarkers in Airway Diseases

    Directory of Open Access Journals (Sweden)

    Janice M Leung

    2013-01-01

    Full Text Available The inherent limitations of spirometry and clinical history have prompted clinicians and scientists to search for surrogate markers of airway diseases. Although few biomarkers have been widely accepted into the clinical armamentarium, the authors explore three sources of biomarkers that have shown promise as indicators of disease severity and treatment response. In asthma, exhaled nitric oxide measurements can predict steroid responsiveness and sputum eosinophil counts have been used to titrate anti-inflammatory therapies. In chronic obstructive pulmonary disease, inflammatory plasma biomarkers, such as fibrinogen, club cell secretory protein-16 and surfactant protein D, can denote greater severity and predict the risk of exacerbations. While the multitude of disease phenotypes in respiratory medicine make biomarker development especially challenging, these three may soon play key roles in the diagnosis and management of airway diseases.

  15. Ultrasound of the airway

    Directory of Open Access Journals (Sweden)

    Pankaj Kundra

    2011-01-01

    Full Text Available Currently, the role of ultrasound (US in anaesthesia-related airway assessment and procedural interventions is encouraging, though it is still ill defined. US can visualise anatomical structures in the supraglottic, glottic and subglottic regions. The floor of the mouth can be visualised by both transcutaneous view of the neck and also by transoral or sublinguial views. However, imaging the epiglottis can be challenging as it is suspended in air. US may detect signs suggestive of difficult intubation, but the data are limited. Other possible applications in airway management include confirmation of correct endotracheal tube placement, prediction of post-extubation stridor, evaluation of soft tissue masses in the neck prior to intubation, assessment of subglottic diameter for determination of paediatric endotracheal tube size and percutaneous dilatational tracheostomy. With development of better probes, high-resolution imaging, real-time picture and clinical experience, US has become the potential first-line noninvasive airway assessment tool in anaesthesia and intensive care practice.

  16. Clinical application of sodium hyaluronate,levarterenol and indicarmine solution in endoscopic submucosal dissection

    Directory of Open Access Journals (Sweden)

    Fei GAO

    2011-07-01

    Full Text Available Objective To assess the clinical value of sodium hyaluronate,levarterenol and indicarmine solution used in endoscopic submucosal dissection(ESD.Methods Sixteen patients were involved in present study who were diagnosed as precancerous lesion or submucosal tumor in digestive tract by chromoendoscopy and endoscopic ultrasonography from Nov,2010 to Feb,2011 at General Hospital of Shenyang Command.The injected solution was mixed with 0.2% indicarmine 10ml,levarterenol 10mg,sodium hyaluronate 20mg,and 0.9% normal saline 200ml.The liquid pad was formed under the submucosal layer by the injection of the mixture.Hybrid knife was employed to perform the injection,cutting and coagulation with no interruption during the procedure of ESD.Satisfactory degree was assessed,and the total solution volume,success rate,bleeding rate,perforation rate,operation duration,and length of stay in hospital were recorded.The recurrence and healing condition were observed at following-up.Results The length of lesion was 0.8~4.5cm with mean of 2.2cm.The operation duration was 45~240 min with an mean time of 95.4 min.The mean dosage of the mixed solution for submucosal injection was 102.4ml.Success rate of endoscopic submucosal dissection was 87.5%.The satisfactory degree was high.Intractable bleeding occurred in 2 cases with lateral spreading tumor(LST during the procedure,but it was controlled after high temperature coagulation without producing perforation.The dissection surface was covered by aluminum phosphate gel in all cases,and metal clips were applied in some cases for closure.The mean length of stay in hospital after ESD was 3.8 days.Conclusions The mixture of sodium hyaluronate,levarterenol,indicarmine and normal saline,when used for submucosal injection in ESD,is safe and satisfactory.

  17. Neurochemical features of endomorphin-2-containing neurons in the submucosal plexus of the rat colon

    Science.gov (United States)

    Li, Jun-Ping; Zhang, Ting; Gao, Chang-Jun; Kou, Zhen-Zhen; Jiao, Xu-Wen; Zhang, Lian-Xiang; Wu, Zhen-Yu; He, Zhong-Yi; Li, Yun-Qing

    2015-01-01

    AIM: To investigate the distribution and neurochemical phenotype of endomorphin-2 (EM-2)-containing neurons in the submucosal plexus of the rat colon. METHODS: The mid-colons between the right and left flexures were removed from rats, and transferred into Kreb’s solution. For whole-mount preparations, the mucosal, outer longitudinal muscle and inner circular muscle layers of the tissues were separated from the submucosal layer attached to the submucosal plexus. The whole-mount preparations from each rat mid-colon were mounted onto seven gelatin-coated glass slides, and processed for immunofluorescence histochemical double-staining of EM-2 with calcitonin gene-related peptide (CGRP), choline acetyltransferase (ChAT), nitric oxide synthetase (NOS), neuron-specific enolase (NSE), substance P (SP) and vasoactive intestinal peptide (VIP). After staining, all the fluorescence-labeled sections were observed with a confocal laser scanning microscope. To estimate the extent of the co-localization of EM-2 with CGRP, ChAT, NOS, NSE, SP and VIP, ganglia, which have a clear boundary and neuronal cell outline, were randomly selected from each specimen for this analysis. RESULTS: In the submucosal plexus of the mid-colon, many EM-2-immunoreactive (IR) and NSE-IR neuronal cell bodies were found in the submucosal plexus of the rat mid-colon. Approximately 6 ± 4.2 EM-2-IR neurons aggregated within each ganglion and a few EM-2-IR neurons were also found outside the ganglia. The EM-2-IR neurons were also immunopositive for ChAT, SP, VIP or NOS. EM-2-IR nerve fibers coursed near ChAT-IR neurons, and some of these fibers were even distributed around ChAT-IR neuronal cell bodies. Some EM-2-IR neuronal cell bodies were surrounded by SP-IR nerve fibers, but many long processes connecting adjacent ganglia were negative for EM-2 immunostaining. Long VIP-IR processes with many branches coursed through the ganglia and surrounded the EM-2-IR neurons. The percentages of the EM-2-IR neurons

  18. Mammary gland stem cells

    DEFF Research Database (Denmark)

    Fridriksdottir, Agla J R; Petersen, Ole W; Rønnov-Jessen, Lone

    2011-01-01

    Distinct subsets of cells, including cells with stem cell-like properties, have been proposed to exist in normal human breast epithelium and breast carcinomas. The cellular origins of epithelial cells contributing to gland development, tissue homeostasis and cancer are, however, still poorly...... and differences between mouse and human gland development with particular emphasis on the identity and localization of stem cells, and the influence of the surrounding microenvironment. It is concluded that while recent advances in the field have contributed immense insight into how the normal mammary gland...... develops and is maintained, significant discrepancies exist between the mouse and human gland which should be taken into consideration in current and future models of mammary stem cell biology....

  19. Anticholinergic treatment in airways diseases.

    LENUS (Irish Health Repository)

    Flynn, Robert A

    2009-10-01

    The prevalence of chronic airways diseases such as chronic obstructive pulmonary disease and asthma is increasing. They lead to symptoms such as a cough and shortness of breath, partially through bronchoconstriction. Inhaled anticholinergics are one of a number of treatments designed to treat bronchoconstriction in airways disease. Both short-acting and long-acting agents are now available and this review highlights their efficacy and adverse event profile in chronic airways diseases.

  20. Pediatric salivary gland imaging

    Energy Technology Data Exchange (ETDEWEB)

    Boyd, Zachary T. [University of Missouri-Kansas City School of Medicine, Kansas City, MO (United States); Goud, Asha R. [University of California Irvine Medical Center, Department of Radiology, Orange, CA (United States); Lowe, Lisa H. [Children' s Mercy Hospitals and Clinics and the University of Missouri-Kansas City, Department of Radiology, Kansas City, MO (United States); Shao, Lei [Children' s Mercy Hospitals and Clinics and the University of Missouri-Kansas City, Department of Pathology, Kansas City, MO (United States)

    2009-07-15

    A variety of lesions occur in the pediatric salivary glands. With modern imaging techniques such as Doppler sonography, helical CT, and MRI, identification of a specific etiology is often possible. Knowledge of clinical information, normal anatomy, and imaging characteristics of salivary gland pathology are essential for appropriate radiologic evaluation. This review illustrates the various congenital, neoplastic, and inflammatory entities that can occur within the parotid, submandibular, and sublingual spaces. (orig.)

  1. Airway epithelium is a predominant source of endogenous airway GABA and contributes to relaxation of airway smooth muscle tone

    OpenAIRE

    Gallos, George; Townsend, Elizabeth; Yim, Peter; Virag, Laszlo; Zhang, Yi; Xu, Dingbang; Bacchetta, Matthew; Emala, Charles W.

    2012-01-01

    Chronic obstructive pulmonary disease and asthma are characterized by hyperreactive airway responses that predispose patients to episodes of acute airway constriction. Recent studies suggest a complex paradigm of GABAergic signaling in airways that involves GABA-mediated relaxation of airway smooth muscle. However, the cellular source of airway GABA and mechanisms regulating its release remain unknown. We questioned whether epithelium is a major source of GABA in the airway and whether the ab...

  2. Mammary gland development.

    Science.gov (United States)

    Macias, Hector; Hinck, Lindsay

    2012-01-01

    The mammary gland develops through several distinct stages. The first transpires in the embryo as the ectoderm forms a mammary line that resolves into placodes. Regulated by epithelial–mesenchymal interactions, the placodes descend into the underlying mesenchyme and produce the rudimentary ductal structure of the gland present at birth. Subsequent stages of development—pubertal growth, pregnancy, lactation, and involution—occur postnatally under the regulation of hormones. Puberty initiates branching morphogenesis, which requires growth hormone (GH) and estrogen, as well as insulin-like growth factor 1 (IGF1), to create a ductal tree that fills the fat pad. Upon pregnancy, the combined actions of progesterone and prolactin generate alveoli, which secrete milk during lactation. Lack of demand for milk at weaning initiates the process of involution whereby the gland is remodeled back to its prepregnancy state. These processes require numerous signaling pathways that have distinct regulatory functions at different stages of gland development. Signaling pathways also regulate a specialized subpopulation of mammary stem cells that fuel the dramatic changes in the gland occurring with each pregnancy. Our knowledge of mammary gland development and mammary stem cell biology has significantly contributed to our understanding of breast cancer and has advanced the discovery of therapies to treat this disease.

  3. Radionuclide salivary gland imaging

    Energy Technology Data Exchange (ETDEWEB)

    Mishkin, F.S.

    1981-10-01

    Salivary gland imaging with 99mTc as pertechnetate provides functional information concerning trapping and excretion of the parotid and submandibular glands. Anatomic information gained often adds little to clinical evaluation. On the other hand, functional information may detect subclinical involvement, which correlates well with biopsy of the minor labial salivary glands. Salivary gland abnormalities in systemic disease such as sarcoidosis, rheumatoid arthritis, lupus erythematosus, and other collagenvascular disorders may be detected before they result in the clinical manifestaions of Sjoegren's syndrome. Such glands, after initially demonstrating increased trapping in the acute phase, tend to have decreased trapping and failure to discharge pertechnetate in response to an appropriate physiologic stimulus. Increased uptake of gallium-67 citrate often accompanies these findings. Inflammatory parotitis can be suspected when increased perfusion is evident on radionuclide angiography with any agent. The ability of the salivary gland image to detect and categorize mass lesions, which result in focal areas of diminished activity such as tumors, cysts, and most other masses, is disappointing, while its ability to detect and categorize Warthin's tumor, which concentrates pertechnetate, is much more valuable, although not specific.

  4. Pharmacology of airway smooth muscle proliferation

    NARCIS (Netherlands)

    Gosens, Reinoud; Roscioni, Sara S.; Dekkers, Bart G. J.; Pera, Tonio; Schmidt, Martina; Schaafsma, Dedmer; Zaagsma, Johan; Meurs, Herman

    2008-01-01

    Airway smooth muscle thickening is a pathological feature that contributes significantly to airflow limitation and airway hyperresponsiveness in asthma. Ongoing research efforts aimed at identifying the mechanisms responsible for the increased airway smooth muscle mass have indicated that hyperplasi

  5. Cholinergic regulation of airway inflammation and remodelling

    NARCIS (Netherlands)

    Kolahian, Saeed; Gosens, Reinoud

    2012-01-01

    Acetylcholine is the predominant parasympathetic neurotransmitter in the airways that regulates bronchoconstriction and mucus secretion. Recent findings suggest that acetylcholine regulates additional functions in the airways, including inflammation and remodelling during inflammatory airway disease

  6. A case of idiopathic gastroesophageal submucosal hematoma and its disappearance observed by endoscopy.

    Science.gov (United States)

    Oe, Shinji; Watanabe, Tatsuyuki; Kume, Keiichiro; Shibata, Michihiko; Hiura, Masaaki; Yoshikawa, Ichiro; Harada, Masaru

    2014-06-01

    A 74-year-old man was hospitalized due to hematemesis. Upper gastrointestinal endoscopy revealed a very large and dark red mass in the cardiac region of the stomach that extended from the upper esophagus. A biopsy specimen showed hemorrhagic tissue and no malignant cells. The tumor-like region ulcerated at 5 days after the administration of intravenous lansoprazole at a dose of 30 mg twice a day and resolved with scar formation at 2 months after a change to oral rabeprazole at a dose of 10 mg/day.We diagnosed the patient with gastroesophageal submucosal hematoma. Gastroesophageal submucosal hematoma is a rare complication. In this case, we could follow the process of its disappearance by endoscopy.

  7. Endoscopic submucosal dissection of a rectal carcinoid tumor using grasping type scissors forceps

    Institute of Scientific and Technical Information of China (English)

    Kazuya Akahoshi; Yasuaki Motomura; Masaru Kubokawa; Noriaki Matsui; Manami Oda; Risa Okamoto; Shingo Endo; Naomi Higuchi; Yumi Kashiwabara; Masafumi Oya; Hidefumi Akahane; Haruo Akiba

    2009-01-01

    Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate. The shortcomings of this method are the inability to fix the knife to the target lesion, and compression of the lesion. These can lead to major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (GSF), which can grasp and incise the targeted tissue using electrosurgical current. Colonoscopy on a 55-year-old woman revealed a 10-mm rectal submucosal nodule. The histological diagnosis of the specimen obtained by biopsy was carcinoid tumor. Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement. It was safely and accurately resected without unexpected incision by ESD using a GSF. No delayed hemorrhage or perforation occurred. Histological examination confirmed the carcinoid tumor was completely excised with negative resection margin.

  8. Effect of submucosal application of tramadol on postoperative pain after third molar surgery.

    Science.gov (United States)

    Gönül, Onur; Satılmış, Tülin; Bayram, Ferit; Göçmen, Gökhan; Sipahi, Aysegül; Göker, Kamil

    2015-10-14

    The aim of this study was to evaluate the effectiveness of submucosal application of tramadol, for acute postoperative facial pain, following the extraction of impacted third molar teeth. This prospective, double-blind, randomised placebo-controlled study included 60 ASA I-II patients undergoing impacted third molar surgery under local anaesthesia. Following the surgical procedure, patients were randomly divided into two groups; group T (1 mg/kg tramadol) and group S (2-mL saline). Treatments were applied submucosally after surgery. Pain after extraction was evaluated using a visual analogue scale (VAS) 0.5, 1, 2, 4, 6, 12, 24, and 48 h postoperatively. The time at which the first analgesic drug was taken, the total analgesic dose used, and adverse tissue reactions were also evaluated. In group T, postoperative VAS scores were significantly lower compared to that in group S (p third molar surgery.

  9. Isolated submucosal lipomatosis of appendix mimicking acute appendicitis: computed tomography findings

    Directory of Open Access Journals (Sweden)

    Şükrü Şanlı

    2014-03-01

    Full Text Available Acute appendicitis is one of the more common surgical emergencies, and it is one of the most common causes of acute abdominal pain. Intestinal lipomatosis is a rare condition particularly the isolated form of lipomatosis of the appendix which may mimic or present as an acute appendicitis, that frequently requires the surgical exploration.In this paper, we report computed tomography findings of a case wıth isolated form of submucosal lipomatosis of appendix.

  10. A laterally-spreading tumor in a colonic interposition treated by endoscopic submucosal dissection

    Institute of Scientific and Technical Information of China (English)

    Hideaki; Bando; Hiroaki; Ikematsu; Kuang-I; Fu; Yasuhiro; Oono; Takashi; Kojima; Keiko; Minashi; Tomonori; Yano; Takahisa; Matsuda; Yutaka; Saito; Kazuhiro; Kaneko; Atsushi; Ohtsu

    2010-01-01

    Herein we describe an early colonic carcinoma which developed in a colonic interposition 14 years after surgery for esophageal cancer, which was successfully treated by endoscopic submucosal dissection (ESD). An 80-year-old man underwent colonic interposition between the upper esophagus and stomach after surgery for an early esophageal squamous cell carcinoma in 1994. He received a surveillance endoscopy, and a laterally-spreading tumor of granular type, approximately 20 mm in size, was identified in the co...

  11. Endoscopic submucosal dissection in dogs in a World Gastroenterology Organisation training center

    Institute of Scientific and Technical Information of China (English)

    Miguel; A; Tanimoto; Gonzalo; Torres-Villalobos; Rikiya; Fujita; Patricio; Santillan-Doherty; Jorge; Albores-Saavedra; German; Gutierrez; Luis; A; Martin-del-Campo; Carlos; Bravo-Reyna; Octavio; Villanueva; Jose; J; Villalobos; Misael; Uribe; Miguel; A; Valdovinos

    2010-01-01

    AIM: To evaluate if canine models are appropriate for teaching endoscopy fellows the techniques of endoscopic submucosal dissection (ESD). METHODS: ESD was performed in 10 canine models under general anesthesia, on artificial lesions of the esophagus or stomach marked with coagulation points. After ESD, each canine model was euthanized and surgical resection of the esophagus or stomach was carried out according to "The Principles of Humane Experimental Technique, Russel and Burch". The ESD specimens were fi...

  12. Prevention and Treatment of Esophageal Stenosis after Endoscopic Submucosal Dissection for Early Esophageal Cancer

    Directory of Open Access Journals (Sweden)

    Jing Wen

    2014-01-01

    Full Text Available Endoscopic submucosal dissection (ESD for the treatment of esophageal mucosal lesions is associated with a risk of esophageal stenosis, especially for near-circumferential or circumferential esophageal mucosal defects. Here, we review historic and modern studies on the prevention and treatment of esophageal stenosis after ESD. These methods include prevention via pharmacological treatment, endoscopic autologous cell transplantation, endoscopic esophageal dilatation, and stent placement. This short review will focus on direct prevention and treatment, which may help guide the way forward.

  13. Endoscopic submucosal dissection for large laterally spreading tumors involving the ileocecal valve and terminal ileum

    Institute of Scientific and Technical Information of China (English)

    Gustavo Kishimoto; Yutaka Saito; Hajime Takisawa; Haruhisa Suzuki; Taku Sakamoto; Takeshi Nakajima; Takahisa Matsuda

    2012-01-01

    Endoscopic submucosal dissection is a challenging technique that enables en-bloc resection for large colorectal tumors, as laterally spreading tumors, particularly difficult, if the ileocecal valve and terminal ileum is involved. Herein, we report on one of 4 cases. The procedures, using a bipolar needle knife (B-Knife) to reduce the perforation risk and carbon dioxide instead of conventional air insufflation for patient comfort, achieved curative resections without any complications.

  14. Esophageal Endoscopic Submucosal Dissection Assisted by an Overtube with a Traction Forceps: An Animal Study

    Directory of Open Access Journals (Sweden)

    Ken Ohata

    2016-01-01

    Full Text Available Esophageal endoscopic submucosal dissection (ESD is technically difficult. To make it safer, we developed a novel method using overtube with a traction forceps (OTF for countertraction during submucosal dissection. We conducted an ex vivo animal study and compared the clinical outcomes between OTF-ESD and conventional method (C-ESD. A total of 32 esophageal ESD procedures were performed by four beginner and expert endoscopists. After circumferential mucosal incision for the target lesion, structured as the isolated pig esophagus 3 cm long, either C-ESD or OTF-ESD was randomly selected for submucosal dissection. All the ESD procedures were completed as en bloc resections, while perforation only occurred in a beginner’s C-ESD procedure. The dissection time for OTF-ESD was significantly shorter than that for C-ESD for both the beginner and expert endoscopists (22.8±8.3 min versus 7.8±4.5 min, P<0.001, and 11.3±4.4 min versus 5.9±2.5 min, P=0.01, resp.. The frequency and volume of the submucosal injections were significantly smaller for OTF-ESD than for C-ESD (1.3±0.6 times versus 2.9±1.5 times, P<0.001, and 5.3±2.8 mL versus 15.6±7.3 mL, P<0.001, resp.. Histologically, muscular injury was more common among the C-ESD procedures (80% versus 13%, P=0.009. Our results indicated that the OTF-ESD technique is useful for the safe and easy completion of esophageal ESD.

  15. Heading toward the right direction--solution package for endoscopic submucosal tunneling resection in the stomach.

    Directory of Open Access Journals (Sweden)

    Jiaoyang Lu

    Full Text Available The emerging submucosal tunneling and endoscopic resection (STER technique provides definitive histological diagnosis as well as a therapeutic method for the gastric submucosal tumors (SMTs. We aim to present our experience and discuss key technical issues of STER.45 patients with gastric SMTs arising from MP received STER. First, a mucosal incision was made 3 cm proximal to the tumour, a submucosal tunnel was subsequently built from the incision to the tumor. The tumor was gradually exposed and dissected from surrounding tissue and retrieved from the tunnel. The initial mucosal incision was closed by metal clips. For SMTs in the gastric fundus near cardia, the submucosal tunnel was built from lower esophagus, through the angle of His, to the tumor for resection.STER was successfully performed in 43 patients; the other two were converted to surgery. Mean operating time was 79.3 min (range 45-150 min. Mean tumor size was 1.4 cm (range 0.5-5 cm. Of the total 47 resected SMTs, 36 were GISTs, 10 were leiomyomas and 1 was schwannoma. Complete resection was achieved in all patients. Intra-procedural peumoperitoneum occurred in 3 cases because of iatrogenic perforation, no special treatment was given. 7 patients presented with mild abdominal pain/distention and fever were given antibotics. No severe post-operative complication happened. No tumor recurrence occurred in the median 11 month follow-up period.Based on short-term follow-up observation, STER is a feasible, safe and minimally invasive method for the diagnosis and treatment of small (<3 cm SMTs in gastric body, antrum and proximal cardia.

  16. Analysis of airway secretions in a model of sulfur dioxide induced chronic obstructive pulmonary disease (COPD

    Directory of Open Access Journals (Sweden)

    Fischer Axel

    2006-06-01

    Full Text Available Abstract Hypersecretion and chronic phlegm are major symptoms of chronic obstructive pulmonary disease (COPD but animal models of COPD with a defined functional hypersecretion have not been established so far. To identify an animal model of combined morphological signs of airway inflammation and functional hypersecretion, rats were continuously exposed to different levels of sulfur dioxide (SO2, 5 ppm, 10 ppm, 20 ppm, 40 ppm, 80 ppm for 3 (short-term or 20–25 (long-term days. Histology revealed a dose-dependent increase in edema formation and inflammatory cell infiltration in short-term-exposed animals. The submucosal edema was replaced by fibrosis after long-term-exposure. The basal secretory activity was only significantly increased in the 20 ppm group. Also, stimulated secretion was significantly increased only after exposure to 20 ppm. BrdU-assays and AgNOR-analysis demonstrated cellular metaplasia and glandular hypertrophy rather than hyperplasia as the underlying morphological correlate of the hypersecretion. In summary, SO2-exposure can lead to characteristic airway remodeling and changes in mucus secretion in rats. As only long-term exposure to 20 ppm leads to a combination of hypersecretion and airway inflammation, only this mode of exposure should be used to mimic human COPD. Concentrations less or higher than 20 ppm or short term exposure do not induce the respiratory symptom of hypersecretion. The present model may be used to characterize the effects of new compounds on mucus secretion in the background of experimental COPD.

  17. Action of N-acylated ambroxol derivatives on secretion of chloride ions in human airway epithelia.

    Science.gov (United States)

    Yamada, Takahiro; Takemura, Yoshizumi; Niisato, Naomi; Mitsuyama, Etsuko; Iwasaki, Yoshinobu; Marunaka, Yoshinori

    2009-03-13

    We report the effects of new N-acylated ambroxol derivatives (TEI-588a, TEI-588b, TEI-589a, TEI-589b, TEI-602a and TEI-602b: a, aromatic amine-acylated derivative; b, aliphatic amine-acylated derivative) induced from ambroxol (a mucolytic agent to treat human lung diseases) on Cl(-) secretion in human submucosal serous Calu-3 cells under a Na(+)/K(+)/2Cl(-) cotransporter-1 (NKCC1)-mediated hyper-secreting condition. TEI-589a, TEI-589b and TEI-602a diminished hyper-secretion of Cl(-) by diminishing the activity of NKCC1 without blockade of apical Cl(-) channel (TEI-589a>TEI-602a>TEI-589b), while any other tested compounds including ambroxol had no effects on Cl(-) secretion. These indicate that the inhibitory action of an aromatic amine-acylated derivative on Cl(-) secretion is stronger that that of an aliphatic amine-acylated derivative, and that 3-(2,5-dimethyl)furoyl group has a strong action in inhibition of Cl(-) secretion than cyclopropanoyl group. We here indicate that TEI-589a, TEI-589b and TEI-602a reduce hyper-secretion to an appropriate level in the airway, providing a possibility that the compound can be an effective drug in airway obstructive diseases including COPD by reducing the airway resistance under a hyper-secreting condition.

  18. Submucosal anoderm-preserving hemorrhoidectomy revisited: a modified technique for the surgical management of hemorrhoidal crisis.

    Science.gov (United States)

    Theodoropoulos, George E; Michalopoulos, Nikolaos V; Linardoutsos, Dimitrios; Flessas, Ioannis; Tsamis, Dimitrios; Zografos, George

    2013-11-01

    Submucosal hemorrhoidectomy (Parks' procedure) is a recognized method for treating acute hemorrhoidal crisis. Anoderm preservation has been stressed in various techniques described for elective or emergency excisional hemorrhoidal management. Mucopexy techniques have been proven useful as an adjunct to minimally resectional techniques. A modified submucosal technique with anoderm preservation and mucopexy was applied to 45 patients who presented on an emergency basis with hemorrhoidal crisis. External piles were minimally removed, the minimum possible amount of diseased mucosa was excised, a linear incision was used at the anoderm to enter the subanodermal/mucosal plane to achieve the submucosal excision, and a mucopexy was added at the approximation of the mucosal flaps. Postoperative morbidity was minimal and pain after the procedure remained at acceptable levels. This technique allows for an excision limited to the pathology with important anatomic tissue preservation. This results in conservation of the sensitive and useful anoderm, a decreased risk of stenosis, and addresses the mucosal prolapse. The level of postoperative pain with this technique is acceptable and long-term follow-up reveals a high degree of patient satisfaction.

  19. Local and systemic toxicity of intraoral submucosal injections of phentolamine mesylate (OraVerse).

    Science.gov (United States)

    Rutherford, Bruce; Zeller, Jillynne R; Thake, Daryl

    2009-01-01

    OraVerse, an injectable formulation of phentolamine mesylate (PM), was recently approved by the U.S. Food and Drug Administration (FDA) for reversal of anesthesia of the lip and tongue and associated functional deficits resulting from an intraoral submucosal injection of a local anesthetic containing a vasoconstrictor. Because PM had not been approved previously for submucosal administration, 2 Good Laboratory Practices (GLP) studies in dogs designed to investigate systemic toxicity and the local effects of single and repeated dosing of OraVerse on the inferior alveolar nerve and branches of the superior alveolar nerve and adjacent soft tissues after local administration were conducted. Systemic toxicity was measured by preinjection and postinjection clinical examinations, clinical chemistry, and gross and microscopic examinations of major organs after necropsy. No evidence of systemic toxicity was detected. Local nerve and adjacent tissue damage was assessed by conventional histopathology. Nerve degeneration was evident in 1 animal. Mild perineural inflammation adjacent to the inferior alveolar nerve and inflammatory exudates were observed in submucosal tissues in several animals. No changes were observed in the nerves at injection sites of dogs from any dose group that were considered directly related to the test articles. These data reveal that single and repeated intraoral administrations of OraVerse are well tolerated in beagle dogs.

  20. Efficacy of submucosal injection of different solutions inclusive blood components on mucosa elevation for endoscopic resection

    Directory of Open Access Journals (Sweden)

    Al-Taie OH

    2012-04-01

    Full Text Available Oliver H Al-Taie1, Yildiz Bauer2, Christoph G Dietrich3, Wolfgang Fischbach21Department of Internal Medicine, Sankt Elisabeth-Hospital, Gütersloh, 2Department of Internal Medicine II, Klinikum Aschaffenburg, Aschaffenburg, 3Department of Internal Medicine, Bethlehem-Hospital, Stolberg, GermanyBackground: Endoscopic resection has become the standard treatment for noninvasive gastrointestinal malignancies. In flat mucosal tumors, normal saline is frequently used for submucosal fluid injection in order to reduce the risk of complications during endoscopic resection. Recent studies have demonstrated longer-lasting mucosa elevation by injection of agents such as hyaluronic acid or glyceol, rather than normal saline. We investigated the efficacy of different blood components in comparison with other solutions for use as a submucosal fluid cushion.Methods: Normal saline, sodium hyaluronate, glyceol, hydroxyethyl starch, serum, plasma, and whole blood were evaluated for their effectiveness in creating a submucosal cushion. One milliliter of each solution was injected into the submucosa of 5 × 5 cm specimens of resected porcine stomach. Mucosa elevation was measured before and up to 60 minutes after injection.Results: The shortest duration of mucosa elevation was observed after injection of normal saline, glyceol, and 0.125% hyaluronic acid. A significantly longer duration was obtained after injection of hydroxyethyl starch, 0.25% and 0.5% hyaluronic acid, serum, and plasma. However, whole blood generated a longer-lasting mucosa elevation than all other agents.Conclusion: The results of the current study suggest that whole blood is more effective in generating long-lasting mucosa elevation than any other commonly used solution. Because autologous blood is readily available at almost no cost, this seems to be an optimal agent for creating the mucosa elevation needed for endoscopic resection. Further in vivo studies in humans are needed to clarify the

  1. Malignant salivary gland tumours

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, S.H. (University of the Witwatersrand, Johannesburg (South Africa). Dept. of Oral Pathology)

    1982-08-01

    The most frequent malignant salivary gland tumours are the mucoepidermoid tumour, adenoid cystic carcinoma and adenocarcinoma. The major salivary glands and the minor glands of the mouth and upper respiratory tract may potentially develop any of these malignant lesions. Malignant lesions most frequently present as a palpable mass and tend to enlarge more rapidly than benign neoplasms. Pain, paresthesia, muscle paralysis and fixation to surrounding tissue are all ominous signs and symptoms. The only reliable means of differential diagnosis of these lesions is biopsy and histologic analysis. Therapy involves surgery or a combination of surgery and radiation therapy. The ultimate prognosis is governed by the intrinsic biologic behaviour of the neoplasms, the extent of disease and adequate clinical therapy.

  2. Undifferentiated salivary gland carcinomas

    DEFF Research Database (Denmark)

    Herbst, H.; Hamilton-Dutoit, S.; Jakel, K.T.;

    2004-01-01

    Undifferentiated salivary gland carcinomas may be divided into small cell and large cell types. Among large cell undifferentiated carcinomas, lymphoepithelial carcinomas have to be distinguished, the latter of which are endemic in the Arctic regions and southern China where virtually all cases...... of these tumors are associated with the Epstein-Barr virus (EBV). Association with EBV may also be observed in sporadic cases, and detection of EBV gene products may aid their diagnosis. Immunohistology may be employed to resolve the differential diagnosis of undifferentiated salivary gland carcinomas, comprising...... malignant lymphomas, amelanotic melanomas, Merkel cell carcinomas, and adenoid cystic carcinomas, in particular in small biopsy materials. Because of the rarity of undifferentiated salivary gland carcinomas, the differential diagnosis should always include metastases of undifferentiated carcinomas arising...

  3. Salivary gland myoepithelial carcinoma.

    Science.gov (United States)

    Vilar-González, S; Bradley, K; Rico-Pérez, J; Vogiatzis, P; Golka, D; Nigam, A; Sivaramalingam, M; Kazmi, S

    2015-11-01

    Salivary gland myoepithelial carcinoma (MC) or malignant myoepithelioma is a rare entity. MC usually presents as a slow-growing painless mass arising in the parotid gland, but may involve other salivary glands. This tumour may be particularly locally aggressive, but its clinical and biological features are not yet fully understood. MC may arise from pre-existing benign lesions, such as pleomorphic adenomas or benign myoepitheliomas, or may arise de novo. It usually affects patients over 50 years old, with no gender preference. Because it is often asymptomatic, the presentation and diagnosis can be delayed by months, even years. The current WHO classification considers MC to be an intermediate- to high-grade malignancy. Other published data suggest it is likely to be a high-grade neoplasm, consistent with its aggressive behaviour. Its epidemiology, histopathological features, immunohistochemical profile, clinical behaviour and optimal management are not well understood. Following review of the current literature we aim to address these.

  4. Munc18/SNARE proteins' regulation of exocytosis in guinea pig duodenal Brunner's gland acini

    Institute of Scientific and Technical Information of China (English)

    Laura I Cosen-Binker; Gerry P Morris; Stephen Vanner; Herbert Y Gaisano

    2008-01-01

    AIM: To examine the molecular mechanism of exocytosis in the Brunner's gland acinar cell.METHODS: We used a submucosal preparation of guinea pig duodenal Brunner's gland acini to visualize the dilation of the ductal lumen in response to cholinergic stimulus. We correlated this to electron microscopy to determine the extent of exocytosis of the mucin-filled vesicles. We then examined the behavior of SNARE and interacting Munc18 proteins by confocal microscopy.RESULTS: One and 6 μmol/L carbachol evoked a dosedependent dilation of Brunner's gland acini lumen, which correlated to the massive exocytosis of mucin. Munc18c and its cognate SNARE proteins Syntaxin-4 and SNAP-23 were localized to the apical plasma membrane, and upon cholinergic stimulation, Munc18c was displaced into the cytosol leaving Syntaxin-4 and SNAP-23 intact.CONCLUSION: Physiologic cholinergic stimulation induces Munc18c displacement from the Brunner's gland acinar apical plasma membrane, which enables apical membrane Syntaxin-4 and SNAP-23 to form a SNARE complex with mucin-filled vesicle SNARE proteins to affect exocytosis.

  5. Salivary gland carcinomas

    DEFF Research Database (Denmark)

    Therkildsen, M H; Andersen, L J; Christensen, M;

    1998-01-01

    The prognosis of salivary gland carcinomas is difficult to assess. Simple mucin-type carbohydrates (T and sialosyl-T antigens, Tn and sialosyl-Tn antigens) have been shown to be of value in predicting prognosis for carcinomas in other locations. We studied the prognostic significance...... of the expression of these structures in a retrospective study of 133 patients with salivary gland carcinomas, using immunohistochemistry and a panel of well-defined monoclonal antibodies (MAbs) on formalin-fixed paraffin-embedded tissues. Sialosyl-Tn, T and sialosyl-T antigens were not correlated with prognosis...

  6. Poly(lactic acid-co-glycolic acid)-poly(ethylene glycol)-poly(lactic acid-co-glycolic acid) thermogel as a novel submucosal cushion for endoscopic submucosal dissection.

    Science.gov (United States)

    Yu, Lin; Xu, Wei; Shen, Wenjia; Cao, Luping; Liu, Yan; Li, Zhaoshen; Ding, Jiandong

    2014-03-01

    Endoscopic submucosal dissection (ESD) is a clinical therapy for early stage neoplastic lesions in the gastrointestinal tract. It is, however, faced with a crucial problem: the high occurrence of perforation. The formation of a submucosal fluid cushion (SFC) via a fluid injection is the best way to avoid perforation, and thus an appropriate biomaterial is vital for this minimally invasive endoscopic technique. In this study, we introduced an injectable thermogel as a novel submucosal injection substance in ESD. The hydrogel synthesized by us was composed of poly(lactic acid-co-glycolic acid)-poly(ethylene glycol)-poly(lactic acid-co-glycolic acid) (PLGA-PEG-PLGA) triblock copolymers. The polymer/water system was a low-viscosity fluid at room temperature and thus easily injected, and turned into a non-flowing gel at body temperature after injection. The submucosal injection of the thermogel to create SFCs was performed in both resected porcine stomachs and living minipigs. High mucosal elevation with a clear margin was maintained for a long duration. Accurate en bloc resection was achieved with the assistance of the thermogel. The mean procedure time was strikingly reduced. Meanwhile, no obvious bleeding, perforation and tissue damage were observed. The application of the thermogel not only facilitated the ESD procedure, but also increased the efficacy and safety of ESD. Therefore, the PLGA-PEG-PLGA thermogel provides an excellent submucosal injection system, and has great potential to improve the ESD technique significantly.

  7. Human Lacrimal Gland Gene Expression

    Science.gov (United States)

    Aakalu, Vinay Kumar; Parameswaran, Sowmya; Maienschein-Cline, Mark; Bahroos, Neil; Shah, Dhara; Ali, Marwan; Krishnakumar, Subramanian

    2017-01-01

    Background The study of human lacrimal gland biology and development is limited. Lacrimal gland tissue is damaged or poorly functional in a number of disease states including dry eye disease. Development of cell based therapies for lacrimal gland diseases requires a better understanding of the gene expression and signaling pathways in lacrimal gland. Differential gene expression analysis between lacrimal gland and other embryologically similar tissues may be helpful in furthering our understanding of lacrimal gland development. Methods We performed global gene expression analysis of human lacrimal gland tissue using Affymetrix ® gene expression arrays. Primary data from our laboratory was compared with datasets available in the NLM GEO database for other surface ectodermal tissues including salivary gland, skin, conjunctiva and corneal epithelium. Results The analysis revealed statistically significant difference in the gene expression of lacrimal gland tissue compared to other ectodermal tissues. The lacrimal gland specific, cell surface secretory protein encoding genes and critical signaling pathways which distinguish lacrimal gland from other ectodermal tissues are described. Conclusions Differential gene expression in human lacrimal gland compared with other ectodermal tissue types revealed interesting patterns which may serve as the basis for future studies in directed differentiation among other areas. PMID:28081151

  8. Anatomy of the thymus gland.

    Science.gov (United States)

    Safieddine, Najib; Keshavjee, Shaf

    2011-05-01

    In the case of the thymus gland, the most common indications for resection are myasthenia gravis or thymoma. The consistency and appearance of the thymus gland make it difficult at times to discern from mediastinal fatty tissues. Having a clear understanding of the anatomy and the relationship of the gland to adjacent structures is important.

  9. Vessel-guided Airway Tree Segmentation

    DEFF Research Database (Denmark)

    Lo, P.; Sporring, J.; Ashraf, H.;

    2010-01-01

    This paper presents a method for airway tree segmentation that uses a combination of a trained airway appearance model, vessel and airway orientation information, and region growing. We propose a voxel classification approach for the appearance model, which uses a classifier that is trained...... to differentiate between airway and non-airway voxels. This is in contrast to previous works that use either intensity alone or hand crafted models of airway appearance. We show that the appearance model can be trained with a set of easily acquired, incomplete, airway tree segmentations. A vessel orientation...

  10. Canine mammary gland tumors.

    Science.gov (United States)

    Sorenmo, Karin

    2003-05-01

    The National Consensus Group recommends that all women with tumors larger than 1 cm be offered chemotherapy regardless of tumor histology of lymph node status. This recommendation is to ensure that everyone at risk for failing, even though the risk may be low in women with relatively small tumors and favorable histology, has a choice and receives the benefit of adjuvant chemotherapy. This type of treatment recommendation may also be made in dogs based on recognized, well-accepted prognostic factors such as tumor size, stage, type, and histologic differentiation. Based on the limited clinical information available in veterinary medicine, the drugs that are effective in human breast cancer, such as cyclophosphamide, 5-fluorouracil, and doxorubicin, may also have a role in the treatment of malignant mammary gland tumors in dogs. Randomized prospective studies are needed, however, to evaluate the efficacy of chemotherapy in dogs with high-risk mammary gland tumors and to determine which drugs and protocols are the most efficacious. Until such studies are performed, the treatment of canine mammary gland tumors will be based on the individual oncologist's understanding of tumor biology, experience, interpretation of the available studies, and a little bit of gut-feeling. Table 2 is a proposal for treatment guidelines for malignant canine mammary gland tumors according to established prognostic factors, results from published veterinary studies, and current recommendations for breast cancer treatment in women.

  11. Submandibular gland excision

    DEFF Research Database (Denmark)

    Springborg, Line Kanstrup; Møller, Martin Nue

    2013-01-01

    cosmetic result and all scars were ≤6 on the Vancouver Scar Scale. Problems with scarring were more common if there had been postoperative infection. We continue to use the lateral transcervical approach as standard in our institution for patients who cannot be managed by gland-sparing procedures....

  12. Airway complications after lung transplantation.

    Science.gov (United States)

    Machuzak, Michael; Santacruz, Jose F; Gildea, Thomas; Murthy, Sudish C

    2015-01-01

    Airway complications after lung transplantation present a formidable challenge to the lung transplant team, ranging from mere unusual images to fatal events. The exact incidence of complications is wide-ranging depending on the type of event, and there is still evolution of a universal characterization of the airway findings. Management is also wide-ranging. Simple observation or simple balloon bronchoplasty is sufficient in many cases, but vigilance following more severe necrosis is required for late development of both anastomotic and nonanastomotic airway strictures. Furthermore, the impact of coexisting infection, rejection, and medical disease associated with high-level immunosuppression further complicates care.

  13. Airway vascular reactivity and vascularisation in human chronic airway disease

    NARCIS (Netherlands)

    Bailey, Simon R; Boustany, Sarah; Burgess, Janette K; Hirst, Stuart J; Sharma, Hari S; Simcock, David E; Suravaram, Padmini R; Weckmann, Markus

    2009-01-01

    Altered bronchial vascular reactivity and remodelling including angiogenesis are documented features of asthma and other chronic inflammatory airway diseases. Expansion of the bronchial vasculature under these conditions involves both functional (vasodilation, hyperperfusion, increased microvascular

  14. Endoscopic Submucosal Excavation for Submucosal Tumors%内镜黏膜下挖除术在黏膜下肿瘤中的应用

    Institute of Scientific and Technical Information of China (English)

    张秀华; 文卫; 范志宁; 王敏; 梁军才

    2011-01-01

    目的 探讨内镜黏膜下挖除术(endoscopic submucosal excavation,ESE)处理消化道黏膜下肿瘤(submucosal tumor,SMT)的疗效和安全性. 方法 2009年1~11月内镜发现的22例黏膜下病灶(食管11例、贲门2例、胃8例、结肠1例)作为入选对象,通过内镜超声(endoscopic ultrasonography,EUS)检查明确病灶大小、位置、性质,进行ESE治疗,观察其疗效和并发症情况. 结果 20例(91%)完整挖除,2例ESE术后创面仍有肿瘤残留且病理报告低度恶性,转外科手术扩大切除治疗.病灶直径0.5~3.5 cm(平均1.5 cm),手术时间20~220 min(平均75 min).3例穿孔均保守治愈.术后随访1~12个月(平均6.5月),20例完整挖除者均未见复发. 结论 ESE对消化道的SMT具有可完整挖除病灶、创伤小、术后恢复快等优点,值得推广.%Objective To assess the effectiveness and safety of endoscopic submucosal excavation (ESE) in the treatment of patients with submucosal tumor (SMT). Methods Totally 22 patients with SMT in the gastrointestinal tract detected by endoscopy were enrolled into this study from January 2009 to August 2009. Endoscopic ultrasonography (EUS) were applied to confirm the size,location, and nature of the lesions. The patients were then treated by ESE, and the efficacy and complications were observed afterwards. Results In the 22 cases, the tumor was completely removed in 20 patients (91%) by ESE, the other two patients who had residual tumor tissues were confirmed with low malignancy and thus were converted to open surgery for extended resection. The mean size of lesions in our group was 1.5 cm (0.5 - 3.5 cm) , and the mean operation time for ESE was 75 min (20 - 220 min).Three patients developed perforation during the procedure and were then cured by conservative therapy. A mean of 6.5-month follow-up ( 1 - 12 months) was achieved in the patients, during which the 20 patients who had the lesion removed completely had no recurrence.Conclusions ESE is a

  15. Airway Epithelium Stimulates Smooth Muscle Proliferation

    OpenAIRE

    Malavia, Nikita K.; Raub, Christopher B.; Mahon, Sari B.; Brenner, Matthew; Reynold A Panettieri; George, Steven C.

    2009-01-01

    Communication between the airway epithelium and stroma is evident during embryogenesis, and both epithelial shedding and increased smooth muscle proliferation are features of airway remodeling. Hence, we hypothesized that after injury the airway epithelium could modulate airway smooth muscle proliferation. Fully differentiated primary normal human bronchial epithelial (NHBE) cells at an air–liquid interface were co-cultured with serum-deprived normal primary human airway smooth muscle cells (...

  16. Does the polystomatic gland exist?

    Science.gov (United States)

    Imai, M; Shibata, T; Moriguchi, K; Kinbara, M

    1989-03-01

    According to the P.N.A., the N.A.J. and some scholars, the sublingual gland has the ductus sublingualis major and ductus sublinguales minores. This means that the gland is a polystomatic gland. We intended to determine whether the so-called polystomatic gland exists or not. 1. According to the P.N.A., the N.A.J. and some scholars, the gl. sublingualis has the ductus sublingualis major and ductus sublinguales minores. This means the gland is a polystomatic gland. However, the formation of one gland with plural excretory ducts is embryologically impossible, in other words, the polystomatic gland does not exist. 2. Many scholars described that the gl. sublingualis was composed of the gl. sublingualis major and g11. sublinguales minores. However, they are completely different kinds of glands. Accordingly, we suggest the terms for these glands: the g1. sublingualis and its ductus sublingualis ("major" is useless), the g11. sublinguales minores and their ductus sublinguales minores. 3. The N.A.V.J. and some scholars use the term g1. sublingualis polystomatica or parvicanalaris. However, this is a group of a number of independent glands each of which has its own excretory duct. Such a gland should not be regarded as a single gland. We suggest that the term g11. sublinguales minores and their excretory ducts should be replaced with the term the ductus sublinguales minores. 4. The g1. lingualis anterior, g1. retromolaris and g1. lacrimalis are not single glands but a group of several independent glands each of which has its own excretory duct. Accordingly, they should be termed the g11. linguales anteriores, g11. retromolares and g11. lacrimales such as the g11. labiales, g11. buccales and g11. palatinae.

  17. Effect of retinoic acid on the nitrergic innervation of meibomian glands in rats

    Directory of Open Access Journals (Sweden)

    A. Bolekova

    2012-11-01

    Full Text Available The purpose of this study was to investigate the effect of prenatal administration of retinoic acid (RA on the development of nicotinamide adenine dinucleotide diaphorase (NADPH-d positive structures in the rat Meibomian glands. One mg/kg of RA was applied to pregnant Wistar rats intraperitonaelly during the gestational period in each of the 12th-14th embryonic days (totally 3 mg/kg. Sections of the central upper eyelids were investigated in rat pups on the 14th postnatal day. They were processed histochemically for NADPH-d, to study the presence and distribution of nitric oxide synthase (NOS positive nerve structures. NADPH-d staining of Meibomian glands was compared in two groups of rat pups. In the control group, eyelids of 14 day-old rats were studied with no experimental intervention. The second group consisted of rat pups which were prenatally administered the excess of RA. Histochemical analysis of control eyelids revealed numerous NADPH-d well-stained acini of Meibomian glands arranged tightly into groups. Intensively stained vessels and NADPH-d/NOS-positive nerve fibers bordered acini of Meibomian glands. These structures were present in the submucosal layer as well. The analysis of RA group showed less numerous, shrunken acini of Meibomian glands that were seen not only smaller in size, but also in density of their staining and the amount of nitrergic nerve fibers around acini were considerably lowered. In the submucosa differences were noticed compared to the control group, there were numerous NADPH-d stained vessels accompanied by NADPH-d/NOS-positive nerve fibers. The excess of RA during the prenatal period may influence on the development and morphology of NADPH-d positive structures of rat’s Meibomian glands.

  18. Effect of retinoic acid on the nitrergic innervation of meibomian glands in rats.

    Science.gov (United States)

    Bolekova, A; Kluchova, D; Tomasova, L; Hvizdosova, N

    2012-11-30

    The purpose of this study was to investigate the effect of prenatal administration of retinoic acid (RA) on the development of nicotinamide adenine dinucleotide diaphorase (NADPH-d) positive structures in the rat Meibomian glands. One mg/kg of RA was applied to pregnant Wistar rats intraperitonaelly during the gestational period in each of the 12th-14th embryonic days (totally 3 mg/kg). Sections of the central upper eyelids were investigated in rat pups on the 14th postnatal day. They were processed histochemically for NADPH-d, to study the presence and distribution of nitric oxide synthase (NOS) positive nerve structures. NADPH-d staining of Meibomian glands was compared in two groups of rat pups. In the control group, eyelids of 14 day-old rats were studied with no experimental intervention. The second group consisted of rat pups which were prenatally administered the excess of RA. Histochemical analysis of control eyelids revealed numerous NADPH-d well-stained acini of Meibomian glands arranged tightly into groups. Intensively stained vessels and NADPH-d/NOS-positive nerve fibers bordered acini of Meibomian glands. These structures were present in the submucosal layer as well. The analysis of RA group showed less numerous, shrunken acini of Meibomian glands that were seen not only smaller in size, but also in density of their staining and the amount of nitrergic nerve fibers around acini were considerably lowered. In the submucosa differences were noticed compared to the control group, there were numerous NADPH-d stained vessels accompanied by NADPH-d/NOS-positive nerve fibers. The excess of RA during the prenatal period may influence on the development and morphology of NADPH-d positive structures of rat's Meibomian glands.

  19. Tumors of the lacrimal gland

    DEFF Research Database (Denmark)

    Von Holstein, Sarah Linéa; Rasmussen, Peter Kristian; Heegaard, Steffen

    2016-01-01

    Tumors of the lacrimal gland comprise a wide spectrum, of which the most common demonstrate epithelial and lymphoid differentiation. The diagnosis of lacrimal gland tumors depends primarily on histological evaluation, as do the choice of treatment and prognosis. For some lacrimal gland neoplasms......, such as adenoid cystic carcinoma, the outlook is grave. Optimal treatment for several lacrimal gland tumors is also a matter of controversy. However, recent progress has been made in the molecular and genetic understanding of tumorigenesis for such lesions. This article presents an overview of the histopathology...... of lacrimal gland tumors, together with their epidemiological features, clinical characteristics, and treatment strategies....

  20. Tumors of the sublingual gland

    DEFF Research Database (Denmark)

    Andreasen, Simon; Bjørndal, K; Agander, T K

    2016-01-01

    Tumors of the salivary glands are a heterogeneous group of diseases most often originating in the major salivary glands. Only a minor proportion of mainly malignant tumors arise in the sublingual gland. Due to the rarity of sublingual gland tumors (SGTs), little is known about the clinicopathologic...... (ACC). Patient demography was similar to salivary gland tumors in other locations. All fine needle aspiration cytologies (FNACs) interpreted as benign were from ACCs. Metastatic disease was found in 12.5 % of ACCs at diagnosis with one third of all ACC patients having metastases at the end of follow...

  1. Airway management and morbid obesity

    DEFF Research Database (Denmark)

    Kristensen, Michael S

    2010-01-01

    Morbidly obese patients present with excess fatty tissue externally on the breast, neck, thoracic wall and abdomen and internally in the mouth, pharynx and abdomen. This excess tissue tends to make access (intubation, tracheostomy) to and patency (during sedation or mask ventilation) of the upper...... in morbidly obese patients and should be followed by actions to counteract atelectasis formation. The decision as to weather to use a rapid sequence induction, an awake intubation or a standard induction with hypnotics should depend on the thorough airway examination and comorbidity and should not be based...... solely on whether morbid obesity is present or not. It is important to ensure sufficient depth of anaesthesia before initiating manipulation of the airway because inadequate anaesthesia depth predisposes to aspiration if airway management becomes difficult. The intubating laryngeal mask airway is more...

  2. Novel use of laryngeal mask airway classic excel™ for bronchoscopy and tracheal intubation

    Directory of Open Access Journals (Sweden)

    Anusha Kannan

    2013-01-01

    Full Text Available The usage frequency and scope of supraglottic airway devices in anesthesia has expanded since the original laryngeal mask airway (LMA prototype was invented by Dr Archie Brain in the early 1980s. Today, anesthesiologists are spoilt-for-choice with more than thirty options. The LMA Classic Excel™ was introduced to anesthesia practice in 2009; designed with an epiglottic elevating bar and a removable airway connector to facilitate tracheal intubation using the LMA as a conduit. We present a case report of a women diagnosed with papillary carcinoma of thyroid, who underwent bronchoscopic assessment of the trachea and subsequent intubation for an en-bloc dissection and removal of thyroid gland through the LMA Classic Excel™.

  3. Morphologic aspects of airways of patients with pulmonary emphysema followed by bronchial asthma-like attack.

    Science.gov (United States)

    Haraguchi, M; Shimura, S; Shirato, K

    1996-02-01

    Morphometric analysis of airways was performed in autopsied lungs from four patients with pulmonary emphysema (PE) followed by bronchial-asthma (BA)-like attacks (Group PE+BA) (four males, 72 +/- 9 yr). The results were compared with those from five pulmonary emphysema patients (Group PE) (five males, age 71 +/- 4 hr), three patients with bronchial asthma (Group BA) (one female and two males, age 65 +/- 7 yr), and four control subjects with no pulmonary diseases (Group Cont) (one female, three males, age 64 +/- 4 yr). The proportion of gland area to bronchial wall (gland%), ratio of goblet-cell occupancy to the total epithelial layer (goblet%), thickness of the basement membrane, amount of intraluminal mucus (mucus occupying ratio; MOR%), and number of various cell types per square millimeter in airway walls in a section 4 microns thick were measured in central (3 to 8 mm diameter) and peripheral airways (2 mm or less diameter). Gland% for the PE+BA group was significantly greater than that for the Cont group, whereas it did not differ significantly from that of the PE or BA groups. Goblet% and thickness of the basement membrane in central and/or peripheral airways in Group PE+BA were significantly greater than those in Group Cont, whereas those in Group PE were similar to those in Group Cont. Although not statistically significant, MOR% in central and peripheral airways from Group PE+BA showed a similar value to that in Group BA, whereas MOR% in Group PE was the same as that in Group Cont. The eosinophil number in peripheral airways walls in Group PE+BA showed a similar value to that in Group BA, which was significantly greater than in Group Cont. Other cells (macrophages, lymphocytes, and neutrophils) showed similar values among Groups PE+BA, PE, and BA. The number of eosinophils in central and/or peripheral airways correlated significantly with both goblet% and BMT, whereas other cells did not. These findings indicate that the airways of Group PE+BA are

  4. Brunner’s Gland Adenoma – A Rare Cause of Gastrointestinal Bleeding: Case Report and Systematic Review

    Directory of Open Access Journals (Sweden)

    Michele Sorleto

    2017-01-01

    Full Text Available Brunner’s gland adenoma is an extremely rare benign small bowel neoplasm, often discovered incidentally during upper gastrointestinal endoscopy or radiological diagnostics. In few cases, it tends to cause gastrointestinal hemorrhage or intestinal obstruction. We report here our experience with a 47-year-old woman with a Brunner’s gland adenoma of more than 6 cm in size, located in the first part of the duodenum and causing gastrointestinal bleeding. Initially, we performed a partial endoscopic resection using endoloop and snare alternatively to prevent severe bleeding. A rest endoscopic polypectomy with the submucosal dissection technique was planned. However, on request of the patient, an elective surgical duodenotomy with submucosal resection of the remaining small duodenal tumor was performed. To better define the patient’s characteristics and treatment options of such lesions, we performed a systematic review of the available literature in PubMed. Recently, an endoscopic removal is being increasingly practiced and is considered as a safe treatment modality of such lesions.

  5. Endoscopic submucosal dissection training with pig models in a Western country

    Institute of Scientific and Technical Information of China (English)

    Adolfo; Parra-Blanco; María; Rosa; Arnau; David; Nicolás-Pérez; Antonio; Z; Gimeno-García; Nicolás; González; Juan; A; Díaz-Acosta; Alejandro; Jiménez; Enrique; Quintero

    2010-01-01

    AIM:To test a strategy for endoscopic submucosal dissection(ESD) training in animal models designed to overcome the initial learning curve.METHODS:ESD was attempted in ex vivo and in vivo pig models.Thirty ESD procedures were attempted in the esophagus(n=9) or the stomach(n=21).The ex vivo model was used until initial competence was achieved.In the in vivo model,several ESD procedures were performed in up to 3 sessions.The following variables were analyzed:specimen size,complete and en bloc resection rate,t...

  6. A new removable airway stent

    Directory of Open Access Journals (Sweden)

    Tore Amundsen

    2016-09-01

    Full Text Available Background: Malignant airway obstruction is a feared complication and will most probably occur more frequently in the future because of increasing cancer incidence and increased life expectancy in cancer patients. Minimal invasive treatment using airway stents represents a meaningful and life-saving palliation. We present a new removable airway stent for improved individualised treatment. Methods: To our knowledge, the new airway stent is the world's first knitted and uncovered self-expanding metal stent, which can unravel and be completely removed. In an in vivo model using two anaesthetised and spontaneously breathing pigs, we deployed and subsequently removed the stents by unravelling the device. The procedures were executed by flexible bronchoscopy in an acute and a chronic setting – a ‘proof-of-principle’ study. Results: The new stent was easily and accurately deployed in the central airways, and it remained fixed in its original position. It was easy to unravel and completely remove from the airways without clinically significant complications. During the presence of the stent in the chronic study, granulation tissue was induced. This tissue disappeared spontaneously with the removal. Conclusions: The new removable stent functioned according to its purpose and unravelled easily, and it was completely removed without significant technical or medical complications. Induced granulation tissue disappeared spontaneously. Further studies on animals and humans are needed to define its optimal indications and future use.

  7. Vessel-guided airway tree segmentation

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau; Sporring, Jon; Ashraf, Haseem

    2010-01-01

    This paper presents a method for airway tree segmentation that uses a combination of a trained airway appearance model, vessel and airway orientation information, and region growing. We propose a voxel classification approach for the appearance model, which uses a classifier that is trained...... to differentiate between airway and non-airway voxels. This is in contrast to previous works that use either intensity alone or hand crafted models of airway appearance. We show that the appearance model can be trained with a set of easily acquired, incomplete, airway tree segmentations. A vessel orientation...... similarity measure is introduced, which indicates how similar the orientation of an airway candidate is to the orientation of the neighboring vessel. We use this vessel orientation similarity measure to overcome regions in the airway tree that have a low response from the appearance model. The proposed...

  8. Analysis of airways in computed tomography

    DEFF Research Database (Denmark)

    Petersen, Jens

    Chronic Obstructive Pulmonary Disease (COPD) is major cause of death and disability world-wide. It affects lung function through destruction of lung tissue known as emphysema and inflammation of airways, leading to thickened airway walls and narrowed airway lumen. Computed Tomography (CT) imaging...... have become the standard with which to assess emphysema extent but airway abnormalities have so far been more challenging to quantify. Automated methods for analysis are indispensable as the visible airway tree in a CT scan can include several hundreds of individual branches. However, automation...... of scan on airway dimensions in subjects with and without COPD. The results show measured airway dimensions to be affected by differences in the level of inspiration and this dependency is again influenced by COPD. Inspiration level should therefore be accounted for when measuring airways, and airway...

  9. Upper airway resistance syndrome.

    Science.gov (United States)

    Montserrat, J M; Badia, J R

    1999-03-01

    This article reviews the clinical picture, diagnosis and management of the upper airway resistance syndrome (UARS). Presently, there is not enough data on key points like the frequency of UARS and the morbidity associated with this condition. Furthermore, the existence of LIARS as an independent sleep disorder and its relation with snoring and obstructive events is in debate. The diagnosis of UARS is still a controversial issue. The technical limitations of the classic approach to monitor airflow with thermistors and inductance plethysmography, as well as the lack of a precise definition of hypopnea, may have led to a misinterpretation of UARS as an independent diagnosis from the sleep apnea/hypopnea syndrome. The diagnosis of this syndrome can be missed using a conventional polysomnographic setting unless appropriate techniques are applied. The use of an esophageal balloon to monitor inspiratory effort is currently the gold standard. However, other sensitive methods such as the use of a pneumotachograph and, more recently, nasal cannula/pressure transducer systems or on-line monitoring of respiratory impedance with the forced oscillation technique may provide other interesting possibilities. Recognition and characterization of this subgroup of patients within sleep breathing disorders is important because they are symptomatic and may benefit from treatment. Management options to treat UARS comprise all those currently available for sleep apnea/hypopnea syndrome (SAHS). However, the subset of patients classically identified as LIARS that exhibit skeletal craneo-facial abnormalities might possibly obtain further benefit from maxillofacial surgery.

  10. Submucosal lipoma of the large intestine masquerading as a colonic malignancy.

    Science.gov (United States)

    Coyne, Pe; Teemul, T; Dent, B; Henderson, D; Crabbe, R; Garud, T

    2011-02-01

    Lipomas of the alimentary tract are rare tumours that can mimic malignant lesions. They are often small and asymptomatic although larger tumours can present with intusussception or as abdominal masses. We present a case of a transverse colon submucosal lipoma masquerading as a colonic adenocarcinoma leading to resection. A 74 year-old-man was referred urgently for assessment with altered bowel habits, and lower abdominal discomfort along with a positive Faecal-Occult-Blood sample. Colonoscopy demonstrated a large polypoidal lesion at the hepatic flexure with ulceration. Biopsies were inconclusive. A staging CT scan confirmed a 3.3 x 4.3 x 3.4cm Polyp with colonic wall thickening suspicious of malignancy. An extended right hemi-colectomy was performed. Histology showed a large submucosal lipoma with 12 reactive lymph nodes. Colonic lipoma often present as incidental findings detected on either imaging or endoscopically whilst investigating other symptoms. Their appearances can mimic colonic malignancy and surgical resection may be required.

  11. Laparoscopic endoscopic cooperative surgery as a minimally invasive treatment for gastric submucosal tumor

    Institute of Scientific and Technical Information of China (English)

    Tsutomu; Namikawa; Kazuhiro; Hanazaki

    2015-01-01

    Laparoscopic wedge resection is a useful procedure fortreating patients with submucosal tumor(SMT) including gastrointestinal stromal tumor(GIST) of the stomach. However, resection of intragastric-type SMTs can be problematic due to the difficulty in accurately judging the location of endoluminal tumor growth, and often excessive amounts of healthy mucosa are removed; thus, full-thickness local excision using laparoscopic and endoscopic cooperative surgery(LECS) is a promising procedure for these cases. Our experience with LECS has confirmed this procedure to be a safe, feasible, and minimally invasive treatment method for gastric GISTs less than 5 cm in diameter, with outcomes similar to conventional laparoscopic wedge resection. The important advantage of LECS is the reduction in the resected area of the gastric wall compared to that in conventional laparoscopic wedge resection using a linear stapler. Early gastric cancer fits the criteria for endoscopic resection; however, if performing endoscopic submucosal dissection is difficult, the LECS procedure might be a good alternative. In the future, LECS is also likely to be indicated for duodenal tumors, as well as gastric tumors. Furthermore, developments in endoscopic and laparoscopic technology have generated various modified LECS techniques, leading to even less invasive surgery.

  12. Traction-assisted colonic endoscopic submucosal dissection using clip and line: a feasibility study

    Science.gov (United States)

    Yamasaki, Yasushi; Takeuchi, Yoji; Uedo, Noriya; Kato, Minoru; Hamada, Kenta; Aoi, Kenji; Tonai, Yusuke; Matsuura, Noriko; Kanesaka, Takashi; Yamashina, Takeshi; Akasaka, Tomofumi; Hanaoka, Noboru; Higashino, Koji; Ishihara, Ryu; Iishi, Hiroyasu

    2016-01-01

    Background and study aims: Colonic endoscopic submucosal dissection (ESD) is a challenging procedure because it is often difficult to maintain good visualization of the submucosal layer. To facilitate colonic ESD, we designed a novel traction method, namely traction-assisted colonic ESD using clip and line (TAC), and investigated its feasibility. Patients and methods: We retrospectively analyzed 23 patients with large colonic superficial lesions who had undergone TAC. The main outcome was the procedural success rate of TAC, which we defined as successful, sustained application of clip and line to the lesion until the end of the procedure. Results: The procedural success rate of TAC was 87 % (20/23). In all three unsuccessful cases, the lesions were in the proximal colon and the procedure times over 100 minutes. The overall mean procedure time was 61 min (95 % confidence interval, 18 – 172 min). We achieved en bloc resections of all lesions. There were no perforations or fatal adverse events. Conclusions: TAC is feasible and safe for colonic ESD and may improve the ease of performing this procedure. PMID:26793785

  13. Robotic Transanal Endoscopic Submucosal Dissection (RTESD of Large Rectal Tumor in Prone Position

    Directory of Open Access Journals (Sweden)

    Lajevardi

    2016-05-01

    Full Text Available Introduction Endoscopic submucosal dissection (ESD of large tumors of the rectum is particularly challenging using colonoscopy or with laparoscopic instruments. More recently robotic assisted technique has been described. Case Presentation We describe the first reported case of robotic transanal endoscopic submucosal dissection (RTESD in Australia for a large circumferential laterally spreading tumor of the rectum using the da Vinci® Si system with the patient in the prone position. The case took 145 minutes and the authors found good manoeuvrability due to the intuitive nature of the robot’s endowristed miniaturised graspers. The prone position facilitated robot docking and reduced the external robotic arm clashing. This procedure was safely performed and the patient was discharged the following day. Colonoscopic follow up to one year revealed no recurrence of disease. Conclusions RTESD in the prone position is safe and presents a feasible alternative for management of large rectal tumors. We also anticipate the technique to further improve with the advancement of robotic technology.

  14. Lacrimal glands: Size does matter!

    Directory of Open Access Journals (Sweden)

    Suyash Mohan

    2011-01-01

    Full Text Available A 40-year-old woman presented with vague headaches and blurred vision. Contrast-enhanced magnetic resonance imaging of the brain revealed bilaterally symmetrical diffuse enlargement of the lacrimal glands. A fine needle biopsy of the lacrimal gland was consistent with sarcoidosis. Although, isolated lacrimal gland involvement is rare, it may be the initial clinical presentation of sarcoidosis, as seen in this patient. Imaging plays a vital role in these unsuspected cases and careful evaluation of the lacrimal glands with dedicated thin section, fat suppressed, axial and coronal orbital imaging, may help identify a pathological cause and avoid a delay in diagnosis.

  15. Treating asthma means treating airway smooth muscle cells

    NARCIS (Netherlands)

    Zuyderduyn, S; Sukkar, M B; Fust, A; Dhaliwal, S; Burgess, J K

    2008-01-01

    Asthma is characterised by airway hyperresponsiveness, airway inflammation and airway remodelling. Airway smooth muscle cells are known to be the main effector cells of airway narrowing. In the present paper, studies will be discussed that have led to a novel view of the role of airway smooth muscle

  16. A case of a ruptured submucosal aneurysm of the small intestine identified using double-balloon enteroscopy.

    Science.gov (United States)

    Chiba, Hirofumi; Endo, Katsuya; Fujishima, Fumiyoshi; Ohtsuka, Hideo; Naitoh, Takeshi; Kuroha, Masatake; Kimura, Tomoya; Shiga, Hisashi; Kakuta, Yoichi; Kinouchi, Yoshitaka; Unno, Michiaki; Shimosegawa, Tooru

    2016-04-01

    A 47-year-old woman was admitted to our hospital urgently with sudden-onset hematochezia. She was temporarily in a state of hemorrhagic shock. As we strongly suspected bleeding from the small intestine, peroral double-balloon enteroscopy was performed, and indicated a 2.0-cm diameter hemispheric elevated lesion in the jejunum. Moreover, a blood clot was observed at the top of the protrusion. The site was marked by injecting India ink, without taking a biopsy specimen, to avoid further hemorrhaging. Subsequently, laparoscopic partial small bowel resection was performed. On histopathological examination, the lesion was found to be a sac-like submucosal arterial aneurysm, with a diameter of 3.5 mm, comprising several small abnormal arteries. The final diagnosis was a ruptured submucosal aneurysm of the small intestine. Ruptured submucosal aneurysms are very rarely observed in the small intestine. Only a few reports have described their endoscopic findings. Our experience indicates that small bowel enteroscopy may be useful for managing ruptured submucosal aneurysms of the small intestine.

  17. Neurogastroenterology of tegaserod (HTF 919) in the submucosal division of the guinea-pig and human enteric nervous system.

    Science.gov (United States)

    Fang, X; Liu, S; Wang, X-Y; Gao, N; Hu, H-Z; Wang, G-D; Cook, C H; Needleman, B J; Mikami, D J; Xia, Y; Fei, G-J; Hicks, G A; Wood, J D

    2008-01-01

    Actions of the 5-HT(4) serotonergic receptor partial agonist, tegaserod, were investigated on mucosal secretion in the guinea-pig and human small intestine and on electrophysiological behaviour of secretomotor neurons in the guinea-pig small intestinal submucosal plexus. Expression of 5-HT(4) receptor protein and immunohistochemical localization of the 5-HT(4) receptor in the submucosal plexus in relation to expression and localization of choline acetyltransferase and the vesicular acetylcholine (ACh) transporter were determined for the enteric nervous system of human and guinea-pig small intestine. Immunoreactivity for the 5-HT(4) receptor was expressed as ring-like fluorescence surrounding the perimeter of the neuronal cell bodies and co-localized with the vesicular ACh transporter. Exposure of mucosal/submucosal preparations to tegaserod in Ussing chambers evoked increases in mucosal secretion reflected by stimulation of short-circuit current. Stimulation of secretion had a relative high EC(50) of 28.1 +/- 1.3 mumol L(-1), was resistant to neural blockade and appeared to be a direct action on the secretory epithelium. Tegaserod acted at presynaptic 5-HT(4) receptors to facilitate the release of ACh at nicotinic synapses on secretomotor neurons in the submucosal plexus. The 5-HT(2B) receptor subtype was not involved in actions at nicotinic synapses or stimulation of secretion.

  18. Multiscale Vessel-guided Airway Tree Segmentation

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau; Sporring, Jon; de Bruijne, Marleen

    2009-01-01

    that is trained to differentiate between airway and non-airway voxels. Vessel and airway orientation information are used in the form of a vessel orientation similarity measure, which indicates how similar the orientation of the an airway candidate is to the orientation of the neighboring vessel. The method...... is evaluated within EXACT’09 on a diverse set of CT scans. Results show a favorable combination of a relatively large portion of the tree detected correctly with very few false positives....

  19. Pharmacogenetics, pharmacogenomics and airway disease

    Directory of Open Access Journals (Sweden)

    Hall Ian P

    2001-11-01

    Full Text Available Abstract The availability of a draft sequence for the human genome will revolutionise research into airway disease. This review deals with two of the most important areas impinging on the treatment of patients: pharmacogenetics and pharmacogenomics. Considerable inter-individual variation exists at the DNA level in targets for medication, and variability in response to treatment may, in part, be determined by this genetic variation. Increased knowledge about the human genome might also permit the identification of novel therapeutic targets by expression profiling at the RNA (genomics or protein (proteomics level. This review describes recent advances in pharmacogenetics and pharmacogenomics with regard to airway disease.

  20. Imaging of salivary gland tumours

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Y.Y.P.; Wong, K.T.; King, A.D. [Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong (Hong Kong); Ahuja, A.T. [Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong (Hong Kong)], E-mail: aniltahuja@cuhk.edu.hk

    2008-06-15

    Salivary gland neoplasms account for <3% of all tumors. Most of them are benign and parotid gland is the commonest site. As a general rule, the smaller the involved salivary gland, the higher is the possibility of the tumor being malignant. The role of imaging in assessment of salivary gland tumour is to define intra-glandular vs. extra-glandular location, detect malignant features, assess local extension and invasion, detect nodal metastases and systemic involvement. Image guided fine needle aspiration cytology provides a safe means to obtain cytological confirmation. For lesions in the superficial parotid and submandibular gland, ultrasound is an ideal tool for initial assessment. These are superficial structures accessible by high resolution ultrasound and FNAC which provides excellent resolution and tissue characterization without a radiation hazard. Nodal involvement can also be assessed. If deep tissue extension is suspected or malignancy confirmed on cytology, an MRI or CT is mandatory to evaluate tumour extent, local invasion and perineural spread. For all tumours in the sublingual gland, MRI should be performed as the risk of malignancy is high. For lesions of the deep lobe of parotid gland and the minor salivary glands, MRI and CT are the modalities of choice. Ultrasound has limited visualization of the deep lobe of parotid gland which is obscured by the mandible. Minor salivary gland lesions in the mucosa of oral cavity, pharynx and tracheo-bronchial tree, are also not accessible by conventional ultrasound. Recent study suggests that MR spectroscopy may differentiate malignant and benign salivary gland tumours as well as distinguishing Warthin's tumor from pleomorphic adenoma. However, its role in clinical practice is not well established. Similarly, the role of nuclear medicine and PET scan, in imaging of parotid masses is limited. Sialography is used to delineate the salivary ductal system and has limited role in assessment of tumour extent.

  1. Treatment Options by Stage (Salivary Gland Cancer)

    Science.gov (United States)

    ... and Oropharyngeal Cancer Screening Research Salivary Gland Cancer Treatment (PDQ®)–Patient Version General Information About Salivary Gland ... in diagnosing salivary gland cancer. Certain factors affect treatment options and prognosis (chance of recovery). The treatment ...

  2. Functional phenotype of airway myocytes from asthmatic airways

    NARCIS (Netherlands)

    Wright, David B.; Trian, Thomas; Siddiqui, Sana; Pascoe, Chris D.; Ojo, Oluwaseun O.; Johnson, Jill R.; Dekkers, Bart G. J.; Dakshinamurti, Shyamala; Bagchi, Rushita; Burgess, Janette K.; Kanabar, Varsha

    2013-01-01

    In asthma, the airway smooth muscle (ASM) cell plays a central role in disease pathogenesis through cellular changes which may impact on its microenvironment and alter ASM response and function. The answer to the long debated question of what makes a 'healthy' ASM cell become 'asthmatic' still remai

  3. Management of salivary gland tumors

    NARCIS (Netherlands)

    Andry, Guy; Hamoir, Marc; Locati, Laura D.; Licitra, Lisa; Langendijk, Johannes A.

    2012-01-01

    Surgery after proper imaging (MRI or CT scan) is the main stay of treatment for salivary gland tumors. Although excision margins should be >= 5 mm for malignant tumors in cases of parotid gland carcinoma, the facial nerve should be preserved whenever it is not infiltrated. Adjuvant external radiatio

  4. Prolonged ozone exposure in an allergic airway disease model: Adaptation of airway responsiveness and airway remodeling

    Directory of Open Access Journals (Sweden)

    Park Chang-Soo

    2006-02-01

    Full Text Available Abstract Background Short-term exposure to high concentrations of ozone has been shown to increase airway hyper-responsiveness (AHR. Because the changes in AHR and airway inflammation and structure after chronic ozone exposure need to be determined, the goal of this study was to investigate these effects in a murine model of allergic airway disease. Methods We exposed BALB/c mice to 2 ppm ozone for 4, 8, and 12 weeks. We measured the enhanced pause (Penh to methacholine and performed cell differentials in bronchoalveolar lavage fluid. We quantified the levels of IL-4 and IFN-γ in the supernatants of the bronchoalveolar lavage fluids using enzyme immunoassays, and examined the airway architecture under light and electron microscopy. Results The groups exposed to ozone for 4, 8, and 12 weeks demonstrated decreased Penh at methacholine concentrations of 12.5, 25, and 50 mg/ml, with a dose-response curve to the right of that for the filtered-air group. Neutrophils and eosinophils increased in the group exposed to ozone for 4 weeks compared to those in the filtered-air group. The ratio of IL-4 to INF-γ increased significantly after exposure to ozone for 8 and 12 weeks compared to the ratio for the filtered-air group. The numbers of goblet cells, myofibroblasts, and smooth muscle cells showed time-dependent increases in lung tissue sections from the groups exposed to ozone for 4, 8, and 12 weeks. Conclusion These findings demonstrate that the increase in AHR associated with the allergic airway does not persist during chronic ozone exposure, indicating that airway remodeling and adaptation following repeated exposure to air pollutants can provide protection against AHR.

  5. The human airway epithelial basal cell transcriptome.

    Directory of Open Access Journals (Sweden)

    Neil R Hackett

    Full Text Available BACKGROUND: The human airway epithelium consists of 4 major cell types: ciliated, secretory, columnar and basal cells. During natural turnover and in response to injury, the airway basal cells function as stem/progenitor cells for the other airway cell types. The objective of this study is to better understand human airway epithelial basal cell biology by defining the gene expression signature of this cell population. METHODOLOGY/PRINCIPAL FINDINGS: Bronchial brushing was used to obtain airway epithelium from healthy nonsmokers. Microarrays were used to assess the transcriptome of basal cells purified from the airway epithelium in comparison to the transcriptome of the differentiated airway epithelium. This analysis identified the "human airway basal cell signature" as 1,161 unique genes with >5-fold higher expression level in basal cells compared to differentiated epithelium. The basal cell signature was suppressed when the basal cells differentiated into a ciliated airway epithelium in vitro. The basal cell signature displayed overlap with genes expressed in basal-like cells from other human tissues and with that of murine airway basal cells. Consistent with self-modulation as well as signaling to other airway cell types, the human airway basal cell signature was characterized by genes encoding extracellular matrix components, growth factors and growth factor receptors, including genes related to the EGF and VEGF pathways. Interestingly, while the basal cell signature overlaps that of basal-like cells of other organs, the human airway basal cell signature has features not previously associated with this cell type, including a unique pattern of genes encoding extracellular matrix components, G protein-coupled receptors, neuroactive ligands and receptors, and ion channels. CONCLUSION/SIGNIFICANCE: The human airway epithelial basal cell signature identified in the present study provides novel insights into the molecular phenotype and biology of

  6. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts

    DEFF Research Database (Denmark)

    Deprez, P H; Bergman, J J; Meisner, S;

    2010-01-01

    Endoscopic submucosal dissection (ESD) is the gold standard technique for performing en bloc resection of large superficial tumors in the upper and lower gastrointestinal tract. Experience in Europe, however, is still limited and ESD is only performed in a few selected centers, with low volumes...... cancer; 2) treatment aims for R0 resection; 3) ESD should meet quality standards; 4) ESD should be performed following national or European Society of Gastrointestinal Endoscopy (ESGE) guidelines or under institutional review board approval; and 5) ESD cases should be registered. Due to the high level...... of expertise needed to perform the technique safely, ESD should be performed in a step-up approach, starting with lesions presenting in the rectum or in the distal stomach, then colon, proximal stomach, and finally in the esophagus. Registration is advised either at the local site or at a national or ESGE...

  7. Breast Cancer Metastasis to the Stomach That Was Diagnosed after Endoscopic Submucosal Dissection

    Directory of Open Access Journals (Sweden)

    Masahide Kita

    2016-01-01

    Full Text Available A 52-year-old woman presented with stage IIB primary breast cancer (cT2N1M0, which was treated using neoadjuvant chemotherapy (epirubicin, cyclophosphamide, and paclitaxel. However, the tumor persisted in patchy areas; therefore, we performed modified radical mastectomy and axillary lymph node dissection. Routine endoscopy at 8 months revealed a depressed lesion on the gastric angle’s greater curvature, and histology revealed signet ring cell proliferation. We performed endoscopic submucosal dissection for gastric cancer, although immunohistochemistry revealed that the tumor was positive for estrogen receptor, mammaglobin, and gross cystic disease fluid protein-15 (E-cadherin-negative. Therefore, we revised the diagnosis to gastric metastasis from the breast cancer.

  8. Breast Cancer Metastasis to the Stomach That Was Diagnosed after Endoscopic Submucosal Dissection

    Science.gov (United States)

    Kita, Masahide; Hori, Keisuke; Kawahara, Yoshiro; Taira, Naruto; Nogami, Tomohiro; Shien, Tadahiko; Tanaka, Takehiro; Doihara, Hiroyoshi; Okada, Hiroyuki

    2016-01-01

    A 52-year-old woman presented with stage IIB primary breast cancer (cT2N1M0), which was treated using neoadjuvant chemotherapy (epirubicin, cyclophosphamide, and paclitaxel). However, the tumor persisted in patchy areas; therefore, we performed modified radical mastectomy and axillary lymph node dissection. Routine endoscopy at 8 months revealed a depressed lesion on the gastric angle's greater curvature, and histology revealed signet ring cell proliferation. We performed endoscopic submucosal dissection for gastric cancer, although immunohistochemistry revealed that the tumor was positive for estrogen receptor, mammaglobin, and gross cystic disease fluid protein-15 (E-cadherin-negative). Therefore, we revised the diagnosis to gastric metastasis from the breast cancer. PMID:27957354

  9. Generalized morphea, lichen sclerosis et atrophicus associated with oral submucosal fibrosis in an adult male

    Directory of Open Access Journals (Sweden)

    Virdi Sarvjit

    2009-01-01

    Full Text Available Generalized morphea is a disease characterized by wide-spread sclerosis of the skin. A 39-year-old man presented with history of multiple pigmented and bound-down plaques on the body along with mucosal involvement. Dermatological examination showed multiple indurated and sclerosed plaques with follicular plugging in few of them and gross thickened eroded and glazed tongue. The constellation of these findings with histopathological correlation led us to diagnosis of this spectrum of cutaneous involvement. The coexistence of localized morphea with lichen sclerosis et atrophicus has been reported earlier but existence of these entities with submucosal fibrosis in a same patient is documented here and is the first of its kind.

  10. Submucosal electrocoagulation for prolapsed hemorrhoids:a new operative approach to hemorrhoidal varices

    Directory of Open Access Journals (Sweden)

    Yada,Yoshihiko

    2010-12-01

    Full Text Available The results of submucosal electrocoagulation (SEC, a new radical operation for prolapsed hemorrhoids, in 403 patients with third- or fourth-degree hemorrhoids are reported. After resecting the anal skin tags that coexisted with prolapsed hemorrhoids, the hemorrhoidal varices could be resected and electrically coagulated through the wound without cutting the anal canal epithelium by using a fine needle-type electric knife. The results of this series indicated that SEC could dramatically reduce the incidence of the postoperative complications that sometimes occur after conventional hemorrhoid-ectomy, such as severe anal pain, massive anal bleeding and anal stenosis. Moreover, SEC could ensure that operated patients make an early return to social activities and have a satisfactory quality of life. Relapse of prolapsed hemorrhoids after SEC was rare.

  11. Clinical nursing path after endoscopic submucosal dissection reduces the risk of postoperative complications

    Institute of Scientific and Technical Information of China (English)

    Xia Bai; Jun-Ping Wang; Lan Ming; Ya-Jie Xu; Xia Sun

    2016-01-01

    Objective: To investigate the effect of the nursing path on postoperative complications after endoscopic submucosal dissection (ESD). Method: Patients' nursing paths for ESD were established based on a systematic analysis of relevant literature, previous clinical procedures and consultation with chief physicians from a gastroenterology department. Forty patients were divided into the observation or control group and were assigned to follow the nursing path or the conventional path after an ESD, respectively. Next, the incidence of postoperative complications of these two groups was measured, primarily assessing the occurrences of bleeding, perforation, infection, and anxiety. Results: The incidence of complications after ESD in the observation group was remarkably lower than that of the control group (P Conclusion: The nursing path for ESD has a positive role in reducing certain frequent complications that occur after ESD, particularly infection and anxiety;in addition, the nursing path optimizes nursing care in patients with gastrointestinal stromal tumor.

  12. Do you have what it takes for challenging endoscopic submucosal dissection cases?

    Institute of Scientific and Technical Information of China (English)

    Kyoung-Oh Kim; Sung Jung Kim; Tae Hyeon Kim; Jong-Jae Park

    2011-01-01

    Endoscopic submucosal dissection (ESDD) is a widely accepted treatment for early gastric cancer (EGC), especially in Korea and Japan. The criteria for the therapeutic use of ESDD for EGC have been expanded recently. However, attention should be drawn to the technical feasibility of the ESDD treatment which depends on a lesion's location, size or fibrosis level, or operator's experience. In the case of a lesion with a high level of difficulty, a more experienced operator is required. Thus, the treatment for a lesion with a high level of difficulty should be performed according to the degree of the operator's experience. In this paper, the authors describe the ESDD procedure for lesions with a high level of difficulty.

  13. Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection

    Institute of Scientific and Technical Information of China (English)

    Masau Sekiguchi; Haruhisa Suzuki; Ichiro Oda; Shigetaka Yoshinaga; Satoru Nonaka; Makoto Saka; Hitoshi Katai

    2012-01-01

    Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection (ESD).In terms of the treatment of such perforations,we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively.We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure.In December 2006,we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis.A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection.Intensive conservative management was conducted following ESD,however,an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy.

  14. Colorectal endoscopic submucosal dissection from a Westernperspective: Today's promises and future challenges

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Over the last few years, endoscopic submucosal dissection(ESD) has shown to be effective in the management ofearly colorectal neoplasms, particularly in Asian countrieswhere the technique was born. In the Western world, itsimplementation has been slow and laborious. In this paper,the indications for ESD, its learning model, the availablemethods to predict the presence of deep submucosalinvasion before the procedure and the published outcomesfrom Asia and Europe will be reviewed. Since ESD hasseveral limitations in terms of learning achievement inthe West, and completion of the procedure for the firstcases is difficult in our part of the world, a short review oncolorectal assisted ESD has been included. Finally, otherendoscopic and surgical treatment modalities that are incompetition with colorectal ESD will be summarized.

  15. Inflammatory Myofibroblastic Tumor: A Rarely Seen Submucosal Lesion of the Stomach

    Directory of Open Access Journals (Sweden)

    Deniz Arslan

    2013-01-01

    Full Text Available Inflammatory myofibroblastic tumor (IMT is a rare mesenchymal benign tumor which is generally seen in children and in young adults. It is especially located in the lungs. In histopathological examination, neoplastic fusiform cells originating from a subtype of accessory immune system cells which are called fibroblastic reticulum cells are seen (Kouichi and Youichirou, 2008. Although IMT is histopathologically benign, imaging methods show its tendency for local recurrence and invasion. In most of the cases, it may not be possible to make a distinction whether it is malign or benign. Complete surgical resection is the most important treatment method. In this study, we have discussed the findings of our case having a gastric submucosal located IMT in light of the current literatures.

  16. Inflammatory Myofibroblastic Tumor: A Rarely Seen Submucosal Lesion of the Stomach

    Science.gov (United States)

    Arslan, Deniz; Gündüz, Şeyda; Tural, Deniz; Uysal, Mükremin; Tatlı, Ali Murat; Başsorgun, Cumhur İbrahim; Elpek, Gülsüm Özlem; Coşkun, Hasan Şenol; Bozcuk, Hakan Şat; Savaş, Burhan

    2013-01-01

    Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal benign tumor which is generally seen in children and in young adults. It is especially located in the lungs. In histopathological examination, neoplastic fusiform cells originating from a subtype of accessory immune system cells which are called fibroblastic reticulum cells are seen (Kouichi and Youichirou, 2008). Although IMT is histopathologically benign, imaging methods show its tendency for local recurrence and invasion. In most of the cases, it may not be possible to make a distinction whether it is malign or benign. Complete surgical resection is the most important treatment method. In this study, we have discussed the findings of our case having a gastric submucosal located IMT in light of the current literatures. PMID:23573435

  17. Outcome after endoscopic submucosal dissection for early gastric cancer in Korea

    Institute of Scientific and Technical Information of China (English)

    Jun Haeng Lee; Su Jin Hong; Jae Young Jang; Seong Eun Kim; Sang Young Seol

    2011-01-01

    Endoscopic treatment, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), has been established as one of the treatment options for selected cases with early gastric cancer (EGC). Most studies on this topic have been carried out by researchers in Japan. Recently, the experience in EMR/ESD for EGC outside Japan is increasingly reported. In Korea, gastric cancer is the most common malignant disease, and the second leading cause of cancer death. Currently, EMR for EGC is widely performed in many centers in Korea. Early results with a short-term follow-up period are very promising in Korea. The complete resection rate of EMR was 37.8%-94.3%, and that of ESD was 77.4%-93.1%. In this review, we will provide an overview of the outcomes of endoscopic treatments in Korea.

  18. Incidence of unanticipated difficult airway using an objective airway score versus a standard clinical airway assessment

    DEFF Research Database (Denmark)

    Nørskov, Anders Kehlet; Rosenstock, Charlotte Valentin; Wetterslev, Jørn

    2013-01-01

    the examination and registration of predictors for difficult mask ventilation with a non-specified clinical airway assessment on prediction of difficult mask ventilation.Method/Design: We cluster-randomized 28 Danish departments of anaesthesia to airway assessment either by the SARI or by usual non...... reduction equalling a number needed to treat of 180. Sample size estimation is adjusted for the study design and based on standards for randomization on cluster-level. With an average cluster size of 2,500 patients, 70,000 patients will be enrolled over a 1-year trial period. The database is programmed so...

  19. Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers

    Institute of Scientific and Technical Information of China (English)

    Sadettin Hulagu; Ali Erkan Duman; Neslihan Bozkurt; Gokhan Dindar; Tan Attila; Yesim Gurbuz; Orhan Tarcin; Cem Kalayci; Omer Senturk; Cem Aygun; Orhan Kocaman; Altay Celebi; Tolga Konduk; Deniz Koc; Goktug Sirin; Ugur Korkmaz

    2011-01-01

    AIM: To investigate the indication, feasibility, safety,and clinical utility of endoscopic submucosal dissection(ESD) in the management of various gastrointestinalpathologies.METHODS: The medical records of 60 consecutive patients(34 female, 26 male) who underwent ESD at the gastroenterology department of Kocaeli University from2006-2010 were examined. Patients selected for ESDhad premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic andhistological diagnoses. Early cancers were considered to be confined to the submucosa, with no lymph node involvement by means of computed tomography andendosonography.RESULTS: Sixty ESD procedures were performed. The indications were epithelial lesions (n = 39) (33/39 adenoma with high grade dysplasia, 6/39 adenoma with low grade dysplasia), neuroendocrine tumor (n = 7),cancer (n = 7) (5/7 early colorectal cancer, 2/7 early gastric cancer), granular cell tumor (n = 3), gastrointestinal stromal tumor (n = 2), and leiomyoma (n = 2). En bloc and piecemeal resection rates were 91.6% (55/60) and 8.3% (5/60), respectively. Complete and incomplete resection rates were 96.6% (58/60) and 3.3%(2/60), respectively. Complications were major bleeding[n = 3 (5%)] and perforations [n = 5 (8.3%)] (4colon, 1 stomach). Two patients with colonic perforations and two patients with submucosal lymphatic and microvasculature invasion (1 gastric carcinoid tumor,1 colonic adenocarcinoma) were referred to surgery.During a mean follow-up of 12 mo, 1 patient with adenoma with high grade dysplasia underwent a second ESD procedure to resect a local recurrence.CONCLUSION: ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.

  20. Effects of bradykinin B2 receptor stimulation at submucosal ganglia from rat distal colon.

    Science.gov (United States)

    Avemary, Janine; Diener, Martin

    2010-02-10

    Bradykinin acts as an inflammatory mediator in the gut. In the present study we characterized bradykinin-induced changes in the intracellular calcium concentration ([Ca(2+)](i)) in whole-mount submucosal preparations from rat distal colon and examined the bradykinin receptors and subsequent signalling cascades involved. Bradykinin (2.10(-10)-2.10(-7)mol/l) evoked a concentration-dependent increase in [Ca(2+)](i) in about 90% of the investigated neurones. This Ca(2+) response was abolished by the bradykinin B(2) receptor antagonist HOE 140. The B(2) receptor agonist [Hyp(3)]-bradykinin mimicked the kinin response. In contrast, the B(1) receptor antagonist [des-Arg(10)]-HOE 140 and the B(1) receptor agonist bradykinin fragment 1-8 were ineffective. Immunohistochemical experiments confirmed the presence of bradykinin B(2) receptors in submucosal neurones. The effect of bradykinin on [Ca(2+)](i) was not mediated by a release of prostaglandins, as it was resistant against the cyclooxygenase inhibitor indomethacin. Blocking of G(q/11) proteins with YM-254890 suppressed the action of bradykinin, revealing that neuronal bradykinin B(2) receptors are coupled to this G protein. However, the subsequent signalling cascade differed from the classical phospholipase C signalling pathway, as the bradykinin response was resistant against the phospholipase C inhibitor U-73221, the ryanodine receptor antagonist dehydroryanodine, and only marginally sensitive against the blocker of IP(3)-receptors xestospongin C. Vice versa, the effect of bradykinin was nearly completely dependent on the presence of external Ca(2+) and could be reduced by lanthanum, a blocker of voltage-operated Ca(2+) channels, suggesting that the bradykinin-induced Ca(2+) response is achieved by an influx from the extracellular space via voltage-operated Ca(2+) channels.

  1. Endoscopic submucosal dissection for silent gastric Dieulafoy lesions mimicking gastrointestinal stromal tumors

    Science.gov (United States)

    Chen, Xue; Cao, Hailong; Wang, Sinan; Wang, Dan; Xu, Mengque; Piao, Meiyu; Wang, Bangmao

    2016-01-01

    Abstract Background: Dieulafoy lesion is a rare but serious cause of gastrointestinal hemorrhage. However, some cases can be occasionally found without bleeding during the endoscopic screening, and the management remains unclear. The aim of this article was to report the efficacy and safety of endoscopic submucosal dissection (ESD) for silent gastric Dieulafoy lesions, which presented as protrusion lesions mimicking gastrointestinal stromal tumors (GISTs). Methods: Data from the patients with gastric protrusion lesions who underwent ESD from September 2008 to April 2016 in General Hospital, Tianjin Medical University, China were recorded. Seven cases with pathological diagnosis of Dieulafoy lesion without bleeding were enrolled for further analysis. Results: A total of 7 patients (2 males and 5 females) with mean age of 57.7 ± 4.15 years were pathologically diagnosed as Dieulafoy lesion. Four of the lesions were located in gastric antrum, 2 in the fundus, and 1 in the body of stomach, respectively. The mean sizes of the Dieulafoy lesions under white light endoscopy and endoscopic ultrasonography (EUS) were 1.06 ± 0.28 and 0.84 ± 0.29 cm. The origins of these lesions were submucosa (6/7, 85.7%) and muscularis propria (1/7, 14.3%). Three of them appeared with mixed echo under EUS, 3 with hypoechogenicity, and 1 with hyperechogenicity. En bloc complete resection was achieved in all the lesions by ESD with average time of 76.00 ± 16.86 minutes, and no intraoperative bleeding happened. In addition, all patients were followed up for 1 to 53 months, and no recurrence or long-term complications was observed. Conclusion: Therefore, ESD can be an effective and safe treatment for silent gastric Dieulafoy lesions with clinical presentations of submucosal protrusion lesions mimicking GISTs. PMID:27603399

  2. Molecular analysis of gastric differentiated-type intramucosal and submucosal cancers.

    Science.gov (United States)

    Sugai, Tamotsu; Habano, Wataru; Endoh, Masaki; Konishi, Yasuhiro; Akasaka, Risaburo; Toyota, Minoru; Yamano, Hiroo; Koeda, Keisuke; Wakabayashi, Go; Suzuki, Kazuyuki

    2010-12-01

    Identification of the molecular characteristics of intramucosal (IMCs) and submucosal cancers (SMCs) is essential to our understanding of early gastric carcinogenesis. However, little is known regarding the differences between the 2 lesions. One hundred and forty-eight patients with primary early gastric cancer [IMC, 106; SMC, 42] were characterized for expression of cell cycle-related proteins and loss of heterozygosity (LOH). We also examined microsatellite instability (MSI) and methylation status. For LOH and methylation studies, we used a panel of 17 microsatellite markers (3p, 4p, 5q, 9p. 13q, 17p, 18q and 22q) and promoter regions of 9 genes (MLH-1, RUNX3, p16, HPP1, RASSF2A, SFRP1, DKK-1, ZFP64 and SALL4) that are frequently altered or methylated in gastric cancers. Overexpression of p53 and cyclin D1 was observed in SMC. In addition, low expression of p27 was more frequent in SMC than in IMC. Frequencies of 4p, 9p, 13q and 22q were significantly higher in SMC than in IMC. The SALL4 gene was frequently methylated in SMC compared with IMC. However, other gene methylations were common in both IMC and SMC. The frequency of LOH-high status/methylation-low status was significantly higher in SMC than in IMC. However, LOH-low status/methylation-high status in SMC was more frequently found in IMC. Our data confirm that methylation of cancer-related genes plays a major role in the development of IMCs. Importantly, the results also show that gastric submucosal progression is characterized by the accumulation of specific genetic alterations. In addition, changes of cell cycle-related proteins are associated with cancer progression.

  3. Photofrin-PDT for gastric cancer in the era of endoscopic submucosal dissection

    Science.gov (United States)

    Nishiwaki, Yoshiro; Ikematsu, Yoshito; Tokunaga, Yuuji; Kanai, Toshikazu

    2009-06-01

    Background: Endoscopic mucosal resection (EMR) was originated to treat early gastric cancer (EGC). EMR was suitable for small, mucosal and well-differentiated adenocarcinoma without ulceration. It was difficult to resect larger tumors en bloc by this method. In recent years, a more useful method, endoscopic submuscosal dissection (ESD) has been developed, which enables en bloc resection of large mucosal lesions. On the contrary, photodynamic therapy (PDT) is applicable to submucosal, poorly differentiated, or carcinoma with ulceration. In the era of ESD, we evaluated the value of Photofrin-PDT. Patients & Methods: We applied PDT to 36 patients including three advanced cancers, who had been excluded from EMR (ESD) and were at high risks for surgery or refused surgery. Four EGC patients who had not been cured by EMR (ESD) were included. Our PDT procedure consisted of polyhematoporphyrin ether/ester administration (Photofrin, 2 mg/Kg) and pulsed excimer dye laser irradiation at 630 nm 48 hours (and 96 hours) after sensitization. Results: Complete response (CR) at three months was obtained in 84% (21/25) of mucosal cancer and in 50% (4/8) of submucosal cancer. Although three patients with an advanced cancer improved but were not cured, quality of their life was maintained. There were no serious side effects except skin photosensitivity. Conclusion: Photofrin-PDT should be applied not only EGC patients who are excluded from ESD and have not been cured by ESD with poor risk for surgery, and have high possibilitiy to be cured by PDT, but also advanced cancer patients for local improvement of lesions.

  4. Vessel-guided Airway Tree Segmentation

    DEFF Research Database (Denmark)

    Lo, P.; Sporring, J.; Ashraf, H.;

    2010-01-01

    This paper presents a method for airway tree segmentation that uses a combination of a trained airway appearance model, vessel and airway orientation information, and region growing. We propose a voxel classification approach for the appearance model, which uses a classifier that is trained...... method is evaluated on 250 low dose computed tomography images from a lung cancer screening trial. Our experiments showed that applying the region growing algorithm on the airway appearance model produces more complete airway segmentations, leading to on average 20% longer trees, and 50% less leakage...

  5. Inflammatory bowel disease and airway diseases

    Science.gov (United States)

    Vutcovici, Maria; Brassard, Paul; Bitton, Alain

    2016-01-01

    Airway diseases are the most commonly described lung manifestations of inflammatory bowel disease (IBD). However, the similarities in disease pathogenesis and the sharing of important environmental risk factors and genetic susceptibility suggest that there is a complex interplay between IBD and airway diseases. Recent evidence of IBD occurrence among patients with airway diseases and the higher than estimated prevalence of subclinical airway injuries among IBD patients support the hypothesis of a two-way association. Future research efforts should be directed toward further exploration of this association, as airway diseases are highly prevalent conditions with a substantial public health impact. PMID:27678355

  6. The Lung Microbiome and Airway Disease.

    Science.gov (United States)

    Lynch, Susan V

    2016-12-01

    A growing body of literature has demonstrated relationships between the composition of the airway microbiota (mixed-species communities of microbes that exist in the respiratory tract) and critical features of immune response and pulmonary function. These studies provide evidence that airway inflammatory status and capacity for repair are coassociated with specific taxonomic features of the airway microbiome. Although directionality has yet to be established, the fact that microbes are known drivers of inflammation and tissue damage suggests that in the context of chronic inflammatory airway disease, the composition and, more importantly, the function, of the pulmonary microbiome represent critical factors in defining airway disease outcomes.

  7. Mucus hypersecretion in the airway

    Institute of Scientific and Technical Information of China (English)

    WANG Ke; WEN Fu-qiang; XU Dan

    2008-01-01

    @@ Mucus hypersecretion is a distinguishing feature of Chronic intlammation diseases,such as asthma,1chronic bronchitis.2 bronchiectasis3 and cystic fibrosis.4Mucus hypersecretion leads to impairment of mucociliary clearance,abnormal bacterial plantation,mucus plug in the airway,and dysfunction of gas exchange.5

  8. Nasal continuous positive airway pressure

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Lamwers, Stephanie; Tepel, Martin;

    2012-01-01

    Obstructive sleep apnoea (OSA) is linked to increased cardiovascular risk. This risk can be reduced by nasal continuous positive airway pressure (nCPAP) treatment. As OSA is associated with an increase of several vasoconstrictive factors, we investigated whether nCPAP influences the digital volum...

  9. Airway nerves: in vitro electrophysiology.

    Science.gov (United States)

    Fox, Alyson

    2002-06-01

    Recording the activity of single airway sensory fibres or neuronal cell bodies in vitro has allowed detailed characterisation of fibre types and membrane properties. Fibre types can be identified by their conduction velocities and further studied by the application of drugs to their receptive field. C-fibres are sensitive to mechanical stimuli and a range of irritant chemicals (bradykinin, capsaicin, low pH, platelet-activating factor), whereas Adelta-fibres are relatively insensitive to chemical stimuli and appear to correlate to the rapidly adapting receptors identified in airways in vivo. Their site of origin also differs: upper airway C-fibres arise predominantly from the jugular ganglion and Adelta-fibres from the jugular and nodose ganglia. Intracellular recording from cell bodies in the ganglia has revealed a calcium-dependent potassium current common to many putative C-fibre cell bodies. This slow after hyperpolarisation current may be inhibited by stimuli that excite and sensitise C-fibres - this could be an important mechanism underlying the sensitisation of C-fibres in airway irritability.

  10. Sarcoidosis of the upper and lower airways.

    Science.gov (United States)

    Morgenthau, Adam S; Teirstein, Alvin S

    2011-12-01

    Sarcoidosis is a systemic granulomatous disease of undetermined etiology characterized by a variable clinical presentation and disease course. Although clinical granulomatous inflammation may occur within any organ system, more than 90% of sarcoidosis patients have lung disease. Sarcoidosis is considered an interstitial lung disease that is frequently characterized by restrictive physiologic dysfunction on pulmonary function tests. However, sarcoidosis also involves the airways (large and small), causing obstructive airways disease. It is one of a few interstitial lung diseases that affects the entire length of the respiratory tract - from the nose to the terminal bronchioles - and causes a broad spectrum of airways dysfunction. This article examines airway dysfunction in sarcoidosis. The anatomical structure of the airways is the organizational framework for our discussion. We discuss sarcoidosis involving the nose, sinuses, nasal passages, larynx, trachea, bronchi and small airways. Common complications of airways disease, such as, atelectasis, fibrosis, bullous leions, bronchiectasis, cavitary lesions and mycetomas, are also reviewed.

  11. Cryopreservation of Parathyroid Glands

    Directory of Open Access Journals (Sweden)

    Marlon A. Guerrero

    2010-01-01

    Full Text Available The risk of permanent hypoparathyroidism following thyroid and parathyroid surgery is around 1% in the hands of experienced endocrine surgeons. Although this complication is rare, rendering a patient permanently aparathyroid has significant consequences on the health and quality of life of the patient. Immediate autotransplantation of parathyroid glands that are injured or unintentionally removed offers the best possibility of graft viability and functionality. However, since the majority of cases of hypoparathyroidism are transient, immediate autotransplantation can complicate postoperative surveillance in certain patients, especially those with primary hyperparathyroidism. Cryopreservation of parathyroid tissue is an alternate technique that was developed to treat patients with permanent hypoparathyroidism. This method allows for parathyroid tissue to be stored and then autotransplanted in a delayed fashion once permanent hypoparathyroidism is confirmed. This article provides a contemporary review on cryopreservation of parathyroid tissue and its current role in thyroid and parathyroid surgery.

  12. Organizing the thymus gland.

    Science.gov (United States)

    Muñoz, Juan José; García-Ceca, Javier; Alfaro, David; Stimamiglio, Marco Augusto; Cejalvo, Teresa; Jiménez, Eva; Zapata, Agustín G

    2009-02-01

    Eph receptors and their ligands, ephrins, are molecules involved in the morphogenesis of numerous tissues, including the central nervous system in which they play a key role in determining cell positioning and tissue domains containing or excluding nerve fibers. Because common features have been suggested to occur in the microenvironmental organization of brain and thymus, a highly compartmentalized organ central for T cell differentiation, we examined the expression and possible role of Eph/ephrins in the biology of the thymus gland. We reviewed numerous in vivo and in vitro results that confirm a role for Eph and ephrins in the maturation of the thymic epithelial cell (TEC) network and T cell differentiation. Their possible involvement in different steps of early thymus organogenesis, including thymus primordium branching, lymphoid colonization, and thymocyte-TEC interactions, that determine the organization of a mature three-dimensional thymic epithelial network is also analyzed.

  13. Pituitary gland tumors; Hypophysentumoren

    Energy Technology Data Exchange (ETDEWEB)

    Jesser, J.; Schlamp, K.; Bendszus, M. [Radiologische Klinik, Universitaetsklinikum Heidelberg, Abteilung fuer Neuroradiologie, Heidelberg (Germany)

    2014-10-15

    This article gives an overview of the most common tumors of the pituitary gland and the differential diagnostics with special emphasis on radiological diagnostic criteria. A selective search of the literature in PubMed was carried out. Pituitary adenomas constitute 10-15 % of all intracranial tumors and are the most common tumors of the sellar region. Tumors smaller than 1 cm in diameter are called microadenomas while those larger than 1 cm in diameter are called macroadenomas. Approximately 65 % of pituitary gland adenomas secrete hormones whereby approximately 50 % secrete prolactin, 10 % secrete growth hormone (somatotropin) and 6 % secrete corticotropin. Other tumors located in the sella turcica can also cause endocrinological symptoms, such as an oversecretion of pituitary hormone or pituitary insufficiency by impinging on the pituitary gland or its stalk. When tumors spread into the space cranial to the sella turcica, they can impinge on the optic chiasm and cause visual disorders. A common differential diagnosis of a sellar tumor is a craniopharyngeoma. In children up to 10 % of all intracranial tumors are craniopharyngeomas. Other differential diagnoses for sellar tumors are metastases, meningiomas, epidermoids and in rare cases astrocytomas, germinomas or Rathke cleft cysts As these tumors are located in an anatomically complex region of the skull base and are often very small, a highly focused imaging protocol is required. The currently favored modality is magnetic resonance imaging (MRI) with the administration of a contrast agent. The sellar region should be mapped in thin slices. In cases of suspected microadenoma the imaging protocol should also contain a sequence with dynamic contrast administration in order to assess the specific enhancement characteristics of the tumor and the pituitary gland. (orig.) [German] Diese Arbeit ist eine Uebersicht ueber die haeufigsten Hypophysentumoren und deren Differenzialdiagnosen mit Augenmerk auf die

  14. Airway remodeling in asthma: what really matters.

    Science.gov (United States)

    Fehrenbach, Heinz; Wagner, Christina; Wegmann, Michael

    2017-03-01

    Airway remodeling is generally quite broadly defined as any change in composition, distribution, thickness, mass or volume and/or number of structural components observed in the airway wall of patients relative to healthy individuals. However, two types of airway remodeling should be distinguished more clearly: (1) physiological airway remodeling, which encompasses structural changes that occur regularly during normal lung development and growth leading to a normal mature airway wall or as an acute and transient response to injury and/or inflammation, which ultimately results in restoration of a normal airway structures; and (2) pathological airway remodeling, which comprises those structural alterations that occur as a result of either disturbed lung development or as a response to chronic injury and/or inflammation leading to persistently altered airway wall structures and function. This review will address a few major aspects: (1) what are reliable quantitative approaches to assess airway remodeling? (2) Are there any indications supporting the notion that airway remodeling can occur as a primary event, i.e., before any inflammatory process was initiated? (3) What is known about airway remodeling being a secondary event to inflammation? And (4), what can we learn from the different animal models ranging from invertebrate to primate models in the study of airway remodeling? Future studies are required addressing particularly pheno-/endotype-specific aspects of airway remodeling using both endotype-specific animal models and "endotyped" human asthmatics. Hopefully, novel in vivo imaging techniques will be further advanced to allow monitoring development, growth and inflammation of the airways already at a very early stage in life.

  15. A phase II clinical trial of endoscopic submucosal dissection for early gastric cancer of undifferentiated type: Japan Clinical Oncology Group study JCOG1009/1010.

    Science.gov (United States)

    Takizawa, Kohei; Takashima, Atsuo; Kimura, Aya; Mizusawa, Junki; Hasuike, Noriaki; Ono, Hiroyuki; Terashima, Masanori; Muto, Manabu; Boku, Narikazu; Sasako, Mitsuru; Fukuda, Haruhiko

    2013-01-01

    A Phase II clinical trial has been initiated to evaluate the efficacy and safety of endoscopic submucosal dissection for intramucosal (cT1a) gastric cancer of undifferentiated type. Patients with cT1a gastric cancer with undifferentiated-type adenocarcinoma are eligible for the study. The tumor size should be 2 cm or less without ulceration. The study will enroll a total of 325 patients from 51 institutions over a 4-year period. The primary endpoint is proportion of 5-year overall survival (% 5-year overall survival) in patients with undifferentiated dominant type. The secondary endpoints are overall survival, relapse-free survival, distant metastasis-free survival, % 5-year overall survival without either recurrence or gastrectomy, % en-bloc resection with endoscopic submucosal dissection, % pathological curative resection with endoscopic submucosal dissection, % 5-year overall survival in patients with differentiated dominant type, % 5-year overall survival in patients with pathologically curative resection with endoscopic submucosal dissection and adverse events.

  16. Endoscopic Ultrasound-Assisted Tunnel-Type Endoscopic Submucosal Dissection for the Treatment of Esophageal Tumors Arising in the Muscularis Propria (with video)

    OpenAIRE

    Ge, Nan; Sun, Siyu; Wang, Sheng; Liu, Xiang; Wang, Guoxin; Guo, Jintao

    2013-01-01

    Objective: Esophageal tumors arising in the muscularis propria are difficult to be resected endoscopically using standard electro-surgical techniques, even the endoscopic submucosal dissection (ESD) technique appeared recently. Our purpose is to investigate the efficacy of endoscopic ultrasound (EUS)-assisted tunnel-type ESD for resection of these tumors. Methods: A total of 17 patients were included in this study. A standard endoscope was used. The submucosal tunnel was created with the tria...

  17. Selective mucosal ablation using CO2 laser for the development of novel endoscopic submucosal dissection: comparison of continuous wave and nanosecond pulsed wave

    Science.gov (United States)

    Ishii, K.; Watanabe, S.; Obata, D.; Hazama, H.; Morita, Y.; Matsuoka, Y.; Kutsumi, H.; Azuma, T.; Awazu, K.

    2010-02-01

    Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment technique for small early gastric cancers. Procedures are carried out using some specialized electrosurgical knifes with a submucosal injection solution. However it is not widely used because its procedure is difficult. The objective of this study is to develop a novel ESD method which is safe in principle and widely used by using laser techniques. In this study, we used CO2 lasers with a wavelength of 10.6 μm for mucosal ablation. Two types of pulse, continuous wave and pulsed wave with a pulse width of 110 ns, were studied to compare their values. Porcine stomach tissues were used as a sample. Aqueous solution of sodium hyaluronate (MucoUpR) with 50 mg/ml sodium dihydrogenphosphate is injected to a submucosal layer. As a result, ablation effect by CO2 laser irradiation was stopped because submucosal injection solution completely absorbed CO2 laser energy in the invasive energy condition which perforates a muscle layer without submucosal injection solution. Mucosal ablation by the combination of CO2 Laser and a submucosal injection solution is a feasible technique for treating early gastric cancers safely because it provides a selective mucosal resection and less-invasive interaction to muscle layer.

  18. Successful resection of giant esophageal liposarcoma by endoscopic submucosal dissection combined with surgical retrieval: a case report and literature review.

    Science.gov (United States)

    Takiguchi, Gosuke; Nakamura, Tetsu; Otowa, Yasunori; Tomono, Ayako; Kanaji, Shingo; Oshikiri, Taro; Suzuki, Satoshi; Ishida, Tsukasa; Kakeji, Yoshihiro

    2016-12-01

    Liposarcoma of the esophagus is very rare. We experienced a huge (27.5 × 11.6 cm) liposarcoma of the esophagus. A 73-year-old man presented with severe dyspnea requiring emergency tracheal intubation. Computed tomography and esophagogastroduodenoscopy showed a large submucosal tumor arising from the esophageal entrance and extending intraluminally to the lower esophagus. We successfully performed endoscopic submucosal dissection (ESD) and esophagotomy to remove the tumor, which preserved swallowing and phonation. The final diagnosis by histopathologic and immunohistologic examination was well-differentiated liposarcoma of the esophagus. Treatment by the combination of ESD and esophagotomy can be performed even for a very large tumor. This method preserves deglutition with a lower risk of recurrent laryngeal nerve paralysis than that with esophagectomy.

  19. Diagnosis of a submucosal mass at the staple line after sigmoid colon cancer resection by endoscopic cuttingmucosa biopsy

    Institute of Scientific and Technical Information of China (English)

    Mitsuaki Morimoto; Koji Koinuma; Alan K Lefor; Hisanaga Horie; Homare Ito; Naohiro Sata; Yoshikazu Hayashi; Keijiro Sunada; Hironori Yamamoto

    2016-01-01

    A 48-year-old man underwent laparoscopic sigmoid colon resection for cancer and surveillance colonoscopy was performed annually thereafter. Five years after the resection, a submucosal mass was found at the anastomotic staple line, 15 cm from the anal verge. Computed tomography scan and endoscopic ultrasound were not consistent with tumor recurrence. Endoscopic mucosa biopsy was performed to obtain a definitive diagnosis. Mucosal incision over the lesion with the cutting needle knife technique revealed a creamy white material, which was completely removed. Histologic examination showed fibrotic tissue without caseous necrosis or tumor cells. No bacteria, including mycobacterium, were found on culture. The patient remains free of recurrence at five years since the resection. Endoscopic biopsy with a cutting mucosal incision is an important technique for evaluation of submucosal lesions after rectal resection.

  20. [Applied embryology of parathyroid glands].

    Science.gov (United States)

    Henry, J F; Sebag, F

    2006-01-01

    The article describes the normal structure of the parathyroid glands (PTG) and their development, anomalies of migration in the process of embryogenesis and congenital ectopias of PTG as well as possible supplementary PTG and their congenital ectopias.

  1. [Inflammation of the parathyroid glands].

    Science.gov (United States)

    Ting, S; Synoracki, S; Sheu, S-Y; Schmid, K W

    2016-05-01

    Inflammation of the parathyroid glands is rare when compared to other endocrine organs. This leads to the use of descriptive terms as well as the lack of a generally accepted classification for inflammatory disorders of the parathyroid glands. This review article proposes that parathyroid inflammation be subdivided morphologically into (a) non-specific lymphocytic infiltration, which is more an expression of damage to small vessels, due to e. g. severe systemic inflammation or myocardial infarction, (b) autoimmunogenic lymphocytic parathyroiditis, (c) nonimmunogenic inflammation caused by granulomatous diseases or infections and (d) invasive sclerosing (peri) parathyroiditis. As only parathyroid glands removed due to hyperparathyroidism and normal parathyroid glands incidentally removed during thyroid surgery are seen almost exclusively in routine histopathology, virtually no information about the morphological correlate of hypoparathyroidism is available.

  2. Calcium signaling in lacrimal glands.

    Science.gov (United States)

    Putney, James W; Bird, Gary S

    2014-06-01

    Lacrimal glands provide the important function of lubricating and protecting the ocular surface. Failure of proper lacrimal gland function results in a number of debilitating dry eye diseases. Lacrimal glands secrete lipids, mucins, proteins, salts and water and these secretions are at least partially regulated by neurotransmitter-mediated cell signaling. The predominant signaling mechanism for lacrimal secretion involves activation of phospholipase C, generation of the Ca(2+)-mobilizing messenger, IP3, and release of Ca(2+) stored in the endoplasmic reticulum. The loss of Ca(2+) from the endoplasmic reticulum then triggers a process known as store-operated Ca(2+) entry, involving a Ca(2+) sensor in the endoplasmic reticulum, STIM1, which activates plasma membrane store-operated channels comprised of Orai subunits. Recent studies with deletions of the channel subunit, Orai1, confirm the important role of SOCE in both fluid and protein secretion in lacrimal glands, both in vivo and in vitro.

  3. Brunner’s Gland Hamartoma: A Rare Cause of Gastrointestinal Bleeding – Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    David R Stolpman

    2002-01-01

    Full Text Available An unusual cause of upper gastrointestinal bleeding is described in a previously healthy 45-year-old man who was admitted to hospital with weakness and fatigue, and had experienced an episode of melena two days before admission. His medical and surgical history was unremarkable. Upon admission to hospital, he showed evidence of iron-deficiency anemia, with a hemoglobin concentration of 61 g/L (normal range 135 to 175 g/L, a mean corpuscular volume of 73 fL (normal range 85.0 to 95.0 fL and a ferritin concentration of 1.0 µg/L (normal range in males 15 to 400 µg/L. Upper gastrointestinal endoscopy revealed a 3.5 cm ulcerated submucosal mass in the third portion of the duodenum, for which mucosal biopsies were nondiagnostic. A subsequent endoscopic ultrasound revealed a 2.7×4.0 cm hyperechoic, cystic, submucosal tumour in the third portion of the duodenum. Endoscopic ultrasound-guided fine needle aspiration revealed no malignant cells. The patient eventually underwent a resection of the third portion of his duodenum. Surgical pathology revealed that this tumour was a Brunner’s gland hamartoma, 4.5 cm in its greatest dimension.

  4. Investigation of airways using MDCT for visual and quantitative assessment in COPD patients

    Directory of Open Access Journals (Sweden)

    Pierre-Yves Brillet

    2008-03-01

    Full Text Available Pierre-Yves Brillet1, Catalin I Fetita2, Amaury Saragaglia2, Anne-Laure Brun3, Catherine Beigelman-Aubry3, Françoise Prêteux2, Philippe A Grenier31Department of Radiology, Avicenne Hospital, Assistance Publique–Hôpitaux de Paris, Université Léonard de Vinci–Paris Nord, EA 2361, Bobigny, France; 2ARTEMIS Department, Institut National des Télécommunications, Université Paris V, Evry, France; 3Department of Radiology, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, FranceAbstract: Multidetector computed tomography (MDCT acquisition during a single breath hold using thin collimation provides high resolution volumetric data set permitting multiplanar and three dimensional reconstruction of the proximal airways. In chronic obstructive pulmonary disease (COPD patients, this technique provides an accurate assessment of bronchial wall thickening, tracheobronchial deformation, outpouchings reflecting dilatation of the submucous glands, tracheobronchomalacia, and expiratory air trapping. New software developed to segment adequately the lumen and walls of the airways on MDCT scans allows quantitative assessment of the airway dimensions which has shown to be reliable in clinical practice. This technique can become important in longitudinal studies of the pathogenesis of COPD, and in the assessment of therapeutic interventions.Keywords: COPD – tracheobronchial tree, multidetector CT – airway remodeling, tracheobronchomalacia

  5. Allergic rhinitis and asthma: inflammation in a one-airway condition

    Directory of Open Access Journals (Sweden)

    Haahtela Tari

    2006-11-01

    Full Text Available Abstract Background Allergic rhinitis and asthma are conditions of airway inflammation that often coexist. Discussion In susceptible individuals, exposure of the nose and lungs to allergen elicits early phase and late phase responses. Contact with antigen by mast cells results in their degranulation, the release of selected mediators, and the subsequent recruitment of other inflammatory cell phenotypes. Additional proinflammatory mediators are released, including histamine, prostaglandins, cysteinyl leukotrienes, proteases, and a variety of cytokines, chemokines, and growth factors. Nasal biopsies in allergic rhinitis demonstrate accumulations of mast cells, eosinophils, and basophils in the epithelium and accumulations of eosinophils in the deeper subepithelium (that is, lamina propria. Examination of bronchial tissue, even in mild asthma, shows lymphocytic inflammation enriched by eosinophils. In severe asthma, the predominant pattern of inflammation changes, with increases in the numbers of neutrophils and, in many, an extension of the changes to involve smaller airways (that is, bronchioli. Structural alterations (that is, remodeling of bronchi in mild asthma include epithelial fragility and thickening of its reticular basement membrane. With increasing severity of asthma there may be increases in airway smooth muscle mass, vascularity, interstitial collagen, and mucus-secreting glands. Remodeling in the nose is less extensive than that of the lower airways, but the epithelial reticular basement membrane may be slightly but significantly thickened. Conclusion Inflammation is a key feature of both allergic rhinitis and asthma. There are therefore potential benefits for application of anti-inflammatory strategies that target both these anatomic sites.

  6. Airway injury during emergency transcutaneous airway access: a comparison at cricothyroid and tracheal sites.

    LENUS (Irish Health Repository)

    Salah, Nazar

    2009-12-01

    Oxygenation via the cricothyroid membrane (CTM) may be required in emergencies, but inadvertent tracheal cannulation may occur. In this study, we compared airway injury between the tracheal and CTM sites using different techniques for airway access.

  7. Scent glands in legume flowers.

    Science.gov (United States)

    Marinho, C R; Souza, C D; Barros, T C; Teixeira, S P

    2014-01-01

    Scent glands, or osmophores, are predominantly floral secretory structures that secrete volatile substances during anthesis, and therefore act in interactions with pollinators. The Leguminosae family, despite being the third largest angiosperm family, with a wide geographical distribution and diversity of habits, morphology and pollinators, has been ignored with respect to these glands. Thus, we localised and characterised the sites of fragrance production and release in flowers of legumes, in which scent plays an important role in pollination, and also tested whether there are relationships between the structure of the scent gland and the pollinator habit: diurnal or nocturnal. Flowers in pre-anthesis and anthesis of 12 legume species were collected and analysed using immersion in neutral red, olfactory tests and anatomical studies (light and scanning electron microscopy). The main production site of floral scent is the perianth, especially the petals. The scent glands are distributed in a restricted way in Caesalpinia pulcherrima, Anadenanthera peregrina, Inga edulis and Parkia pendula, constituting mesophilic osmophores, and in a diffuse way in Bauhinia rufa, Hymenaea courbaril, Erythrostemon gilliesii, Poincianella pluviosa, Pterodon pubescens, Platycyamus regnellii, Mucuna urens and Tipuana tipu. The glands are comprised of cells of the epidermis and mesophyll that secrete mainly terpenes, nitrogen compounds and phenols. Relationships between the presence of osmophores and type of anthesis (diurnal and nocturnal) and the pollinator were not found. Our data on scent glands in Leguminosae are original and detail the type of diffuse release, which has been very poorly studied.

  8. Telocytes in parotid glands.

    Science.gov (United States)

    Nicolescu, Mihnea I; Bucur, Alexandru; Dinca, Octavian; Rusu, Mugurel C; Popescu, Laurentiu M

    2012-03-01

    The parotid histological structure includes acinar, ductal, and myoepithelial cells, surrounded by a connective stromal component. The parotid stroma is mostly regarded as an inert shell, consisting of septa, which divide the parenchyma. Telocytes were recently identified as a new stromal cell type in various organs, including exocrine pancreas. We aimed to evaluate telocytes presence in parotid stroma and whether their topographical features might support an involvement in parotid function modulation. Serial ultrathin sections of human and rat parotid glands were studied and compared by transmission electron microscopy. Two-dimensional concatenation of sequenced micrographs allowed the ultrastructural identification of parotid telocytes, with their specific long, thin, and moniliform prolongations (telopodes). Telocyte location appeared frequently as a strategic one, in close contact or vicinity of both secretory (acini and ducts) and regulatory (nerves and blood vessels) apparatuses. They were also found in the interacinar and the subductal stroma. Two previously reported telocyte markers (c-kit/CD117 and vimentin) were assayed by immunohistochemistry. Actin expression was also evaluated. Telocytes are making a network, especially by branching of their long telopodes. Elements of this telocyte network are interacting with each other (homocellular connections) as well as with other cell types (heterocellular connections). These interactions are achieved either by direct contact (stromal synapse), or mediated via shed microvesicles/exosomes. Since telocyte connections include both neurovascular and exocrine elements (e.g., acini and ducts), it is attractive to think that telocytes might mediate and integrate neural and/or vascular input with parotid function.

  9. Primary Submucosal Squamous Cell Carcinoma of the Rectum Diagnosed by Endoscopic Ultrasound: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    M.Najeeb Al Hallak

    2010-07-01

    Full Text Available Primary colorectal squamous cell carcinoma (SCC is one of the very rare malignancies of the gastrointestinal tract. The diagnosis cannot be made before ruling out other common primary sites. Using the endoscopic ultrasound (EUS technique to get a tissue biopsy for submucosal tumors has not been demonstrated as the best diagnostic approach in the literature. Surgery is the gold standard treatment with arising evidence of good efficacy following conventional chemoradiation therapy. A 49-year-old male presented with rectal discomfort. Sigmoidoscopy revealed multiple submucosal masses in the rectosigmoid colon. Mucosal biopsies showed nonspecific inflammation. Subsequently, an EUS with fine needle biopsy was done and established the diagnosis of rectal SCC. There were no other primary sites noticed in the extensive evaluation. The patient chose to be treated only with chemoradiation without surgery. At the time of writing this report he had no evidence of recurrence achieving 2.5 years of survival. EUS is an emerging excellent approach to diagnose submucosal colorectal SCC. This case will add supportive evidence of having a complete response following combining treatment with squamous cell directed chemotherapy and external beam radiotherapy without preceded surgery.

  10. A case of a gastric submucosal tumor treated with combined therapy using superselective TAE and endoscopic local resection.

    Science.gov (United States)

    Chikamori, Fumio; Kuniyoshi, Nobutoshi; Okamoto, Hiroshi; Kuniyoshi, Kazushige

    2012-10-01

    The case was a 76-year-old female, who was noted to have a gastric submucosal tumor 25 mm in size located at the lesser curvature of the gastric body. Computed tomography revealed that the tumor was located near the coronary loop between the left and right gastric arteries. On the day before endoscopic local resection, abdominal angiography was performed and it revealed that the tumor was supplied by the left and right gastric arteries. Superselective transarterial embolization of the left and right gastric arteries around the tumor was performed to prevent accidental bleeding during the endoscopic procedure. Endoscopic local resection using full-thickness resection and submucosal dissection techniques was performed under general anesthesia. The tumor was completely resected without accidental bleeding. A gastric wall defect was closed using metallic clips and loop snares. Histologic examination revealed that the tumor was a low-risk gastrointestinal stromal tumor. We suggest that the combined therapy using superselective transarterial embolization and endoscopic local resection is an optional safe method for the treatment of gastric submucosal tumors.

  11. Treatment of chronic bacterial prostatits with amikacin through anal submucosal injection

    Institute of Scientific and Technical Information of China (English)

    Wei-LieHU; Shi-ZhenZHONG; 等

    2002-01-01

    Abstract Aim:To assess the efficacy and safety of anal submucosal injection(ASI)of amikacin in chronic bacterial prostatitis(CBP).Methods:Fifty male outpatients with CBP were randomly diided into two groups.Thirty cases of ASI group were given amikacin 400mg daily by ASI for ten times and the other twenty cases of intramuscular injection(IM)group were given the same drug daily by IM,All patients were evaluated with NIH-Chronic prostatitis symptom index(NIH-CPSI),the bacteria culture of the expressed prostate secretion(EPS),proctoscopic examination,rectal biopsy and the clinical manifestation were checked at pretreatment and on day 7and 90after cessation of therapy,Results:The cure rate ,apparent effective rate and effective rate of ASI group and IM group were 33.3%vs5%(P0.05).respectively.The score of NIH-CPSI in both of ASI group and IM group decreased significantly 7days after cessation of therapy,both ASI and IMof amikacin could relieve symptoms within a short time,However,3months after cessation of therapy the score of NIH-CPSIin ASIgroup continued own in spite of no significant differences compared with 7days after cessation of theragy,but the score of IMgroup was rebound nearly colsed to level of pretreatment at23.8±8.5and significantly higher than that of ASI group.The amount of white blood cell(WBC)of EPS in ASIgroup increased slightly at7days after cessation of therapy without significant difference with pretreatment(P>0.050,but it significantly decreased at 3months after cessation of therapy,the amount of WBCof EPS in ASIgroup was lower than that of IM group at 3months after cessation of therapy(P<0.05).Proctoscopic examination of anal canal were normal after ASI therapy and the rectum biopsy showed no obvious histopathologic abnormality at the site of injection except mild focal submucosal infiltration of lymphocytes and plasma cells at 7days after cessation of therapy which disappeared on 3months after cessation of therapy.All patients had no evident

  12. Method for 3D Airway Topology Extraction

    Directory of Open Access Journals (Sweden)

    Roman Grothausmann

    2015-01-01

    Full Text Available In lungs the number of conducting airway generations as well as bifurcation patterns varies across species and shows specific characteristics relating to illnesses or gene variations. A method to characterize the topology of the mouse airway tree using scanning laser optical tomography (SLOT tomograms is presented in this paper. It is used to test discrimination between two types of mice based on detected differences in their conducting airway pattern. Based on segmentations of the airways in these tomograms, the main spanning tree of the volume skeleton is computed. The resulting graph structure is used to distinguish between wild type and surfactant protein (SP-D deficient knock-out mice.

  13. Airway Tree Extraction with Locally Optimal Paths

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau; Sporring, Jon; Pedersen, Jesper Johannes Holst

    2009-01-01

    This paper proposes a method to extract the airway tree from CT images by continually extending the tree with locally optimal paths. This is in contrast to commonly used region growing based approaches that only search the space of the immediate neighbors. The result is a much more robust method...... for tree extraction that can overcome local occlusions. The cost function for obtaining the optimal paths takes into account of an airway probability map as well as measures of airway shape and orientation derived from multi-scale Hessian eigen analysis on the airway probability. Significant improvements...

  14. Anatomic Optical Coherence Tomography of Upper Airways

    Science.gov (United States)

    Chin Loy, Anthony; Jing, Joseph; Zhang, Jun; Wang, Yong; Elghobashi, Said; Chen, Zhongping; Wong, Brian J. F.

    The upper airway is a complex and intricate system responsible for respiration, phonation, and deglutition. Obstruction of the upper airways afflicts an estimated 12-18 million Americans. Pharyngeal size and shape are important factors in the pathogenesis of airway obstructions. In addition, nocturnal loss in pharyngeal muscular tone combined with high pharyngeal resistance can lead to collapse of the airway and periodic partial or complete upper airway obstruction. Anatomical optical coherence tomography (OCT) has the potential to provide high-speed three-dimensional tomographic images of the airway lumen without the use of ionizing radiation. In this chapter we describe the methods behind endoscopic OCT imaging and processing to generate full three dimensional anatomical models of the human airway which can be used in conjunction with numerical simulation methods to assess areas of airway obstruction. Combining this structural information with flow dynamic simulations, we can better estimate the site and causes of airway obstruction and better select and design surgery for patients with obstructive sleep apnea.

  15. AIRWAY VISUALIZATION: EYES SEE WHAT MIND KNOWS.

    Science.gov (United States)

    Sorbello, Massimiliano; Frova, Giulio; Zdravković, Ivana

    2016-03-01

    Airway management is basic for anesthesia practice, and sometimes it can represent a really dramatic scenario for both the patient and the physicians. Laryngoscopy has been the gold standard of airway visualization for more than 60 years, showing its limitations and failure rates with time. New technology has made available an opportunity to move the physician's eye inside patient airways thanks to video laryngoscopy and video assisted airway management technique. Undoubtedly, we have entered a new era of high resolution airway visualization and different approach in airway instrumentation. Nevertheless, each new technology needs time to be tested and considered reliable, and pitfalls and limitations may come out with careful and long lasting analysis, so it is probably not the right time yet to promote video assisted approach as a new gold standard for airway visualization, despite the fact that it certainly offers some new prospects. In any case, whatever the visualization approach, no patient dies because of missed airway visualization or failed intubation, but due to failed ventilation, which remains without doubt the gold standard of any patient safety goal and airway management technique.

  16. Cholinergic Regulation of Airway Inflammation and Remodelling

    Directory of Open Access Journals (Sweden)

    Saeed Kolahian

    2012-01-01

    Full Text Available Acetylcholine is the predominant parasympathetic neurotransmitter in the airways that regulates bronchoconstriction and mucus secretion. Recent findings suggest that acetylcholine regulates additional functions in the airways, including inflammation and remodelling during inflammatory airway diseases. Moreover, it has become apparent that acetylcholine is synthesized by nonneuronal cells and tissues, including inflammatory cells and structural cells. In this paper, we will discuss the regulatory role of acetylcholine in inflammation and remodelling in which we will focus on the role of the airway smooth muscle cell as a target cell for acetylcholine that modulates inflammation and remodelling during respiratory diseases such as asthma and COPD.

  17. Ultrasonography in the management of the airway

    DEFF Research Database (Denmark)

    Kristensen, M S

    2011-01-01

    In this study, it is described how to use ultrasonography (US) for real-time imaging of the airway from the mouth, over pharynx, larynx, and trachea to the peripheral alveoli, and how to use this in airway management. US has several advantages for imaging of the airway - it is safe, quick...... or the esophagus by placing the ultrasound probe transversely on the neck at the level of the suprasternal notch during intubation, thus confirming intubation without the need for ventilation or circulation. US can be applied before anesthesia induction and diagnose several conditions that affect airway management...

  18. Airway smooth muscle dynamics : a common pathway of airway obstruction in asthma

    NARCIS (Netherlands)

    An, S S; Bai, T R; Bates, J H T; Black, J L; Brown, R H; Brusasco, V; Chitano, P; Deng, L; Dowell, M; Eidelman, D H; Fabry, B; Fairbank, N J; Ford, L E; Fredberg, J J; Gerthoffer, W T; Gilbert, S H; Gosens, R; Gunst, S J; Halayko, A J; Ingram, R H; Irvin, C G; James, A L; Janssen, L J; King, G G; Knight, D A; Lauzon, A M; Lakser, O J; Ludwig, M S; Lutchen, K R; Maksym, G N; Martin, J G; Mauad, T; McParland, B E; Mijailovich, S M; Mitchell, H W; Mitchell, R W; Mitzner, W; Murphy, T M; Paré, P D; Pellegrino, R; Sanderson, M J; Schellenberg, R R; Seow, C Y; Silveira, P S P; Smith, P G; Solway, J; Stephens, N L; Sterk, P J; Stewart, A G; Tang, D D; Tepper, R S; Tran, T; Wang, L

    2007-01-01

    Excessive airway obstruction is the cause of symptoms and abnormal lung function in asthma. As airway smooth muscle (ASM) is the effecter controlling airway calibre, it is suspected that dysfunction of ASM contributes to the pathophysiology of asthma. However, the precise role of ASM in the series o

  19. Pim1 kinase protects airway epithelial cells from cigarette smoke-induced damage and airway inflammation

    NARCIS (Netherlands)

    de Vries, M.; Heijink, Hilde; Gras, R.; den Boef, L. E.; Reinders-Luinge, M.; Pouwels, S. D.; Hylkema, Machteld; van der Toorn, Marco; Brouwer, U.; van Oosterhout, A. J. M.; Nawijn, M. C.

    2014-01-01

    Exposure to cigarette smoke (CS) is the main risk factor for developing chronic obstructive pulmonary disease and can induce airway epithelial cell damage, innate immune responses, and airway inflammation. We hypothesized that cell survival factors might decrease the sensitivity of airway epithelial

  20. Distribution of voltage-dependent and intracellular Ca2+ channels in submucosal neurons from rat distal colon.

    Science.gov (United States)

    Rehn, Matthias; Bader, Sandra; Bell, Anna; Diener, Martin

    2013-09-01

    We recently observed a bradykinin-induced increase in the cytosolic Ca2+ concentration in submucosal neurons of rat colon, an increase inhibited by blockers of voltage-dependent Ca2+ (Ca(v)) channels. As the types of Ca(v) channels used by this part of the enteric nervous system are unknown, the expression of various Ca(v) subunits has been investigated in whole-mount submucosal preparations by immunohistochemistry. Submucosal neurons, identified by a neuronal marker (microtubule-associated protein 2), are immunoreactive for Ca(v)1.2, Ca(v)1.3 and Ca(v)2.2, expression being confirmed by reverse transcription plus the polymerase chain reaction. These data agree with previous observations that the inhibition of L- and N-type Ca2+ currents strongly inhibits the response to bradykinin. However, whole-cell patch-clamp experiments have revealed that bradykinin does not enhance Ca2+ inward currents under voltage-clamp conditions. Consequently, bradykinin does not directly interact with Ca(v) channels. Instead, the kinin-induced Ca2+ influx is caused indirectly by the membrane depolarization evoked by this peptide. As intracellular Ca2+ channels on Ca(2+)-storing organelles can also contribute to Ca2+ signaling, their expression has been investigated by imaging experiments and immunohistochemistry. Inositol 1,4,5-trisphosphate (IP3) receptors (IP3R) have been functionally demonstrated in submucosal neurons loaded with the Ca(2+)-sensitive fluorescent dye, fura-2. Histamine, a typical agonist coupled to the phospholipase C pathway, induces an increase in the fura-2 signal ratio, which is suppressed by 2-aminophenylborate, a blocker of IP3 receptors. The expression of IP3R1 has been confirmed by immunohistochemistry. In contrast, ryanodine, tested over a wide concentration range, evokes no increase in the cytosolic Ca2+ concentration nor is there immunohistochemical evidence for the expression of ryanodine receptors in these neurons. Thus, rat submucosal neurons are equipped

  1. Adrenal gland and bone.

    Science.gov (United States)

    Hardy, Rowan; Cooper, Mark S

    2010-11-01

    The adrenal gland synthesizes steroid hormones from the adrenal cortex and catecholamines from the adrenal medulla. Both cortisol and adrenal androgens can have powerful effects on bone. The overproduction of cortisol in Cushing's disease leads to a dramatic reduction in bone density and an increase risk of fracture. Overproduction of adrenal androgens in congenital adrenal hyperplasia (CAH) leads to marked changes in bone growth and development with early growth acceleration but ultimately a significant reduction in final adult height. The role of more physiological levels of glucocorticoids and androgens on bone metabolism is less clear. Cortisol levels measured in elderly individuals show a weak correlation with measures of bone density and change in bone density over time with a high cortisol level associated with lower bone density and more rapid bone loss. Cortisol levels and the dynamics of cortisol secretion change with age which could also explain some age related changes in bone physiology. It is also now clear that adrenal steroids can be metabolized within bone tissue itself. Local synthesis of cortisol within bone from its inactive precursor cortisone has been demonstrated and the amount of cortisol produced within osteoblasts appears to increase with age. With regard to adrenal androgens there is a dramatic reduction in levels with aging and several studies have examined the impact that restoration of these levels back to those seen in younger individuals has on bone health. Most of these studies show small positive effects in women, not men, but the skeletal sites where benefits are seen varies from study to study.

  2. Cysteinyl leukotrienes mediate the response of submucosal ganglia from rat colon to bradykinin.

    Science.gov (United States)

    Rehn, Matthias; Diener, Martin

    2012-04-15

    The aim of the present study was to find out the mechanism by which the inflammatory mediator, bradykinin, induces an increase of the cytosolic Ca(2+) concentration ([Ca(2+)](i)) in enteric neurons. For this purpose, ganglia in the isolated submucosa from rat colon were loaded with the Ca(2+)-sensitive dye, fura-2, and were exposed to bradykinin (2·10(-8)mol/l). Under control conditions, the kinin evoked a transient increase in [Ca(2+)](i). Preincubation with quinacrine or arachidonyltrifluoromethylketone (AACOCF(3)), i.e. blockers of cytosolic phospholipase A(2), prevented the raise of [Ca(2+)](i). This inhibition was mimicked by 5,8,11,14-eicosatetrayonic acid (ETYA), an inhibitor of cyclooxygenases as well as lipoxygenases, and by BWA4C, a selective inhibitor of lipoxygenases, whereas indomethacin was ineffective, suggesting the mediation of the kinin response by a lipoxygenase metabolite. Indeed, a leukotriene, leukotriene D(4) (LTD(4)), mimicked the effect of bradykinin. The LTD(4) receptor blocker, MK-571, inhibited the increase in [Ca(2+)](i) evoked by LTD(4) and by bradykinin. Consequently, bradykinin receptors in submucosal ganglia from rat colon are coupled to a stimulation of phospholipase A(2), the release of arachidonic acid and the production of LTD(4), which seems to be finally responsible for the change in the cytosolic Ca(2+) concentration.

  3. Clinical problems with antithrombotic therapy for endoscopic submucosal dissection for gastric neoplasms

    Science.gov (United States)

    Yoshio, Toshiyuki; Nishida, Tsutomu; Hayashi, Yoshito; Iijima, Hideki; Tsujii, Masahiko; Fujisaki, Junko; Takehara, Tetsuo

    2016-01-01

    Endoscopic submucosal dissection (ESD) is minimally invasive and thus has become a widely accepted treatment for gastric neoplasms, particularly for patients with comorbidities. Antithrombotic agents are used to prevent thrombotic events in patients with comorbidities such as cardio-cerebrovascular diseases and atrial fibrillation. With appropriate cessation, antithrombotic therapy does not increase delayed bleeding in low thrombosis-risk patients. However, high thrombosis-risk patients are often treated with combination therapy with antithrombotic agents and occasionally require the continuation of antithrombotic agents or heparin bridge therapy (HBT) in the perioperative period. Dual antiplatelet therapy (DAPT), a representative combination therapy, is frequently used after placement of drug-eluting stents and has a high risk of delayed bleeding. In patients receiving DAPT, gastric ESD may be postponed until DAPT is no longer required. HBT is often required for patients treated with anticoagulants and has an extremely high bleeding risk. The continuous use of warfarin or direct oral anticoagulants may be possible alternatives. Here, we show that some antithrombotic therapies in high thrombosis-risk patients increase delayed bleeding after gastric ESD, whereas most antithrombotic therapies do not. The management of high thrombosis-risk patients is crucial for improved outcomes. PMID:28042389

  4. Risk factors for postoperative bleeding after gastric endoscopic submucosal dissection in patients under antithrombotics

    Institute of Scientific and Technical Information of China (English)

    Yuji Shindo; Satohiro Matsumoto; Hiroyuki Miyatani; Yukio Yoshida; Hirosato Mashima

    2016-01-01

    AIM: To evaluate the risk factors for postoperative bleeding after gastric endoscopic submucosal dissection(ESD) based on the latest guidelines.METHODS: A total of 262 gastric neoplasms were treated by ESD at our center during a 2-year period from October 2012. We analyzed the data of these cases retrospectively to identify the risk factors for postESD bleeding.RESULTS: Of the 48(18.3%) cases on antithrombotic treatment, 10 were still receiving antiplatelet drugs perioperatively, 13 were on heparin replacement after oral anticoagulant withdrawal, and the antithrombotic therapy was discontinued perioperatively in 25 cases. Postoperative bleeding occurred in 23 cases(8.8%). The postoperative bleeding rate in the heparin replacement group was 61.5%, significantly higher than that in the non-antithrombotic therapy group(6.1%). Univariate analysis identified history of antithrombotic drug use, heparin replacement, hemodialysis, cardiovascular disease, diabetes mellitus, elevated prothrombin timeinternational normalized ratio, and low hemoglobin level on admission as risk factors for post ESD bleeding. Multivariate analysis identified only heparin replacement(OR = 13.7, 95%CI: 1.2-151.3, P = 0.0329) as a significant risk factor for post-ESD bleeding.CONCLUSION: Continued administration of antiplatelet agents, based on the guidelines, was not a risk factor for postoperative bleeding after gastric ESD; however, heparin replacement, which is recommended after withdrawal of oral anticoagulants, was identified as a significant risk factor.

  5. Endoscopic submucosal dissection in early gastric cancer inelderly patients and comorbid conditions

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    The prognosis of early gastric cancer (EGC) is goodif there is no concomitant lymph node metastasis.Therefore, the early detection of EGC is important toimprove the prognosis of patients with gastric cancer.In Japan, 40% to 50% of all gastric cancers areEGC, and endoscopic submucosal dissection (ESD) iswidely accepted as a local treatment for these lesions,particularly for large lesions that at one time were anindication for gastrectomy because of the difficultyof en-bloc resection. Consequently, this procedurecan preserve the entire stomach and the patient'spostoperative quality of life. ESD has become a generaltechnique with improved procedures and devices, andhas become the preferred treatment for EGC ratherthan gastrectomy. Therefore, ESD may demonstratemany advantages in patients who have several comorbidities,particularly elderly population, patients takingantithrombotic agents, or patients with chronic kidneydisease, or liver cirrhosis. However, it is not yet clearwhether patients with both EGC and comorbidities arefeasible candidates for ESD and whether they wouldconsequently be able to achieve a survival benefitafter ESD. In this review, we discuss the clinical problemsof ESD in patients with EGC and those comorbidconditions.

  6. Early Squamous Cell Carcinoma of the Anal Canal Resected by Endoscopic Submucosal Dissection

    Directory of Open Access Journals (Sweden)

    Yuzuru Tamaru

    2015-04-01

    Full Text Available The standard treatment approach for squamous cell carcinoma (SCC of the anal canal includes abdominoperineal resection and chemoradiotherapy. However, there are currently very few reports of early SCC of the anal canal resected by endoscopic submucosal dissection (ESD. We report 2 rare cases of SCC of the anal canal resected by ESD. In case 1, a 66-year-old woman underwent a colonoscopy due to blood in her stool, and an elevated lesion, 15 mm in size, was identified from the rectum to the dentate line of the anal canal on internal hemorrhoids. The lesion was diagnosed as an early SCC of the anal canal, and ESD was successfully performed. The histopathological diagnosis was SCC in situ. In case 2, a 71-year-old woman underwent a colonoscopy due to constipation, and an elevated lesion, 25 mm in size, was identified from the dentate line to the anal canal. The lesion was diagnosed as early-stage SCC of the anal canal, and ESD was successfully performed. The histopathological diagnosis was SCC in situ. No complications or recurrence after ESD occurred in either case.

  7. Delayed perforation occurring after endoscopic submucosal dissection for early gastric cancer.

    Science.gov (United States)

    Ikezawa, Kenji; Michida, Tomoki; Iwahashi, Kiyoshi; Maeda, Kosaku; Naito, Masafumi; Ito, Toshifumi; Katayama, Kazuhiro

    2012-01-01

    Delayed perforation occurring after endoscopic submucosal dissection (ESD) is a rare but serious complication which sometimes requires emergent surgery. However, reports of its characteristics, including endoscopic imaging and management, are not fully detailed. A 70-year-old woman was referred to our hospital for the treatment of early gastric cancer. On the day of the ESD, hematemesis was observed because of a Mallory-Weiss tear, and a visible vessel in the post-ESD ulcer was additionally treated endoscopically by coagulation. Second-look endoscopic examination on the next day revealed a perforation 3 mm in diameter at the treated vessel in the ulcer. The shape of the perforation was round and the color of the surrounding muscle layer had become whitish. The perforation was closed with endoclips, and decompression of the pneumoperitoneum was performed. The patient was conservatively managed and was discharged 13 days after the ESD. We show endoscopic images of delayed perforation and discuss the mechanism and management of this complication.

  8. Detection and characterization of early gastric cancer for curative endoscopic submucosal dissection.

    Science.gov (United States)

    Yao, Kenshi; Nagahama, Takashi; Matsui, Toshiyuki; Iwashita, Akinori

    2013-03-01

    Because endoscopic submucosal dissection (ESD) of gastric cancer can only be curative if the cancer is detected at an early stage and a precise preoperative diagnosis is made, we reviewed the detection and characterization of early gastric cancer (EGC) using both conventional endoscopy with white-light imaging (C-WLI) and image-enhanced endoscopy (chromoendoscopy [CE] and magnifying narrow-band imaging [M-NBI]). Systematic screening of the stomach by C-WLI after ideal preparation of the patient is important for detecting a mucosal lesion, which can then be characterized using CE. However, a limitation of C-WLI with CE is the diagnosis of flat or small gastric cancers. To overcome this, M-NBI together with a comprehensive diagnostic system, termed the 'vessel plus surface classification' system, was developed and has proven very useful. Preoperative assessment for ESD involves determining: (i) histological type; (ii) size; (iii) depth of invasion; (iv) presence or absence of associated ulceration; and (v) horizontal extent of the cancer. A limitation of endoscopic diagnosis using M-NBI is the histologically undifferentiated type of carcinoma, in which case the biopsy specimen is used to make a histopathological diagnosis.

  9. The laminin β1-competing peptide YIGSR induces a hypercontractile, hypoproliferative airway smooth muscle phenotype in an animal model of allergic asthma

    Directory of Open Access Journals (Sweden)

    Zaagsma Johan

    2010-12-01

    Full Text Available Abstract Background Fibroproliferative airway remodelling, including increased airway smooth muscle (ASM mass and contractility, contributes to airway hyperresponsiveness in asthma. In vitro studies have shown that maturation of ASM cells to a (hypercontractile phenotype is dependent on laminin, which can be inhibited by the laminin-competing peptide Tyr-Ile-Gly-Ser-Arg (YIGSR. The role of laminins in ASM remodelling in chronic asthma in vivo, however, has not yet been established. Methods Using an established guinea pig model of allergic asthma, we investigated the effects of topical treatment of the airways with YIGSR on features of airway remodelling induced by repeated allergen challenge, including ASM hyperplasia and hypercontractility, inflammation and fibrosis. Human ASM cells were used to investigate the direct effects of YIGSR on ASM proliferation in vitro. Results Topical administration of YIGSR attenuated allergen-induced ASM hyperplasia and pulmonary expression of the proliferative marker proliferating cell nuclear antigen (PCNA. Treatment with YIGSR also increased both the expression of sm-MHC and ASM contractility in saline- and allergen-challenged animals; this suggests that treatment with the laminin-competing peptide YIGSR mimics rather than inhibits laminin function in vivo. In addition, treatment with YIGSR increased allergen-induced fibrosis and submucosal eosinophilia. Immobilized YIGSR concentration-dependently reduced PDGF-induced proliferation of cultured ASM to a similar extent as laminin-coated culture plates. Notably, the effects of both immobilized YIGSR and laminin were antagonized by soluble YIGSR. Conclusion These results indicate that the laminin-competing peptide YIGSR promotes a contractile, hypoproliferative ASM phenotype in vivo, an effect that appears to be linked to the microenvironment in which the cells are exposed to the peptide.

  10. Immunology of the mammary gland

    Directory of Open Access Journals (Sweden)

    Lazarević Miodrag

    2003-01-01

    Full Text Available The mammary gland is an organ of specific structure whose elementary task is to supply offspring with nutritive and other biologically active substances during the first weeks, or, depending on the species, the first months of life. This prolongs the period of close contact between the mother and her young, which is necessary for their regular growth. Most mammal offspring are born with physiological agammaglobulinaemia, because of the specific structure of the placenta, so that they receive the first specific protection against pathogenic microorganisms through colostrum. Furthermore, this gland is in direct contact with the outer environment through the secretary ducts, so that there are great possibilities for the occurrence of infections. It is therefore necessary to secure protective mechanisms which would prevent such infections. It is clear that there is a distinct connection between the immunological system and the mammary gland, and that link is the central topic of this paper. It presents the basic mechanisms of mammary gland defense which are divided into two categories: nonspecific (innate and specific immune response. The mammary gland secretion contains several types of leukocytes, such as lymphocytes, macrophages, and neutrophiles, as well as 2% epithelial cells. On the average, there are 0.2 x 106 somatic cells in one mililiter of milk. Macrophages account for most of these (58%, as well as lymphocytes (28%, while a smaller number of somatic cells (12% are polymorphonuclears (PMN. The paper considers the characteristics and main functions of these cell types.

  11. Airway smooth muscle dynamics: a common pathway of airway obstruction in asthma.

    Science.gov (United States)

    An, S S; Bai, T R; Bates, J H T; Black, J L; Brown, R H; Brusasco, V; Chitano, P; Deng, L; Dowell, M; Eidelman, D H; Fabry, B; Fairbank, N J; Ford, L E; Fredberg, J J; Gerthoffer, W T; Gilbert, S H; Gosens, R; Gunst, S J; Halayko, A J; Ingram, R H; Irvin, C G; James, A L; Janssen, L J; King, G G; Knight, D A; Lauzon, A M; Lakser, O J; Ludwig, M S; Lutchen, K R; Maksym, G N; Martin, J G; Mauad, T; McParland, B E; Mijailovich, S M; Mitchell, H W; Mitchell, R W; Mitzner, W; Murphy, T M; Paré, P D; Pellegrino, R; Sanderson, M J; Schellenberg, R R; Seow, C Y; Silveira, P S P; Smith, P G; Solway, J; Stephens, N L; Sterk, P J; Stewart, A G; Tang, D D; Tepper, R S; Tran, T; Wang, L

    2007-05-01

    Excessive airway obstruction is the cause of symptoms and abnormal lung function in asthma. As airway smooth muscle (ASM) is the effecter controlling airway calibre, it is suspected that dysfunction of ASM contributes to the pathophysiology of asthma. However, the precise role of ASM in the series of events leading to asthmatic symptoms is not clear. It is not certain whether, in asthma, there is a change in the intrinsic properties of ASM, a change in the structure and mechanical properties of the noncontractile components of the airway wall, or a change in the interdependence of the airway wall with the surrounding lung parenchyma. All these potential changes could result from acute or chronic airway inflammation and associated tissue repair and remodelling. Anti-inflammatory therapy, however, does not "cure" asthma, and airway hyperresponsiveness can persist in asthmatics, even in the absence of airway inflammation. This is perhaps because the therapy does not directly address a fundamental abnormality of asthma, that of exaggerated airway narrowing due to excessive shortening of ASM. In the present study, a central role for airway smooth muscle in the pathogenesis of airway hyperresponsiveness in asthma is explored.

  12. Extraction of Airways from CT (EXACT’09)

    DEFF Research Database (Denmark)

    Lo, Pechin; Ginneken, Bram van; Reinhardt, Joseph M.;

    2012-01-01

    This paper describes a framework for establishing a reference airway tree segmentation, which was used to quantitatively evaluate 15 different airway tree extraction algorithms in a standardized manner. Because of the sheer difficulty involved in manually constructing a complete reference standar...

  13. Extraction of airways from CT (EXACT’09)

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau; Ginneken, Bram van; Reinhardt, Joseph M.

    2012-01-01

    This paper describes a framework for establishing a reference airway tree segmentation, which was used to quantitatively evaluate 15 different airway tree extraction algorithms in a standardized manner. Because of the sheer difficulty involved in manually constructing a complete reference standard...... or not it is a correctly segmented part of the airway tree. Finally, the reference airway trees are constructed by taking the union of all correctly extracted branch segments. Fifteen airway tree extraction algorithms from different research groups are evaluated on a diverse set of 20 chest computed tomography (CT) scans...... from the evaluation showed that no single algorithm could extract more than an average of 74% of the total length of all branches in the reference standard, indicating substantial differences between the algorithms. A fusion scheme that obtained superior results is presented, demonstrating...

  14. 内镜黏膜下剥离术治疗消化道黏膜下肿瘤43例分析%Endoscopic submucosal dissection for treatment of gastrointestinal submucosal tumors:43 ca-ses analysis

    Institute of Scientific and Technical Information of China (English)

    任春蓉; 孙晓滨; 史维; 奚维东; 赵聪; 王琼; 袁德强; 唐宇

    2015-01-01

    Objective To evaluate the safety and reliability of endoscopic submucosal dissection (ESD)for complete resection of gastrointestinal submucosal tumors(SMT).Methods Forty-three patients with SMT underwent ESD .The complete resection rate,in-traoperative perforation and delayed hemorrhage were statistically analyzed .The patients were followed up for evaluation of the histologi -cal cure rate.Results Of the 43 patients,29 SMT were completely resected (67.44%),and 14 cases were transferred into laparoscopic resection.Intraoperative perforation happened in 11 patients(25.58%) including 1 case with gastric submucosal granulosa cell tumor and 10 cases with interstitialoma in muscularis propria layer .Of those perforations,10 cases were resulted from planed endoscopic full -thickness resection and 1 was due to APC treatment.Except for 3 cases transferred to laparoscopic closing ,others were successfully closed under endoscopy followed by gastrointestinal decompression and antibiotics treatment .Thirty-three patients were followed -up for 1 to 3 years and no recurrence was found .Conclusion ESD is an effective and safe treatment of gastrointestinal submucosal tumors .This technique is able to resect the deep gastrointestinal lesions and provide precise pathological information about the lesion .The minimal invasiveness,rapid recovery time and low complication rate of this technique provide another choice for SMT patients to avoid from inva -sive surgery.%目的:探讨内镜黏膜下剥离术(endoscopic submucosal dissection ,ESD)完整切除消化道黏膜下肿瘤(submucosal tumor,SMT)的可靠性及安全性。方法43例 SMT 患者行 ESD,统计病灶一次性完整切除率,观察术中穿孔及术后出血情况,评价病灶组织学治愈率。结果43例患者中,29例(67.44%)一次完整剥离成功,14例改用腹腔镜完整切除病灶。术中穿孔11例(25.58%),包括1例胃粘膜下层颗粒细胞瘤,10例固

  15. A Case of Hyalinizing Clear Cell Carcinoma, So-Called Clear Cell Carcinoma, Not Otherwise Specified, of the Minor Salivary Glands of the Buccal Mucosa

    Directory of Open Access Journals (Sweden)

    Takahiro Yamanishi

    2015-01-01

    Full Text Available Hyalinizing clear cell carcinoma (HCCC, so-called clear cell carcinoma, not otherwise specified (CCC (NOS, of the salivary glands is a rare and low-grade malignant tumor. We report a case of HCCC so-called CCC (NOS (referred to as HCCC of the minor salivary gland of the buccal mucosa. A 52-year-old woman had presented with a gradually growing and indolent mass in the right buccal mucosa for about two years. The first biopsy histopathologically suggested the possibility of malignancy derived from the minor salivary glands. A month later, she visited our hospital. The tumor measured approximately 1.5 cm in diameter and was elastic hard, smooth, and well movable. Image examinations demonstrated internal homogeneity of the lesion, which had a smooth margin, in the right buccal mucosa. Complete tumor resection followed by covering with a polyglycolic acid sheet and fibrin glue spray was performed without surgical flap reconstruction. Histopathological findings revealed proliferating tumor cells with clear cytoplasm surrounded by hyalinizing stroma in the submucosal minor salivary glands. Immunohistochemical stains revealed these tumor cells to be positive for epithelial cell markers but negative for myoepithelial ones. These findings confirmed the diagnosis of HCCC. Good wound healing and no evidence of local recurrence and metastasis have been shown since surgery.

  16. Polystyrene nanoparticles activate ion transport in human airway epithelial cells

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    McCarthy J

    2011-06-01

    Full Text Available J McCarthy1, X Gong2, D Nahirney2, M Duszyk2, MW Radomski11School of Pharmacy and Pharmaceutical Sciences, Panoz Institute, Trinity College Dublin, Dublin, Ireland; 2Department of Physiology, University of Alberta, Edmonton, Alberta, CanadaBackground: Over the last decade, nanotechnology has provided researchers with new nanometer materials, such as nanoparticles, which have the potential to provide new therapies for many lung diseases. In this study, we investigated the acute effects of polystyrene nanoparticles on epithelial ion channel function.Methods: Human submucosal Calu-3 cells that express cystic fibrosis transmembrane conductance regulator (CFTR and baby hamster kidney cells engineered to express the wild-type CFTR gene were used to investigate the actions of negatively charged 20 nm polystyrene nanoparticles on short-circuit current in Calu-3 cells by Ussing chamber and single CFTR Cl- channels alone and in the presence of known CFTR channel activators by using baby hamster kidney cell patches.Results: Polystyrene nanoparticles caused sustained, repeatable, and concentration-dependent increases in short-circuit current. In turn, these short-circuit current responses were found to be biphasic in nature, ie, an initial peak followed by a plateau. EC50 values for peak and plateau short-circuit current responses were 1457 and 315.5 ng/mL, respectively. Short-circuit current was inhibited by diphenylamine-2-carboxylate, a CFTR Cl- channel blocker. Polystyrene nanoparticles activated basolateral K+ channels and affected Cl- and HCO3- secretion. The mechanism of short-circuit current activation by polystyrene nanoparticles was found to be largely dependent on calcium-dependent and cyclic nucleotide-dependent phosphorylation of CFTR Cl- channels. Recordings from isolated inside-out patches using baby hamster kidney cells confirmed the direct activation of CFTR Cl- channels by the nanoparticles.Conclusion: This is the first study to identify

  17. Characterization of human pineal gland proteome.

    Science.gov (United States)

    Yelamanchi, Soujanya D; Kumar, Manish; Madugundu, Anil K; Gopalakrishnan, Lathika; Dey, Gourav; Chavan, Sandip; Sathe, Gajanan; Mathur, Premendu P; Gowda, Harsha; Mahadevan, Anita; Shankar, Susarla K; Prasad, T S Keshava

    2016-11-15

    The pineal gland is a neuroendocrine gland located at the center of the brain. It is known to regulate various physiological functions in the body through secretion of the neurohormone melatonin. Comprehensive characterization of the human pineal gland proteome has not been undertaken to date. We employed a high-resolution mass spectrometry-based approach to characterize the proteome of the human pineal gland. A total of 5874 proteins were identified from the human pineal gland in this study. Of these, 5820 proteins were identified from the human pineal gland for the first time. Interestingly, 1136 proteins from the human pineal gland were found to contain a signal peptide domain, which indicates the secretory nature of these proteins. An unbiased global proteomic profile of this biomedically important organ should benefit molecular research to unravel the role of the pineal gland in neuropsychiatric and neurodegenerative diseases.

  18. Bacterial adherence in otitis media: Determination of N-acetylgalactosamine (GalNAc) residues in the submucosal glands and surface epithelium of the normal and diseased Eustachian tube

    DEFF Research Database (Denmark)

    Kirkeby, S; Friis, M; Mikkelsen, H B

    2011-01-01

    Acute otitis media (AOM) is the most common childhood infection caused by bacteria. The pathogenesis of AOM implicates initial adherence of a pathogen to the nasopharyngeal epithelium, which is followed by bacterial colonization of the middle ear cavity through the Eustachian tube. N......-acetylgalactosamine (GalNAc) is an important constituent of mucins and GalNAc containing sugar residues seem to be essential for initial adherence of respiratory bacteria to the surface of epithelial cells....

  19. Laparoscopic resection of submucosal tumor on posterior wall of gastric fundus

    Institute of Scientific and Technical Information of China (English)

    Zhong-Wei Ke; Cheng-Zhu Zheng; Ming-Gen Hu; Dan-Lei Chen

    2004-01-01

    AIM: Laparoscopic resection of tumors on the posterior wall of gastric fundus, especially when they are next to the esophagocardiac junction (ECJ), is both difficult and timeconsuming. Furthermore, it can lead to inadvertent esophagus stenosis and injury to the spleen. In order to overcome these difficulties, laparoscopically extraluminal resection of gastric fundus was designed to manage submucosal tumors located on the posterior wall of gastric fundus and next to ECJ.METHODS: From January 2001 to September 2003,laparoscopically extraluminal resection of gastric fundus was successfully carried out on 15 patients. There were11 males and 4 females with an average age of 58 years(range, 38 to 78 years). The mean diameter of the tumors was 4.8 cm. The distance of the tumor border from ECJ was about 1.5-2.5 cm. The four-portal operation procedures were as follows: localization of the tumor, dissection of the omentum, mobilization of the gastric fundus and the upper polar of spleen, exposure of ECJ, and resection of the gastric fundus with Endo GIA.RESULTS: The laparoscopic operation time averaged(66.2±10.4) min, the average amount of bleeding was(89.4±21.7) mL. The mean post-operative hospital stay was (5.3±1.1) d. Within 36 h post-operation, 73.3% of all the patients recovered their gastrointestinal function and began to eat something and to walk. In all the operations,no apparent tumor focus was left and no complication or conversion to open surgery occurred.CONCLUSION: Our newly designed procedure,laparoscopically extraluminal resection of the gastric fundus, can avoid contamination of the abdominal cavity,injury to the spleen and esophageal stenosis. The procedure seems to be both safe and effective.

  20. Amniotic membrane grafts for the prevention of esophageal stricture after circumferential endoscopic submucosal dissection.

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    Maximilien Barret

    Full Text Available The prevention of esophageal strictures following circumferential mucosal resection remains a major clinical challenge. Human amniotic membrane (AM is an easily available material, which is widely used in ophthalmology due to its wound healing, anti-inflammatory and anti-fibrotic properties. We studied the effect of AM grafts in the prevention of esophageal stricture after endoscopic submucosal dissection (ESD in a swine model.In this prospective, randomized controlled trial, 20 swine underwent a 5 cm-long circumferential ESD of the lower esophagus. In the AM Group (n = 10, amniotic membrane grafts were placed on esophageal stents; a subgroup of 5 swine (AM 1 group was sacrificed on day 14, whereas the other 5 animals (AM 2 group were kept alive. The esophageal stent (ES group (n = 5 had ES placement alone after ESD. Another 5 animals served as a control group with only ESD.The prevalence of symptomatic strictures at day 14 was significantly reduced in the AM group and ES groups vs. the control group (33%, 40% and 100%, respectively, p = 0.03; mean esophageal diameter was 5.8±3.6 mm, 6.8±3.3 mm, and 2.6±1.7 mm for AM, ES, and control groups, respectively. Median (range esophageal fibrosis thickness was 0.87 mm (0.78-1.72, 1.19 mm (0.28-1.95, and 1.65 mm (0.7-1.79 for AM 1, ES, and control groups, respectively. All animals had developed esophageal strictures by day 35.The anti-fibrotic effect of AM on esophageal wound healing after ESD delayed the development of esophageal stricture in our model. However, this benefit was of limited duration in the conditions of our study.

  1. Endoscopic submucosal dissection for superficial Barrett’s esophageal cancer in the Japanese state and perspective

    Science.gov (United States)

    Yamamoto, Sachiko; Hanaoka, Noboru; Takeuchi, Yoji; Higashino, Koji; Uedo, Noriya; Iishi, Hiroyasu

    2014-01-01

    The incidence of Barrett’s esophageal cancer is one of the most rapidly increasing among all cancers in the West, and it is also expected to increase in Japan. The optimal treatment for early Barrett’s esophageal cancer remains controversial. En bloc esophagectomy with regional lymph node dissection has been considered the standard therapy. Endoscopic therapies are currently being evaluated as alternatives to esophagectomy because they can provide the least postoperative morbidity and the best quality of life. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) allow for removal of visible lesions and histopathologic review of resected tissue, which help in diagnostic staging of the disease. EMR is limited with respect to resection size, and large lesions must be resected in several fragments. Piecemeal resection of lesions is associated with high local recurrence rates, probably because of minor remnants of neoplastic tissue being left in situ. ESD provides larger specimens than does EMR in patients with early Barrett’s neoplasia. This in turn allows for more precise histological analysis and higher en bloc and curative resection rates, potentially reducing the incidence of recurrence. Detailed endoscopic examination to determine the invasion depth and spread of Barrett’s esophageal cancer is essential before ESD. The initial inspection is usually conducted with white-light imaging followed by narrow-band imaging. The ESD procedure is similar to that for lesions in other parts of the gastrointestinal tract. However, the narrow space of the esophagogastric junction and contraction of the lower esophageal sphincter sometimes disturb the visual field and endoscopic control. Skilled endoscope handling, sometimes including retroflexion, is required during ESD for Barrett’s esophageal cancer. Previous reports have shown that ESD achieves en bloc resection in >80% of lesions. Although promising short-term results are reported, a long

  2. Management and associated factors of delayed perforation after gastric endoscopic submucosal dissection

    Science.gov (United States)

    Suzuki, Haruhisa; Oda, Ichiro; Sekiguchi, Masau; Abe, Seiichiro; Nonaka, Satoru; Yoshinaga, Shigetaka; Nakajima, Takeshi; Saito, Yutaka

    2015-01-01

    AIM: To identify the actual clinical management and associated factors of delayed perforation after gastric endoscopic submucosal dissection (ESD). METHODS: A total of 4943 early gastric cancer (EGC) patients underwent ESD at our hospital between January 1999 and June 2012. We retrospectively assessed the actual management of delayed perforation. In addition, to determine the factors associated with delayed perforation, after excluding 123 EGC patients with perforations that occurred during the ESD procedure, we analyzed the following clinicopathological factors among the remaining 4820 EGC patients by comparing the ESD cases with delayed perforation and the ESD cases without perforation: age, sex, chronological periods, clinical indications for ESD, status of the stomach, location, gastric circumference, tumor size, invasion depth, presence/absence of ulceration, histological type, type of resection, and procedure time. RESULTS: Delayed perforation occurred in 7 (0.1%) cases. The median time until the occurrence of delayed perforation was 11 h (range, 6-172 h). Three (43%) of the 7 cases required emergency surgery, while four were conservatively managed without surgical intervention. Among the 4 cases with conservative management, 2 were successfully managed endoscopically using the endoloop-endoclip technique. The median hospital stay was 18 d (range, 15-45 d). There were no delayed perforation-related deaths. Based on a multivariate analysis, gastric tube cases (OR = 11.0; 95%CI: 1.7-73.3; P = 0.013) were significantly associated with delayed perforation. CONCLUSION: Endoscopists must be aware of not only the identified factors associated with delayed perforation, but also how to treat this complication effectively and promptly. PMID:26640340

  3. The role of immunohistochemistry in the detection of vascular invasion in specimens of endoscopic submucosal dissection

    Directory of Open Access Journals (Sweden)

    Nayze Lucena Sangreman Aldeman

    2013-08-01

    Full Text Available INTRODUCTION: Endoscopic submucosal dissection (ESD of early neoplasias of the gastrointestinal tract (GIT has been increasingly applied as an alternative to invasive surgical procedures, with the aim to preserve the patient's organ and quality of life, although it does not allow the histopathological analysis of lymph nodes. Previous studies demonstrated that the presence of neoplastic emboli in lymphatic (lymphatic vascular invasion [LVI] or blood vessels (blood vascular invasion [BVI] is considered a positive predictive factor for the occurrence of lymph node metastasis. The assessment of vascular invasion carried out only by routine hematoxylin and eosin staining (HE may yield both falsepositive and false-negative results. D2-40 is a specific monoclonal antibody to the lymphatic endothelium. Thus, it is useful for identifying LVI and distinguishing if tumor embolization is found in blood or lymphatic vessels. OBJECTIVE: To determine the role of immunohistochemistry (IHC in the assessment of ESD specimens by comparing the detection of LVI and BVI by HE and IHC with D2-40 and CD34 immunolabeling. METHOD: We conducted the IHC study using D2-40 and CD34 markers (pan-endothelial in 30 cases of ESD with histological diagnosis of carcinoma in order to assess the presence of LVI and BVI. RESULTS: The detection of LVI was more prevalent than BVI. Three out of six cases with LVI were false-positive by HE and six were false-negative by IHC. Regarding BVI, five cases were identified and one was false-negative by IHC. CONCLUSION: Our results indicated that the histopathological analysis of ESD specimens by exclusively routine HE staining does not allow proper evaluation of BVI or LVI.

  4. Quality of Life after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Prospective Multicenter Cohort Study

    Science.gov (United States)

    Kim, Sang Gyun; Ji, Seon Mi; Lee, Na Rae; Park, Seung-Hee; You, Ji Hye; Choi, Il Ju; Lee, Wan Sik; Park, Seun Ja; Lee, Jun Haeng; Seol, Sang-Yong; Kim, Ji Hyun; Lim, Chul-Hyun; Cho, Joo Young; Kim, Gwang Ha; Chun, Hoon Jai; Lee, Yong Chan; Jung, Hwoon-Yong; Kim, Jae J.

    2017-01-01

    Background/Aims Endoscopic submucosal dissection (ESD) has been an established treatment for indicated early gastric cancer (EGC) without deterioration of quality of life (QOL) compared with surgical resection. The aim of this study was to evaluate long-term QOL in patients undergoing ESD for EGC. Methods Patients scheduled to undergo curative ESD for EGC were prospectively enrolled from 12 institutions between May 2010 and December 2011. Assessments of QOL with Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire-core (QLQ-C30) and a gastric cancer-specific questionnaire (STO22) were performed at baseline and at 7 days, 3 months, and 6 months after ESD. Results A total of 666 subjects were assessed for QLQ-C30 and QLQ-STO22. The mean QLQ-C30 score was 69.5 at baseline, 68.8 at 7 days, 73.1 at 3 months, and 73.2 at 6 months. The global health status on the EORTC QLQ-C30 was significantly improved after 3 and 6 months (p=0.0003 and p<0.0001, respectively). The QLQ-C30 and STO22 scores were not significantly different, or they only slightly deteriorated between before and immediately after ESD, but they were significantly improved after 3 and 6 months (p<0.05). Conclusions QOL did not deteriorate immediately after ESD, and it improved more significantly at up to 6 months in patients who underwent curative ESD for EGC without significant complications. PMID:27282267

  5. [Brunners gland hiperplasia. Report of two cases].

    Science.gov (United States)

    Padilla Ruiz, Maykel

    2014-04-01

    Brunner's gland hyperplasia is an infrequent benign injury located on the first or second portion of the duodenum. The disease spectrum includes diffuse nodular hyperplasia, circumscribed nodular hyperplasia, and Brunner's gland adenoma. We report two cases, one with an adenoma of Brunner's glands as a duodenal polyp and the other as a diffuse nodular hyperplasia of the duodenal bulb.

  6. Salivary gland diseases : infections, sialolithiasis and mucoceles

    NARCIS (Netherlands)

    Delli, K; Spijkervet, FK; Vissink, A.

    2014-01-01

    The three most frequently diagnosed salivary gland diseases are salivary gland infections, sialolithiasis and mucoceles. Salivary gland infections are usually of bacterial or viral etiology and can be divided into acute and chronic types. Occasionally they can result from obstruction of the salivary

  7. A new device to expedite endoscopic submucosal dissection procedures: a randomized animal study of efficacy and safety (with videos)

    Science.gov (United States)

    Leblanc, Sarah; Barret, Maximilien; Brehm, Andreas; Rouquette, Alexandre; Camus, Marine; Wintermantel, Erich; Prat, Frederic

    2015-01-01

    Background and study aims: Endoscopic submucosal dissection (ESD) is a recognized method for the curative treatment of superficial neoplasia, but its use is limited by lengthy procedures and the lack of versatility of existing knives. We developed a prototype ESD device with the ability to work as a needle, hook, or “scythe.” This new device was compared to regular ESD knives in a randomized animal study. Patients and methods: Eight pigs underwent two gastric ESD procedures each, similar in size and difficulty, one with a regular ESD device and the other with the new device. The order and location of each ESD, as well as the performing operator, were randomized. Primary judgment criterion was safety of procedures. Overall and submucosal dissection procedure times were measured. Time-to-surface ratios were measured and estimated for ESDs larger than those performed. Histopathology of the resected tissue and remaining stomach was done after each experiment. Results: No complications were observed throughout the study and all resections were completed en-bloc and uneventfully. The submucosal extension of resections was similar with both the standard and the new devices. A comparison of time-consumption between groups did not show statistically significant differences, but a dramatic reduction of procedure duration was observed in some procedures with the new device; based on observed data, a potential time-saving of up to 66 % was anticipated, with a relatively short learning curve. Conclusions: This new versatile device proved to be as safe as regular ESD knives, and seems likely to help reduce the duration of the procedure. PMID:26528499

  8. Arti fi cial Salivary Glands

    Directory of Open Access Journals (Sweden)

    Rezwana Begum Mohammed

    2014-07-01

    Full Text Available Head and neck cancer is the fi fth most common malignancy and accounts for 3% of all new cancer cases each year. Treat- ment for most patients with head and neck cancers includes ionizing radiation. A consequence of this treatment is irreversible damage to salivary glands which is accompanied by a loss of fl uid-secreting acinar-cells and a considerable decrease of saliva output. Despite recent improvements in treating xerostomia (e.g. saliva stimulants, saliva substitutes, and gene therapy, there is a need of more scienti fi c advancements that can be clinically applied toward restoration of compromised salivary gland func- tion. Here we provide a summary of the current salivary cell models that have been used to advance restorative treatments via development of an arti fi cial salivary gland. Although these models are not fully characterized, their improvement may lead to the construction of an arti fi cial salivary gland that is in high demand for improving the quality of life of many patients suffe- ring from salivary secretory dysfunction

  9. A case of endocrine cell carcinoma combined with squamous cell carcinoma of the esophagus resected by endoscopic submucosal dissection.

    Science.gov (United States)

    Watanabe, Ko; Hikichi, Takuto; Sato, Masaki; Nakamura, Jun; Takagi, Tadayuki; Suzuki, Rei; Sugimoto, Mitsuru; Waragai, Yuichi; Kikuchi, Hitomi; Konno, Naoki; Watanabe, Hiroshi; Obara, Katsutoshi; Ohira, Hiromasa

    2014-01-01

    A 55-year-old man with esophageal carcinoma received endoscopic submucosal dissection (ESD) in en-bloc resection. Histopathological examination revealed an admixture of squamous cell carcinoma (SCC) and endocrine cell carcinoma (ECC) with invasion of the deep submucosa. Immunohistochemically, CD 56 and chromogranin A were positive for ECC. Small-cell, medium-cell, and large-cell type ECC were partly surrounded with SCC and partly formed the duct, presenting various patterns. After ESD, he received chemotherapy including CPT-11 plus Cisplatin. He is alive and in good condition today, 55 months after ESD, with no evidence of recurrence.

  10. The genus Prevotella in cystic fibrosis airways.

    Science.gov (United States)

    Field, Tyler R; Sibley, Christopher D; Parkins, Michael D; Rabin, Harvey R; Surette, Michael G

    2010-08-01

    Airway disease resulting from chronic bacterial colonization and consequential inflammation is the leading cause of morbidity and mortality in patients with Cystic Fibrosis (CF). Although traditionally considered to be due to only a few pathogens, recent re-examination of CF airway microbiology has revealed that polymicrobial communities that include many obligate anaerobes colonize lower airways. The purpose of this study was to examine Prevotella species in CF airways by quantitative culture and phenotypic characterization. Expectorated sputum was transferred to an anaerobic environment immediately following collection and examined by quantitative microbiology using a variety of culture media. Isolates were identified as facultative or obligate anaerobes and the later group was identified by 16S rRNA sequencing. Prevotella spp. represented the majority of isolates. Twelve different species of Prevotella were recovered from 16 patients with three species representing 65% of isolates. Multiple Prevotella species were often isolated from the same sputum sample. These isolates were biochemically characterized using Rapid ID 32A kits (BioMérieux), and for their ability to produce autoinducer-2 and beta-lactamases. Considerable phenotypic variability between isolates of the same species was observed. The quantity and composition of Prevotella species within a patients' airway microbiome varied over time. Our results suggest that the diversity and dynamics of Prevotella in CF airways may contribute to airway disease.

  11. Upper airway collapsibility in anesthetized children.

    Science.gov (United States)

    Litman, Ronald S; McDonough, Joseph M; Marcus, Carole L; Schwartz, Alan R; Ward, Denham S

    2006-03-01

    We sought to establish the feasibility of measuring upper airway narrowing in spontaneously breathing, anesthetized children using dynamic application of negative airway pressure. A secondary aim was to compare differences in upper airway collapsibility after the administration of sevoflurane or halothane. Subjects were randomized to either drug for inhaled anesthetic induction. Each was adjusted to their 1 MAC value (0.9% for halothane and 2.5% for sevoflurane) and a blinded anesthesia provider held the facemask without performing manual airway opening maneuvers but with inclusion of an oral airway device. Inspiratory flows were measured during partial upper airway obstruction created by an adjustable negative pressure-generating vacuum motor inserted into the anesthesia circuit. Critical closing pressure of the pharynx (Pcrit) was obtained by plotting the peak inspiratory flow of the obstructed breaths against the corresponding negative pressure in the facemask and extrapolating to zero airflow using linear correlation. Fourteen children were enrolled, seven in each anesthetic group. Two children in the halothane group did not develop flow-limited airway obstruction despite negative pressures as low as -9 cm H2O. Pcrit for sevoflurane ranged from -6.7 to -11.6 (mean +/- sd, -9.8 +/- 1.9) cm H2O. Pcrit for halothane ranged from -8.1 to -33 (mean +/- sd, -19.4 +/- 9.3) cm H2O (sevoflurane versus halothane, P = 0.048). We conclude that when using dynamic application of negative airway pressure, halothane appears to cause less upper airway obstruction than sevoflurane at equipotent concentrations.

  12. Airway smooth muscle growth in asthma: proliferation, hypertrophy, and migration.

    Science.gov (United States)

    Bentley, J Kelley; Hershenson, Marc B

    2008-01-01

    Increased airway smooth muscle mass is present in fatal and non-fatal asthma. However, little information is available regarding the cellular mechanism (i.e., hyperplasia vs. hypertrophy). Even less information exists regarding the functional consequences of airway smooth muscle remodeling. It would appear that increased airway smooth muscle mass would tend to increase airway narrowing and airflow obstruction. However, the precise effects of increased airway smooth muscle mass on airway narrowing are not known. This review will consider the evidence for airway smooth muscle cell proliferation and hypertrophy in asthma, potential functional effects, and biochemical mechanisms.

  13. Pharmacology of airway afferent nerve activity

    Directory of Open Access Journals (Sweden)

    Carr Michael J

    2001-05-01

    Full Text Available Abstract Afferent nerves in the airways serve to regulate breathing pattern, cough, and airway autonomic neural tone. Pharmacologic agents that influence afferent nerve activity can be subclassified into compounds that modulate activity by indirect means (e.g. bronchial smooth muscle spasmogens and those that act directly on the nerves. Directly acting agents affect afferent nerve activity by interacting with various ion channels and receptors within the membrane of the afferent terminals. Whether by direct or indirect means, most compounds that enter the airspace will modify afferent nerve activity, and through this action alter airway physiology.

  14. Mucosal/submucosal blood flow in the small intestine in pigs determined by local washout of 133Xe and microsphere techniques

    DEFF Research Database (Denmark)

    Mortensen, Peter; Olsen, J; Sejrsen, P

    1990-01-01

    In 11 anaesthetized pigs a laparotomy was performed and the mucosal and submucosal blood flow rate in the small intestine of the pig was determined by a local application of 133Xe and by 6.5-microns radioactive microspheres. The 133Xe washout plotted in a semilogarithmic diagram showed a multiexp......In 11 anaesthetized pigs a laparotomy was performed and the mucosal and submucosal blood flow rate in the small intestine of the pig was determined by a local application of 133Xe and by 6.5-microns radioactive microspheres. The 133Xe washout plotted in a semilogarithmic diagram showed...

  15. Epstein-Barr Virus-Associated Lymphoepithelioma-Like Gastric Carcinoma Presenting as a Submucosal Mass: CT Findings with Pathologic Correlation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Won; Shin, Hyeong Cheol; Kim, Il Young; Kim, Chang Jin; Lee, Ji Hye; Lee, Chang Kyun; Jeong, Dong Jun [Soonchunhyang University Cheonan Hospital, Cheonan(Korea, Republic of)

    2010-12-15

    A lymphoepithelioma-like carcinoma, characterized by a carcinoma with heavy lymphocyte infiltration, is one of the histological patterns observed in patients with Epstein-Barr virus (EBV)-associated gastric carcinoma. Less than half of invasive carcinomas with lymphoepithelioma-like histology can grow to make a submucosal mass. These tumors generally have a better prognosis than conventional adenocarcinomas. We report a case of an EBV-associated lymphoepitheliomalike gastric carcinoma that presented as a submucosal mass on multi-detector (MD) CT and correlate them with the pathology

  16. Airway resistance at maximum inhalation as a marker of asthma and airway hyperresponsiveness

    Directory of Open Access Journals (Sweden)

    O'Connor George T

    2011-07-01

    Full Text Available Abstract Background Asthmatics exhibit reduced airway dilation at maximal inspiration, likely due to structural differences in airway walls and/or functional differences in airway smooth muscle, factors that may also increase airway responsiveness to bronchoconstricting stimuli. The goal of this study was to test the hypothesis that the minimal airway resistance achievable during a maximal inspiration (Rmin is abnormally elevated in subjects with airway hyperresponsiveness. Methods The Rmin was measured in 34 nonasthmatic and 35 asthmatic subjects using forced oscillations at 8 Hz. Rmin and spirometric indices were measured before and after bronchodilation (albuterol and bronchoconstriction (methacholine. A preliminary study of 84 healthy subjects first established height dependence of baseline Rmin values. Results Asthmatics had a higher baseline Rmin % predicted than nonasthmatic subjects (134 ± 33 vs. 109 ± 19 % predicted, p = 0.0004. Sensitivity-specificity analysis using receiver operating characteristic curves indicated that baseline Rmin was able to identify subjects with airway hyperresponsiveness (PC20 min % predicted, FEV1 % predicted, and FEF25-75 % predicted, respectively. Also, 80% of the subjects with baseline Rmin min > 145% predicted had hyperresponsive airways, regardless of clinical classification as asthmatic or nonasthmatic. Conclusions These findings suggest that baseline Rmin, a measurement that is easier to perform than spirometry, performs as well as or better than standard spirometric indices in distinguishing subjects with airway hyperresponsiveness from those without hyperresponsive airways. The relationship of baseline Rmin to asthma and airway hyperresponsiveness likely reflects a causal relation between conditions that stiffen airway walls and hyperresponsiveness. In conjunction with symptom history, Rmin could provide a clinically useful tool for assessing asthma and monitoring response to treatment.

  17. Assessment of the validity of the clinical pathway for colon endoscopic submucosal dissection

    Institute of Scientific and Technical Information of China (English)

    Takaya Aoki; Takeshi Nakajima; Yutaka Saito; Takahisa Matsuda; Taku Sakamoto; Takao Itoi; Yassir Khiyar

    2012-01-01

    AIM:To determine the effective hospitalization period as the clinical pathway to prepare patients for endoscopic submucosal dissection (ESD).METHODS:This is a retrospective observational study which included 189 patients consecutively treated by ESD at the National Cancer Center Hospital from May 2007 to March 2009.Patients were divided into 2 groups; patients in group A were discharged in 5 d and patients in group B included those who stayed longer than 5 d.The following data were collected for both groups:mean hospitalization period,tumor site,median tumor size,post-ESD rectal bleeding requiring urgent endoscopy,perforation during or after ESD,abdominal pain,fever above 38 ℃,and blood test results positive for inflammatory markers before and after ESD.Each parameter was compared after data collection.RESULTS:A total of 83% (156/189) of all patients could be discharged from the hospital on day 3 postESD.Complications were observed in 12.1% (23/189)of patients.Perforation occurred in 3.7% (7/189) of patients.All the perforations occurred during the ESD procedure and they were managed with endoscopic clipping.The incidence of post-operative bleeding was 2.6% (5/189); all the cases involved rectal bleeding.We divided the subjects into 2 groups:tumor diameter ≥ 4 cm and < 4 cm; there was no significant difference between the 2 groups (P =0.93,x2 test with Yates correction).The incidence of abdominal pain was 3.7% (7/189).All the cases occurred on the day of the procedure or the next day.The median white blood cell count was 6800 ± 2280 (cells/μL; ± SD) for group A,and 7700 ± 2775 (cells/μL; ± SD) for group B,showing a statistically significant difference (P =0.023,t-test).The mean C-reactive protein values the day after ESD were 0.4 ± 1.3 mg/dL and 0.5 ± 1.3 mg/dL for groups A and B,respectively,with no significant difference between the 2 groups (P =0.54,t-test).CONCLUSION:One-day admission is sufficient in the absence of complications during

  18. Clinical relevance of aberrant polypoid nodule scar after endoscopic submucosal dissection

    Science.gov (United States)

    Arantes, Vitor; Uedo, Noriya; Pedrosa, Moises Salgado; Tomita, Yasuhiko

    2016-01-01

    AIM To describe a series of patients with aberrant polypoid nodule scar developed after gastric endoscopic submucosal dissection (ESD), and to discuss its pathogenesis and clinical management. METHODS We reviewed retrospectively the endoscopic database of two academic institutions located in Brazil and Japan and searched for all patients that underwent ESD to manage gastric neoplasms from 2003 to 2015. The criteria for admission in the study were: (1) successful en bloc ESD procedure with R0 and curative resection confirmed histologically; (2) postoperative endoscopic examination with identification of a polypoid nodule scar (PNS) at ESD scar; (3) biopsies of the PNS with hyperplastic or regenerative tissue, reviewed by two independent experienced gastrointestinal pathologists, one from each Institution. Data were examined for patient demographics, Helicobacter pylori status, precise neoplastic lesion location in the stomach, tumor size, histopathological assessment of the ESD specimen, and postoperative information including medical management, endoscopic and histological findings, and clinical outcome. RESULTS A total of 14 patients (10 men/4 women) fulfilled the inclusion criteria and were enrolled in this study. One center contributed with 8 cases out of 60 patients (13.3%) from 2008 to 2015. The second center contributed with 6 cases (1.7%) out of 343 patients from 2003 to 2015. Postoperative endoscopic follow-up revealed similar findings in all patients: A protruded polypoid appearing nodule situated in the center of the ESD scar surrounded by convergence of folds. Biopsies samples were taken from PNS, and histological assessment revealed in all cases regenerative and hyperplastic tissue, without recurrent tumor or dysplasia. Primary neoplastic lesions were located in the antrum in 13 patients and in the angle in one patient. PNS did not develop in any patient after ESD undertaken for tumors located in the corpus, fundus or cardia. All patients have been

  19. Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Antonio; Facciorusso; Matteo; Antonino; Marianna; Di; Maso; Nicola; Muscatiello

    2014-01-01

    AIM: To compare endoscopic submucosal dissection(ESD) and endoscopic mucosal resection(EMR) for early gastric cancer(EGC).METHODS: Computerized bibliographic search was performed on PubMed/Medline, Embase, Google Schol-ar and Cochrane library databases. Quality of each included study was assessed according to current Co-chrane guidelines. Primary endpoints were en bloc re-section rate and histologically complete resection rate. Secondary endpoints were length of procedure, post-treatment bleeding, post-procedural perforation and re-currence rate. Comparisons between the two treatment groups across all the included studies were performed by using Mantel-Haenszel test for fixed-effects mod-els(in case of low heterogeneity) or DerSimonian and Laird test for random-effects models(in case of high heterogeneity).RESULTS: Ten retrospective studies(8 full text and 2 abstracts) were included in the meta-analysis. Overall data on 4328 lesions, 1916 in the ESD and 2412 in the EMR group were pooled and analyzed. The mean operation time was longer for ESD than for EMR(stan-dardized mean difference 1.73, 95%CI: 0.52-2.95, P =0.005) and the "en bloc " and histological complete re-section rates were significantly higher in the ESD group [OR = 9.69(95%CI: 7.74-12.13), P < 0.001 and OR = 5.66,(95%CI: 2.92-10.96), P < 0.001, respectively]. As a consequence of its greater radicality, ESD provided lower recurrence rate [OR = 0.09,(95%CI: 0.05-0.17), P < 0.001]. Among complications, perforation rate was significantly higher after ESD [OR = 4.67,(95%CI, 2.77-7.87), P < 0.001] whereas the bleeding incidences did not differ between the two techniques [OR = 1.49(0.6-3.71), P = 0.39].CONCLUSION: In the endoscopic therapy of EGC, ESD showed a superior efficacy but higher complication rate with respect to EMR.

  20. Effect of submucosal injection of dexamethasone after third molar surgery: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Moraschini, V; Hidalgo, R; Porto Barboza, E dS

    2016-02-01

    The aim of this meta-analysis was to analyse the effectiveness of submucosal injection of dexamethasone to control the postoperative signs and symptoms resulting from impacted third molar surgery. An electronic search was conducted, without restriction on date or language, in the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science databases until June 2015 . The eligibility criteria included non-randomized or randomized clinical trials in humans. After the search and selection process, eight articles were included. The fixed-effects or random-effects model, depending on heterogeneity, was built on the inverse-variance method used. The estimations of intervention were expressed as the mean difference (MD) in millimetres. The results of this meta-analysis suggest that the submucosal injection of dexamethasone presents a reduction in the postoperative signs and symptoms resulting from impacted third molar surgery, especially those associated with oedema and pain. In relation to trismus, the meta-analysis showed no statistically significant difference between dexamethasone and the placebo solution.

  1. Predictors of Airway Hyperresponsiveness in Elite Athletes

    DEFF Research Database (Denmark)

    Toennesen, Louise L; Porsbjerg, Celeste; Pedersen, Lars;

    2015-01-01

    INTRODUCTION: Elite athletes frequently suffer from asthma and airway hyperresponsiveness (AHR). We aimed to investigate predictors of airway pathophysiology in a group of unselected elite summer-sport athletes, training for the summer 2008 Olympic Games, including markers of airway inflammation......, systemic inflammation and training intensity. METHODS: 57 Danish elite summer-sport athletes with and without asthma symptoms all gave a blood sample for measurements of high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor alpha (TNF....... In these subjects, no association was found between the levels of AHR to mannitol and methacholine (r=0.032, p=0.91). CONCLUSION: Airway hyperresponsiveness in elite athletes is related to the amount of weekly training and the level of serum TNF-α. No association was found between the level of AHR to mannitol...

  2. The effect of the transplanted pineal gland on the sympathetic innervation of the rat sublingual gland.

    Science.gov (United States)

    Chanthaphavong, R S; Murphy, S M; Anderson, C R

    2004-08-01

    We investigated the effect of the pineal on sympathetic neurons that normally innervate the sublingual gland of the rat. When the pineal gland was transplanted into the sublingual gland, it remained as a distinct mass that was innervated by sympathetic axons. Injection of the retrograde tracer, Fast Blue, into the sublingual gland labelled sympathetic neurons in the ipsilateral superior cervical ganglion (SCG). Thirty per cent of all neurons labelled retrogradely by Fast Blue injection into transplanted pineal glands were immunoreactive for both neuropeptide Y (NPY) and calbindin. This combination is characteristic of sympathetic neurons innervating the pineal gland in its normal location, but not the sympathetic vasoconstrictor neurons normally innervating the sublingual gland. This, and our previous study in which the pineal gland was shown to similarly influence the phenotype of salivary secretomotor neurons, suggests that a range of different functional classes of sympathetic neuron are able to change their phenotype in response to signals released by the pineal gland.

  3. Central airways remodeling in COPD patients

    Directory of Open Access Journals (Sweden)

    Pini L

    2014-09-01

    Full Text Available Laura Pini,1 Valentina Pinelli,2 Denise Modina,1 Michela Bezzi,3 Laura Tiberio,4 Claudio Tantucci1 1Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, 2Department of Respiratory Medicine, Spedali Civili di Brescia, 3Department Bronchoscopy, Spedali Civili di Brescia, 4Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy Background: The contribution to airflow obstruction by the remodeling of the peripheral airways in chronic obstructive pulmonary disease (COPD patients has been well documented, but less is known about the role played by the large airways. Few studies have investigated the presence of histopathological changes due to remodeling in the large airways of COPD patients. Objectives: The aim of this study was to verify the presence of airway remodeling in the central airways of COPD patients, quantifying the airway smooth muscle (ASM area and the extracellular matrix (ECM protein deposition, both in the subepithelial region and in the ASM, and to verify the possible contribution to airflow obstruction by the above mentioned histopathological changes. Methods: Biopsies of segmental bronchi spurs were performed in COPD patients and control smoker subjects and immunostained for collagen type I, versican, decorin, biglycan, and alpha-smooth muscle actin. ECM protein deposition was measured at both subepithelial, and ASM layers. Results: The staining for collagen I and versican was greater in the subepithelial layer of COPD patients than in control subjects. An inverse correlation was found between collagen I in the subepithelial layer and both forced expiratory volume in 1 second and ratio between forced expiratory volume in 1 second and forced vital capacity. A statistically significant increase of the ASM area was observed in the central airways of COPD patients versus controls. Conclusion: These findings indicate that airway remodeling also affects

  4. Environmental and genetical factors in airway allergies

    OpenAIRE

    Katarzyna Idzik

    2012-01-01

    It is estimated that approximately 23% of the European population is clinically diagnosed with allergies. In the past three decades, an increase in the incidence of respiratory allergies was noted. At the beginning of the 20th century allergic inflammations affected only around 1% of the world population. Medical symptoms of allergic airway inflammation are variable for different patients. Airways allergy are complex phenotypes, which are determined by both genetic and...

  5. Ultrasound: A novel tool for airway imaging

    Directory of Open Access Journals (Sweden)

    Siddharthkumar Bhikhabhai Parmar

    2014-01-01

    Full Text Available Context: The scope of ultrasound is emerging in medical science, particularly outside traditional areas of radiology practice. Aims: We designed this study to evaluate feasibility of bedside sonography as a tool for airway assessment and to describe sonographic anatomy of airway. Settings and Design: A prospective, clinical study. Materials and Methods: We included 100 adult, healthy volunteers of either sex to undergo airway imaging systemically starting from floor of the mouth to the sternal notch in anterior aspect of neck by sonography. Results: We could visualize mandible and hyoid bone as a bright hyperechoic structure with hypoechoic acoustic shadow underneath. Epiglottis, thyroid cartilage, cricoid cartilage, and tracheal rings appeared hypoechoic. Vocal cords were visualized through thyroid cartilage. Interface between air and mucosa lining the airway produced a bright hyperechoic linear appearance. Artifacts created by intraluminal air prevented visualization of posterior pharynx, posterior commissure, and posterior wall of trachea. Conclusions: Ultrasound is safe, quick, noninvasive, repeatable, and bedside tool to assess the airway and can provide real-time dynamic images relevant for several aspects of airway management.

  6. The laryngeal mask airway at altitude.

    Science.gov (United States)

    Wilson, Grant D; Sittig, Steven E; Schears, Gregory J

    2008-02-01

    The Laryngeal Mask Airway (LMA) is an accepted adjunct for airway management in emergency patients. There are a number of case reports describing its use in transport medicine for infant to adult patients, including during flight. Although studies of the effect altitude has on air-filled tracheal tubes exists, we were unable to find documentation of the effect of altitude on laryngeal mask airways. Our objective was to assess the effect of altitude on the LMA in both fixed wing and rotary wing models. We performed an in vitro study of the effect of altitude on the LMA cuff. Infant and adult airway trainer mannequins with properly sized and inserted LMA-Classic laryngeal mask airways were monitored for cuff pressure changes while flown at altitudes commonly encountered during air medical transport. Both models demonstrated that LMA cuff pressures may exceed manufacturer recommended levels for safe use even at the relatively low altitudes experienced during rotor wing flight. Properly inserted and inflated laryngeal mask airways at ground level may result in overinflated LMA cuffs when flown to altitudes commonly used for rotor and fixed wing medical transport unless monitored and corrected.

  7. Link between vitamin D and airway remodeling

    Directory of Open Access Journals (Sweden)

    Berraies A

    2014-04-01

    Full Text Available Anissa Berraies, Kamel Hamzaoui, Agnes HamzaouiPediatric Respiratory Diseases Department, Abderrahmen Mami Hospital, Ariana, and Research Unit 12SP15 Tunis El Manar University, Tunis, TunisiaAbstract: In the last decade, many epidemiologic studies have investigated the link between vitamin D deficiency and asthma. Most studies have shown that vitamin D deficiency increases the risk of asthma and allergies. Low levels of vitamin D have been associated with asthma severity and loss of control, together with recurrent exacerbations. Remodeling is an early event in asthma described as a consequence of production of mediators and growth factors by inflammatory and resident bronchial cells. Consequently, lung function is altered, with a decrease in forced expiratory volume in one second and exacerbated airway hyperresponsiveness. Subepithelial fibrosis and airway smooth muscle cell hypertrophy are typical features of structural changes in the airways. In animal models, vitamin D deficiency enhances inflammation and bronchial anomalies. In severe asthma of childhood, major remodeling is observed in patients with low vitamin D levels. Conversely, the antifibrotic and antiproliferative effects of vitamin D in smooth muscle cells have been described in several experiments. In this review, we briefly summarize the current knowledge regarding the relationship between vitamin D and asthma, and focus on its effect on airway remodeling and its potential therapeutic impact for asthma.Keywords: vitamin D, asthma, airway remodeling, airway smooth muscle, supplementation

  8. Effects of lung inflation on airway heterogeneity during histaminergic bronchoconstriction.

    Science.gov (United States)

    Kaczka, David W; Mitzner, Wayne; Brown, Robert H

    2013-09-01

    Lung inflation has been shown to dilate airways by altering the mechanical equilibrium between opposing airway and parenchymal forces. However, it is not known how heterogeneously such dilation occurs throughout the airway tree. In six anesthetized dogs, we measured the diameters of five to six central airway segments using high-resolution computed tomography, along with respiratory input impedance (Zrs) during generalized aerosol histamine challenge, and local histamine challenge in which the agonist was instilled directly onto the epithelia of the imaged central airways. Airway diameters and Zrs were measured at 12 and 25 cmH2O. The Zrs spectra were fitted with a model that incorporated continuous distributions of airway resistances. Airway heterogeneity was quantified using the coefficient of variation for predefined airway distribution functions. Significant reductions in average central airway diameter were observed at 12 cmH2O for both aerosolized and local challenges, along with significant increases upon inflation to 25 cmH2O. No significant differences were observed for the coefficient of variation of airway diameters under any condition. Significant increases in effective airway resistance as measured by Zrs were observed only for the aerosolized challenge at 12 cmH2O, which was completely reversed upon inflation. We conclude that the lung periphery may be the most dominant contributor to increases in airway resistance and tissue elastance during bronchoconstriction induced by aerosolized histamine. However, isolated constriction of only a few central airway segments may also affect tissue stiffness via interdependence with their surrounding parenchyma.

  9. Airway Inflammation in Chronic Rhinosinusitis with Nasal Polyps and Asthma: The United Airways Concept Further Supported

    DEFF Research Database (Denmark)

    Håkansson, Kåre; Bachert, Claus; Konge, Lars;

    2015-01-01

    Background It has been established that patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often have co-existing asthma. Objective We aimed to test two hypotheses: (i) upper and lower airway inflammation in CRSwNP is uniform in agreement with the united airways concept; and (ii) bro...

  10. Full Airway Drainage by Fiber Bronchoscopy Through Artificial Airway in the Treatment of Occult Traumatic Atelectasis.

    Science.gov (United States)

    Zhao, Xue Hong; Zhang, Yun; Liang, Zhong Yan; Zhang, Shao Yang; Yu, Wen Qiao; Huang, Fang-Fang

    2015-12-01

    The objective of this study is to investigate the effects of full airway drainage by fiber bronchoscopy through artificial airway in the treatment of traumatic atelectasis with occult manifestations. From May 2006 to May 2011, 40 cases of occult traumatic atelectasis were enrolled into our prospective study. Group A (n = 18) received drainage by nasal bronchoscope; group B underwent airway drainage by fiber bronchoscopy through artificial airway (n = 22). The effects of treatment were evaluated by the incidence of adult respiratory distress syndrome (ARDS), lung abscess, and the average length of hospital stay. Compared with nasal fiber-optic treatment, airway drainage by fiber bronchoscopy through artificial airway reduced the incidence of ARDS (p = 0.013) and lung abscess (p = 0.062) and shortened the mean length of stay (p = 0.018). Making the decision to create an artificial airway timely and carry out lung lavage by fiber bronchoscopy through artificial airway played a significant role in the treatment of occult traumatic atelectasis.

  11. 75 FR 13079 - Action Affecting Export Privileges; MAHAN AIRWAYS; Mahan Airways, Mahan Tower, No. 21, Azadegan...

    Science.gov (United States)

    2010-03-18

    ... Secretary Jackson issued an Order adding Blue Airways FZE and Blue Airways, both of Dubai, United Arab... conduct illustrates its refusal to comply with the TDO or U.S. export control laws.\\6\\ \\6\\ My findings are... full written statement in support of the appeal with the Office of the Administrative Law Judge,...

  12. Airway Inflammation in Chronic Rhinosinusitis with Nasal Polyps and Asthma: The United Airways Concept Further Supported

    DEFF Research Database (Denmark)

    Håkansson, Kåre; Bachert, Claus; Konge, Lars;

    2015-01-01

    Background It has been established that patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often have co-existing asthma. Objective We aimed to test two hypotheses: (i) upper and lower airway inflammation in CRSwNP is uniform in agreement with the united airways concept; and (ii...

  13. Lipocalin2 protects against airway inflammation and hyperresponsiveness in a murine model of allergic airway disease

    DEFF Research Database (Denmark)

    Dittrich, A M; Krokowski, M; Meyer, H-A;

    2010-01-01

    Allergen-induced bronchial asthma is a chronic airway disease that involves the interplay of various genes with environmental factors triggering different inflammatory pathways.......Allergen-induced bronchial asthma is a chronic airway disease that involves the interplay of various genes with environmental factors triggering different inflammatory pathways....

  14. 内镜黏膜切除术的配合体会%Experiences of nursing co-operation during Endoscopic Submucosal Dissection (ESD)

    Institute of Scientific and Technical Information of China (English)

    姜素峰; 韩树堂

    2011-01-01

    目的 探讨内镜黏膜切除术时护理配合治疗.方法 术前给患者心理指导和术前常规准备,并备好各种治疗器械,术中配合术者操作,术后做好健康教育预防并发症的发生.结果 58例胃肠道侧向发育型肿瘤均经内镜切除,成功率100%.结论护士能否在术前、术中和术后做好配合影响内镜下侧向发育型肿瘤切除术的效果.%Objective To explore the role of nursing cooperation during endoscopic submucosal dissection (ESD). Methods Psychological counseling and regular preparation were carried out pre- operationally, co- operation with the operator was done during endoscopic submucosal dissection (ESD), and health education was given to prevent the complications. Results Totally 58 cases of laterally spreading tumor (LST) were resected by endoscopic submucosal dissection (ESD), the successful rate was 100%. Conclusion Whether nursing co-operation was performed skillfully in perioperative period influenced the effects of endoscopic submucosal dissection of laterally spreading tumor (LST).

  15. Site of iodination in rat mammary gland

    Energy Technology Data Exchange (ETDEWEB)

    Strum, J.M.

    1978-10-01

    The ability of the mammary gland to take up and organically bind radioiodide was studied in non-pregnant, pregnant, and lactating rats. Autoradiography was used to determine whether duct cells or alveolar cells are responsible for iodination in the rat mammary gland. Iodination was not detected in mammary glands from non-pregnant rats, but occurred late in the twelfth day of gestation and continued throughout pregnancy and lactation. Protein-containing vacuoles in alveolar cells and casein-like proteins in milk were the major sites where iodination occurred within the gland. Milk proteins in the lumens of ductules adjacent to alveoli were also iodinated. In contrast, ducts, myoepithelial cells, fat cells, blood vessels and other histological components of the gland did not show iodinating capability. Cytochemistry was also used to identify endogenous mammary peroxidase activity in the same glands, and it was found that the presence and location of this enzyme were correlated with the ability to iodinate.

  16. Moderate evidence to recommend submucosal injection of dexamethasone in reducing post-operative oedema and pain after third molar extraction.

    Science.gov (United States)

    Freda, Nicolas M; Keenan, Analia Veitz

    2016-06-01

    Data sourcesThe electronic databases searched included: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (Central) and Web of Science until June 2015. There was no restriction to language and the reference lists from relevant studies were searched for further articles.Study selectionRandomised and prospective controlled trials that compared the effect of submucosal injection of dexamethasone with that of placebo after impacted third molar surgery in humans. Studies involving volunteers with decompensated metabolic disease were excluded.Data extraction and synthesisStudy selection, data extraction and quality assessment (risk of bias) were assessed by two reviewers. All disagreements were resolved through discussion. A meta-analysis was performed for all continuous variables (oedema, pain and trismus) when at least two of the studies analysed the same data type.ResultsEight studies involving a total of 476 patients of which six were included in the meta-analysis. All of the surgical procedures were performed on the lower molars, submucosal injections of dexamethasone were used in concentrations of 4 mg, 8 mg, or 10 mg, and saline was used as a control. Antibiotic medications were administered prophylactically before surgery or by continuous use after the procedure. Seven of the eight studies identified the impactions according to the Pell and Gregory Classification. Oedema was measured using facial contours of pre-established reference points. The meta-analysis presented a mean difference (MD) of -2.20 (95% CI -2.70 to -1.70), with a statistically significant difference favouring dexamethasone (Pincluding a VAS were used for meta-analysis. Pain presented with a MD of -1.79 (95% CI -3.28 to -0.30) and showed a statistically significant difference favouring dexamethasone.ConclusionsThe review found moderate quality evidence that submucosal injections of dexamethasone reduced post-operative oedema and pain compared to a placebo following impacted third

  17. Lacrimal gland fistula after upper eyelid blepharoplasty

    Directory of Open Access Journals (Sweden)

    Mohsen Bahmani Kashkouli

    2011-01-01

    Full Text Available To report the first case of lacrimal gland fistula after upper eyelid blepharoplasty for blepharochalasis. Standard upper blepharoplasty and the hooding excision were performed in a female with blepharochalasis. The patient developed a fistulous tract with tearing from the incision few days after hooding excision. Fistula excision and lacrimal gland repositioning were performed. There were no complications after the repositioning procedure (6 months follow up. Prolapsed lacrimal gland and fistula formation can occur after upper blepharoplasty hooding excision.

  18. Effect of submucosal or oral administration of prednisolone on postoperative sequelae following surgical extraction of impacted mandibular third molar: A randomized controlled study

    Science.gov (United States)

    Ibikunle, Adebayo Aremu; Adeyemo, Wasiu Lanre; Ladeinde, Akinola Ladipo

    2016-01-01

    Background: The aim of the study was to evaluate the effect of preoperatively administered submucosal and oral prednisolone on postoperative pain, facial swelling, and trismus following third molar surgery. Patients and Methods: This was a randomized controlled trial in which subjects were randomly distributed into three groups. Group A consisted of subjects who received 40 mg oral prednisolone; Group B consisted of subjects who received 40 mg submucosal injection of prednisolone while Group C consisted of subjects who did not receive prednisolone. Each group had 62 subjects. Measurements for facial width/facial swelling, pain, and mouth opening were recorded preoperatively and postoperatively. The postoperative evaluation points were postoperative days 1, 3, and 7. These measurements were compared with the preoperative values both within and among the groups. Results: Most of the subjects were in their third decade of life. A considerable increase in the mean postoperative values for pain, facial width and trismus was observed. Notably, subjects who did not receive prednisolone showed comparatively higher values for the measured parameters throughout the postoperative evaluation period. Subjects who received submucosal injection of prednisolone showed overall lower values compared to those who received oral prednisolone. Conclusion: The results of this study indicate that the administration of prednisolone has a significantly beneficial effect in ameliorating the postoperative sequelae of the third molar surgery. In addition, the effect of submucosally injected prednisolone is comparable to the orally administered prednisolone; indeed it shows superiority to the latter in a number of dimensions. Submucosal injection of prednisolone offers a simple, effective, easy, safe, and minimally invasive option to existing therapeutic methods of reducing these postoperative sequelae. PMID:27833246

  19. Parotitis and Sialendoscopy of the Parotid Gland.

    Science.gov (United States)

    Hernandez, Stephen; Busso, Carlos; Walvekar, Rohan R

    2016-04-01

    Nonneoplastic disorders of the salivary glands involve inflammatory processes. These disorders have been managed conservatively with antibiotics, warm compresses, massage, sialogogues, and adequate hydration. Up to 40% of patients may have an inadequate response or persistent symptoms. When conservative techniques fail, the next step is operative intervention. Sialendoscopy offers a minimally invasive option for the diagnosis and management of chronic inflammatory disorders of the salivary glands and offers the option of gland and function preservation. In this article, we review some of the more common nonneoplastic disorders of the parotid gland, indications for diagnostic and interventional sialendoscopy, and operative techniques.

  20. Preparation of the patient and the airway for awake intubation

    Directory of Open Access Journals (Sweden)

    Venkateswaran Ramkumar

    2011-01-01

    Full Text Available Awake intubation is usually performed electively in the presence of a difficult airway. A detailed airway examination is time-consuming and often not feasible in an emergency. A simple 1-2-3 rule for airway examination allows one to identify potential airway difficulty within a minute. A more detailed airway examination can give a better idea about the exact nature of difficulty and the course of action to be taken to overcome it. When faced with an anticipated difficult airway, the anaesthesiologist needs to consider securing the airway in an awake state without the use of anaesthetic agents or muscle relaxants. As this can be highly discomforting to the patient, time and effort must be spent to prepare such patients both psychologically and pharmacologically for awake intubation. Psychological preparation is best initiated by an anaesthesiologist who explains the procedure in simple language. Sedative medications can be titrated to achieve patient comfort without compromising airway patency. Additional pharmacological preparation includes anaesthetising the airway through topical application of local anaesthetics and appropriate nerve blocks. When faced with a difficult airway, one should call for the difficult airway cart as well as for help from colleagues who have interest and expertise in airway management. Preoxygenation and monitoring during awake intubation is important. Anxious patients with a difficult airway may need to be intubated under general anaesthesia without muscle relaxants. Proper psychological and pharmacological preparation of the patient by an empathetic anaesthesiologist can go a long way in making awake intubation acceptable for all concerned.

  1. 气道平滑肌细胞在哮喘气道重塑中的作用%The effect of airway smooth muscle cell on asthma airway remodeling

    Institute of Scientific and Technical Information of China (English)

    李淼

    2010-01-01

    气道重塑是气道慢性炎症的结果,包括气道壁增厚和基质沉积、胶原沉积、上皮下纤维化、平滑肌增生和肥大、肌成纤维细胞增殖及黏液腺、杯状细胞化生及增生、上皮下网状层增厚、微血管生成等病理改变.在这些病理变化中,气道平滑肌的改变被认为是导致气道高反应性和哮喘加重的重要因素.有很多因素导致气道平滑肌增生及肥大,如炎症介质、生长因子、细胞因子、细胞外基质蛋白和遗传因子等.最近的研究揭示气道平滑肌也是炎症介质的重要来源.建议在哮喘发病早期应用激素吸入治疗.%Airway remodeling is the result of chronic inflammation, which including airway wall thickening, matrix and collagen deposition, epithelial hyperplasia and fibrosis, smooth proliferation and hypertrophy,fibroblast proliferation, and mucus glands and goblet cell proliferation, micrangium generation and other pathological changes. Airway smooth muscle change is known as the reason of airway hyper - responsiveness and asthma aggravating. There are many factors which can induce airway smooth muscle hypertrophy and proliferation, such as inflammation, cytokines,extracellular matrix and genetic factors. In addition, recent researches reveal the airway smooth muscle is also an important source of inflammation. In this paper the latest opinion of the role of asthma airway smooth muscle in the airway remodeling were elaborated,and inhale hormone earlier was suggested.

  2. Salivary gland choristoma (heterotopic salivary gland tissue) on the anterior chest wall of a newborn.

    Science.gov (United States)

    Aby, Janelle L; Patel, Mayha; Sundram, Uma; Benjamin, Latanya T

    2014-01-01

    Salivary gland choristoma (heterotopic salivary gland tissue) is a rare condition typically seen in the newborn period. This developmental heterotopia is generally nonprogressive, with little risk of malignant transformation. We present the second known reported case of a salivary gland choristoma located on the anterior chest wall. Knowledge of this rare entity will allow for accurate diagnosis and management of this benign anatomic variant.

  3. Emergency surgical airway management in Denmark

    DEFF Research Database (Denmark)

    Rosenstock, C V; Kehlet Nørskov, Anders; Wetterslev, J;

    2016-01-01

    BACKGROUND: The emergency surgical airway (ESA) is the final option in difficult airway management. We identified ESA procedures registered in the Danish Anaesthesia Database (DAD) and described the performed airway management. METHODS: We extracted a cohort of 452 461 adult patients undergoing...... for difficult airway management. RESULTS: In the DAD cohort 27 out of 452 461 patients had an ESA representing an incidence of 0.06 events per thousand (95% CI; 0.04 to 0.08). A total of 12 149/452 461 patients underwent Ear-Nose and Throat (ENT) surgery, giving an ESA incidence among ENT patients of 1.6 events...... per thousand (95% CI; 1.0-2.4). A Supraglottic Airway Device and/or the administration of a neuromuscular blocking agent before ESA were used as a rescue in 6/27 and 13/27 of the patients, respectively. In 19/27 patients ENT surgeons performed the ESA's and anaesthetists attempted 6/27 of the ESAs...

  4. Acoustic simulation of a patient's obstructed airway.

    Science.gov (United States)

    van der Velden, W C P; van Zuijlen, A H; de Jong, A T; Lynch, C T; Hoeve, L J; Bijl, H

    2016-01-01

    This research focuses on the numerical simulation of stridor; a high pitched, abnormal noise, resulting from turbulent airflow and vibrating tissue through a partially obstructed airway. Characteristics of stridor noise are used by medical doctors as indication for location and size of the obstruction. The relation between type of stridor and the various diseases associated with airway obstruction is unclear; therefore, simply listening to stridor is an unreliable diagnostic tool. The overall aim of the study is to better understand the relationship between characteristics of stridor noise and localization and size of the obstruction. Acoustic analysis of stridor may then in future simplify the diagnostic process, and reduce the need for more invasive procedures such as laryngoscopy under general anesthesia. In this paper, the feasibility of a coupled flow, acoustic and structural model is investigated to predict the noise generated by the obstruction as well as the propagation of the noise through the airways, taking into account a one-way coupled fluid, structure, and acoustic interaction components. The flow and acoustic solver are validated on a diaphragm and a simplified airway model. A realistic airway model of a patient suffering from a subglottic stenosis, derived from a real computed tomography scan, is further analyzed. Near the mouth, the broadband noise levels at higher frequencies increased with approximately 15-20 dB comparing the stridorous model with the healthy model, indicating stridorous sound.

  5. Silibinin attenuates allergic airway inflammation in mice

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yun Ho [Department of Anatomy, Medical School, Institute for Medical Sciences, Chonbuk National University, Jeonju, Jeonbuk 561-756 (Korea, Republic of); Jin, Guang Yu [Department of Radiology, Yanbian University Hospital, YanJi 133002 (China); Guo, Hui Shu [Centralab, The First Affiliated Hospital of Dalian Medical University, Dalian 116011 (China); Piao, Hong Mei [Department of Respiratory Medicine, Yanbian University Hospital, YanJi 133000 (China); Li, Liang chang; Li, Guang Zhao [Department of Anatomy and Histology and Embryology, Yanbian University School of Basic Medical Sciences, 977 Gongyuan Road, YanJi 133002, Jilin (China); Lin, Zhen Hua [Department of Pathology, Yanbian University School of Basic Medical Sciences, YanJi 133000 (China); Yan, Guang Hai, E-mail: ghyan@ybu.edu.cn [Department of Anatomy and Histology and Embryology, Yanbian University School of Basic Medical Sciences, 977 Gongyuan Road, YanJi 133002, Jilin (China)

    2012-10-26

    Highlights: Black-Right-Pointing-Pointer Silibinin diminishes ovalbumin-induced inflammatory reactions in the mouse lung. Black-Right-Pointing-Pointer Silibinin reduces the levels of various cytokines into the lung of allergic mice. Black-Right-Pointing-Pointer Silibinin prevents the development of airway hyperresponsiveness in allergic mice. Black-Right-Pointing-Pointer Silibinin suppresses NF-{kappa}B transcriptional activity. -- Abstract: Allergic asthma is a chronic inflammatory disease regulated by coordination of T-helper2 (Th2) type cytokines and inflammatory signal molecules. Silibinin is one of the main flavonoids produced by milk thistle, which is reported to inhibit the inflammatory response by suppressing the nuclear factor-kappa B (NF-{kappa}B) pathway. Because NF-{kappa}B activation plays a pivotal role in the pathogenesis of allergic inflammation, we have investigated the effect of silibinin on a mouse ovalbumin (OVA)-induced asthma model. Airway hyperresponsiveness, cytokines levels, and eosinophilic infiltration were analyzed in bronchoalveolar lavage fluid and lung tissue. Pretreatment of silibinin significantly inhibited airway inflammatory cell recruitment and peribronchiolar inflammation and reduced the production of various cytokines in bronchoalveolar fluid. In addition, silibinin prevented the development of airway hyperresponsiveness and attenuated the OVA challenge-induced NF-{kappa}B activation. These findings indicate that silibinin protects against OVA-induced airway inflammation, at least in part via downregulation of NF-{kappa}B activity. Our data support the utility of silibinin as a potential medicine for the treatment of asthma.

  6. Macrophage adaptation in airway inflammatory resolution

    Directory of Open Access Journals (Sweden)

    Manminder Kaur

    2015-09-01

    Full Text Available Bacterial and viral infections (exacerbations are particularly problematic in those with underlying respiratory disease, including post-viral infection, asthma, chronic obstructive pulmonary disease and pulmonary fibrosis. Patients experiencing exacerbations tend to be at the more severe end of the disease spectrum and are often difficult to treat. Most of the unmet medical need remains in this patient group. Airway macrophages are one of the first cell populations to encounter airborne pathogens and, in health, exist in a state of reduced responsiveness due to interactions with the respiratory epithelium and specific factors found in the airway lumen. Granulocyte–macrophage colony-stimulating factor, interleukin-10, transforming growth factor-β, surfactant proteins and signalling via the CD200 receptor, for example, all raise the threshold above which airway macrophages can be activated. We highlight that following severe respiratory inflammation, the airspace microenvironment does not automatically re-set to baseline and may leave airway macrophages more restrained than they were at the outset. This excessive restraint is mediated in part by the clearance of apoptotic cells and components of extracellular matrix. This implies that one strategy to combat respiratory exacerbations would be to retune airway macrophage responsiveness to allow earlier bacterial recognition.

  7. Double Endoscopic Intraluminal Operation (DEILO) for Early Gastric Cancer: Outcome of Novel Procedure for Endoscopic Submucosal Dissection.

    Science.gov (United States)

    Ogata, Kyoichi; Yanai, Mitsuhiro; Kuriyama, Kengo; Suzuki, Masaki; Yanoma, Toru; Kimura, Akiharu; Kogure, Norimichi; Toyomasu, Yoshitaka; Ohno, Tetsuro; Mochiki, Erito; Kuwano, Hiroyuki

    2017-01-01

    Endoscopic submucosal dissection (ESD) has been used to treat patients with early gastric cancer (EGC). Although several endoscopic devices have been developed to ensure easy and safe ESD, this technique still requires an experienced, highly skilled endoscopist, as it is performed through a single gastroscope, thus requiring one-handed surgical techniques. To overcome these limitations, many ESD procedures with counter-traction have been developed, such as the double scope, double channel scope, clip with line, magnetic anchor, percutaneous traction and external grasping forceps methods. We devised a double endoscopic intraluminal operation (DEILO). Two endoscopes were simultaneously inserted into the stomach. One endoscope was used to lift the lesion, and the other was used to excise the lesion. The DEILO procedure was performed on 122 cases of EGC. In this article, we report the efficacy and safety of DEILO in patients with EGC.

  8. Colorectal carcinomas with submucosal invasion (pT1): analysis of histopathological and molecular factors predicting lymph node metastasis.

    Science.gov (United States)

    Pai, Reetesh K; Chen, Yuwei; Jakubowski, Maureen A; Shadrach, Bonnie L; Plesec, Thomas P; Pai, Rish K

    2017-01-01

    Submucosally invasive colorectal carcinoma (pT1) has the potential to be cured by local excision. In US surgical intervention is reserved for tumors with high-grade morphology, lymphvascular invasion, and close/positive margin. In other countries, particularly Japan, surgical therapy is also recommended for mucinous tumors, tumors with >1000 μm of submucosal invasion, and those with high tumor budding. These histological features have not been well evaluated in a western cohort of pT1 carcinomas. In a cohort of 116 surgically resected pT1 colorectal carcinomas, high tumor budding (P1000 μm (P=0.04), and high-grade morphology (P=0.04) were significantly associated with lymph node metastasis on univariate analysis. Mucinous differentiation, tumor location, tumor growth pattern, and size of invasive component were not significant. On multivariate analysis, only high tumor budding was associated with lymph node metastasis with an odds ratio of 4.3 (P=0.004). A subset of 48 tumors (22 node-positive and 26 node-negative) was analyzed for mutations in 50 oncogenes and tumor suppressors. No statistically significant molecular alterations in these 50 genes were associated with lymph node status. However, lymphatic invasion was associated with BRAF mutations (P=0.01). Furthermore, high tumor budding was associated with mutations in TP53 (P=0.03) and inversely associated with mutations in the mTOR pathway (PIK3CA and AKT, P=0.02). In conclusion, this study demonstrates the importance of identifying high tumor budding in pT1 carcinomas when considering additional surgical resection. Molecular alterations associated with adverse histological features are identified.

  9. Neutrophil elastase-mediated increase in airway temperature during inflammation

    DEFF Research Database (Denmark)

    Schmidt, Annika; Belaaouaj, Azzaq; Bissinger, Rosi

    2014-01-01

    Background How elevated temperature is generated during airway infections represents a hitherto unresolved physiological question. We hypothesized that innate immune defence mechanisms would increase luminal airway temperature during pulmonary infection. Methods We determined the temperature in t...

  10. Eosinophilic airway inflammation in asthma is associated with an altered airway microbiome

    DEFF Research Database (Denmark)

    Sverrild, Asger; Kiilerich, Pia; Brejnrod, Asker

    2016-01-01

    BACKGROUND: Subjects with asthma have higher microbiome diversity, and an altered composition with more Proteobacteria and less Bacteroidetes compared to healthy controls. Studies comparing airway inflammation and airway microbiome are sparse, especially in subjects not on anti-inflammatory treat......BACKGROUND: Subjects with asthma have higher microbiome diversity, and an altered composition with more Proteobacteria and less Bacteroidetes compared to healthy controls. Studies comparing airway inflammation and airway microbiome are sparse, especially in subjects not on anti......-inflammatory treatment. OBJECTIVE: To describe the relationship between the airway microbiome and patterns of airway inflammation in steroid-free subjects with asthma and healthy controls. METHODS: Broncho-alveolar lavage was collected from 23 steroid-free, non-smoking subjects with asthma and 10 healthy controls....... The overall composition of the airway microbiome of asthmatics with the lowest levels of eosinophils, but not asthmatics with the highest levels of eosinophils deviated significantly from that of healthy individuals. Asthmatics with the lowest levels of eosinophils had an altered bacterial abundance profile...

  11. A Brief History of Airway Smooth Muscle’s Role in Airway Hyperresponsiveness

    Directory of Open Access Journals (Sweden)

    C. D. Pascoe

    2012-01-01

    Full Text Available A link between airway smooth muscle (ASM and airway hyperresponsiveness (AHR in asthma was first postulated in the midnineteenth century, and the suspected link has garnered ever increasing interest over the years. AHR is characterized by excessive narrowing of airways in response to nonspecific stimuli, and it is the ASM that drives this narrowing. The stimuli that can be used to demonstrate AHR vary widely, as do the potential mechanisms by which phenotypic changes in ASM or nonmuscle factors can contribute to AHR. In this paper, we review the history of research on airway smooth muscle’s role in airway hyperresponsiveness. This research has ranged from analyzing the quantity of ASM in the airways to testing for alterations in the plastic behavior of smooth muscle, which distinguishes it from skeletal and cardiac muscles. This long history of research and the continued interest in this topic mean that the precise role of ASM in airway responsiveness remains elusive, which makes it a pertinent topic for this collection of articles.

  12. Host-microbe interactions in distal airways: relevance to chronic airway diseases.

    Science.gov (United States)

    Martin, Clémence; Burgel, Pierre-Régis; Lepage, Patricia; Andréjak, Claire; de Blic, Jacques; Bourdin, Arnaud; Brouard, Jacques; Chanez, Pascal; Dalphin, Jean-Charles; Deslée, Gaetan; Deschildre, Antoine; Gosset, Philippe; Touqui, Lhousseine; Dusser, Daniel

    2015-03-01

    This article is the summary of a workshop, which took place in November 2013, on the roles of microorganisms in chronic respiratory diseases. Until recently, it was assumed that lower airways were sterile in healthy individuals. However, it has long been acknowledged that microorganisms could be identified in distal airway secretions from patients with various respiratory diseases, including cystic fibrosis (CF) and non-CF bronchiectasis, chronic obstructive pulmonary disease, asthma and other chronic airway diseases (e.g. post-transplantation bronchiolitis obliterans). These microorganisms were sometimes considered as infectious agents that triggered host immune responses and contributed to disease onset and/or progression; alternatively, microorganisms were often considered as colonisers, which were considered unlikely to play roles in disease pathophysiology. These concepts were developed at a time when the identification of microorganisms relied on culture-based methods. Importantly, the majority of microorganisms cannot be cultured using conventional methods, and the use of novel culture-independent methods that rely on the identification of microorganism genomes has revealed that healthy distal airways display a complex flora called the airway microbiota. The present article reviews some aspects of current literature on host-microbe (mostly bacteria and viruses) interactions in healthy and diseased airways, with a special focus on distal airways.

  13. Host–microbe interactions in distal airways: relevance to chronic airway diseases

    Directory of Open Access Journals (Sweden)

    Clémence Martin

    2015-03-01

    Full Text Available This article is the summary of a workshop, which took place in November 2013, on the roles of microorganisms in chronic respiratory diseases. Until recently, it was assumed that lower airways were sterile in healthy individuals. However, it has long been acknowledged that microorganisms could be identified in distal airway secretions from patients with various respiratory diseases, including cystic fibrosis (CF and non-CF bronchiectasis, chronic obstructive pulmonary disease, asthma and other chronic airway diseases (e.g. post-transplantation bronchiolitis obliterans. These microorganisms were sometimes considered as infectious agents that triggered host immune responses and contributed to disease onset and/or progression; alternatively, microorganisms were often considered as colonisers, which were considered unlikely to play roles in disease pathophysiology. These concepts were developed at a time when the identification of microorganisms relied on culture-based methods. Importantly, the majority of microorganisms cannot be cultured using conventional methods, and the use of novel culture-independent methods that rely on the identification of microorganism genomes has revealed that healthy distal airways display a complex flora called the airway microbiota. The present article reviews some aspects of current literature on host–microbe (mostly bacteria and viruses interactions in healthy and diseased airways, with a special focus on distal airways.

  14. Airway Clearance Devices for Cystic Fibrosis

    Science.gov (United States)

    2009-01-01

    Executive Summary Objective The purpose of this evidence-based analysis is to examine the safety and efficacy of airway clearance devices (ACDs) for cystic fibrosis and attempt to differentiate between devices, where possible, on grounds of clinical efficacy, quality of life, safety and/or patient preference. Background Cystic fibrosis (CF) is a common, inherited, life-limiting disease that affects multiple systems of the human body. Respiratory dysfunction is the primary complication and leading cause of death due to CF. CF causes abnormal mucus secretion in the airways, leading to airway obstruction and mucus plugging, which in turn can lead to bacterial infection and further mucous production. Over time, this almost cyclical process contributes to severe airway damage and loss of respiratory function. Removal of airway secretions, termed airway clearance, is thus an integral component of the management of CF. A variety of methods are available for airway clearance, some requiring mechanical devices, others physical manipulation of the body (e.g. physiotherapy). Conventional chest physiotherapy (CCPT), through the assistance of a caregiver, is the current standard of care for achieving airway clearance, particularly in young patients up to the ages of six or seven. CF patients are, however, living much longer now than in decades past. The median age of survival in Canada has risen to 37.0 years for the period of 1998-2002 (5-year window), up from 22.8 years for the 5-year window ending in 1977. The prevalence has also risen accordingly, last recorded as 3,453 in Canada in 2002, up from 1,630 in 1977. With individuals living longer, there is a greater need for independent methods of airway clearance. Airway Clearance Devices There are at least three classes of airway clearance devices: positive expiratory pressure devices (PEP), airway oscillating devices (AOD; either handheld or stationary) and high frequency chest compression (HFCC)/mechanical percussion (MP

  15. The airway in patients with craniofacial abnormalities.

    Science.gov (United States)

    Nargozian, Charles

    2004-01-01

    Airway management for patients with craniofacial disorders poses many challenges. The anaesthesiologist must be familiar with the normal bony and soft-tissue anatomy in the airway and how anatomy is altered by various congenital disorders. Specific areas to assess include the oral cavity, anterior mandibular space, maxilla, temporomandibular joint and vertebral column. Congenital conditions that may alter normal anatomy and therefore anaesthetic management include cleft lip and palate with or without Pierre Robin syndrome, craniofacial dysostosis, mandibulofacial dysostosis/Treacher Collins syndrome, hemifacial microsomia, Klippel-Feil syndrome, Beckwith-Wiedemann syndrome, trisomy 21/Down's syndrome, Freeman-Sheldon/whistling face syndrome/craniocarpotarsal dysplasia, fibrodysplasia ossificans progressiva, mucopolysaccharidosis and vascular malformations.

  16. Automatic Airway Deletion in Pulmonary Segmentation

    Institute of Scientific and Technical Information of China (English)

    WANG Ping; ZHUANG Tian-ge

    2005-01-01

    A method of removing the airway from pulmonary segmentation image was proposed. This method firstly segments the image into several separate regions based on the optimum threshold and morphological operator,and then each region is labeled and noted with its mean grayscale. Therefore, most of the non-lung regions can be removed according to the tissue's Hounsfield units (HU) and the imaging modality. Finally, the airway region is recognized and deleted automatically through using the priori information of its HU and size. This proposed method is tested using several clinical images, yielding satisfying results.

  17. Regional & Topical Anaesthesia of Upper Airways

    Directory of Open Access Journals (Sweden)

    Nibedita Pani

    2009-01-01

    Full Text Available A combination of techniques are required to adequately anaesthetise upper airway structures for awake intubation . The widest coverage is provided by the inhalational technique. This technique, however, does not always provide a dense enough level of anaesthesia for all patients. Supplementation of this technique with any of the specific nerve blocks is an excellent way to accomplish efficacious anaesthesia for awake inubation. Anaesthetising upper airway is not a difficult skill to master and should be in the armamentarium of all practising anaesthetist.

  18. Salivary gland hypofunction in elderly patients.

    Science.gov (United States)

    Navazesh, M

    1994-03-01

    Elderly dental patients often complain of mouth dryness. This complaint is most often caused by xerogenic medications or, less often, by systemic diseases. Aging per se has no significant clinical impact on salivary gland output. Salivary gland hypofunction, whether caused by medications or systemic disorders, have a strong negative impact on intraoral tissues, with a significant reduction in the quality of life.

  19. Epithelial tumours of the lacrimal gland

    DEFF Research Database (Denmark)

    von Holstein, Sarah Linéa; Coupland, Sarah E; Briscoe, Daniel;

    2013-01-01

    Epithelial tumours of the lacrimal gland represent a large spectrum of lesions with similarities in clinical signs and symptoms but with different biological behaviour and prognosis. They are rare, but with aggressive malignant potential. Tumours of the lacrimal gland may present with swelling of...

  20. Flagelliform or coronata glands of Nephila clavipes.

    Science.gov (United States)

    Rodríguez, R; Candelas, G C

    1995-07-01

    The flagelliform or coronata glands of the orb-web spider, Nephila clavipes, have been studied and compared to other silk-producing glands from the organism. The glands, which produce silk for the double filament of the core thread in the sticky spiral, exhibit three distinct morphological areas: tail, sac, and duct. Electrophoretic separation of the solubilized contents of the glands yields an uppermost diffuse band of high molecular size, preceded by a stepladder of well-defined peptides, which have been shown to be products of discontinuous translation in three other sets of glands. The luminal contents do not migrate as a discrete and well-defined band as those of the other glands, but rather as a diffuse area, typical of glycosylated proteins. Fibroin synthesis is stimulated by the mechanical depletion of the organism's stored silks, as in other Nephila glands, judged by the increased intensity of the bands and also by the structural alterations seen in cross sections of the glands' tails.

  1. Pathology of the parathyroid glands in hyperparathyroidism.

    Science.gov (United States)

    Baloch, Zubair W; LiVolsi, Virginia A

    2013-08-01

    This paper reviews the embryology, histology and pathology of the human parathyroid glands. It emphasizes those pathologic lesions which are found in the setting of clinical hyperparathyroidism. Also discussed are certain molecular features of hyperfunctioning parathyroid glands. The difficulties encountered in parathyroid FNA are reviewed and illustrated.

  2. Dysfunctional lung anatomy and small airways degeneration in COPD

    Directory of Open Access Journals (Sweden)

    Burgel PR

    2013-01-01

    Full Text Available Clémence Martin, Justine Frija, Pierre-Régis BurgelDepartment of Respiratory Medicine, Cochin Hospital, AP-HP and Université Paris Descartes, Sorbonne Paris Cité, Paris, FranceAbstract: Chronic obstructive pulmonary disease (COPD is characterized by incompletely reversible airflow obstruction. Direct measurement of airways resistance using invasive techniques has revealed that the site of obstruction is located in the small conducting airways, ie, bronchioles with a diameter < 2 mm. Anatomical changes in these airways include structural abnormalities of the conducting airways (eg, peribronchiolar fibrosis, mucus plugging and loss of alveolar attachments due to emphysema, which result in destabilization of these airways related to reduced elastic recoil. The relative contribution of structural abnormalities in small conducting airways and emphysema has been a matter of much debate. The present article reviews anatomical changes and inflammatory mechanisms in small conducting airways and in the adjacent lung parenchyma, with a special focus on recent anatomical and imaging data suggesting that the initial event takes place in the small conducting airways and results in a dramatic reduction in the number of airways, together with a reduction in the cross-sectional area of remaining airways. Implications of these findings for the development of novel therapies are briefly discussed.Keywords: emphysema, small airways disease, airway mucus, innate immunity, adaptive immunity

  3. Airway remodeling: Effect of current and future asthma therapies

    NARCIS (Netherlands)

    Burgess, Janette K.; Moir, Lyn M.

    2007-01-01

    Airway remodeling (the structural changes which occur in the airways) is one of the characteristic features of severe persistent asthma. These changes include thickening of the laminar reticularis, an increase in the bulk of the airway smooth muscle, thickening of the basement membrane and alteratio

  4. Rigid fibrescope Bonfils: use in simulated difficult airway by novices

    Directory of Open Access Journals (Sweden)

    Piepho Tim

    2009-07-01

    Full Text Available Abstract Background The Bonfils intubation fibrescope is a promising alternative device for securing the airway. We examined the success rate of intubation and the ease of use in standardized simulated difficult airway scenarios by physicians. We compared the Bonfils to a classical laryngoscope with Macintosh blade. Methods 30 physicians untrained in the use of rigid fibrescopes but experienced in airway management performed endotracheal intubation in an airway manikin (SimMan, Laerdal, Kent, UK with three different airway conditions. We evaluated the success rate using the Bonfils (Karl Storz, Tuttlingen, Germany or the Macintosh laryngoscope, the time needed for securing the airway, and subjective rating of both techniques. Results In normal airway all intubations were successful using laryngoscope (100% vs. 82% using the Bonfils (p Conclusion The Bonfils can be successfully used by physicians unfamiliar with this technique in an airway manikin. The airway could be secured with at least the same success rate as using a Macintosh laryngoscope in difficult airway scenarios. Use of the Bonfils did not delay intubation in the presence of a difficult airway. These results indicate that intensive special training is advised to use the Bonfils effectively in airway management.

  5. Vessel-guided airway segmentation based on voxel classification

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau; Sporring, Jon; Ashraf, Haseem;

    2008-01-01

    This paper presents a method for improving airway tree segmentation using vessel orientation information. We use the fact that an airway branch is always accompanied by an artery, with both structures having similar orientations. This work is based on a  voxel classification airway segmentation...

  6. Association between peripheral airway function and neutrophilic inflammation in asthma

    NARCIS (Netherlands)

    Farah, Claude S.; Keulers, Laurien A. B.; Hardaker, Kate M.; Peters, Matthew J.; Berend, Norbert; Postma, Dirkje S.; Salome, Cheryl M.; King, Gregory G.

    2015-01-01

    Background and objectiveSmall airway dysfunction is associated with asthma severity and control, but its association with airway inflammation is unknown. The aim was to determine the association between sputum inflammatory cells and the site of small airway dysfunction, measured by multiple breath n

  7. Research on airway inflammation: present status in Mainland China

    Institute of Scientific and Technical Information of China (English)

    WANG Zeng-li

    2005-01-01

    @@ Airway inflammation involving activated eosinophils, mast cells and T lymphocytes is an established feature of asthma and has been the key target to treatment. Airway structural changes that occur in patients with asthma in response to persistent inflammation are termed airway remodeling.

  8. [Modern airway management--current concepts for more patient safety].

    Science.gov (United States)

    Timmermann, Arnd

    2009-04-01

    Effective and safe airway management is one of the core skills among anaesthesiologists and all physicians involved in acute care medicine. However, failure in airway management is still the most frequent single incidence with the highest impact on patient's morbidity and mortality known from closed claims analyses. The anaesthesiologist has to manage the airway in elective patients providing a high level of safety with as little airway injury and interference with the cardio-vascular system as possible. Clinical competence also includes the management of the expected and unexpected difficult airway in different clinical environments. Therefore, it is the anaesthesiologist's responsibility not only to educate and train younger residents, but also all kinds of medical personnel involved in airway management, e.g. emergency physicians, intensive care therapists or paramedics. Modern airway devices, strategies and educational considerations must fulfill these sometimes diverse and large range requirements. Supraglottic airway devices will be used more often in the daily clinical routine. This is not only due the multiple advantages of these devices compared to the tracheal tube, but also because of the new features of some supraglottic airways, which separate the airway from the gastric track and give information of the pharyngeal position. For the event of a difficult airway, new airway devices and concepts should be trained and applied in daily practice.

  9. Bronchoconstriction and airway biology : potential impact and therapeutic opportunities

    NARCIS (Netherlands)

    Gosens, Reinoud; Grainge, Chris

    2015-01-01

    Recent work has demonstrated that mechanical forces occurring in the airway as a consequence of bronchoconstriction are sufficient to not only induce symptoms but also influence airway biology. Animal and human in vitro and in vivo work demonstrates that the airways are structurally and functionally

  10. Picornavirus-Induced Airway Mucosa Immune Profile in Asymptomatic Neonates

    DEFF Research Database (Denmark)

    Wolsk, Helene M.; Følsgaard, Nilofar V.; Birch, Sune;

    2016-01-01

    Bacterial airway colonization is known to alter the airway mucosa immune response in neonates whereas the impact of viruses is unknown. The objective was therefore to examine the effect of respiratory viruses on the immune signature in the airways of asymptomatic neonates. Nasal aspirates from 571...

  11. The role of pineal gland and exogenous melatonin on the irradiation stress response of suprarenal gland.

    Science.gov (United States)

    Alicelebić, Selma; Mornjaković, Zakira; Susko, Irfan; Cosović, Esad; Beganović-Petrović, Amira

    2006-11-01

    Pineal gland has and antistressogenic role. Its main hormone, melatonin, has radio protective effect on endocrine and other dynamic tissues. In our previous study, we have shown that pinealectomy changes the behavior of suprarenal gland in totally irradiated rats. The aim of this study is to evaluate the effect of exogenous melatonin on suprarenal gland of rats with or without pineal gland. Four months after pinealectomy (experimental group) or shampinealectomy (control group), adult Wistar male rats were daily treated with 0,2 mg of melatonin intraperitoneally, during two weeks. Thereafter, all animals were totally irradiated with 8 Gy of Gamma rays produced from Cobalt 60. Animals who survived were sacrificed on the 17(th) post irradiation day. Qualitative and quantitative characteristics of the suprarenal gland were studied using histological methods. The results show that exogenous melatonin had protective role on suprarenal gland in totally irradiated rats and that those effects were more pronounced in the presence of pineal gland.

  12. Submaxillary gland mucocele: presentation of a case.

    Science.gov (United States)

    Boneu-Bonet, Fernando; Vidal-Homs, Enric; Maizcurrana-Tornil, Aránzazu; González-Lagunas, Javier

    2005-01-01

    The term mucocele is referred to two concepts: the extravasation cysts resulting from salivary glandular duct rupture, with mucin leakage into the surrounding peri-glandular soft tissue, and the retention cysts, caused by a glandular duct obstruction and resulting in a decrease or even an absence of glandular secretion. Mucocele can not be considered as a true cyst because its wall lacks an epithelial lining. These lesions are very common in the minor salivary glands (particularly in the labial glands), but are very infrequent in the major salivary glands--including the submaxillary glands. The present study describes a clinical case of a right submaxillary gland mucocele resolved by surgical treatment and reviews the differential diagnosis with other clinical entities.

  13. Orbital Lymphoma Mimicking Lacrimal Gland Pleomorphic Adenoma

    Directory of Open Access Journals (Sweden)

    Diego Strianese

    2013-09-01

    Full Text Available Purpose: To describe the case of a patient affected by orbital lymphoma mimicking pleomorphic adenoma of the lacrimal gland. Methods: This was a retrospective case report. Results: We present the case of a patient with 15-year history of slowly progressive left proptosis and inferomedial bulbar dislocation who had the presumptive diagnosis of lacrimal gland pleomorphic adenoma based on clinical and radiological features. The patient underwent lateral orbitotomy and lacrimal gland excision. Postoperative histological features were consistent with low-grade B-cell non-Hodgkin lymphoma. Conclusion: The accepted clinico-radiological criteria used for the diagnosis of lacrimal gland fossa lesions might have a certain false-positive rate, even in recent years. The initial surgical approach with the appropriate choice between fine-needle aspiration biopsies, intraoperative biopsies and lacrimal gland excisions might be a challenge.

  14. Primary malignant lymphoma of the parotid gland

    Directory of Open Access Journals (Sweden)

    Sudha H Metikurke

    2012-01-01

    Full Text Available Lymphoma of the salivary gland accounts for 5% of cases of extranodal lymphoma and 10% of malignant salivary gland tumors. Most primary salivary gland lymphomas are B marginal zone lymphomas arising on a background of sialadenitis associated with an autoimmune disorder such as Sjorgen′s syndrome. This report describes a case of primary B-cell lymphoma arising in the parotid gland in a middle-aged female, which was not associated with an autoimmune disorder. Immunohistochemistry studies confirmed the clonal B-cell nature of the tumor. This case highlights the fact that B-cell lymphoma in the salivary gland can go unrecognized due to its non-specific symptoms and requires immunohistochemistry studies for confirmation. We present this case for its rarity.

  15. Prehospital endotracheal tube airway or esophageal gastric tube airway: a critical comparison.

    Science.gov (United States)

    Shea, S R; MacDonald, J R; Gruzinski, G

    1985-02-01

    This study compares two similar groups of patients in cardiopulmonary arrest with ventricular fibrillation (VF). In the survival study group of 296 patients, 148 patients received an endotracheal tube airway (ETA) and 148 patients received an esophageal gastric tube airway (EGTA), the improved version of the esophageal obturator airway (EOA). Survival rates, both short term (ETA = 35.8%, EGTA = 39.1%) and long term (ETA = 11.5%, EGTA = 16.2%), and neurological sequelae of survivors showed no statistically significant difference between the two groups (P greater than .05). In addition, we found that success and complication rates of intubation were similar. Training time was longer for the ETA. We conclude that both airways have a place in the prehospital setting.

  16. Automatic airway-artery analysis on lung CT to quantify airway wall thickening and bronchiectasis

    DEFF Research Database (Denmark)

    Perez-Rovira, Adria; Kuo, Wieying; Petersen, Jens;

    2016-01-01

    area percentage (WAP), wall thickness ratio (WTR), and airway diameters. Results: The method was thoroughly evaluated using 8000 manual annotations of airway-artery pairs from 24 full-inspiration pediatric CT scans (12 diseased and 12 controls). Limits of agreement between the automatically...... and manually measured diameters were comparable to interobserver limits of agreement. Differences in automatically obtained WAR, AAR, WAP, and WTR between bronchiectatic subjects and controls were similar as when manual annotations were used: WAR and outer AAR were significantly higher in the bronchiectatic......Purpose: Bronchiectasis and airway wall thickening are commonly assessed in computed tomography (CT) by comparing the airway size with the size of the accompanying artery. Thus, in order to automate the quantification of bronchiectasis and wall thickening following a similar principle...

  17. The metapleural gland of ants

    DEFF Research Database (Denmark)

    Yek, Sze Huei; Mueller, Ulrich G

    2011-01-01

    The metapleural gland (MG) is a complex glandular structure unique to ants, suggesting a critical role in their origin and ecological success. We synthesize the current understanding of the adaptive function, morphology, evolutionary history, and chemical properties of the MG. Two functions......-compressible invagination of the integument and the secretion is thought to ooze out passively through the non-closable opening of the MG or is groomed off by the legs and applied to target surfaces. MG loss has occurred repeatedly among the ants, particularly in the subfamilies Formicinae and Myrmicinae, and the MG...... is more commonly absent in males than in workers. MG chemistry has been characterized mostly in derived ant lineages with unique biologies (e.g. leafcutter ants, fire ants), currently precluding any inferences about MG chemistry at the origin of the ants. A synthetic approach integrating functional...

  18. 联合气道疾病%Combined airway disease

    Institute of Scientific and Technical Information of China (English)

    闫占峰; 王宁宇

    2012-01-01

    datas of epidemiological, clinical, and immunopathology demonstrate there is an important link between upper and lower airways. The upper airways diseases including the allergy rhinitis, the professional rhinitis, the sleep apnea and hypoventilation syndrome, nose polyposis (with/without aspirin sensitive) , the chronic rhinosinusitis and so on,have an important contacting with lower airways diseases. Understanding how the upper airway does affect the lower airway disease, has the influential role to diagnosis, the treatment and the prognosis. This article made the brief summary on the important relation about among the nose, the paranasal sinus and the lung recent years.

  19. Vessel-guided airway tree segmentation: A voxel classification approach

    DEFF Research Database (Denmark)

    Ashraf, Haseem; Pedersen, Jesper J H; Lo, Pechin Chien Pau;

    2010-01-01

    This paper presents a method for airway tree segmentation that uses a combination of a trained airway appearance model, vessel and airway orientation information, and region growing. We propose a voxel classification approach for the appearance model, which uses a classifier that is trained...... method is evaluated on 250 low dose computed tomography images from a lung cancer screening trial. Our experiments showed that applying the region growing algorithm on the airway appearance model produces more complete airway segmentations, leading to on average 20% longer trees, and 50% less leakage...

  20. Mechanisms of Airway Remodeling in Asthma

    Directory of Open Access Journals (Sweden)

    Etsuko Tagaya

    2007-01-01

    To date, many studies have identified candidate mechanisms and mediators for these observed structural changes, which are thus potential targets in the treatment of asthma. In this review, we describe the recent knowledge of the mechanisms and clinical implications of airway remodeling in asthma.

  1. Qualitative analysis of unanticipated difficult airway management

    DEFF Research Database (Denmark)

    Rosenstock, C; Hansen, E G; Kristensen, M S;

    2006-01-01

    Unanticipated difficult airway management (DAM) is a major challenge for the anaesthesiologist and is associated with a risk of severe patient damage. We analysed 24 cases of unanticipated DAM for actual case management and anaesthesiologists knowledge, technical and non-technical skills. Anaesth...

  2. Fabry disease, respiratory symptoms, and airway limitation

    DEFF Research Database (Denmark)

    Svensson, Camilla Kara; Feldt-Rasmussen, Ulla; Backer, Vibeke

    2015-01-01

    abnormalities in patients with Fabry disease. Electron microscopy of lung biopsy and induced sputum show lamellar inclusion bodies (Zebra bodies) in the cytoplasm of cells in the airway wall. X-ray and CT scan have shown patchy ground-glass pulmonary infiltrations, fibrosis, and air trapping. Fibrosis diagnosed...

  3. Manual airway labeling has limited reproducibility

    DEFF Research Database (Denmark)

    Petersen, Jens; Feragen, Aasa; Thomsen, Laura Hohwü;

    from low-dose chest CT scans. Methods and Materials: We selected 40 participants of the Danish Lung Cancer Screening Trial, 10 of each category: asymptomatic, mild, moderate, and severe COPD. Each subject contributed 2 CT scans with an average interval of 4 years. The airways were segmented...

  4. Severe upper airway obstruction during sleep.

    Science.gov (United States)

    Bonekat, H William; Hardin, Kimberly A

    2003-10-01

    Few disorders may manifest with predominantly sleep-related obstructive breathing. Obstructive sleep apnea (OSA) is a common disorder, varies in severity and is associated with significant cardiovascular and neurocognitive morbidity. It is estimated that between 8 and 18 million people in the United States have at least mild OSA. Although the exact mechanism of OSA is not well-delineated, multiple factors contribute to the development of upper airway obstruction and include anatomic, mechanical, neurologic, and inflammatory changes in the pharynx. OSA may occur concomitantly with asthma. Approximately 74% of asthmatics experience nocturnal symptoms of airflow obstruction secondary to reactive airways disease. Similar cytokine, chemokine, and histologic changes are seen in both disorders. Sleep deprivation, chronic upper airway edema, and inflammation associated with OSA may further exacerbate nocturnal asthma symptoms. Allergic rhinitis may contribute to both OSA and asthma. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA. Treatment with CPAP therapy has also been shown to improve both daytime and nighttime peak expiratory flow rates in patients with concomitant OSA and asthma. It is important for allergists to be aware of how OSA may complicate diagnosis and treatment of asthma and allergic rhinitis. A thorough sleep history and high clinical suspicion for OSA is indicated, particularly in asthma patients who are refractory to standard medication treatments.

  5. CT quantification of central airway in tracheobronchomalacia

    Energy Technology Data Exchange (ETDEWEB)

    Im, Won Hyeong; Jin, Gong Yong; Han, Young Min; Kim, Eun Young [Dept. of Radiology, Chonbuk National University Hospital, Jeonju (Korea, Republic of)

    2016-05-15

    To know which factors help to diagnose tracheobronchomalacia (TBM) using CT quantification of central airway. From April 2013 to July 2014, 19 patients (68.0 ± 15.0 years; 6 male, 13 female) were diagnosed as TBM on CT. As case-matching, 38 normal subjects (65.5 ± 21.5 years; 6 male, 13 female) were selected. All 57 subjects underwent CT with end-inspiration and end-expiration. Airway parameters of trachea and both main bronchus were assessed using software (VIDA diagnostic). Airway parameters of TBM patients and normal subjects were compared using the Student t-test. In expiration, both wall perimeter and wall thickness in TBM patients were significantly smaller than normal subjects (wall perimeter: trachea, 43.97 mm vs. 49.04 mm, p = 0.020; right main bronchus, 33.52 mm vs. 42.69 mm, p < 0.001; left main bronchus, 26.76 mm vs. 31.88 mm, p = 0.012; wall thickness: trachea, 1.89 mm vs. 2.22 mm, p = 0.017; right main bronchus, 1.64 mm vs. 1.83 mm, p = 0.021; left main bronchus, 1.61 mm vs. 1.75 mm, p = 0.016). Wall thinning and decreased perimeter of central airway of expiration by CT quantification would be a new diagnostic indicators in TBM.

  6. Water permeability in human airway epithelium

    DEFF Research Database (Denmark)

    Pedersen, Peter Steen; Procida, Kristina; Larsen, Per Leganger;

    2005-01-01

    Osmotic water permeability (P(f)) was studied in spheroid-shaped human airway epithelia explants derived from nasal polyps by the use of a new improved tissue collection and isolation procedure. The fluid-filled spheroids were lined with a single cell layer with the ciliated apical cell membrane...

  7. Airway epithelial cell responses to ozone injury

    Energy Technology Data Exchange (ETDEWEB)

    Leikauf, G.D.; Simpson, L.G.; Zhao, Qiyu [Univ. of Cincinnati Medical Center, OH (United States)] [and others

    1995-03-01

    The airway epithelial cell is an important target in ozone injury. Once activated, the airway epithelium responds in three phases. The initial, or immediate phase, involves activation of constitutive cells, often through direct covalent interactions including the formation of secondary ozonolysis products-hydroxyhydroperoxides, aldehydes, and hydrogen peroxide. Recently, we found hydroxyhydroperoxides to be potent agonists; of bioactive eicosanoid formation by human airway epithelial cells in culture. Other probable immediate events include activation and inactivation of enzymes present on the epithelial surface (e.g., neutral endopeptidase). During the next 2 to 24 hr, or early phase, epithelial cells respond by synthesis and release of chemotactic factors, including chemokines-macrophage inflammatory protein-2, RANTES, and interleukin-8. Infiltrating leukocytes during this period also release elastase, an important agonist of epithelial cell mucus secretion and additional chemokine formation. The third (late) phase of ozone injury is characterized by eosinophil or monocyte infiltration. Cytokine expression leads to alteration of structural protein synthesis, with increases in fibronectin evident by in situ hybridization. Synthesis of epithelial antiproteases, e.g., secretary leukocyte protease inhibitor, may also increase locally 24 to 48 hr after elastase concentrations become excessive. Thus, the epithelium is not merely a passive barrier to ozone injury but has a dynamic role in directing the migration, activating, and then counteracting inflammatory cells. Through these complex interactions, epithelial cells can be viewed as the initiators (alpha) and the receptors (omega) of ozone-induced airway disease. 51 refs., 2 figs., 3 tabs.

  8. Walking with continuous positive airway pressure

    NARCIS (Netherlands)

    Dieperink, W.; Goorhuis, JF; de Weerd, W; Hazenberg, A; Zijistra, JG; Nijsten, MWN

    2006-01-01

    A ventilator-dependent child had been in the paediatric intensive care unit (PICU) ever since birth. As a result, she had fallen behind considerably in her development. After 18 months, continuous positive airway tracheostomy tube with a novel lightweight device device, the child was discharged home

  9. Qualitative analysis of unanticipated difficult airway management

    DEFF Research Database (Denmark)

    Rosenstock, C; Hansen, E G; Kristensen, M S

    2006-01-01

    Unanticipated difficult airway management (DAM) is a major challenge for the anaesthesiologist and is associated with a risk of severe patient damage. We analysed 24 cases of unanticipated DAM for actual case management and anaesthesiologists knowledge, technical and non-technical skills...

  10. Essential ultrasound techniques of the pediatric airway

    DEFF Research Database (Denmark)

    Stafrace, Samuel; Engelhardt, Thomas; Teoh, Wendy H;

    2016-01-01

    Ultrasound of the airways is a technique which has been described in a number of recent articles and reviews highlighting the diagnostic possibilities and simple methodology. However, there is a paucity of information focusing specifically on such methods in children where equipment, technique, a...

  11. Quantitative analysis of airway abnormalities in CT

    DEFF Research Database (Denmark)

    Petersen, Jens; Lo, Pechin Chien Pau; Nielsen, Mads;

    2010-01-01

    A coupled surface graph cut algorithm for airway wall segmentation from Computed Tomography (CT) images is presented. Using cost functions that highlight both inner and outer wall borders, the method combines the search for both borders into one graph cut. The proposed method is evaluated on 173 ...

  12. PPARγ as a Potential Target to Treat Airway Mucus Hypersecretion in Chronic Airway Inflammatory Diseases

    Directory of Open Access Journals (Sweden)

    Yongchun Shen

    2012-01-01

    Full Text Available Airway mucus hypersecretion (AMH is a key pathophysiological feature of chronic airway inflammatory diseases such as bronchial asthma, cystic fibrosis, and chronic obstructive pulmonary disease. AMH contributes to the pathogenesis of chronic airway inflammatory diseases, and it is associated with reduced lung function and high rates of hospitalization and mortality. It has been suggested that AMH should be a target in the treatment of chronic airway inflammatory diseases. Recent evidence suggests that a key regulator of airway inflammation, hyperresponsiveness, and remodeling is peroxisome proliferator-activated receptor gamma (PPARγ, a ligand-activated transcription factor that regulates adipocyte differentiation and lipid metabolism. PPARγ is expressed in structural, immune, and inflammatory cells in the lung. PPARγ is involved in mucin production, and PPARγ agonists can inhibit mucin synthesis both in vitro and in vivo. These findings suggest that PPARγ is a novel target in the treatment of AMH and that further work on this transcription factor may lead to new therapies for chronic airway inflammatory diseases.

  13. [Use of airway stent subsequent to endoscopic Nd-YAG laser treatment in central airway obstruction].

    Science.gov (United States)

    Akaogi, E; Yuasa, H; Ishibashi, O; Inage, Y; Dai, Y; Sato, Y; Ishikawa, S; Morita, R; Onizuka, M; Mitsui, K

    1992-01-01

    Ten cases of central airway obstruction mainly caused by extrinsic compression due to the growth of extratracheal malignant tumors or longitudinal extension of tracheal adenoid cystic carcinomas, underwent palliative intubation subsequent to endoscopic Nd-YAG laser treatment. Mean length of the severe stenosis in these cases was 4.4 cm (3-7 cm). Sole application of endoscopic Nd-YAG laser to the stenosis failed relief of the symptom and an immediate palliative intubation was recommended. Mean time of the temporary intubation was 7 days (4-11 days). Airway was maintained by this intubation and also retained enough after extubation. Therefore, it seemed that, in a palliative treatment of the central airway severe stenosis, usefulness of the combination management of Nd-YAG laser with following temporary intubation was revealed. However, in order to maintain the airway for recurrence of the obstruction, use of indwelling airway stents seemed a better application. The longest period of follow-up in the cases treated by indwelling airway stents was 6 months and one of the cases is a now in comfortable state.

  14. Nursing endoscopic submucosal excavation in submucosal tumors%内镜黏膜下挖除术治疗消化道黏膜下肿瘤的护理

    Institute of Scientific and Technical Information of China (English)

    潘学勤; 吴萍

    2012-01-01

    目的 探讨内镜黏膜下挖除术(ESE)处理消化道黏膜下肿瘤(SMT)的临床护理方法.方法 以2009年1月至2010年11月内镜发现的黏膜下病灶22例(食道11例、贲门2例、胃8例、结肠1例)患者作为护理对象,通过术前EUS检查明确病灶大小、位置、性质,进行ESE治疗.结果 20例(91%)完整挖除,2例ESE术后创面仍有肿瘤残留且病理报告低度恶性,后行外科手术扩大切除治疗.3例穿孔均保守治愈.术后随访2~18个月,20例完整挖除患者均未见复发.结论 加强对行ESE患者的精心护理,可以减少并发症,提高手术成功率.%Objective To study the nursing of endosoopic submucosal excavation (ESE) in submucosal tumors(SMTs). Methods A total of 22 patients with SMT of gastrointestinal tract who were detected and confirmed by endoscopy from January 2009 to November 2010 were enrolled in the study. Among them, 11 patients had lesions located in esophagus, 2 in cardia, 8 in stomach, and 1 in rectum. Endoscopic ultrasonography (EUS) was applied to confirm the size, location, and nature of the lesions. The patients were treated with ESE. Results Twenty patients (91%) had complete ESE, and 2 received extra surgeries because of the residual and low malignant tumor in the wound after ESE. Three patients were treated conservatively because of perforations. The folbw - up of 2 to 18 months revealed that no recurrence occurred. Conclusion Good and corresponding nursing can reduce the incidence of complications and increase the success rate of surgery.

  15. Estimation of airway obstruction using oximeter plethysmograph waveform data

    Directory of Open Access Journals (Sweden)

    Desmond Renee' A

    2005-06-01

    Full Text Available Abstract Background Validated measures to assess the severity of airway obstruction in patients with obstructive airway disease are limited. Changes in the pulse oximeter plethysmograph waveform represent fluctuations in arterial flow. Analysis of these fluctuations might be useful clinically if they represent physiologic perturbations resulting from airway obstruction. We tested the hypothesis that the severity of airway obstruction could be estimated using plethysmograph waveform data. Methods Using a closed airway circuit with adjustable inspiratory and expiratory pressure relief valves, airway obstruction was induced in a prospective convenience sample of 31 healthy adult subjects. Maximal change in airway pressure at the mouthpiece was used as a surrogate measure of the degree of obstruction applied. Plethysmograph waveform data and mouthpiece airway pressure were acquired for 60 seconds at increasing levels of inspiratory and expiratory obstruction. At each level of applied obstruction, mean values for maximal change in waveform area under the curve and height as well as maximal change in mouth pressure were calculated for sequential 7.5 second intervals. Correlations of these waveform variables with mouth pressure values were then performed to determine if the magnitude of changes in these variables indicates the severity of airway obstruction. Results There were significant relationships between maximal change in area under the curve (P Conclusion The findings suggest that mathematic interpretation of plethysmograph waveform data may estimate the severity of airway obstruction and be of clinical utility in objective assessment of patients with obstructive airway diseases.

  16. Small ampullate glands of Nephila clavipes.

    Science.gov (United States)

    Ortíz, R; Céspedes, W; Nieves, L; Robles, I V; Plazaola, A; File, S; Candelas, G C

    2000-02-01

    The small ampullate glands of the orb-web spider, Nephila clavipes, have been studied and compared to other of the silk producing glands from this organism. They exhibit the same gross morphological features of the other glands. Electrophoretic analyses show that the gland's luminal contents migrate as a single band, while the contents of the secretory epithelium reveal a step-ladder array of peptides in addition to the full size product. Previous studies from our laboratory identified these peptides as products generated by translational pauses. This alternate mode of translation is typical of fibroin synthesis in all the spider glands thus far studied as well as in those of the silkworm. The correlation of the peptides to the process of fibroin synthesis is shown through experimental evidence in this paper. The gradual ultrastructural changes in Golgi vesicles elicited by the fibroin synthesis stimulus can be seen in this paper. The response to stimulation is of a higher magnitude in these glands than in any of those previously analyzed. These studies show the small ampullate glands are a promising and certainly exploitable model system for studies on the synthesis of tissue-specific protein product and its control. J. Exp. Zool. 286:114-119, 2000.

  17. Primary parotid gland lymphoma: a case report

    Directory of Open Access Journals (Sweden)

    Paraskevas Katsaronis

    2011-08-01

    Full Text Available Abstract Introduction Mucosa associated lymphoid tissue lymphomas are the most common lymphomas of the salivary glands. The benign lymphoepithelial lesion is also a lymphoproliferative disease that develops in the parotid gland. In the present case report, we describe one case of benign lymphoepithelial lesion with a subsequent low transformation to grade mucosa associated lymphoid tissue lymphoma appearing as a cystic mass in the parotid gland. Case presentation A 78-year-old Caucasian female smoker was referred to our clinic with a non-tender left facial swelling that had been present for approximately three years. The patient underwent resection of the left parotid gland with preservation of the left facial nerve through a preauricular incision. The pathology report was consistent with a low-grade marginal-zone B-cell non-Hodgkin lymphoma (mucosa associated lymphoid tissue lymphoma following benign lymphoepithelial lesion of the gland. Conclusions Salivary gland mucosa associated lymphoid tissue lymphoma should be considered in the differential diagnosis of cystic or bilateral salivary gland lesions. Parotidectomy is recommended in order to treat the tumor and to ensure histological diagnosis for further follow-up planning. Radiotherapy and chemotherapy should be considered in association with surgery in disseminated forms or after removal.

  18. The Diagnosis and Management of Airway Complications Following Lung Transplantation.

    Science.gov (United States)

    Mahajan, Amit K; Folch, Erik; Khandhar, Sandeep J; Channick, Colleen L; Santacruz, Jose F; Mehta, Atul C; Nathan, Steven D

    2017-03-05

    Airway complications following lung transplantation result in considerable morbidity and are associated with a mortality of 2-4 percent. The incidence of lethal and non-lethal airway complications has decreased since the early experiences with double- and single-lung transplantation. The most common risk factor associated with post-lung transplant airway complications is anastomotic ischemia. Airway complications include development of exophytic granulation tissue, bronchial stenosis, bronchomalacia, airway fistula, endobronchial infection, and anastomotic dehiscence. The broadening array of bronchoscopic therapies has enhanced treatment options for lung transplant recipients with airway complications. This article reviews the risk factors, clinical manifestations, and treatments of airway complications following lung transplantation, and provides our expert opinion where evidence is lacking.

  19. Thyroid Gland in Patients with Rheumatoid Arthritis

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    B T Turumhambetova

    2009-09-01

    Full Text Available The purpose of our study was to investigate the main parameters of thyroid status in patients with rheumatoid arthritis (RA, as well as particularities of course of this disease depending on of thyroid gland function disorder. Materials and methods. 52 women with RA were examined. The first group consisted of 11 women with subclinical and manifestive hypothyroidism the second one 41 women without thyroid gland function disorder. The group comparison was conducted on main indexes of thyroid gland condition the hormon level, AT-TPO, ultrasonic data, as well as clinical and laboratory RA data. Results. In women with hypothyroidism the systemic manifestations of RA were more often truely diagnosed; DAS28 indexes, ESR, the number ot swollen joints were higher. The high level ot AT-TPO was diagnosed in 54,55% – I group and in 31,7% – II group TTG level was really less in patients receiving synthetic glycocorticoids. Small thyroid gland volume was diagnosed in 23,07% of examined patients. The thyroid gland status indexes in them did not differ from patients with normal thyroid gland volume. Reliable increasing of the peripheral resistance index was revealed in lower thyroid artery according to the ultrasonic study data under the reduced thyroid gland size. Conclusions. High incidence of hypothyroidism and AT-TPO carriage in RA was revealed. Hypothyroidism development is accompanied by high clinic-laboratory RA activity. The reduction of the thyroid gland volumes in RA is possibly stipulated not only by autoimmunal pathology, but also chronic ischemia of the organ in the conditions of immune-complex vasculitis and early atherosclerosis. The TTG level in patients with RA is defined not only by pathology of the thyroid gland, but glycocorticoid therapy as well.

  20. Covered Bronchial Stent Insertion to Manage Airway Obstruction with Hemoptysis Caused by Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sae Ah; Kim, Do Hyeong [Dankook University College of Medicine, Dankook University Hospital, Cheonan (Korea, Republic of); Jen, Gyeong Sik [Bundang CHA General Hospital, CHA University, Seongnam (Korea, Republic of)

    2012-07-15

    Malignant airway obstruction and hemoptysis are common in lung cancer patients. Recently, airway stent is commonly used to preserve airway in malignant airway obstruction. Hemoptysis can be managed through various methods including conservative treatment, endobronchial tamponade, bronchoscopic intervention, embolization and surgery. In our case studies, we sought to investigate the effectiveness of airway stents for re-opening the airway as well as tamponade effects in four patients with malignant airway obstruction and bleeding caused by tumors or lymph node invasions.

  1. Creation of effective antireflux mechanism without creation of submucosal tunnel in surgical correction of vesicoureteric reflux: Myth or reality?-An experimental study

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    Archika Gupta

    2014-01-01

    Full Text Available Objective: To evaluate the possibility of creating an effective antireflux mechanism without the need to create submucosal tunnel in surgical correction of vesicoureteric reflux. Materials and Methods: Ethical clearance was obtained from the institute ethical committee. The prospective experimental study was conducted on fresh postmortem specimens comprising of intact ureter-bladder-urethra of slaughtered lamb. Through perurethral tube, bladder distension revealed intact antireflux mechanism which disappeared following a cephalad slit of ureteric orifice. After intravesical advancement, mobilized ureters were anchored to the hiatus and the exposed detrusor along the proposed submucosal tunnel after stripping the bladder mucosa. Limited nonobstructed narrowing of the advanced ureteric ends was fashioned. After closure, bladder was distended and reflux was observed through proximal transected ureteric orifices with check cystogram. In second part of experiment, in a rectal reservoir, two intestinal segments as dilated ureters were implanted without creating submucosal tunnel, but anchoring the intrarectal segment to exposed submucosa. Intraluminal end of one segment was narrowed, while other left as such. Reservoir distension test was done to notice the status of reflux. In 24 months, 12 experiments were conducted. Results: In first part of experiment, successful antireflux mechanism was created in 11 ureters. In second part of experiment, reflux persisted in the ureteral segment implanted with obliquity but without distal nonobstructed narrowing, while there was no reflux in the ureteral segment with both obliquity and narrowing. Conclusion: Advancement and anchoring of the ureteral segment to the exposed detrusor with creation of nonobstructive and limited narrowing can create effective antireflux mechanism without the need to create submucosal tunnel.

  2. How should tracers be injected to detect for sentinel nodes in gastric cancer – submucosally from inside or subserosally from outside of the stomach?

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    Yoshida Kazumichi

    2008-12-01

    Full Text Available Abstract Background In sentinel node (SN detection for cases of early gastric cancer, the submucosal dye injection method appears to be more reasonable than the subserosal injection. To compare the two injection methods, we have focused on the rate of concordance between hot nodes (HNs obtained from the radioisotope (RI method and green nodes (GNs obtained from the dye-guided method in addition to the number and distribution of GNs detected, and the sensitivity of metastatic detection. Methods The subjects of this study were 63 consecutive patients with gastric cancer (sT1–T2, sN0, tumor diameter ≦ 4 cm in whom we attempted SN detection using a combination of RI and dye methods. 99mTc-tin colloid was injected a day before the surgery, and indocyanine green was injected either submucosally (n = 43 with endoscopes or subserosally (n = 20 by direct vision. Results An average of hot and green nodes (H&G: 4 ± 3 vs. 4 ± 3, hot and non-green nodes (H&NG: 2 ± 3 vs. 1 ± 2, cold and green nodes (C&G: 2 ± 2 vs. 3 ± 4, and the rate of concordance (H&G/H&G + H&NG + C&G: 45 + 27% vs. 48 ± 30% were not significantly different between the submucosal and subserosal injection methods. The spread of GNs to tier 2 stations (24% vs. 30% and metastatic detection sensitivity (86% vs. 100% were also not different between the submucosal and subserosal injection methods. Conclusion The tracer injection sites do not have to be limited to the submucosa.

  3. Imaging of the major salivary glands

    DEFF Research Database (Denmark)

    Afzelius, Pia; Nielsen, Ming-Yuan; Ewertsen, Caroline;

    2016-01-01

    dental caries or swelling. Imaging plays an important role in visualization of morphology and function, to establish a diagnosis, for treatment, and for surgical planning. There are several options for diagnostic imaging: plain radiography, sialography, ultrasound (US), magnetic resonance imaging (MRI......The major salivary glands, submandibular, parotid and sublingual glands play an important role in preserving the oral cavity and dental health. Patients with problems of the major salivary glands may present with symptoms such as dry mouth, dysphagia and obstruction of duct, inflammation, severe...

  4. Salivary gland carcinomas of the larynx

    DEFF Research Database (Denmark)

    Nielsen, Troels Krogh; Bjørndal, Kristine; Krogdahl, Annelise

    2012-01-01

    OBJECTIVE: Salivary gland carcinomas of the larynx are rare. The purpose of this study is to present a national series of laryngeal salivary gland carcinoma patients and to bring a review of recent literature. METHODS: By merging The Danish Cancer Registry, The National Pathology Registry...... a review of literature from 1991 to 2010 was performed. RESULTS: Six Danish patients with a malignant salivary gland tumor in the larynx were identified resulting in an incidence of 0.001/100,000 inhabitants/year. Four had adenoid cystic carcinoma and two a mucoepidermoid carcinoma. All patients were male...

  5. Homeobox Genes in the Rodent Pineal Gland

    DEFF Research Database (Denmark)

    Rath, Martin Fredensborg; Rohde, Kristian; Klein, David C;

    2013-01-01

    The pineal gland is a neuroendocrine gland responsible for nocturnal synthesis of melatonin. During early development of the rodent pineal gland from the roof of the diencephalon, homeobox genes of the orthodenticle homeobox (Otx)- and paired box (Pax)-families are expressed and are essential...... functions, homeobox genes appear to be key regulators in postnatal phenotype maintenance in this tissue. In this paper, we review ontogenetic and phylogenetic aspects of pineal development and recent progress in understanding the involvement of homebox genes in rodent pineal development and adult function...

  6. Pseudomonas aeruginosa biofilm-associated homoserine lactone C12 rapidly activates apoptosis in airway epithelia.

    Science.gov (United States)

    Schwarzer, Christian; Fu, Zhu; Patanwala, Maria; Hum, Lauren; Lopez-Guzman, Mirielle; Illek, Beate; Kong, Weidong; Lynch, Susan V; Machen, Terry E

    2012-05-01

    Pseudomonas aeruginosa (PA) forms biofilms in lungs of cystic fibrosis (CF) patients, a process regulated by quorum-sensing molecules including N-(3-oxododecanoyl)-l-homoserine lactone (C12). C12 (10-100 µM) rapidly triggered events commonly associated with the intrinsic apoptotic pathway in JME (CF ΔF508CFTR, nasal surface) epithelial cells: depolarization of mitochondrial (mito) membrane potential (Δψ(mito)) and release of cytochrome C (cytoC) from mitos into cytosol and activation of caspases 3/7, 8 and 9. C12 also had novel effects on the endoplasmic reticulum (release of both Ca(2+) and ER-targeted GFP and oxidized contents into the cytosol). Effects began within 5 min and were complete in 1-2 h. C12 caused similar activation of caspases and release of cytoC from mitos in Calu-3 (wtCFTR, bronchial gland) cells, showing that C12-triggered responses occurred similarly in different airway epithelial types. C12 had nearly identical effects on three key aspects of the apoptosis response (caspase 3/7, depolarization of Δψ(mito) and reduction of redox potential in the ER) in JME and CFTR-corrected JME cells (adenoviral expression), showing that CFTR was likely not an important regulator of C12-triggered apoptosis in airway epithelia. Exposure of airway cultures to biofilms from PAO1wt caused depolarization of Δψ(mito) and increases in Ca(cyto) like 10-50 µM C12. In contrast, biofilms from PAO1ΔlasI (C12 deficient) had no effect, suggesting that C12 from P. aeruginosa biofilms may contribute to accumulation of apoptotic cells that cannot be cleared from CF lungs. A model to explain the effects of C12 is proposed.

  7. Dysgenetic polycystic disease of the minor and submandibular salivary glands

    NARCIS (Netherlands)

    Koudounarakis, Eleftherios; Willems, Stefan; Karakullukcu, Baris

    2016-01-01

    Background Dysgenetic polycystic salivary gland disease is a rare pathology. No case of minor salivary gland involvement has been reported in the literature. Methods A female patient presented with bilateral tumors of the parotid glands, bilateral submandibular gland enlargement, and multiple cystic

  8. Predominant constitutive CFTR conductance in small airways

    Directory of Open Access Journals (Sweden)

    Lytle Christian

    2005-01-01

    Full Text Available Abstract Background The pathological hallmarks of chronic obstructive pulmonary disease (COPD are inflammation of the small airways (bronchiolitis and destruction of lung parenchyma (emphysema. These forms of disease arise from chronic prolonged infections, which are usually never present in the normal lung. Despite the fact that primary hygiene and defense of the airways presumably requires a well controlled fluid environment on the surface of the bronchiolar airway, very little is known of the fluid and electrolyte transport properties of airways of less than a few mm diameter. Methods We introduce a novel approach to examine some of these properties in a preparation of minimally traumatized porcine bronchioles of about 1 mm diameter by microperfusing the intact bronchiole. Results In bilateral isotonic NaCl Ringer solutions, the spontaneous transepithelial potential (TEP; lumen to bath of the bronchiole was small (mean ± sem: -3 ± 1 mV; n = 25, but when gluconate replaced luminal Cl-, the bionic Cl- diffusion potentials (-58 ± 3 mV; n = 25 were as large as -90 mV. TEP diffusion potentials from 2:1 NaCl dilution showed that epithelial Cl- permeability was at least 5 times greater than Na+ permeability. The anion selectivity sequence was similar to that of CFTR. The bionic TEP became more electronegative with stimulation by luminal forskolin (5 μM+IBMX (100 μM, ATP (100 μM, or adenosine (100 μM, but not by ionomycin. The TEP was partially inhibited by NPPB (100 μM, GlyH-101* (5–50 μM, and CFTRInh-172* (5 μM. RT-PCR gave identifying products for CFTR, α-, β-, and γ-ENaC and NKCC1. Antibodies to CFTR localized specifically to the epithelial cells lining the lumen of the small airways. Conclusion These results indicate that the small airway of the pig is characterized by a constitutively active Cl- conductance that is most likely due to CFTR.

  9. [Pheochromocytomas as adrenal gland incidentalomas].

    Science.gov (United States)

    Cerović, Snezana; Cizmić, Milica; Milović, Novak; Ajdinović, Boris; Brajusković, Goran

    2002-07-01

    Adrenal incidentalomas are a heterogeneous group of pathological entities, including benign or malignant adrenocortical or medullary tumors, hormonally active or inactive lesions, which are identified incidentally during the examination of nonadrenal-related abdominal complaints. About 1.5% to 23% of adrenal incidentalomas are pheochromocytomas. Composite pheochromocytoma is a rare tumour of adrenal medulla with divergente clinical course. This type of pheochromocytoma is designated "composite" or "mixed," depending on whether pheochromocytoma and nonpheochromocytoma components show the same embryologic origin. Nonpheochromocytoma components found in the composite pheochromocytoma include ganglioneuroma, ganglioneuroblastoma, neuroblastoma, and malignant schwannoma. The biologic behavior of composite pheochromocytomas may be as difficult to predict as more traditional pheochromocytomas; based on the number of cases reported to date the presence of areas resembling ganglioneuroblastoma or neuroblastoma does not necessary indicate a poor prognosis. Some may behave in a malignant fashion with metastasis by a component of the tumour which has neural features. Pheochromocytomas and paragangliomas are well-defined entities. Some of their nonsporadic associations and unusual morphological appearances are not universally appreciated. We report on a rare association of left adrenal CP, with typical right adrenal phochromocytoma and retroperitoneal paraganglioma, and a review of literature. We analyzed the clinical and immunohistochemical features in a 24-year-old woman with composite pheochromocytoma localized in the left adrenal gland and associated with blood pressure of 200/140 mmHg. Abdominal computed tomography and 131-J MIBG revealed a 65 x 60 mm mass in the right adrenal gland, but no revealed 45 x 40 mm retroperitoneal mass and 20 x 20 mm mass in the left adrenal region. Serum and urinary adrenaline levels were high, and catecholamine levels in the blood sample of

  10. Structure and context in prostatic gland segmentation and classification.

    Science.gov (United States)

    Nguyen, Kien; Sarkar, Anindya; Jain, Anil K

    2012-01-01

    A novel gland segmentation and classification scheme applied to an H&E histology image of the prostate tissue is proposed. For gland segmentation, we associate appropriate nuclei objects with each lumen object to create a gland segment. We further extract 22 features to describe the structural information and contextual information for each segment. These features are used to classify a gland segment into one of the three classes: artifact, normal gland and cancer gland. On a dataset of 48 images at 5x magnification (which includes 525 artifacts, 931 normal glands and 1,375 cancer glands), we achieved the following classification accuracies: 93% for artifacts v. true glands; 79% for normal v. cancer glands, and 77% for discriminating all three classes. The proposed method outperforms state of the art methods in terms of segmentation and classification accuracies and computational efficiency.

  11. Myeloid sarcoma of submandibular salivary gland

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    Federico Dagna

    2016-01-01

    Full Text Available Objective: To report a rare case of a myeloid sarcoma of submandibular salivary gland. Methods: A 65-year-old woman with a history of successfully treated myelodysplastic syndrome, presenting with periodic painful swelling of her right submandibular area. Results: Physical evaluation, ultrasound and CT scan revealed the presence of a 3-cm mass contiguous to the submandibular salivary gland. A core needle biopsy confirmed the diagnosis of myeloid sarcoma. Bone marrow biopsy was still showing complete remission and the submandibular gland was the only extramedullary site involved. The patient was submitted to chemotherapy. Conclusion: Myeloid sarcoma is a rare extramedullary neoplasm. It can virtually involve any anatomic site, but it usually involves lymph nodes, paranasal sinuses, skin, soft tissue and periostium. Myeloid sarcomas of salivary glands are very rare and ENTs should be aware of this disease in order to include it in the differential diagnosis of a solitary neck mass.

  12. Ectopic mineral formation in the prostate gland

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    R.A.Moskalenko

    2011-01-01

    Full Text Available This work analyzes the data of cont emporary scientific literature regarding the ectopic mineralization in the prostate gland, its pathogenetic features are considered. The scientific literature of recent decades gives grounds to assert that the processes of concrement formation in the prostate gland are influenced by many factors, pathological mineralization can be realized by different mechanisms. They include chronic inflammation, stagnation fract ions in gland, reflux of urine from the urethra at intravesicle obstruction, malformation of prostate and seminal vesicles, specific inflammation, polymorphism of gene protein inhibitors of calcification. These mechanisms are interconnected, each of them may participate in the overall development of concrement fo rmation in the prostate. In recent years, due to improved instrumental diagnosis we observe a significant increase of the number of patients, who were found with pathogenic prostate gland biol iths, which requires more detailed and in-depth study of the mechanisms of mineral formation in the prostate.

  13. LYMPHOEPITHELIOMA OF PAROTID GLAND. UNUSUAL FINDING

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    Pomar-Blanco P

    2011-04-01

    Full Text Available Lymphoepitheliomas are malignant tumours with a characteristic histological growth pattern, mixing undifferentiated epithelial cells and a predominant T cell lymphoid infiltrate. Nasopharynx is the main site for this lesion but also can affect salivary glands, so is named lymphoepithelioma-like carcinoma (LELC. These are aggressive tumours and they could metastasize into the lymph neck nodes, bones, lung and liver. The treatment for these tumours is the surgery over the parotid gland, homolateral neck nodes dissection and postoperative radiotherapy. The prognosis is determined by distant metastases, related with advanced neck node disease.We report a case of a patient diagnosed of a salivary gland lymphoepithelioma, which consults for located mass into the parotid gland, with almost three years evolution.

  14. Plexiform Neurofibroma Involving the Lacrimal Gland

    Science.gov (United States)

    Hofsli, Mikael; Gampenrieder, Nico; Heegaard, Steffen

    2017-01-01

    Background To present a rare case of a 2-year-old girl with neurofibromatosis type 1 (NF1) who presented with ptosis of the right upper eyelid along with a tumor in the eyelid. Methods A magnetic resonance imaging scan of the orbit revealed a solid tumor located extraconally at the site of the right lacrimal gland. A transcranial orbitotomy was performed. Results Histopathological examination demonstrated expanded nerve branches/fascicles cut in various planes in between normal lacrimal gland acini. These findings were consistent with a plexiform neurofibroma presumably deriving from the lacrimal nerve and/or a supraorbital nerve branch. Conclusion This is the first case of a plexiform neurofibroma involving the lacrimal gland ever described and the tumor shows similarities with neurofibroma in other salivary glands with a high recurrence rate. Plexiform neurofibromas are frequently seen in patients with NF1 and rarely undergo malignant transformation. PMID:28203199

  15. Role of sebaceous glands in inflammatory dermatoses.

    Science.gov (United States)

    Shi, Vivian Y; Leo, Michael; Hassoun, Lauren; Chahal, Dev S; Maibach, Howard I; Sivamani, Raja K

    2015-11-01

    Skin is an important interface between the host and its environment. Inflammatory dermatoses often have disrupted skin barrier function, rendering patients more susceptible to allergenic triggers leading to an exaggerated immune response. The skin surface lipid film, an important component of the skin barrier, comprises a mixture of keratinocyte and sebaceous gland-derived lipids. Recent evidence demonstrated that defective keratinocyte lipid synthesis predisposes for the development of atopic dermatitis. However, the important role of sebaceous gland-derived lipids in skin inflammatory diseases may be underrecognized. This overview focuses on the importance of the contribution of sebaceous glands to barrier function. Sebaceous gland alteration may play a role in the pathogenesis of common skin diseases including acne vulgaris, atopic dermatitis, psoriasis, rosacea, and seborrheic dermatitis.

  16. Salivary Gland Biopsy for Sjogren's Syndrome

    NARCIS (Netherlands)

    Delli, Konstantina; Vissink, Arjan; Spijkervet, Fred K. L.

    2014-01-01

    Salivary gland biopsy is a technique broadly applied for the diagnosis of Sjogren's syndrome (SS), lymphoma accompanying SS, sarcoidosis, amyloidosis, and other connective tissue disorders. SS has characteristic microscopic findings involving lymphocytic infiltration surrounding the excretory ducts

  17. Lymphoepithelial cyst of the submandibular gland

    Directory of Open Access Journals (Sweden)

    A Saneem Ahamed

    2014-01-01

    Full Text Available Lymphoepithelial cysts are benign, slowly growing unilocular or multilocular lesions that appear in the head and neck. They are also called Branchial cyst. The head and neck sites are the salivary glands(more commonly parotid and rarely submandibular gland and the oral cavity (usually the floor of the mouth. there are various methods of investigation available today, of which Fine needle aspiration cytology (FNAC can be used to provide an immediate diagnosis of a lymphoepithelial cyst. The other investigations include, Ultrasonogram,and Computed tomography.It usually occurs due to the process of lymphocyte-induced cystic ductular dilatation and the confirmatory diagnosis is always made postoperatively by histopathological examination. The mainstay in the treatment of a lymphoepithelial cyst remains the surgical approach, which includes complete enucleation of the cyst along with total excision of the involved salivary gland. This is a report of a lymphoepithelial cyst involving the submandibular salivary gland and its management.

  18. Randomized crossover comparison of the laryngeal mask airway classic with i-gel laryngeal mask airway in the management of difficult airway in post burn neck contracture patients

    Directory of Open Access Journals (Sweden)

    Jeevan Singh

    2012-01-01

    Full Text Available Purpose: The objective of the study was to compare the performance of i-gel supraglottic airway with cLMA in difficult airway management in post burn neck contracture patients and assess the feasibility of i-gel use for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening. Methods: Prospective, crossover, randomized controlled trial was performed amongst forty eight post burn neck contracture patients with limited mouth opening and neck movement. i-gel and cLMA were placed in random order in each patient. Primary outcome was overall success rate. Other measurements were time to successful ventilation, airway leak pressure, fiberoptic glottic view, visualization of square wave pattern. Results: Success rate for the i-gel was 91.7% versus 79.2% for the cLMA. i-gel required shorter insertion time (19.3 seconds vs. 23.5 seconds, P=0.000. Airway leak pressure difference was statistically significant (i-gel 21.2 cm H20; cLMA 16.9 cm H 2 0; P=0.00. Fiberoptic view through the i-gel showed there were less epiglottic downfolding and better fiberoptic view of the glottis than cLMA. Overall agreement in insertion outcome for i-gel was 22/24 (91.7% successes and 2/24(8.3% failure and for cLMA, 19/24 (79.16% successes and 5/24 (16.7% failure in the first attempt. Conclusion: The i-gel is cheap, effective airway device which is easier to insert and has better clinical performance in the difficult airway management of the airway in the post burn contracture of the neck. Our study shows that i-gel is feasible for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening in post burn neck.

  19. Airway acidification initiates host defense abnormalities in cystic fibrosis mice

    Science.gov (United States)

    Shah, Viral S.; Meyerholz, David K.; Tang, Xiao Xiao; Reznikov, Leah; Alaiwa, Mahmoud Abou; Ernst, Sarah E.; Karp, Philip H.; Wohlford-Lenane, Christine L.; Heilmann, Kristopher P.; Leidinger, Mariah R.; Allen, Patrick D.; Zabner, Joseph; McCray, Paul B.; Ostedgaard, Lynda S.; Stoltz, David A.; Randak, Christoph O.; Welsh, Michael J.

    2016-01-01

    Cystic fibrosis (CF) is caused by mutations in the gene that encodes the cystic fibrosis transmembrane conductance regulator (CFTR) anion channel. In humans and pigs, the loss of CFTR impairs respiratory host defenses, causing airway infection. But CF mice are spared. We found that in all three species, CFTR secreted bicarbonate into airway surface liquid. In humans and pigs lacking CFTR, unchecked H+ secretion by the nongastric H+/K+ adenosine triphosphatase (ATP12A) acidified airway surface liquid, which impaired airway host defenses. In contrast, mouse airways expressed little ATP12A and secreted minimal H+; consequently, airway surface liquid in CF and non-CF mice had similar pH. Inhibiting ATP12A reversed host defense abnormalities in human and pig airways. Conversely, expressing ATP12A in CF mouse airways acidified airway surface liquid, impaired defenses, and increased airway bacteria. These findings help explain why CF mice are protected from infection and nominate ATP12A as a potential therapeutic target for CF. PMID:26823428

  20. Effect of P2X(7) receptor knockout on exocrine secretion of pancreas, salivary glands and lacrimal glands

    DEFF Research Database (Denmark)

    Novak, Ivana; Jans, Ida M; Wohlfahrt, Louise

    2010-01-01

    the P2X(7) receptors affect fluid secretion in pancreas, salivary glands and tear glands. We monitored gland secretions in in vivo preparations of wild-type and P2X(7)(-/-) (Pfizer) mice stimulated with pilocarpine. In cell preparations from pancreas, parotid and lacrimal glands we measured ATP release...

  1. Management of xerostomia and salivary gland hypofunction.

    Science.gov (United States)

    Ram, Saravanan; Kumar, Satish; Navazesh, Mahvash

    2011-09-01

    Xerostomia and salivary gland hypofunction are conditions that have been associated with increased prevalence of caries, periodontitis, and candidiasis. Oral health care providers must be aware of the etiologies and clinical manifestations of salivary gland hypofunction in order to identify patients with this condition and to prevent its potential complications. The various modalities available to manage this condition range from frequent sips of water to the intake of systemic medications like pilocarpine or cevimeline.

  2. Histiocytosis mimicking a pineal gland tumour

    Energy Technology Data Exchange (ETDEWEB)

    Gizewski, E.R.; Forsting, M. [Dept. of Neuroradiology, Univ. of Essen (Germany)

    2001-08-01

    We report an unusual case of isolated Langerhans cell histiocytosis of the central nervous system. A 19-year-old man presented with an incomplete ocular palsy. MRI revealed a solitary mass in the pineal gland with marked contrast enhancement. Complete microsurgical excision was followed by local radiotherapy. Histological examination revealed histiocytosis. Unifocal brain involvement by histiocytosis X is rare with few cases in the literature; the most commonly involved areas are the hypothalamus and the pituitary gland. (orig.)

  3. Adenoid cystic carcinoma of the lacrimal gland

    DEFF Research Database (Denmark)

    von Holstein, Sarah L; Fehr, André; Persson, Marta;

    2013-01-01

    To investigate genetic alterations in lacrimal gland adenoid cystic carcinomas (ACCs) with emphasis on the MYB-NFIB fusion oncogene and its downstream targets, MYB rearrangements, and copy number alterations in relation to clinical data and survival.......To investigate genetic alterations in lacrimal gland adenoid cystic carcinomas (ACCs) with emphasis on the MYB-NFIB fusion oncogene and its downstream targets, MYB rearrangements, and copy number alterations in relation to clinical data and survival....

  4. Pheromones and exocrine glands in Isoptera.

    Science.gov (United States)

    Costa-Leonardo, Ana Maria; Haifig, Ives

    2010-01-01

    Termites are eusocial insects that have a peculiar and intriguing system of communication using pheromones. The termite pheromones are composed of a blend of chemical substances and they coordinate different social interactions or activities, including foraging, building, mating, defense, and nestmate recognition. Some of these sociochemicals are volatile, spreading in the air, and others are contact pheromones, which are transmitted by trophallaxis and grooming. Among the termite semiochemicals, the most known are alarm, trail, sex pheromones, and hydrocarbons responsible for the recognition of nestmates. The sources of the pheromones are exocrine glands located all over the termite body. The principal exocrine structures considered pheromone-producing glands in Isoptera are the frontal, mandibular, salivary or labial, sternal, and tergal glands. The frontal gland is the source of alarm pheromone and defensive chemicals, but the mandibular secretions have been little studied and their function is not well established in Isoptera. The secretion of salivary glands involves numerous chemical compounds, some of them without pheromonal function. The worker saliva contains a phagostimulating pheromone and probably a building pheromone, while the salivary reservoir of some soldiers contains defensive chemicals. The sternal gland is the only source of trail-following pheromone, whereas sex pheromones are secreted by two glandular sources, the sternal and tergal glands. To date, the termite semiochemicals have indicated that few molecules are involved in their chemical communication, that is, the same compound may be secreted by different glands, different castes and species, and for different functions, depending on the concentration. In addition to the pheromonal parsimony, recent studies also indicate the occurrence of a synergic effect among the compounds involved in the chemical communication of Isoptera.

  5. Sclerosing polycystic adenosis of the parotid gland

    Directory of Open Access Journals (Sweden)

    Hugo Lara-Sánchez

    2015-10-01

    Conclusion: The SPA is similar to the fibrocystic changes, sclerosing adenosis and adenoid tumors of the mammary gland. The main location of the SPA is the parotid gland and it is considered a disease due to a pseudotumoral inflammatory reaction with a possible association with the Epstein–Barr virus. There is evidence that monoclonal cell populations exist. The treatment consists in excision of the tumor with a superficial parotidectomy, which has demonstrated high cure rates.

  6. [Adenomatoid tumour of the adrenal gland].

    Science.gov (United States)

    Bandier, Philippe Claus; Hansen, Alastair; Thorelius, Lars

    2009-01-26

    An adenomatoid tumour in the right suprarenal gland was discovered during clinical cancer staging of a 73-year-old woman. Adenomatoid tumours in the suprarenal glands are rare and are most often found incidentally. A definitive diagnosis is made on the basis of histology since imaging methods are non-specific. Differential diagnoses comprise malignant vascular neoplasm or adenocarcinoma. Immunohistochemistry or electron microscopy allows uncomplicated distinction between these tumours. In general, it is recommended to obtain biopsies from suprarenal processes.

  7. Rectal laterally spreading tumors successfully treated in two steps by endoscopic submucosal dissection and endoscopic mucosal resection

    Directory of Open Access Journals (Sweden)

    Palmieri Giovanni

    2010-11-01

    Full Text Available Abstract Background Endoscopic submucosal dissection (ESD is an advanced technique of therapeutic endoscopy alternative to endoscopic mucosal resection (EMR for superficial gastrointestinal neoplasms >2 cm. ESD allows for the direct dissection of the submucosa and large lesions can be resected en bloc. ESD is not limited by resection size, increases histologically complete resection rates and may reduce the local recurrence. Nevertheless, the technique is time-consuming, technically demanding and associated with a high complication rate. To reduce the risk of complications, different devices and technical advances have been proposed with conflicting results and, still, ESD en bloc resections of huge lesions are associated with increased complications. Case Presentation We successfully used a combined ESD/EMR technique for huge rectal laterally spreading tumors (LSTs. ESD was used for circumferential resection of 2/3 of the lesion followed by piecemeal resection (2-3 pieces of the central part of the tumour. In all three patients we obtained the complete dissection of the polyp and the complete histological evaluation in absence of complications and recurrence at 6 months' follow up. Conclusions In the treatment of rectal LSTs, the combined treatment - ESD/EMR resection may be considered a suitable therapeutic option, indicated in selected cases as an alternative to surgery, in which the two techniques are neither reliable nor safe separately. However, to confirm our results, larger trials with longer follow up are required together with improvement of the technique and of the technical devices.

  8. Low Incidence of Synchronous or Metachronous Tumors after Endoscopic Submucosal Dissection for Early Gastric Cancer with Undifferentiated Histology.

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    Chan Hyuk Park

    Full Text Available Gastric cancer with undifferentiated histology has different clinicopathologic characteristics compared to differentiated type gastric cancer. We aimed to compare the risk of synchronous or metachronous tumors after curative resection of early gastric cancer (EGC via endoscopic submucosal dissection (ESD, according to the histologic differentiation of the primary lesion.Clinicopathological data of patients with initial-onset EGC curatively resected via ESD between January 2007 and November 2014 in a single institution were reviewed. We analyzed the incidence of synchronous or metachronous tumors after ESD with special reference to the differentiation status of the primary lesion.Of 1,560 patients with EGC who underwent curative resection via ESD, 1,447 had differentiated type cancers, and 113 had undifferentiated type cancers. The cumulative incidence of metachronous or synchronous tumor after ESD was higher in the differentiated cancer group than in the undifferentiated cancer group (P = 0.008. Incidence of metachronous or synchronous tumor was 4.8% and 1.2% per person-year in the differentiated and undifferentiated cancer groups, respectively. The Cox proportional hazard model revealed that undifferentiated cancers were associated with a low risk of synchronous or metachronous tumors after adjusting for confounding variables (hazard ratio [95% confidence interval] = 0.287 [0.090-0.918].The rate of synchronous or metachronous tumors after curative ESD was significantly lower for undifferentiated cancers compare to differentiated cancers. These findings suggest that ESD should be actively considered as a possible treatment for undifferentiated type EGCs.

  9. The neurobiology of the meibomian glands.

    Science.gov (United States)

    Cox, Stephanie M; Nichols, Jason J

    2014-07-01

    This article compiles research regarding the neuroanatomy of the meibomian glands and their associated blood vessels. After a review of meibomian gland morphology and regulation via hormones, a case for innervation is made based on anatomical findings whereby the nerves lack a myelin sheath and Schwann cells. The localization and co-localization of dopamine beta-hydroxylase, tyrosine hydroxylase, neuropeptide Y, vasoactive intestinal polypeptide, calcitonin gene-related peptide, and substance P are explored with emphasis on differences that exist between species. The presence of the various neuropeptides/neurotransmitters adjacent to the meibomian gland versus the vasculature associated with the meibomian gland is documented so that conclusions can be made with regard to direct and indirect effects. Research regarding the presence of receptors and receptor proteins for these neuropeptides is documented. Evidence supporting the influence of certain neurotransmitters and/or neuropeptides on the meibomian gland is given based on research that correlates changes in meibomian gland morphology and/or tear film with changes in neurotransmitter and/or neuropeptide presence. Conclusions are drawn related to direct and indirect regulation and differences between the various nervous systems.

  10. The pineal gland from development to function.

    Science.gov (United States)

    Sapède, Dora; Cau, Elise

    2013-01-01

    The pineal gland is a small neuroendocrine organ whose main and most conserved function is the nighttime secretion of melatonin. In lower vertebrates, the pineal gland is directly photosensitive. In contrast, in higher vertebrates, the direct photosensitivity of the pineal gland had been lost. Rather, the action of this gland as a relay between environmental light conditions and body functions involves reception of light information by the retina. In parallel to this sensory regression, the pineal gland (and its accessory organs) appears to have lost several functions in relation to light and temperature, which are important in lower vertebrate species. In humans, the functions of the pineal gland overlap with the functions of melatonin. They are extremely widespread and include general effects both on cell protection and on more precise functions, such as sleep and immunity. Recently, the role of melatonin has received a considerable amount of attention due to increased cancer risk in shift workers and the discovery that patients suffering from neurodegenerative diseases, autism, or depression exhibit abnormal melatonin rhythms.

  11. Cell therapy for salivary gland regeneration.

    Science.gov (United States)

    Lin, C-Y; Chang, F-H; Chen, C-Y; Huang, C-Y; Hu, F-C; Huang, W-K; Ju, S-S; Chen, M-H

    2011-03-01

    There are still no effective therapies for hyposalivation caused by irradiation. In our previous study, bone marrow stem cells can be transdifferentiated into acinar-like cells in vitro. Therefore, we hypothesized that transplantation with bone marrow stem cells or acinar-like cells may help functional regeneration of salivary glands. Bone marrow stem cells were labeled with nanoparticles and directly co-cultured with acinar cells to obtain labeled acinar-like cells. In total, 140 severely combined immune-deficiency mice were divided into 4 groups for cell therapy experiments: (1) normal mice, (2) mice receiving irradiation around their head-and-neck areas; (3) mice receiving irradiation and intra-gland transplantation with labeled stem cells; and (4) mice receiving irradiation and intra-gland transplantation with labeled acinar-like cells. Our results showed that salivary glands damaged due to irradiation can be rescued by cell therapy with either bone marrow stem cells or acinar-like cells for recovery of saliva production, body weight, and gland weight. Transdifferentiation of bone marrow stem cells into acinar-like cells in vivo was also noted. This study demonstrated that cell therapy with bone marrow stem cells or acinar-like cells can help functional regeneration of salivary glands, and that acinar-like cells showed better therapeutic potentials than those of bone marrow stem cells.

  12. Epithelial myoepithelial carcinoma of the parotid gland

    Directory of Open Access Journals (Sweden)

    Sachin A Badge

    2015-01-01

    Full Text Available Epithelial-myoepithelial carcinoma (EMC is a low-grade malignant tumor of the salivary glands. It is extremely rare neoplasm accounting for <1% of all salivary gland neoplasms. It is most commonly seen in parotid gland, but has also been described in the submandibular gland, minor salivary glands and extra oral sites. It is most commonly seen in females; with a peak occurrence in the seventh decade. We present a case of EMC of parotid gland in a 55-year-old male patient presented with painless swelling of 8 cm × 8 cm in preauricular region since 1-year. There was no history of fever and no palpable cervical lymphadenopathy. Facial nerve function was intact. All other findings in general examination were within normal limit. As EMC is a very rare tumor having high rate of recurrence we must aware of this entity while giving diagnosis on histopathological examination. Surgeons and oncologist must focus on the best treatment approach to prevent the recurrence of this tumor. Wide local excision, followed by radiotherapy remains the treatment of choice.

  13. Iatrogenic causes of salivary gland dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Schubert, M.M.; Izutsu, K.T.

    1987-02-01

    Saliva is important for maintaining oral health and function. There are instances when medical therapy is intended to decrease salivary flow, such as during general anesthesia, but most instances of iatrogenic salivary gland dysfunction represent untoward or unavoidable side-effects. The clinical expression of the salivary dysfunction can range from very minor transient alteration in saliva flow to a total loss of salivary function. The most common forms of therapy that interfere with salivation are drug therapies, cancer therapies (radiation or chemotherapy), and surgical therapy. These therapies can affect salivation by a number of different mechanisms that include: disruption of autonomic nerve function related to salivation, interference with acinar or ductal cell functions related to salivation, cytotoxicity, indirect effects (vasoconstriction/dilation, fluid and electrolyte balance, etc.), and physical trauma to salivary glands and nerves. A wide variety of drugs is capable of increasing or decreasing salivary flow by mimicking autonomic nervous system actions or by directly acting on cellular processes necessary for salivation: drugs can also indirectly affect salivation by altering fluid and electrolyte balance or by affecting blood flow to the glands. Ionizing radiation can cause permanent damage to salivary glands, damage that is manifest as acinar cell destruction with subsequent atrophy and fibrosis of the glands. Cancer chemotherapy can cause changes in salivation, but the changes are usually much less severe and only transient. Finally, surgical and traumatic injuries interfere with salivation because of either disruption of gland innervation or gross physical damage (or removal) of glandular tissue (including ducts).

  14. The metapleural gland of ants.

    Science.gov (United States)

    Yek, Sze Huei; Mueller, Ulrich G

    2011-11-01

    The metapleural gland (MG) is a complex glandular structure unique to ants, suggesting a critical role in their origin and ecological success. We synthesize the current understanding of the adaptive function, morphology, evolutionary history, and chemical properties of the MG. Two functions of the MG, sanitation and chemical defence, have received the strongest empirical support; two additional possible functions, recognition odour and territorial marking, are less well supported. The design of the MG is unusual for insects; glandular secretions are stored in a rigid, non-compressible invagination of the integument and the secretion is thought to ooze out passively through the non-closable opening of the MG or is groomed off by the legs and applied to target surfaces. MG loss has occurred repeatedly among the ants, particularly in the subfamilies Formicinae and Myrmicinae, and the MG is more commonly absent in males than in workers. MG chemistry has been characterized mostly in derived ant lineages with unique biologies (e.g. leafcutter ants, fire ants), currently precluding any inferences about MG chemistry at the origin of the ants. A synthetic approach integrating functional morphology, phylogenetic transitions and chemical ecology of the MGs of both the derived and the unstudied early-branching (basal) ant lineages is needed to elucidate the evolutionary origin and diversification of the MG of ants.

  15. Mechanically patterning the embryonic airway epithelium

    Science.gov (United States)

    Varner, Victor D.; Gleghorn, Jason P.; Miller, Erin; Radisky, Derek C.; Nelson, Celeste M.

    2015-01-01

    Collections of cells must be patterned spatially during embryonic development to generate the intricate architectures of mature tissues. In several cases, including the formation of the branched airways of the lung, reciprocal signaling between an epithelium and its surrounding mesenchyme helps generate these spatial patterns. Several molecular signals are thought to interact via reaction-diffusion kinetics to create distinct biochemical patterns, which act as molecular precursors to actual, physical patterns of biological structure and function. Here, however, we show that purely physical mechanisms can drive spatial patterning within embryonic epithelia. Specifically, we find that a growth-induced physical instability defines the relative locations of branches within the developing murine airway epithelium in the absence of mesenchyme. The dominant wavelength of this instability determines the branching pattern and is controlled by epithelial growth rates. These data suggest that physical mechanisms can create the biological patterns that underlie tissue morphogenesis in the embryo. PMID:26170292

  16. Endoscopic low coherence interferometry in upper airways

    Science.gov (United States)

    Delacrétaz, Yves; Boss, Daniel; Lang, Florian; Depeursinge, Christian

    2009-07-01

    We introduce Endoscopic Low Coherence Interferometry to obtain topology of upper airways through commonly used rigid endoscopes. Quantitative dimensioning of upper airways pathologies is crucial to provide maximum health recovery chances, for example in order to choose the correct stent to treat endoluminal obstructing pathologies. Our device is fully compatible with procedures used in day-to-day examinations and can potentially be brought to bedside. Besides this, the approach described here can be almost straightforwardly adapted to other endoscopy-related field of interest, such as gastroscopy and arthroscopy. The principle of the method is first exposed, then filtering procedure used to extract the depth information is described. Finally, demonstration of the method ability to operate on biological samples is assessed through measurements on ex-vivo pork bronchi.

  17. The role of mast cell in tissue morphogenesis. Thymus, duodenum, and mammary gland as examples.

    Science.gov (United States)

    Ribatti, Domenico; Crivellato, Enrico

    2016-02-01

    Mast cells (MCs) are strategically located at host/environment interfaces like skin, airways, and gastro-intestinal and uro-genital tracts. MCs also populate connective tissues in association with blood and lymphatic vessels and nerves. MCs are absent in avascular tissues, such as mineralized bone, cartilage, and cornea. MCs have various functions and different functional subsets of MCs are encountered in different tissues. However, we do not' know exactly what is the physiological function of MC. Most of these functions are not essential for life, as various MC-deficient strains of mice and rats seems to have normal life spans. In this review article, we have reported and discussed the literature data concerning the role of MCs in tissue morphogenesis, and in particular their role in the development of thymus, duodenum, and mammary gland.

  18. Gingival hyperplasia by upper airway obstruction

    OpenAIRE

    Díaz Soriano, Ana; Docente Departamento Académico de Estomatología Biosocial.; Lévano Torres, Víctor; Docente Departamento Académico Médico Quirúrgico.; Pastor Yataco, Shamila; Alumnos del 3er año de Odontología de la UNMSM.; Vallejos Pulido, Arturo; Alumnos del 3er año de Odontología de la UNMSM.; Huamanyauri Gonzales, Lizbeth; Alumnos del 3er año de Odontología de la UNMSM.

    2014-01-01

    The effects of mouth breathing are the introduction of cold air, dry and dusty in the mouth and pharynx, the lost functions of heating, humedificacion and filtering the air entering the nose increases the oral mucosa irritation and pharyngeal. A case of a female patient 15 years old who comes for consultation of Periodontology with increase in volume and gingival redness in the upper anterior sector of upper airway obstruction caused by deviated septum right turbinate hypertrophy and maxillar...

  19. Small particles disrupt postnatal airway development

    OpenAIRE

    2010-01-01

    Increasing numbers of epidemiologic studies associate air pollution exposure in children with decreased lung function development. The objective of this study was to examine the effects of exposure to combustion-generated fine [230 and 212 nm number mean aerodynamic particle diameter (NMAD)] to ultrafine (73 nm NMAD) particles differing in elemental (EC) and organic (OC) carbon content on postnatal airway development in rats. Neonatal Sprague-Dawley rats were exposed from postnatal day 7 thro...

  20. Airway wall stiffening increases peak wall shear stress: a fluid-structure interaction study in rigid and compliant airways.

    Science.gov (United States)

    Xia, Guohua; Tawhai, Merryn H; Hoffman, Eric A; Lin, Ching-Long

    2010-05-01

    The airflow characteristics in a computed tomography (CT) based human airway bifurcation model with rigid and compliant walls are investigated numerically. An in-house three-dimensional (3D) fluid-structure interaction (FSI) method is applied to simulate the flow at different Reynolds numbers and airway wall stiffness. As the Reynolds number increases, the airway wall deformation increases and the secondary flow becomes more prominent. It is found that the peak wall shear stress on the rigid airway wall can be five times stronger than that on the compliant airway wall. When adding tethering forces to the model, we find that these forces, which produce larger airway deformation than without tethering, lead to more skewed velocity profiles in the lower branches and further reduced wall shear stresses via a larger airway lumen. This implies that pathologic changes in the lung such as fibrosis or remodeling of the airway wall-both of which can serve to restrain airway wall motion-have the potential to increase wall shear stress and thus can form a positive feed-back loop for the development of altered flow profiles and airway remodeling. These observations are particularly interesting as we try to understand flow and structural changes seen in, for instance, asthma, emphysema, cystic fibrosis, and interstitial lung disease.

  1. Dynamic Properties of Human Bronchial Airway Tissues

    CERN Document Server

    Wang, Jau-Yi; Pallai, Prathap; Corrigan, Chris J; Lee, Tak H

    2011-01-01

    Young's Modulus and dynamic force moduli were measured on human bronchial airway tissues by compression. A simple and low-cost system for measuring the tensile-strengh of soft bio-materials has been built for this study. The force-distance measurements were undertaken on the dissected bronchial airway walls, cartilages and mucosa from the surgery-removed lungs donated by lung cancer patients with COPD. Young's modulus is estimated from the initial slope of unloading force-displacement curve and the dynamic force moduli (storage and loss) are measured at low frequency (from 3 to 45 Hz). All the samples were preserved in the PBS solution at room temperature and the measurements were perfomed within 4 hours after surgery. Young's modulus of the human bronchial airway walls are fond ranged between 0.17 and 1.65 MPa, ranged between 0.25 to 1.96 MPa for cartilages, and between 0.02 to 0.28 MPa for mucosa. The storage modulus are found varying 0.10 MPa with frequency while the loss modulus are found increasing from ...

  2. Environmental and genetical factors in airway allergies

    Directory of Open Access Journals (Sweden)

    Katarzyna Idzik

    2012-12-01

    Full Text Available It is estimated that approximately 23% of the European population is clinically diagnosed with allergies. In the past three decades, an increase in the incidence of respiratory allergies was noted. At the beginning of the 20th century allergic inflammations affected only around 1% of the world population. Medical symptoms of allergic airway inflammation are variable for different patients. Airways allergy are complex phenotypes, which are determined by both genetic and environmental factors. Potential environmental factors include air pollution, tobacco smoke, diet and hygienic habits. The base of phenotypes diversity is still unknown. Genetic studies of allergic disease are complex , the disease derives from the global effect of a series of genes considered individually. What is more, there are epigenetic effects and interactions among the possible causal genes and a range of environmental factors. Single nucleotide polymorphism (SNP in genes encoding chemokines and their receptors, interleukins and their receptors, eosinophil peroxidase and leukotrienes have been found as a possible factor for a development of allergic airway inflammation. It is known that SNPs are specific for different cohort.

  3. A framework for understanding shared substrates of airway protection

    Directory of Open Access Journals (Sweden)

    Michelle Shevon TROCHE

    2014-07-01

    Full Text Available Deficits of airway protection can have deleterious effects to health and quality of life. Effective airway protection requires a continuum of behaviors including swallowing and cough. Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway. There is significant overlap between the control mechanisms for swallowing and cough. In this review we will present the existing literature to support a novel framework for understanding shared substrates of airway protection. This framework was originally adapted from Eccles' model of cough28 (2009 by Hegland, et al.42 (2012. It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits.

  4. Impact of airway morphological changes on pulmonary flows in scoliosis

    Science.gov (United States)

    Farrell, James; Garrido, Enrique; Valluri, Prashant

    2016-11-01

    The relationship between thoracic deformity in scoliosis and lung function is poorly understood. In a pilot study, we reviewed computed tomography (CT) routine scans of patients undergoing scoliosis surgery. The CT scans were processed to segment the anatomy of the airways, lung and spine. A three-dimensional model was created to study the anatomical relationship. Preliminary analysis showed significant airway morphological differences depending on the anterior position of the spine. A computational fluid dynamics (CFD) study was also conducted on the airway geometry using the inspiratory scans. The CFD model assuming non-compliant airway walls was capable of showing pressure drops in areas of high airway resistance, but was unable to predict regional ventilation differences. Our results indicate a dependence between the dynamic deformation of the airway during breathing and lung function. Dynamic structural deformation must therefore be incorporated within any modelling approaches to guide clinicians on the decision to perform surgical correction of the scoliosis.

  5. Safety and Efficacy of Thoracic External Beam Radiotherapy After Airway Stenting in Malignant Airway Obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Rochet, Nathalie, E-mail: nrochet@partners.org [Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany); Hauswald, Henrik; Schmaus, Martina; Hensley, Frank [Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany); Huber, Peter [Department of Radiotherapy, German Cancer Research Center, Heidelberg (Germany); Eberhardt, Ralf; Herth, Felix J. [Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg (Germany); Debus, Juergen; Neuhof, Dirk [Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany)

    2012-05-01

    Purpose: We retrospectively evaluated the outcome and toxicity of external beam radiotherapy (EBRT) after airway stents were placed in patients treated for malignant airway obstruction. Methods and Materials: Between 2004 and 2009, we performed airway stenting followed by EBRT in 43 patients for symptomatic primary lung cancer (n = 31) or other thoracic malignancies (n = 12). The median time interval between stent placement and first irradiation was 14 days. A median total dose of 50 Gy was delivered. Sixty-seven percent of the patients had reduced performance status (Karnofsky performance score, {<=}70). Results: EBRT had to be stopped prematurely in 16 patients (37%), at a median total dose of 17 Gy, for various reasons. In this group of patients, the survival was poor, with a median overall survival (OS) of only 21 days. Twenty-seven patients (63%) completed radiotherapy as planned, with a median OS of 8.4 months. Fourteen of 43 patients (33%) developed at least one Common Terminology Criteria for Adverse Event of grade 3 to 5. The most common event was a malignant restenosis of the stent leading to asphyxia (n = 7), followed by fistula formation (n = 4), necrosis (n = 3), mediastinitis with abscess (n = 1), secondary nonmalignant airway stenosis (n = 1), and hemoptysis (n = 1). With the exception of one event, all events were associated with a local progression of the tumor. Conclusions: Although the long-term prognosis for patients with malignant airway obstruction is poor, airway stenting combined with EBRT offers a possible therapeutic option, achieving fast relief of acute respiratory distress with an associated antitumor effect, resulting in a potential survival benefit. However, due to local advanced tumor growth, increased rates of adverse events are to be expected, necessitating careful monitoring.

  6. Motorcycle exhaust particles induce airway inflammation and airway hyperresponsiveness in BALB/C mice.

    Science.gov (United States)

    Lee, Chen-Chen; Liao, Jiunn-Wang; Kang, Jaw-Jou

    2004-06-01

    A number of large studies have reported that environmental pollutants from fossil fuel combustion can cause deleterious effects to the immune system, resulting in an allergic reaction leading to respiratory tract damage. In this study, we investigated the effect of motorcycle exhaust particles (MEP), a major pollutant in the Taiwan urban area, on airway inflammation and airway hyperresponsiveness in laboratory animals. BALB/c mice were instilled intratracheally (i.t.) with 1.2 mg/kg and 12 mg/kg of MEP, which was collected from two-stroke motorcycle engines. The mice were exposed 3 times i.t. with MEP, and various parameters for airway inflammation and hyperresponsiveness were sequentially analyzed. We found that MEP would induce airway and pulmonary inflammation characterized by infiltration of eosinophils, neutrophils, lymphocytes, and macrophages in bronchoalveolar lavage fluid (BALF) and inflammatory cell infiltration in lung. In addition, MEP treatment enhanced BALF interleukin-4 (IL-4), IL-5, and interferon-gamma (IFN-gamma) cytokine levels and serum IgE production. Bronchial response measured by unrestrained plethysmography with methacholine challenge showed that MEP treatment induced airway hyperresponsiveness (AHR) in BALB/c mice. The chemical components in MEP were further fractionated with organic solvents, and we found that the benzene-extracted fraction exerts a similar biological effect as seen with MEP, including airway inflammation, increased BALF IL-4, serum IgE production, and induction of AHR. In conclusion, we present evidence showing that the filter-trapped particles emitted from the unleaded-gasoline-fueled two-stroke motorcycle engine may induce proinflammatory and proallergic response profiles in the absence of exposure to allergen.

  7. Difficult Airway Management in Field Conditions: Somalia Experience.

    Science.gov (United States)

    Özkan, Ahmet Selim; Nasır, Serdar Nazif

    2015-10-01

    Difficult airway is defined as having the patient's mask ventilation or difficult tracheal intubation of an experienced anaesthesiologist. A number of reasons, such as congenital or acquired anatomical anomalies, can cause difficult intubation and difficult ventilation. Keeping all equipment ready for airway management of patients will reduce mortality and complications. In this case, it is intended that the submission of difficult airway management who encountered in mandibular reconstruction for mandible bone defect repairing with reconstruction plates before at the field conditions in Somalia.

  8. Oral and airway microbiota in HIV-infected pneumonia patients

    OpenAIRE

    Iwai, S.; Fei, M; Huang, D.; Fong, S.; Subramanian, A.; Grieco, K; Lynch, SV; Huang, L

    2012-01-01

    Despite the increased frequency of recurrent pneumonia in HIV-infected patients and recent studies linking the airway bacterial community (microbiota) to acute and chronic respiratory infection, little is known of the oral and airway microbiota that exist in these individuals and their propensity to harbor pathogens despite antimicrobial treatment for acute pneumonia. This pilot study compared paired samples of the oral and airway microbiota from 15 hospitalized HIV-infected patients receivin...

  9. Rescue of salivary gland function after stem cell transplantation in irradiated glands.

    Directory of Open Access Journals (Sweden)

    Isabelle M A Lombaert

    Full Text Available Head and neck cancer is the fifth most common malignancy and accounts for 3% of all new cancer cases each year. Despite relatively high survival rates, the quality of life of these patients is severely compromised because of radiation-induced impairment of salivary gland function and consequential xerostomia (dry mouth syndrome. In this study, a clinically applicable method for the restoration of radiation-impaired salivary gland function using salivary gland stem cell transplantation was developed. Salivary gland cells were isolated from murine submandibular glands and cultured in vitro as salispheres, which contained cells expressing the stem cell markers Sca-1, c-Kit and Musashi-1. In vitro, the cells differentiated into salivary gland duct cells and mucin and amylase producing acinar cells. Stem cell enrichment was performed by flow cytrometric selection using c-Kit as a marker. In vitro, the cells differentiated into amylase producing acinar cells. In vivo, intra-glandular transplantation of a small number of c-Kit(+ cells resulted in long-term restoration of salivary gland morphology and function. Moreover, donor-derived stem cells could be isolated from primary recipients, cultured as secondary spheres and after re-transplantation ameliorate radiation damage. Our approach is the first proof for the potential use of stem cell transplantation to functionally rescue salivary gland deficiency.

  10. Radiation induced cell loss in rat submandibular gland and its relation to gland function

    NARCIS (Netherlands)

    Zeilstra, LJW; Vissink, A; Konings, AWT; Coppes, RP

    2000-01-01

    Purpose: To understand early and late radiation-induced loss of function of the submandibular gland, changes in cell number were documented and correlated with data on gland function. Modulation of the radiation effect by sialogogues was used to investigate possible mechanisms of action. Materials a

  11. Zinc supplementation alters airway inflammation and airway hyperresponsiveness to a common allergen

    Directory of Open Access Journals (Sweden)

    Morgan Carrie I

    2011-12-01

    Full Text Available Abstract Background Zinc supplementation can modulate immunity through inhibition of NF-κB, a transcription factor that controls many immune response genes. Thus, we sought to examine the mechanism by which zinc supplementation tempers the response to a common allergen and determine its effect on allergic airway inflammation. Methods Mice were injected with zinc gluconate prior to German cockroach (GC feces (frass exposure and airway inflammation was assessed. Primary bone marrow-derived neutrophils and DMSO-differentiated HL-60 cells were used to assess the role of zinc gluconate on tumor necrosis factor (TNFα expression. NF-κB:DNA binding and IKK activity were assessed by EMSA and in vitro kinase assay. Protein levels of A20, RIP1 and TRAF6 were assessed by Western blot analysis. Establishment of allergic airway inflammation with GC frass was followed by administration of zinc gluconate. Airway hyperresponsiveness, serum IgE levels, eosinophilia and Th2 cytokine production were assessed. Results Administration of zinc gluconate prior to allergen exposure resulted in significantly decreased neutrophil infiltration and TNFα cytokine release into the airways. This correlated with decreased NF-κB activity in the whole lung. Treatment with zinc gluconate significantly decreased GC frass-mediated TNFα production from bone-marrow derived neutrophils and HL-60 cells. We confirmed zinc-mediated decreases in NF-κB:DNA binding and IKK activity in HL-60 cells. A20, a natural inhibitor of NF-κB and a zinc-fingered protein, is a potential target of zinc. Zinc treatment did not alter A20 levels in the short term, but resulted in the degradation of RIP1, an important upstream activator of IKK. TRAF6 protein levels were unaffected. To determine the application for zinc as a therapeutic for asthma, we administered zinc following the establishment of allergic airway inflammation in a murine model. Zinc supplementation decreased airway hyperresponsiveness

  12. Comparison of Supreme Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway during Cholecystectomy

    OpenAIRE

    2012-01-01

    Objective: This study compared the safety and efficacy of the Supreme Laryngeal Mask Airway (S-LMA) with that of the ProSeal-LMA (P-LMA) in laparoscopic cholecystectomy. Material and Methods: Sixty adults were randomly allocated. Following anaesthesia induction, experienced LMA users inserted the airway devices. Results: Oropharyngeal leak pressure was similar in groups (S-LMA, 27.8±2.9 cmH20; P-LMA, 27.0±4.7 cmH20; p=0.42) and did not change...

  13. Comparison of Supreme Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway during Cholecystectomy

    OpenAIRE

    2012-01-01

    Objective: This study compared the safety and efficacy of the Supreme Laryngeal Mask Airway (S-LMA) with that of the ProSeal-LMA (P-LMA) in laparoscopic cholecystectomy.Material and Methods: Sixty adults were randomly allocated. Following anaesthesia induction, experienced LMA users inserted the airway devices. Results: Oropharyngeal leak pressure was similar in groups (S-LMA, 27.8±2.9 cmH20; P-LMA, 27.0±4.7 cmH20; p=0.42) and did not change during the induction of and throughout pneumoperit...

  14. A kinetic compartment model for evaluating salivary gland scintigraphies

    DEFF Research Database (Denmark)

    Afzelius, Pia; Fuglsang, Stefan

    2014-01-01

    through a syringe. Time activity curves were generated for each of the four major salivary glands (i.e. the right and left submandibular and right and left parotid glands). Excretion fractions (the fraction of mobilizable radioactivity after administering lemon juice) and the gland activity......-to-thyroid activity ratio were calculated. The data were fitted to both a one- and two-phase uptake model. RESULTS: The median uptake slope and maximal activity were significantly higher in the parotid glands than the submandibular glands (Pparotid glands than...... the submandibular glands (Pparotid glands (Pparotid and submandibular glands. CONCLUSIONS: Tracer accumulation can be represented by a one-phase simple uptake model. The background regions...

  15. Practical advance in obtaining an emergency airway via cricothyroidotomy.

    Science.gov (United States)

    Huber, William G; Dahman, Marc H; Thomas, Deanna; Lipschutz, Joshua H

    2007-05-01

    By the time a cricothyroidotomy is deemed necessary, the patient is in critical need of an emergency airway before anoxic damage ensues. Two things are necessary for the delivery of the requisite oxygen. First, an airway must be rapidly established. Second, the airway must be large enough to facilitate ventilation. Present methods for emergency cricothyroidotomy include needle cricothyroidotomy, which suffers from difficulties in both establishment and ventilation. We describe here a practical and widely available method for establishing a timely effective airway that has been used successfully for five patients since 1992.

  16. Airway, responsiveness and inflammation in adolescent elite swimmers

    DEFF Research Database (Denmark)

    Pedersen, Lise; Lund, T.K.; Barnes, P.J.

    2008-01-01

    . There was no difference in FeNO, cellular composition of sputum, airway reactivity, or prevalence of having AHR to methacholine and/or EVH between swimmers with and without respiratory symptoms. Conclusion: Adolescent elite swimmers do not have significant signs of airway damage after only a few years of intense training...... and competition. This leads us to believe that elite swimmers do not have particularly susceptible airways when they take up competitive swimming when young, but that they develop respiratory symptoms, airway inflammation, and AHR during their swimming careers Udgivelsesdato: 2008/8...

  17. Airway management in patients with burn contractures of the neck.

    Science.gov (United States)

    Prakash, Smita; Mullick, Parul

    2015-12-01

    Airway management of patients with burn contracture of the neck (PBC neck) is a challenge to the anesthesiologist. Patient evaluation includes history, physical and airway examination. A safe approach in the airway management of a patient with moderate to severe PBC neck is to secure the airway with the patient awake. The anesthesiologist should have a pre-planned strategy for intubation of the difficult airway. The choices advocated for airway management of such patients include awake fiberoptic-guided intubation, use of intubating laryngeal mask airway, intubation without neuromuscular blocking agents, intubation with neuromuscular blocking agents after testing the ability to ventilate by mask, pre-induction neck scar release under local anesthesia and ketamine or sedation followed by direct laryngoscopy and intubation and video-laryngoscope guided intubation, amongst others. Preparation of the patient includes an explanation of the proposed procedure, sedation, administration of antisialogogues and regional anesthesia of the airway. The various options for intubation of patients with PBC neck, intraoperative concerns and safe extubation are described. Back-up plans, airway rescue strategies and a review of literature on this subject are presented.

  18. Airway management in patients with deep neck infections

    Science.gov (United States)

    Cho, Soo Young; Woo, Jae Hee; Kim, Yoon Jin; Chun, Eun Hee; Han, Jong In; Kim, Dong Yeon; Baik, Hee Jung; Chung, Rack Kyung

    2016-01-01

    Abstract Securing the airway in patients undergoing surgical intervention to control a deep neck infection (DNI) is challenging for anesthesiologists due to the distorted airway anatomy, limited mouth opening, tissue edema, and immobility. It is critical to assess the risk of a potential difficult airway and prepare the most appropriate airway management method. We reviewed our anesthetic experiences managing patients with DNIs, focusing on the need for video-laryngoscope or awake fiberoptic intubation beyond a standard intubation from the anesthesiologist's perspective. When patients had infections in the masticatory space, mouth of floor, oropharyngeal mucosal space, or laryngopharynx, their airways tended to be managed using methods requiring more effort by the anesthesiologists, and more extensive equipment preparation, compared with use of a standard laryngoscope. The degree to which the main lesion influenced the airway anatomy, especially at the level of epiglottis and aryepiglottic fold was related to the airway management method selected. When managing the airways of patients undergoing surgery for DNIs under general anesthesia, anesthesiologists should use imaging with computed tomography to evaluate the preoperative airway status and a comprehensive understanding of radiological findings, comorbidities, and patients’ symptoms is needed. PMID:27399122

  19. KyoT2 downregulates airway remodeling in asthma.

    Science.gov (United States)

    Hu, Mei; Ou-Yang, Hai-Feng; Han, Xing-Peng; Ti, Xin-Yu; Wu, Chang-Gui

    2015-01-01

    The typical pathological features of asthma are airway remodeling and airway hyperresponsiveness (AHR). KyoT2, a negative modulator of Notch signaling, has been linked to asthma in several previous studies. However, whether KyoT2 is involved in the regulation of airway remodeling or the modulation of airway resistance in asthma is unclear. In this study, we aimed to evaluate the therapeutic potential of KyoT2 in preventing asthma-associated airway remodeling and AHR. BALB/c mice were used to generate a mouse model of asthma. Additionally, the expression of Hes1 and Notch1 in airway was analyzed using Immunofluorescence examination. The asthmatic mice were intranasally administered adenovirus expressing KyoT2 and were compared to control groups. Furthermore, subepithelial fibrosis and other airway remodeling features were analyzed using hematoxylin and eosin staining, Van Gieson's staining and Masson's trichrome staining. AHR was also evaluated. This study revealed that KyoT2 downregulated the expression of Hes1, repressed airway remodeling, and alleviated AHR in asthmatic mice. It is reasonable to assume that KyoT2 downregulates airway remodeling and resistance in asthmatic mice through a Hes1-dependent mechanism. Therefore, KyoT2 is a potential clinical treatment strategy for asthma.

  20. Quantitative computed tomography imaging of airway remodeling in severe asthma.

    Science.gov (United States)

    Grenier, Philippe A; Fetita, Catalin I; Brillet, Pierre-Yves

    2016-02-01

    Asthma is a heterogeneous condition and approximately 5-10% of asthmatic subjects have severe disease associated with structure changes of the airways (airway remodeling) that may develop over time or shortly after onset of disease. Quantitative computed tomography (QCT) imaging of the tracheobronchial tree and lung parenchyma has improved during the last 10 years, and has enabled investigators to study the large airway architecture in detail and assess indirectly the small airway structure. In severe asthmatics, morphologic changes in large airways, quantitatively assessed using 2D-3D airway registration and recent algorithms, are characterized by airway wall thickening, luminal narrowing and bronchial stenoses. Extent of expiratory gas trapping, quantitatively assessed using lung densitometry, may be used to assess indirectly small airway remodeling. Investigators have used these quantitative imaging techniques in order to attempt severity grading of asthma, and to identify clusters of asthmatic patients that differ in morphologic and functional characteristics. Although standardization of image analysis procedures needs to be improved, the identification of remodeling pattern in various phenotypes of severe asthma and the ability to relate airway structures to important clinical outcomes should help target treatment more effectively.

  1. Identification of parathyroid glands: anatomical study and surgical implications.

    Science.gov (United States)

    Melo, Catarina; Pinheiro, Susana; Carvalho, Lina; Bernardes, António

    2015-03-01

    While performing thyroid surgery, the unintentional lesion of parathyroid glands and laryngeal nerves results in a profound alteration in patient's quality of life. To minimize thyroid surgery morbidity, the surgeon must have an in-depth knowledge of the thyroid gland morphology and its anatomical relations in the anterior compartment of the neck. This work intended to simulate total thyroidectomies using cadaver parts and isolate fragments that may correspond to parathyroid glands. The thyroid glands and "eventual" parathyroid glands were then submitted to histological study. Ninety-two cadaver parts were used for macroscopic dissection. A total of 242 fragments were isolated, 154 of which were confirmed through histological study to be parathyroid glands. In 36 cases, all "eventual" parathyroid glands isolated during dissection were confirmed through histological verification. In 40 cases, some glands were confirmed. In 16 cases, none of the "eventual" parathyroid glands was confirmed. The 92 thyroid glands isolated during dissection were also submitted to histological study. In 21 thyroid glands, 16 parathyroid glands were identified in the histological cuts: 8 sub-capsular, 8 extra-capsular, 6 intra-thyroidal. There was no statistical difference between the dimensions of the parathyroid glands. Parathyroid gland identification and preservation are sometimes a challenge during thyroid surgery, difficulty that has been demonstrated during dissection of cadaver parts.

  2. Reduction of Eosinophils in Small Airways by Inhaled Steroids is Insufficient in Patients with Adult Asthma

    Directory of Open Access Journals (Sweden)

    Hiroshi Tanaka

    2006-01-01

    Conclusions: It was speculated that inhaled CFC-BDP and DP-FP might deposit mainly in large airways and fail to fully reach small airways, consequently allowing eosinophilic inflammation to continue in small airways.

  3. NEUROTROPHIN MEDIATION OF ALLERGIC AIRWAYS RESPONSES TO INHALED DIESEL PARTICLES IN MICE

    Science.gov (United States)

    Neurotrophins, including nerve growth factor (NGF) partially mediate many features of allergic airways disease including airway hyper-responsiveness. Diesel exhaust particulates (DEP) associated with the combustion of diesel fuel exacerbate many of these allergic airways respons...

  4. Serum cytokine levels, cigarette smoking and airway responsiveness among pregnant women

    NARCIS (Netherlands)

    Tsunoda, M; Litonjua, AA; Kuniak, MP; Weiss, ST; Satoh, T; Guevarra, L; Tollerud, DJ

    2003-01-01

    Background. Five to twenty percent of healthy, nonasthmatic individuals exhibit airway hyperreactivity. Because cytokines are important intermediates in airway responses, we investigated the relationship between serum cytokines and airway responsiveness in a well-characterized population of pregnant

  5. Blockade of Airway Inflammation by Kaempferol via Disturbing Tyk-STAT Signaling in Airway Epithelial Cells and in Asthmatic Mice

    OpenAIRE

    Ju-Hyun Gong; Daekeun Shin; Seon-Young Han; Sin-Hye Park; Min-Kyung Kang; Jung-Lye Kim; Young-Hee Kang

    2013-01-01

    Asthma is characterized by bronchial inflammation causing increased airway hyperresponsiveness and eosinophilia. The interaction between airway epithelium and inflammatory mediators plays a key role in the asthmatic pathogenesis. The in vitro study elucidated inhibitory effects of kaempferol, a flavonoid found in apples and many berries, on inflammation in human airway epithelial BEAS-2B cells. Nontoxic kaempferol at ≤20  μ M suppressed the LPS-induced IL-8 production through the TLR4 activat...

  6. 粘膜固有层替代物体外培养的实验研究%Experimental study of the culture of submucosal tissue substitute in vitro

    Institute of Scientific and Technical Information of China (English)

    丁桂聪; 毛天球; 杨维东; 陈富林

    2001-01-01

    目的 体外构建粘膜固有层的替代物。方法 将粘膜固有层的成纤维细胞、胶原、培养基等成分混合形成凝胶,并在体外培养。结果 复合的胶原细胞凝胶具有粘膜固有层的类似结构,收缩程度受细胞数量和胶原浓度的影响。结论 构建的胶原细胞凝胶可作为粘膜固有层的替代物。%Objective To fabricate submucosal tissue substitute in vitro.Methods Fibroblasts from submucosal tissue and collagen of rat tail tendons were used to construct submucosal tissue equivalents. Results The collagen-fibroblasts composite was similar to the submucosal tissue in structure.Its contraction rate could be regulated by varying the protein content and fibroblast number. Conclusion The constructed collagen gel is a good model of submucosal tissue.

  7. [Morphofunctional and molecular bases of pineal gland aging].

    Science.gov (United States)

    Khavinson, V Kh; Lin'kova, N S

    2012-01-01

    The review analyzed morphology, molecular and functional aspects of pineal gland aging and methods of it correction. The pineal gland is central organ, which regulates activity of neuroimmunoendocrine, antioxidant and other organisms systems. Functional activity of pineal gland is discreased at aging, which is the reason of melatonin level changing. The molecular and morphology research demonstrated, that pineal gland hadn't strongly pronounced atrophy at aging. Long-term experience showed, that peptides extract of pineal gland epithalamin and synthetic tetrapeptide on it base epithalon restored melatonin secretion in pineal gland and had strong regulatory activity at neuroimmunoendocrine and antioxidant organism systems.

  8. Aplasia of the parotid glands with accessory parotid tissue

    Energy Technology Data Exchange (ETDEWEB)

    Higley, Meghan J.; Walkiewicz, Thomas W.; Miller, Jeffrey H.; Curran, John G.; Towbin, Richard B. [Phoenix Children' s Hospital, Department of Radiology, Phoenix, AZ (United States)

    2010-03-15

    Congenital absence of the parotid gland is a rare entity. Absence is most commonly unilateral, and is not associated with accessory glandular tissue. In the majority of reported cases, parotid gland aplasia is seen with craniofacial abnormalities or hypoplasia of other ectodermal structures, particularly the lacrimal glands. We present a 14-year-old male with bilateral parotid gland aplasia detected incidentally on MRI of the brain and then confirmed on neck CT. The studies also revealed accessory parotid tissue superficial to the left masseter muscle. There were no associated craniofacial abnormalities. The lacrimal glands and submandibular glands were normal. (orig.)

  9. Measurement of intraindividual airway tone heterogeneity and its importance in asthma

    OpenAIRE

    Brown, Robert H.; Togias, Alkis

    2016-01-01

    While airways have some degree of baseline tone, the level and variability of this tone is not known. It is also unclear whether there is a difference in airway tone or in the variability of airway tone between asthmatic and healthy individuals. This study examined airway tone and intraindividual airway tone heterogeneity (variance of airway tone) in vivo in 19 individuals with asthma compared with 9 healthy adults. All participants underwent spirometry, body plethysmography, and high-resolut...

  10. Airway management using laryngeal mask airway in insertion of the Montgomery tracheal tube for subglottic stenosis -A case report-.

    Science.gov (United States)

    Park, Jung Sun; Kwon, Young-Suk; Lee, Sangseock; Yon, Jun Heum; Kim, Dong Won

    2010-12-01

    The Montgomery tracheal tube (T-tube) is a device used as a combined tracheal stent and airway after laryngotracheoplasty for patients with tracheal stenosis. This device can present various challenges to anesthesiologists during its placement, including the potential for acute loss of the airway, inadequate administration of inhalation agents, and inadequacy of controlled mechanical ventilation. The present case of successful airway management used a laryngeal mask airway under total intravenous anesthesia with propofol and remifentanil in the insertion of a Montgomery T-tube in a tracheal resection and thyrotracheal anastomosis because of severe subglottic stenosis.

  11. Clinical Outcomes of Endoscopic Submucosal Dissection for Early Esophageal Squamous Cell Neoplasms: A Retrospective Single-Center Study in China

    Directory of Open Access Journals (Sweden)

    Yanfang Chen

    2016-01-01

    Full Text Available Aims. To retrospectively analyze the clinical outcomes for a large number of endoscopic submucosal dissections (ESDs in early esophageal squamous cell neoplasms (ESCNs at the First Affiliated Hospital of Nanjing Medical University. Patients and Methods. From January 2010 to February 2014, 296 patients (mean age 61.4 years, range 31–85 years; 202 men with 307 early ESCNs (79 intramucosal invasive esophageal squamous cell carcinomas (ESCCs and 228 high-grade intraepithelial neoplasia (HGIN cases were included from a total of 519 consecutive patients who were treated by esophageal ESD at our hospital. The primary end points of the study were rates of en bloc resection and complete resection. Secondary end points were complications, residual and recurrence rates, and mortality during follow-up. Results. The en bloc resection rate and complete resection rate were 93.5% and 78.2%, respectively. Complications included strictures (8.4%, perforations (1.0%, and bleedings (0.7%. Twenty-seven (9.1% patients experienced residual and 18 (6.1% patients experienced recurrence during a mean follow-up period of 30 months. Thirteen patients died from causes unrelated to ESCC, and no cancer-related death was observed. Conclusions. Our study showed that ESD is a successful and relatively safe treatment for intramucosal invasive ESCC and HGIN, fulfilling the criteria of lymph node negative tumors. This should encourage clinicians to select ESD performed by experienced operators as a potential or even preferred treatment option for lesions amenable to endoscopic treatment.

  12. Heterotopic gastric mucosa in the anus and rectum: first case report of endoscopic submucosal dissection and systematic review

    Science.gov (United States)

    Iacopini, Federico; Gotoda, Takuji; Elisei, Walter; Rigato, Patrizia; Montagnese, Fabrizio; Saito, Yutaka; Costamagna, Guido; Iacopini, Giampaolo

    2016-01-01

    Background: Heterotopic gastric mucosa (HGM) is the most reported epithelial heterotopia, but it is very rare in the rectum and anus. Methods: The first case of an asymptomatic adult male with a large nonpolypoid HGM in the low rectum underwent complete resection by endoscopic submucosal dissection (ESD) is reported. The systematic review was based on a comprehensive search of MEDLINE, EMBASE and Google Scholar. Studies on humans were identified with the term ‘heterotopic gastric mucosa in the rectum and /or anus.’ Results: The search identified 79 citations, and 72 cases were evaluated comprising the present report. Congenital malformations were observed in 17 (24%) patients; rectal duplication accounted for most of the cases. The HGM was located in the anus and perineal rectum in 25 cases (41%) and low, middle and proximal pelvic rectum in 20 (33%), five (8%) and 11 cases (18%), respectively. Morphology was nonpolypoid in 37 cases (51%), polypoid in 26 cases (36%) and ulcerated in nine cases (13%). Specific anorectal symptoms were reported by 50 (69%) patients of the whole study population, and by 33 (97%) of 34 patients ≤ 18 years. Complications were observed in 23 cases (32%). The HGM was excised in 50 cases (83%). Endoscopic resection was performed in 17 cases (34%); resection was piecemeal in five of 12 lesions ≥15 mm, required argon plasma coagulation in two cases and was associated with residual tissue in two (17%). Intestinal metaplasia and an adenoma with low-grade dysplasia were described in three adults (4%). Discussion: This systematic review shows that the HGM in the rectum and anus may be associated with specific rectal symptoms and serious complications, mainly in the pediatric population, and a risk of malignancy in adults. Its complete excision should be recommended, and the ESD can overcome the technical limits of conventional endoscopic snare resection and avoid unnecessary surgery. PMID:27103738

  13. Deposition of graphene nanomaterial aerosols in human upper airways.

    Science.gov (United States)

    Su, Wei-Chung; Ku, Bon Ki; Kulkarni, Pramod; Cheng, Yung Sung

    2016-01-01

    Graphene nanomaterials have attracted wide attention in recent years on their application to state-of-the-art technology due to their outstanding physical properties. On the other hand, the nanotoxicity of graphene materials also has rapidly become a serious concern especially in occupational health. Graphene naomaterials inevitably could become airborne in the workplace during manufacturing processes. The inhalation and subsequent deposition of graphene nanomaterial aerosols in the human respiratory tract could potentially result in adverse health effects to exposed workers. Therefore, investigating the deposition of graphene nanomaterial aerosols in the human airways is an indispensable component of an integral approach to graphene occupational health. For this reason, this study carried out a series of airway replica deposition experiments to obtain original experimental data for graphene aerosol airway deposition. In this study, graphene aerosols were generated, size classified, and delivered into human airway replicas (nasal and oral-to-lung airways). The deposition fraction and deposition efficiency of graphene aerosol in the airway replicas were obtained by a novel experimental approach. The experimental results acquired showed that the fractional deposition of graphene aerosols in airway sections studied were all less than 4%, and the deposition efficiency in each airway section was generally lower than 0.03. These results indicate that the majority of the graphene nanomaterial aerosols inhaled into the human respiratory tract could easily penetrate through the head airways as well as the upper part of the tracheobronchial airways and then transit down to the lower lung airways, where undesired biological responses might be induced.

  14. Allergen-induced changes in airway responsiveness are related to baseline airway responsiveness

    NARCIS (Netherlands)

    deBruinWeller, MS; Weller, FR; RijssenbeekNouwens, LHM; Jansen, HM; deMonchy, JGR

    1996-01-01

    In the literature, bronchial allergen challenge is usually reported to result in an increase in histamine-induced airway responsiveness (AR). The present study investigated the relation between baseline AR and allergen-induced changes in AR. The effect of allergen challenge on AR was investigated in

  15. Integrity of airway epithelium is essential against obliterative airway disease in transplanted rat tracheas

    NARCIS (Netherlands)

    Qu, N; de Vos, P; Schelfhorst, M; de Haan, A; Timens, W; Prop, J

    2005-01-01

    Background: The pathogenesis of obliterative bronchiolitis after lung transplantation requires further elucidation. In this study we used rat trachea transplantation to examine the role of epithelium in the progression of obliterative airway disease. Methods: Normal and denuded (i.e., epithelium rem

  16. NUT Carcinoma of the Sublingual Gland

    DEFF Research Database (Denmark)

    Hahn, C H; Andreasen, S; French, C A;

    2016-01-01

    NUT carcinoma (NC) is a recently described, rare and extremely aggressive cancer primarily located to supradiaphragmatic structures and affecting young individuals. NC is characterized by translocations involving the NUT gene on 15q14 with the most common translocation partner gene being BRD4 on 19......p13, resulting in the t(15;19)(q14;p13) karyotype. NC is poorly differentiated and is likely to be overlooked and misdiagnosed as poorly differentiated squamous cell carcinoma (SCC) when immunohistochemical evaluation of NUT protein expression is omitted. Previously, NC has been found in the parotid...... and submandibular glands and we present the first case in the sublingual gland arising in a 40-year-old woman. We discuss the diagnostic considerations for poorly differentiated carcinomas of the salivary glands and advocate the inclusion of NUT immunohistochemistry in this setting. Not only does the NC diagnosis...

  17. Thyroid gland in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Miłkowska-Dymanowska, Joanna; Białas, Adam J; Laskowska, Paulina; Górski, Paweł; Piotrowski, Wojciech J

    2017-01-01

    The risk of chronic obstructive pulmonary disease (COPD), as well as thyroid diseases increases with age. COPD is a common systemic disease associated with chronic inflammation. Many endocrinological disorders, including thyroid gland diseases are related to systemic inflammation. Epidemiological studies suggest that patients with COPD are at higher risk of thyroid disorders. These associations are not well-studied and thyroid gland diseases are not included on the broadly acknowledged list of COPD comorbidities. They may seriously handicap quality of life of COPD patients. Unfortunately, the diagnosis may be difficult, as many signs are masked by the symptoms of the index disease. The comprehension of the correlation between thyroid gland disorders and COPD may contribute to better care of patients. In this review, we attempt to revise available literature describing existing links between COPD and thyroid diseases.

  18. Cadmium effects on the thyroid gland.

    Science.gov (United States)

    Jancic, Snezana A; Stosic, Bojan Z

    2014-01-01

    Cadmium has been listed as one of the 126 priority pollutants and a category I carcinogen. Carcinogenic effects of cadmium on the lungs, testicles, and prostate are widely recognized, but there has been insufficient research on the effect of cadmium on the thyroid gland. Cadmium has the affinity to accumulate not only in the liver, kidneys, and pancreas but also in the thyroid gland. It has been established that cadmium blood concentration correlates positively with its accumulation in the thyroid gland. Women of fertile age have higher cadmium blood and urine concentrations than men. In spite of its redox inertia, cadmium brings about oxidative stress and damage to the tissue by indirect mechanisms. Mitochondria are considered to be the main intracellular targets for cadmium. Colloid cystic goiter, adenomatoid follicular hyperplasia with low-grade dysplasia and thyroglobulin hypo- and asecretion, and parafollicular cell diffuse and nodular hyperplasia and hypertrophy are often found in chronic cadmium toxicity.

  19. Pathophysiology of myoepithelial cells in salivary glands

    Directory of Open Access Journals (Sweden)

    Amisha Ashok Kumar Shah

    2016-01-01

    Full Text Available Myoepithelial cells (MECs are considered to be a key participant in most salivary gland diseases, particularly tumors. MECs structurally resemble both epithelial cells and smooth muscles. Diagnostic dilemmas caused are due to inadequacy of characterizing the wide spectrum of morphologic and immunologic features which are different for both normal and neoplastic MECs. This article discusses the development, functions and structure of both normal and neoplastic MECs, their staining properties and differences in the morphologic and immunophenotypic properties of the MEC in detail. It also describes the role of MEC in pathogenesis and morphogenesis of various nonneoplastic and neoplastic salivary gland lesions and thereby are responsible for the myriad histopathology of salivary gland tumors.

  20. Osteopontin expression in salivary gland carcinomas

    DEFF Research Database (Denmark)

    Bjørndal, Kristine; Larsen, Stine R; Godballe, Christian;

    2011-01-01

    J Oral Pathol Med (2010) Background:  In several cancer types, osteopontin (OPN) expression has been correlated with tumor progression and prognosis. Two earlier studies have examined OPN expression in salivary gland carcinomas with contradictory results. Methods:  One hundred and seventy......-five patients with a primary salivary gland carcinoma diagnosed from January 1, 1990 to December 31, 2005 were identified in the local pathology register, Odense University Hospital. Criteria as documented by Allred et al. were used to assess OPN immunostaining that was performed on surgical specimens. Results......:  Osteopontin was expressed in all salivary gland carcinomas. Adenoid cystic carcinomas had the highest mean sum score (7.3) and a significantly higher proportion of carcinomas with high OPN sum score than both mucoepidermoid carcinoma and acinic cell carcinoma. Correlation of OPN expression with known...

  1. Toll-like receptor and airway remodeling in asthma%Toll样受体在支气管哮喘气道重塑中作用的研究进展

    Institute of Scientific and Technical Information of China (English)

    潘姗姗

    2015-01-01

    支气管哮喘是儿童最常见的慢性呼吸系统疾病之一.气道重塑是哮喘病理变化的重要特征,也是哮喘症状难以控制的重要原因.Tol样受体(Toll-like receptor,TLR)是一种模式识别受体,表达于人呼吸道上皮细胞、平滑肌细胞、黏液腺细胞等多种气道壁结构细胞,在哮喘气道重塑中起重要的调节作用.该文就TLR在支气管哮喘气道重塑中的作用研究进展作一综述.%Bronchial asthma is one of the most common chronic respiratory diseases in children.Airway remodeling that makes asthma difficult to control is an important pathological progress of asthma.Toll-like receptors (TLR), a kind of pattern recognition receptors, are expressed in a variety of human airway structure cells, such as airway epithelial cells, smooth muscle cells, mucus gland cells, etc.It is reported that TLRs play important roles in the regulation of airway remodeling in asthma.This article briefly summarizes the role of TLR in airway remodeling of asthma.

  2. Mistakes in ultrasound examination of salivary glands

    Science.gov (United States)

    Jakubowski, Wiesław

    2016-01-01

    Ultrasonography is the first imaging method applied in the case of diseases of the salivary glands. The article discusses basic mistakes that can be made during an ultrasound examination of these structures. The reasons for these mistakes may be examiner-dependent or may be beyond their control. The latter may include, inter alia, difficult conditions during examination (technical or patient-related), similarity of ultrasound images in different diseases, the lack of clinical and laboratory data as well as the lack of results of other examinations, their insufficient number or incorrectness. Doctor-related mistakes include: the lack of knowledge of normal anatomy, characteristics of ultrasound images in various salivary gland diseases and statistical incidence of diseases, but also attaching excessive importance to such statistical data. The complex anatomical structures of the floor of the oral cavity may be mistaken for benign or malignant tumors. Fragments of correct anatomical structures (bones, arterial wall fibrosis, air bubbles in the mouth) can be wrongly interpreted as deposits in the salivary gland or in its excretory duct. Correct lymph nodes in the parotid glands may be treated as pathologic structures. Lesions not being a simple cyst, e.g. lymphoma, benign or malignant tumors of the salivary glands or metastatic lymph nodes, can be mistaken for one. The image of disseminated focal changes, both anechoic and solid, is not pathognomonic for specific diseases in the salivary glands. However, in part, it occurs typically and requires an extended differential diagnosis. Small focal changes and infiltrative lesions pose a diagnostic problem because their etiology cannot be safely suggested on the basis of an ultrasound examination itself. The safest approach is to refer patients with abnormal focal changes for an ultrasoundguided fine-needle aspiration biopsy. PMID:27446603

  3. Cromoglycate and Nedocromil: Influence on Airway Reactivity

    Science.gov (United States)

    Valletta, E. A.

    1994-01-01

    Although basic mechanisms of bronchial hyper-responsiveness (BHR) are still incompletely understood, inflammation of airways is likely to play a fundamental role in modulating BHR in patients with asthma. The involvement of several inflammatory cells (eosinophils, mast cells, lymphocytes, neutrophils, macrophages and platelets) and of bioactive mediators secreted by these cells in the pathogenesis of asthma is well documented. Sodium cromoglycate and nedocromil sodium are two pharmacological agents which have anti-allergic and anti-inflammatory properties. Their clinical effectiveness in mild to moderate asthma, and the capacity to reduce BHR under different natural and experimental conditions, make them valuable drugs for maintenance therapy in patients with asthma. PMID:18475597

  4. Quantitative analysis of airway abnormalities in CT

    DEFF Research Database (Denmark)

    Petersen, Jens; Lo, P.; Nielsen, Mads;

    2010-01-01

    A coupled surface graph cut algorithm for airway wall segmentation from Computed Tomography (CT) images is presented. Using cost functions that highlight both inner and outer wall borders, the method combines the search for both borders into one graph cut. The proposed method is evaluated on 173...... Area (IA) and Wall Area percentage (WA%) was measured by the proposed method on a total of 723 CT scans from a lung cancer screening study. These measures were significantly different for participants with Chronic Obstructive Pulmonary Disease (COPD) compared to asymptomatic participants. Furthermore...

  5. Mucoactive agents for airway mucus hypersecretory diseases.

    Science.gov (United States)

    Rogers, Duncan F

    2007-09-01

    Airway mucus hypersecretion is a feature of a number of severe respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF). However, each disease has a different airway inflammatory response, with consequent, and presumably linked, mucus hypersecretory phenotype. Thus, it is possible that optimal treatment of the mucus hypersecretory element of each disease should be disease-specific. Nevertheless, mucoactive drugs are a longstanding and popular therapeutic option, and numerous compounds (eg, N-acetylcysteine, erdosteine, and ambroxol) are available for clinical use worldwide. However, rational recommendation of these drugs in guidelines for management of asthma, COPD, or CF has been hampered by lack of information from well-designed clinical trials. In addition, the mechanism of action of most of these drugs is unknown. Consequently, although it is possible to categorize them according to putative mechanisms of action, as expectorants (aid and/or induce cough), mucolytics (thin mucus), mucokinetics (facilitate cough transportability), and mucoregulators (suppress mechanisms underlying chronic mucus hypersecretion, such as glucocorticosteroids), it is likely that any beneficial effects are due to activities other than, or in addition to, effects on mucus. It is also noteworthy that the mucus factors that favor mucociliary transport (eg, thin mucus gel layer, "ideal" sol depth, and elasticity greater than viscosity) are opposite to those that favor cough effectiveness (thick mucus layer, excessive sol height, and viscosity greater than elasticity), which indicates that different mucoactive drugs would be required for treatment of mucus obstruction in proximal versus distal airways, or in patients with an impaired cough reflex. With the exception of mucoregulatory agents, whose primary action is unlikely to be directed against mucus, well-designed clinical trials are required to unequivocally determine the

  6. [Clinical importance of thyroid gland cytology].

    Science.gov (United States)

    Ting, S; Synoracki, S; Bockisch, A; Führer, D; Schmid, K W

    2015-11-01

    The cytological evaluation of fine needle biopsies (FNB) of the thyroid gland crucially depends on a close cooperation between clinicians and cytopathologists. Scintigraphy, sonography as well as clinical data and patient history are necessary for a correct interpretation of the indications for FNB; moreover, these data are of outstanding importance for cytopathologists for the correct interpretation of the cytomorphological findings. This overview describes the present standards in the acquisition, technical workup and cytopathological interpretation of thyroid gland tissue obtained by FNB, particularly focusing on the rapidly growing relevance of additional molecular pathological investigations to increase the diagnostic accuracy of thyroid FNB.

  7. Inertial and interceptional deposition of fibers in a bifurcating airway.

    Science.gov (United States)

    Zhang, L; Asgharian, B; Anjilvel, S

    1996-01-01

    A computer model of a three-dimensional bifurcating airway was constructed in which the parent and daughter airways had different lengths but equal diameters. A diameter of 0.6 cm was chosen for the airways based on the third generation of Weibel's symmetric lung model. Different bifurcation angles of 60 degrees, 90 degrees, and 120 degrees were studied. Airflow fields in the airway were obtained by a finite-element method (FIDAP, Fluid Dynamics International, Evanston, IL) for Reynolds numbers of 500 and 1000, assuming uniform parent inlet velocities. The equations of motion for fiber transport in the airways were obtained, and deposition by the combined mechanisms of impaction and interception was incorporated. A computer code was developed that utilized the flow field data and calculated fiber transport in the airways using the equations of motion for fibers. Deposition efficiency was obtained by simulating a large number of fibers of various sizes. Fiber entering the daughter airways tended to orient themselves parallel to the flow. A site of enhanced deposition (or hot spot) was observed at the carina. The dominant parameter for the deposition was the fiber Stokes number. Flow Reynolds number and airway bifurcation angle were also found to affect the deposition.

  8. A hierarchical scheme for geodesic anatomical labeling of airway trees

    DEFF Research Database (Denmark)

    Feragen, Aasa; Petersen, Jens; Owen, Megan;

    2012-01-01

    We present a fast and robust supervised algorithm for label- ing anatomical airway trees, based on geodesic distances in a geometric tree-space. Possible branch label configurations for a given unlabeled air- way tree are evaluated based on the distances to a training set of labeled airway trees....

  9. Mortality by Level of Emphysema and Airway Wall Thickness

    DEFF Research Database (Denmark)

    Johannessen, Ane; Skorge, Trude Duelien; Bottai, Matteo;

    2013-01-01

    There is limited knowledge of the prognostic value of quantitative computed tomography (CT) measures of emphysema and airway wall thickness (AWT) on mortality.......There is limited knowledge of the prognostic value of quantitative computed tomography (CT) measures of emphysema and airway wall thickness (AWT) on mortality....

  10. A hierarchical scheme for geodesic anatomical labeling of airway trees

    DEFF Research Database (Denmark)

    Feragen, Aasa; Petersen, Jens; Owen, Megan

    2012-01-01

    We present a fast and robust supervised algorithm for label- ing anatomical airway trees, based on geodesic distances in a geometric tree-space. Possible branch label configurations for a given unlabeled air- way tree are evaluated based on the distances to a training set of labeled airway trees...

  11. Repair of damaged supraglottic airway devices: A novel method

    Directory of Open Access Journals (Sweden)

    Kapoor Dheeraj

    2010-06-01

    Full Text Available Abstract Damage of laryngeal mask airway and other supraglottic airway devices has always been a matter of concern. Although manufacturer recommends maximum 40 uses of LMA (and its congeners but damage before 40 uses needs to be evaluated. We hereby, describe a novel method of repair of supraglottic devices when damage occurs at mask inflation line or pilot balloon valve assembly.

  12. In vivo models of human airway epithelium repair and regeneration

    Directory of Open Access Journals (Sweden)

    C. Coraux

    2005-12-01

    Full Text Available Despite an efficient defence system, the airway surface epithelium, in permanent contact with the external milieu, is frequently injured by inhaled pollutants, microorganisms and viruses. The response of the airway surface epithelium to an acute injury includes a succession of cellular events varying from the loss of the surface epithelium integrity to partial shedding of the epithelium or even to complete denudation of the basement membrane. The epithelium has then to repair and regenerate to restore its functions. The in vivo study of epithelial regeneration in animal models has shown that airway epithelial cells are able to dedifferentiate, spread, migrate over the denuded basement membrane and progressively redifferentiate to reconstitute a functional respiratory epithelium after several weeks. Humanised tracheal xenograft models have been developed in immunodeficient nude and severe combined immunodeficient (SCID mice in order to mimic the natural regeneration process of the human airway epithelium and to analyse the cellular and molecular events involved during the different steps of airway epithelial reconstitution. These models represent very powerful tools for analysing the modulation of the biological functions of the epithelium during its regeneration. They are also very useful for identifying stem/progenitor cells of the human airway epithelium. A better knowledge of the mechanisms involved in airway epithelium regeneration, as well as the characterisation of the epithelial stem and progenitor cells, may pave the way to regenerative therapeutics, allowing the reconstitution of a functional airway epithelium in numerous respiratory diseases, such as asthma, chronic obstructive pulmonary diseases, cystic fibrosis and bronchiolitis.

  13. Nitrogen Dioxide Exposure and Airway Responsiveness in Individuals with Asthma

    Science.gov (United States)

    Controlled human exposure studies evaluating the effect of inhaled NO2 on the inherent responsiveness of the airways to challenge by bronchoconstricting agents have had mixed results. In general, existing meta-analyses show statistically significant effects of NO2 on the airway r...

  14. Inhaled corticosteroids and growth of airway function in asthmatic children

    NARCIS (Netherlands)

    Merkus, PJFM; van Pelt, W; van Houwelingen, JC; van Essen-Zandvliet, LEM; Duiverman, EJ; Kerrebijn, KF; Quanjer, PH

    2004-01-01

    Airway inflammation and remodelling play an important role in the pathophysiology of asthma. Remodelling may affect childhood lung function, and this process may be reversed by anti-inflammatory treatment. The current study assessed longitudinaily whether asthma affects growth of airway function rel

  15. Numerical analysis of respiratory flow patterns within human upper airway

    Science.gov (United States)

    Wang, Ying; Liu, Yingxi; Sun, Xiuzhen; Yu, Shen; Gao, Fei

    2009-12-01

    A computational fluid dynamics (CFD) approach is used to study the respiratory airflow dynamics within a human upper airway. The airway model which consists of the airway from nasal cavity, pharynx, larynx and trachea to triple bifurcation is built based on the CT images of a healthy volunteer and the Weibel model. The flow characteristics of the whole upper airway are quantitatively described at any time level of respiratory cycle. Simulation results of respiratory flow show good agreement with the clinical measures, experimental and computational results in the literature. The air mainly passes through the floor of the nasal cavity in the common, middle and inferior nasal meatus. The higher airway resistance and wall shear stresses are distributed on the posterior nasal valve. Although the airways of pharynx, larynx and bronchi experience low shear stresses, it is notable that relatively high shear stresses are distributed on the wall of epiglottis and bronchial bifurcations. Besides, two-dimensional fluid-structure interaction models of normal and abnormal airways are built to discuss the flow-induced deformation in various anatomy models. The result shows that the wall deformation in normal airway is relatively small.

  16. Does hyperbaric oxygen therapy prevent airway anastomosis from breakdown?

    NARCIS (Netherlands)

    Dickhoff, C.; Daniels, J.M.; Brink, A. van den; Paul, M.A.; Verhagen, A.F.T.M.

    2015-01-01

    Ischemia with subsequent necrosis of anastomoses, after central airway resection and reconstruction, remains a feared complication for thoracic surgeons and their patients. To date, there is no evidence to support the use of hyperbaric oxygen in the prevention of necrosis of airway reconstructions i

  17. Airway smooth muscle and fibroblasts in the pathogenesis of asthma

    NARCIS (Netherlands)

    Johnson, Peter R A; Burgess, Janette K

    2004-01-01

    Asthma is a disease characterized by marked structural changes within the airway wall. These changes include deposition of extracellular matrix proteins and an increase in the numbers of airway smooth muscle cells and subepithelial fibroblasts. Both these cell types possess properties that would ena

  18. Tetrodotoxin secreting glands in the skin of puffer fishes.

    Science.gov (United States)

    Kodama, M; Sato, S; Ogata, T; Suzuki, Y; Kaneko, T; Aida, K

    1986-01-01

    Unique exocrine glands or gland-like structures were found in the skin of several species of puffer fishes of the genus Takifugu. The glands of T. pardalis and T. vermiculare porphyreum consisted only of secretory cells with a large vacuole. These cells were completely enclosed by epithelial cells with developed microfilaments, except at their opening to the lumen. The contents of the large vacuole in the peculiar secretory cell were forced out when the puffer was stimulated. Exocrine glands or gland-like structures with peculiar secretory cells were also found in the skin of T. poecilonotus, T. niphobles and T. vermiculare radiatum. A high concentration of TTX was detected in the gland contents collected directly from live specimens of T. pardalis. We therefore conclude that these glands are TTX secreting glands.

  19. Airway Management of Two Patients with Penetrating Neck Trauma

    Directory of Open Access Journals (Sweden)

    P Bhattacharya

    2009-01-01

    Full Text Available Direct trauma to the airway is a rare injury which can lead to disastrous consequences due to compounding effect of bleeding, aspiration of blood, airway obstruction and severe sympathetic stimulation. Here we are presenting two cases of open tracheal injury in two adult males following assault with sharp weapon. Two different techniques of securing the airways were employed depending upon the severity and urgency of the situation. In the first case, orotracheal intubation helped the surgeon to repair airway around the endotracheal tube whereas in the second patient this stenting effect was absent as he was intubated through the distal cut-end of trachea in the face of airway emergency.

  20. Submandibular gland mucocele associated with a mixed ranula.

    Science.gov (United States)

    Hze-Khoong, Eugene Poh; Xu, Liqun; Shen, Shukun; Yin, Xuelai; Wang, Lizhen; Zhang, Chenping

    2012-06-01

    Mucoceles of the submandibular gland are extremely rare pathologic occurrences that present an investigative and management dilemma owing to their clinical indistinguishability from plunging ranulas. Of the few that have been documented, these mucous extravasation cysts involved the submandibular gland alone. We describe perhaps the first case of an extensive submandibular gland mucocele occurring in conjunction with a mixed ranula from the ipsilateral sublingual gland, and discuss the various considerations in the management of such lesions.

  1. Continuous positive airway pressure therapy: new generations.

    LENUS (Irish Health Repository)

    Garvey, John F

    2012-02-01

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS). However, CPAP is not tolerated by all patients with OSAS and alternative modes of pressure delivery have been developed to overcome pressure intolerance, thereby improving patient comfort and adherence. Auto-adjustable positive airway pressure (APAP) devices may be utilised for the long-term management of OSAS and may also assist in the initial diagnosis of OSAS and titration of conventional CPAP therapy. Newer modalities such as C-Flex and A-Flex also show promise as treatment options in the future. However, the evidence supporting the use of these alternative modalities remains scant, in particular with regard to long-term cardiovascular outcomes. In addition, not all APAP devices use the same technological algorithms and data supporting individual APAP devices cannot be extrapolated to support all. Further studies are required to validate the roles of APAP, C-Flex and A-Flex. In the interim, standard CPAP therapy should continue as the mainstay of OSAS management.

  2. Continuous positive airway pressure therapy: new generations.

    LENUS (Irish Health Repository)

    Garvey, John F

    2010-02-01

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS). However, CPAP is not tolerated by all patients with OSAS and alternative modes of pressure delivery have been developed to overcome pressure intolerance, thereby improving patient comfort and adherence. Auto-adjustable positive airway pressure (APAP) devices may be utilised for the long-term management of OSAS and may also assist in the initial diagnosis of OSAS and titration of conventional CPAP therapy. Newer modalities such as C-Flex and A-Flex also show promise as treatment options in the future. However, the evidence supporting the use of these alternative modalities remains scant, in particular with regard to long-term cardiovascular outcomes. In addition, not all APAP devices use the same technological algorithms and data supporting individual APAP devices cannot be extrapolated to support all. Further studies are required to validate the roles of APAP, C-Flex and A-Flex. In the interim, standard CPAP therapy should continue as the mainstay of OSAS management.

  3. Mode of Glucocorticoid Actions in Airway Disease

    Directory of Open Access Journals (Sweden)

    Kazuhiro Ito

    2006-01-01

    Full Text Available Synthetic glucocorticoids are the most potent anti-inflammatory agents used to treat chronic inflammatory disease, such as asthma. However, a small number (<5% of asthmatic patients and almost all patients with chronic obstructive pulmonary disease (COPD do not respond well, or at all, to glucocorticoid therapy. If the molecular mechanism of glucocorticoid insensitivity is uncovered, it may in turn provide insight into the key mechanism of glucocorticoid action and allow a rational way to implement treatment regimens that restore glucocorticoid sensitivity. Glucocorticoids exert their effects by binding to a cytoplasmic glucocorticoid receptor (GR, which is subjected to post-translational modifications. Receptor phosphorylation, acetylation, nitrosylation, ubiquitinylation, and other modifications influence hormone binding, nuclear translocation, and protein half-life. Analysis of GR interactions to other molecules, such as coactivators or corepressors, may explain the genetic specificity of GR action. Priming with inflammatory cytokine or oxidative/nitrative stress is a mechanism for the glucocorticoid resistance observed in chronic inflammatory airway disease via reduction of corepressors or GR modification. Therapies targeting these aspects of the GR activation pathway may reverse glucocorticoid resistance in patients with glucocorticoid-insensitive airway disease and some patients with other inflammatory diseases, such as rheumatoid arthritis and inflammatory bowel disease.

  4. Foreign body in children?s airways

    Directory of Open Access Journals (Sweden)

    Cassol Vitor

    2003-01-01

    Full Text Available OBJECTIVE: To determine the clinical characteristics and the results of bronchoscopic treatment of children due to foreign body aspiration in a university hospital. METHOD: Time series of children who underwent bronchoscopies for foreign bodies aspirated into the airway between March 1993 and July 2002. Each patient was analyzed for age, sex, initial clinical diagnosis, nature and location of the foreign body, duration of symptoms between aspiration and bronchoscopy, radiological findings, results of bronchoscopic removal, complications of bronchoscopy and presence of foreign bodies in the airways. RESULTS: Thirty-four children, 20 (59% boys, ages ranging from nine months to nine years (median = 23 months. In 32 (94% children the foreign body was removed by rigid bronchoscope, and two resulted in thoracotomy. Foreign bodies were more frequent in children under three years of age (66%. A clinical history of foreign body inhalation was obtained in 27 (80% cases. Most of the foreign bodies removed were organic (65% and more frequently found in the right bronchial tree (59%. Foreign bodies were removed within 24 hours in 18 (53% cases. The most frequent radiographic findings were: unilateral air trapping, atelectasis and radiopac foreign body. Major bronchoscopy complications occurred in seven children (22%, and there were no deaths. CONCLUSIONS: More attention is necessary to the respiratory symptoms of aspirations, mainly in boys at early ages, with clinical history and compatible radiological findings. Most foreign bodies removed were of organic nature. In this case series, therapeutic rigid bronchoscopy was effective with few complications.

  5. The cystic fibrosis lower airways microbial metagenome

    Science.gov (United States)

    Moran Losada, Patricia; Chouvarine, Philippe; Dorda, Marie; Hedtfeld, Silke; Mielke, Samira; Schulz, Angela; Wiehlmann, Lutz

    2016-01-01

    Chronic airway infections determine most morbidity in people with cystic fibrosis (CF). Herein, we present unbiased quantitative data about the frequency and abundance of DNA viruses, archaea, bacteria, moulds and fungi in CF lower airways. Induced sputa were collected on several occasions from children, adolescents and adults with CF. Deep sputum metagenome sequencing identified, on average, approximately 10 DNA viruses or fungi and several hundred bacterial taxa. The metagenome of a CF patient was typically found to be made up of an individual signature of multiple, lowly abundant species superimposed by few disease-associated pathogens, such as Pseudomonas aeruginosa and Staphylococcus aureus, as major components. The host-associated signatures ranged from inconspicuous polymicrobial communities in healthy subjects to low-complexity microbiomes dominated by the typical CF pathogens in patients with advanced lung disease. The DNA virus community in CF lungs mainly consisted of phages and occasionally of human pathogens, such as adeno- and herpesviruses. The S. aureus and P. aeruginosa populations were composed of one major and numerous minor clone types. The rare clones constitute a low copy genetic resource that could rapidly expand as a response to habitat alterations, such as antimicrobial chemotherapy or invasion of novel microbes. PMID:27730195

  6. Disordered microbial communities in asthmatic airways.

    Directory of Open Access Journals (Sweden)

    Markus Hilty

    Full Text Available BACKGROUND: A rich microbial environment in infancy protects against asthma [1], [2] and infections precipitate asthma exacerbations [3]. We compared the airway microbiota at three levels in adult patients with asthma, the related condition of COPD, and controls. We also studied bronchial lavage from asthmatic children and controls. PRINCIPAL FINDINGS: We identified 5,054 16S rRNA bacterial sequences from 43 subjects, detecting >70% of species present. The bronchial tree was not sterile, and contained a mean of 2,000 bacterial genomes per cm(2 surface sampled. Pathogenic Proteobacteria, particularly Haemophilus spp., were much more frequent in bronchi of adult asthmatics or patients with COPD than controls. We found similar highly significant increases in Proteobacteria in asthmatic children. Conversely, Bacteroidetes, particularly Prevotella spp., were more frequent in controls than adult or child asthmatics or COPD patients. SIGNIFICANCE: The results show the bronchial tree to contain a characteristic microbiota, and suggest that this microbiota is disturbed in asthmatic airways.

  7. Airway Responsiveness to Psychological Processes in Asthma and Health

    Directory of Open Access Journals (Sweden)

    Thomas eRitz

    2012-09-01

    Full Text Available Psychosocial factors have been found to impact airway pathophysiology in respiratory disease with considerable consistency. Influences on airway mechanics have been studied particularly well. The goal of this article is to review the literature on airway responses to psychological stimulation, discuss potential pathways of influence, and present a well-established emotion-induction paradigm to study airway obstruction elicited by unpleasant stimuli. Observational studies have found systematic associations between lung function and daily mood changes. The laboratory –based paradigm of bronchoconstrictive suggestion has been used successfully to elicit airway obstruction in a substantial proportion of asthmatic individuals. Other studies have demonstrated an enhancement of airway responses to standard airway challenges with exercise, allergens, or methacholine. Standardized emotion-induction techniques have consistently shown airway constriction during unpleasant stimulation, with surgery, blood and injury stimuli being particularly powerful. Findings with various forms of stress induction have been more mixed. A number of methodological factors may account for variability across studies, such as choice of measurement technique, temporal association between stimulation and measurement, and the specific quality and intensity of the stimulus material, in particular the extent of implied action-orientation. Research has also begun to elucidate physiological processes associated with psychologically induced airway responses, with vagal excitation and ventilatory influences being the most likely candidate pathways, whereas the role of specific central nervous system pathways and inflammatory processes has been less studied. The technique of emotion-induction using films has the potential to become a standardized challenge paradigm for the further exploration of airway hyperresponsiveness mediated by central nervous system processes.

  8. Mucociliary clearance, airway inflammation and nasal symptoms in urban motorcyclists

    Directory of Open Access Journals (Sweden)

    Tereza C.S. Brant

    2014-01-01

    Full Text Available OBJECTIVES: There is evidence that outdoor workers exposed to high levels of air pollution exhibit airway inflammation and increased airway symptoms. We hypothesized that these workers would experience increased airway symptoms and decreased nasal mucociliary clearance associated with their exposure to air pollution. METHODS: In total, 25 non-smoking commercial motorcyclists, aged 18-44 years, were included in this study. These drivers work 8-12 hours per day, 5 days per week, driving on urban streets. Nasal mucociliary clearance was measured by the saccharine transit test; airway acidification was measured by assessing the pH of exhaled breath condensate; and airway symptoms were measured by the Sino-nasal Outcome Test-20 questionnaire. To assess personal air pollution exposure, the subjects used a passive-diffusion nitrogen dioxide (NO2 concentration-monitoring system during the 14 days before each assessment. The associations between NO2 and the airway outcomes were analyzed using the Mann-Whitney test and the Chi-Square test. Clinicaltrials.gov: NCT01976039. RESULTS: Compared with clearance in healthy adult males, mucociliary clearance was decreased in 32% of the motorcyclists. Additionally, 64% of the motorcyclists had airway acidification and 92% experienced airway symptoms. The median personal NO2 exposure level was 75 mg/m3 for these subjects and a significant association was observed between NO2 and impaired mucociliary clearance (p = 0.036. CONCLUSION: Non-smoking commercial motorcyclists exhibit increased airway symptoms and airway acidification as well as decreased nasal mucociliary clearance, all of which are significantly associated with the amount of exposure to air pollution.

  9. Specific immune responses against airway epithelial cells in a transgenic mouse-trachea transplantation model for obliterative airway disease

    NARCIS (Netherlands)

    Qu, N; de Haan, A; Harmsen, MC; Kroese, FGM; de Leij, LFMH; Prop, J

    2003-01-01

    Background. Immune injury to airway epithelium is suggested to play a central role in the pathogenesis of obliterative bronchiolitis (OB) after clinical lung transplantation. In several studies, a rejection model of murine trachea transplants is used, resulting in obliterative airway disease (OAD) w

  10. What Are Some Types of Adrenal Gland Disorders?

    Science.gov (United States)

    ... Adrenal Gland Tumors Most adrenal gland tumors—abnormal growths on the adrenal glands—are not cancerous. They often do not cause symptoms or require treatment. However, adrenal gland tumors can produce a variety of different hormones, leading hormone levels to get too high. Adrenal ...

  11. Comparative morphology of Liolaemus lizards precloacal glands

    Directory of Open Access Journals (Sweden)

    Soledad Valdecantos

    2014-12-01

    Full Text Available Liolaemid lizards and amphisbaenids have precloacal pores in the anterior border of the cloaca, where epidermal glands drain and expel pheromonal secretions. Precloacal glands occur usually only in males, but in those few species where both sexes have precloacal glands, these are larger in males. Only the morphology and/or histology of precloacal glands of amphisbaenids have been described, and it is unknown whether in lizards these glands differ across ages, sexes and/or species, and if the lack of pores is associated with a lack of glands. We investigated for the first time the morphology and histology of lizard precloacal glands, by studying three Liolaemus species that differ in the presence of pores in their cloaca: L. irregularis, in which adults and juveniles of both sexes have pores; L. poecilochromus, in which only adult males have pores, and L. neuquensis, in which the adults of both sexes lack pores. Results show that the number of pores varies among species and sexes, but not between ages of a species. Adults, but not juveniles, of L. irregularis have sexual dimorphism in pore sizes; these are larger in males than in females. In addition, pores are larger in adult males of L. irregularis than in L. poecilochromus. Glands are tubuloalveolar with holocrine secretion, having similar structure across individuals, although adult males have larger glands than females and juveniles. Finally, the structure of Liolaemus precloacal glands is very similar to those of the amphisbaenid precloacal glands and the femoral glands of other lizard species.

  12. Ulcerative sialadenitis of minor salivary gland: A short case report.

    Science.gov (United States)

    Kashyap, Roopashri Rajesh; Nair, R Gopakumar; Kashyap, Rajesh Shanker

    2015-01-01

    Minor salivary glands have an important role in the physiology and pathology of the oral cavity though they have been neglected at times. Smoking has a direct effect on the palatal minor salivary glands, and their most common presentation is stomatitis nicotina. We report a case of ulceration in the palatal salivary gland presented with intermittent heavy bleeding from the lesion.

  13. Metastatic liposarcoma of the thyroid gland.

    Science.gov (United States)

    Azar, A R; Weynand, B; Daumerie, C; Coche, E

    2003-10-01

    Metastatic liposarcoma of the thyroid gland is exceptionally rare. A case of pleomorphic liposarcoma, which manifested as a soft tissue lump in the neck, is described in a 30-year-old woman. Fine needle aspiration cytology permitted prompt diagnosis. The ultrasound and CT appearance of this type of thyroid metastasis is described which has not been previously reported in the literature.

  14. Adenomatoid hyperplasia of palatal minor salivary glands

    OpenAIRE

    Bryant, C. J.; Manisali, M.; Barrett, A. W.

    1996-01-01

    Adenomatoid hyperplasia of palatal minor mucous glands is rare but significant because the clinical appearance mimics malignant disease. The typical history of a painless, indolent palatal swelling, together with the histological picture of benign glandular hyperplasia and hypertrophy, are illustrated in this report.

  15. Cyst of ectopic (choristomatous lacrimal gland

    Directory of Open Access Journals (Sweden)

    Rao V

    1989-01-01

    Full Text Available A rare case of cyst of an ectopic lacrimal gland in the bulbar conjunctiva is reported in a 40 year-old-man. The clinical presentation histopathology, differential diagnosis and treatment of this choristomatous lacrimal ductal cyst (Group IV according to Bullock′s classification is described.

  16. Salivary duct carcinoma of the parotid gland

    Directory of Open Access Journals (Sweden)

    Mona Mlika

    2012-01-01

    Full Text Available Salivary duct carcinoma of the parotid gland is an uncommon tumor, highly aggressive. About 200 cases have been reported in the English literature. Pathomorphologically, these tumors showed great similarities to ductal carcinoma of the female breast, which is why they described this tumor as "salivary duct carcinoma." The authors describe a new case of salivary duct carcinoma of the parotid gland. We present the case of a 50-year-old patient with progressive facial paralysis. The MRI examination of the head showed two ill-defined formations. A malignant tumor was strongly suspected, so that a total left parotidectomy with excision of the adjacent facial nerve and left lymph node dissection was performed. Microscopic examination concluded to a salivary duct carcinoma of the left parotid gland negative with Her2/neu antibody with lymph node metastasis. There were no recurrences or metastases within 3 years of follow-up. Salivary duct carcinoma of the parotid gland is a rare tumor with an aggressive behavior. This is due to its propensity to infiltrate distant organs. The diagnosis is based on microscopic examination. Treatment modalities are non-consensual, but some authors advocate the necessity of aggressive approach, especially in tumors negative with Heur2/neu antibody. This is due to the fact that the overexpression of this antigen was reported to be associated with a poor prognosis.

  17. On the mechanism of salivary gland radiosensitivity

    NARCIS (Netherlands)

    Konings, AWT; Coppes, RP; Vissink, A

    2005-01-01

    Purpose: To contribute to the understanding of the enigmatic radiosensitivity of the salivary glands by analysis of appropriate literature, especially with respect to mechanisms of action of early radiation damage, and to supply information on the possibilities of amelioration of radiation damage to

  18. FGF23 and the parathyroid glands.

    Science.gov (United States)

    Silver, Justin; Naveh-Many, Tally

    2010-11-01

    Fibroblast growth factor 23 (FGF23) is a phosphatonin that is secreted by osteocytes and osteoblasts in response to hyperphosphatemia and 1,25-dihydroxyvitamin D (1,25D). It acts on its receptor complex, Klotho-FGFR1c (fibroblast growth factor receptor 1 c-splicing form), in the distal convoluted tubule to repress renal phosphorus reabsorption in the proximal tubule and suppress the renal synthesis of 1,25D. Klotho-FGFR1c is also expressed in the parathyroid glands. FGF23 acts on the receptor complex in the parathyroid glands to decrease parathyroid hormone (PTH) gene expression and PTH secretion through activation of the MAPK pathway. In chronic kidney disease (CKD), both FGF23 and PTH are increased, implying resistance of the parathyroid glands to FGF23. There is a decrease in the Klotho-FGFR1c complex in the parathyroid glands in both experimental CKD and in patients with end-stage renal disease. In addition, in advanced experimental CKD, FGF23 has a decreased ability to inhibit PTH expression.

  19. Papillary microcarcinoma of the thyroid gland

    DEFF Research Database (Denmark)

    Londero, Stefano Christian; Godballe, Christian; Krogdahl, Annelise

    2008-01-01

    INTRODUCTION: Papillary microcarcinomas (PMC) of the thyroid gland are defined according to The WHO Committee as papillary carcinomas measuring 10 mm or less in diameter. A large proportion of these tumours are found coincidentally in the treatment of symptomatic goitre and most cases follow...

  20. Fibromatosis of thyroid gland (a case report.

    Directory of Open Access Journals (Sweden)

    Samsi A

    1992-01-01

    Full Text Available Fibromatosis of thyroid gland is a rare condition encountered in surgical practice. Clinically presenting as goitre, it is treated with near total thyroidectomy with good results. We had one such case under our care at the K.E.M. Hospital, Bombay. Rarity of this condition prompted us to publish the data, the literature is briefly reviewed.

  1. Current concepts of salivary gland tumors

    Directory of Open Access Journals (Sweden)

    Raj Kumar Badam

    2015-01-01

    Full Text Available The embryonic development of salivary glands is a complex process that creates compact, highly organized secretory organs with functions essential for oral health. The development is an example of branching morphogenesis, recent research found to involve unexpectedly dynamic cell motility, and novel regulatory pathways. Numerous growth factors, extracellular matrix molecules, gene regulatory pathways, and mechanical forces contribute to salivary gland morphogenesis, but local gene regulation and morphological changes appear to play particularly notable roles. Salivary gland tumors are one of the most complex and relatively rare groups of lesions encountered in oral pathology practice. Their complexity is attributed to the heterogeneity of the cells of origin of these lesions. Frequent overlap of microscopic features among various neoplasms makes us sometimes even to differentiate benign and malignant lesions leading to a diagnostic dilemma. Here, we review and summarize the current concepts regarding the histogenetic and morphogenetic concepts of salivary gland tumors and their relevance to routine diagnosis and classification of these lesions.

  2. [Dermoid cyst of the parotid gland].

    Science.gov (United States)

    Trandafir, Violeta; Trandafir, Daniela; Ferariu, D; Boişteanu, Otilia; Haba, Danisia

    2011-01-01

    Dermoid cyst of the parotid gland is a rare clinical entity. Definitive clinical diagnosis is often difficult to determine preoperatively because of the lack of pathognomonic features. The most frequent location of a parotid dermoid cyst is a triangular area lying above the pinna. Imaging studies do not definitely diagnose a parotid dermoid cyst. Although parotid dermoid cyst is (generally) well-encapsulated, complete removal of the cyst wall is not sufficient to cure it, so it is mandatory to perform careful excision of the cyst by parotidectomy, in terms of preserving facial nerve integrity. Histopathology of the parotid gland tumor removed by parotidectomy makes a diagnosis of certainty, by revealing a cyst wall with keratinization of the squamous epithelium and the presence of skin annexes (hair follicles, sweat glands, sebaceous glands). We present a rare case of parotid dermoid cyst in a 21-year-old male patient with symptoms and imaging rather suggestive of arch I branchial cyst and a brief review of data in the medical literature of the last 20 years.

  3. Airway responsiveness to mannitol in asthma is associated with chymase-positive mast cells and eosinophilic airway inflammation

    DEFF Research Database (Denmark)

    Sverrild, Asger; Bergqvist, Anders; Baines, Katherine J;

    2016-01-01

    BACKGROUND: Airway hyperresponsiveness (AHR) to inhaled mannitol is associated with indirect markers of mast cell activation and eosinophilic airway inflammation. It is unknown how AHR to mannitol relates to mast cell phenotype, mast cell function and measures of eosinophilic inflammation in airway...... tissue. We compared the number and phenotype of mast cells, mRNA expression of mast cell-associated genes and number of eosinophils in airway tissue of subjects with asthma and healthy controls in relation to AHR to mannitol. METHODS: Airway hyperresponsiveness to inhaled mannitol was measured in 23 non......-smoking, corticosteroid-free asthmatic individuals and 10 healthy controls. Mast cells and eosinophils were identified in mucosal biopsies from all participants. Mast cells were divided into phenotypes based on the presence of chymase. mRNA expression of mast cell-associated genes was measured by real-time PCR. RESULTS...

  4. Experimental study of hybrid-knife endoscopic submucosal dissection (ESD versus standard ESD in a Western country

    Directory of Open Access Journals (Sweden)

    Joaquín de-la Peña

    2014-02-01

    Full Text Available Background: Endoscopic submucosal dissection (ESD is an effective but time-consuming treatment for early neoplasia that requires a high level of expertise. Objective: The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with high-pressure water jet and to compare with standard ESD. Material and methods: We performed a prospective non-survival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0, size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed a total of 50 gastric ESD (30 hybrid-knife and 20 standard. Results: Forty-six (92% ESD were en-bloc and 25 (50% R0 (hybrid-knife: n = 13, 44%; standard: n = 16, 80%; p = 0.04. Hybrid-knife ESD was faster than standard (time: 44.6 ± 21.4 minutes vs. 68.7 ± 33.5 minutes; p = 0.009 and velocity: 20.8 ± 9.2 mm²/min vs. 14.3 ± 9.3 mm²/min (p = 0.079. Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 ± 15.68 to 28.18 ± 20.07 mm²/min; p = 0.615 and standard: From 6.4 ± 0.3 to 19.48 ± 19.21 mm²/min; p = 0.607. The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30% to 100%. Conclusion: despite the initial performance of hybrid-knife ESD is worse than standard ESD, the learning curve with hybrid-knife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results.

  5. Primary Myofibroblasts Maintain Short-Term Viability following Submucosal Injection in Syngeneic, Immune-Competent Mice Utilizing Murine Colonoscopy.

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    Hassan A Khalil

    Full Text Available The myofibroblast is an important stromal cell of the gastrointestinal tract. Current in vitro and in vivo models either do not accurately recreate stromal-epithelial interactions or are not specific to myofibroblasts. We sought to create an animal model that would allow the study of myofibroblast-epithelial interactions. We isolated and cultured colonic myofibroblasts from FVB mice. Cells were α-SMA and vimentin positive but desmin negative on immunoblot analysis. We injected the myofibroblasts into the colonic submucosa of syngeneic adult mice (n = 8 via a miniendoscopic system. We then isolated green fluorescent protein (GFP positive colonic myofibroblasts from C57BL/6-Tg(CAG-EGFP1Osb/J mice and injected them into the colonic lamina propria of C57BL/6J mice at 1x10(5 (n = 14, 1x10(6 (n = 9, or 5x10(6 cells/mL (n = 4. A subset of mice were injected with serum-free media and ink without cells (n = 3. Mice underwent repeat endoscopy and euthanasia one or 7 days after injection. Colons were isolated and either fixed in 10% formalin or the inked sites were individually excised and lysed for DNA. We assessed the injection sites via histology and immunohistochemical stains for α-SMA and GFP. We used qPCR to quantify GFP DNA transcripts at the lamina propria injection sites. Submucosal injection of myofibroblasts resulted in the formation of a subepithelial wheal on endoscopy, which persisted to day 7. Myofibroblasts injected either into the submucosa or lamina propria maintained viability on post-injection day 7 as evidenced by positive α-SMA staining. qPCR of lamina propria injections showed a dose-dependent increase in GFP DNA transcripts on post-injection day 1, whereas the number of transcripts on day 7 was equivalent for the concentrations injected. We demonstrate short-term survival of primary cultured colonic myofibroblasts in syngeneic mice. This may prove to be a valuable model for studying the role of myofibroblasts in states of health

  6. GABAergic signaling in the rat pineal gland.

    Science.gov (United States)

    Yu, Haijie; Benitez, Sergio G; Jung, Seung-Ryoung; Farias Altamirano, Luz E; Kruse, Martin; Seo, Jong Bae; Koh, Duk-Su; Muñoz, Estela M; Hille, Bertil

    2016-08-01

    Pinealocytes secrete melatonin at night in response to norepinephrine released from sympathetic nerve terminals in the pineal gland. The gland also contains many other neurotransmitters whose cellular disposition, activity, and relevance to pineal function are not understood. Here, we clarify sources and demonstrate cellular actions of the neurotransmitter γ-aminobutyric acid (GABA) using Western blotting and immunohistochemistry of the gland and electrical recording from pinealocytes. GABAergic cells and nerve fibers, defined as containing GABA and the synthetic GAD67, were identified. The cells represent a subset of interstitial cells while the nerve fibers were distinct from the sympathetic innervation. The GABAA receptor subunit α1 was visualized in close proximity of both GABAergic and sympathetic nerve fibers as well as fine extensions among pinealocytes and blood vessels. The GABAB 1 receptor subunit was localized in the interstitial compartment but not in pinealocytes. Electrophysiology of isolated pinealocytes revealed that GABA and muscimol elicit strong inward chloride currents sensitive to bicuculline and picrotoxin, clear evidence for functional GABAA receptors on the surface membrane. Applications of elevated potassium solution or the neurotransmitter acetylcholine depolarized the pinealocyte membrane potential enough to open voltage-gated Ca(2+) channels leading to intracellular calcium elevations. GABA repolarized the membrane and shut off such calcium rises. In 48-72-h cultured intact glands, GABA application neither triggered melatonin secretion by itself nor affected norepinephrine-induced secretion. Thus, strong elements of GABA signaling are present in pineal glands that make large electrical responses in pinealocytes, but physiological roles need to be found.

  7. Probable IgG4-related sclerosing disease presenting as a gastric submucosal tumor with an intense tracer uptake on PET/CT: a case report.

    Science.gov (United States)

    Otsuka, Ryota; Kano, Masayuki; Hayashi, Hideki; Hanari, Naoyuki; Gunji, Hisashi; Hayano, Koichi; Matsubara, Hisahiro

    2016-12-01

    A 44-year-old man consulted an internist because of abnormalities in an upper gastrointestinal series. It showed an elevated lesion with central depression in the greater curvature of the middle part of the stomach. Upper gastrointestinal endoscopy showed an elevated lesion with central depression, bridging hold, and no abnormalities of the gastric mucosa in the greater curvature of the middle part of the stomach. Endoscopic ultrasonography showed a submucosal tumor derived from the muscle layer of the stomach. Computed tomography showed a 22-mm tumor in the upper part of the stomach. Integrated position emission tomography/computed tomography (PET/CT) showed an intense tracer uptake by the tumor. Based on these findings, a gastrointestinal stromal tumor was suspected and laparoscopic endoscopic cooperative surgery was performed. A histopathological examination showed lymphoplasmacytic infiltration and fibrosis, and an immunohistochemical analysis showed the infiltration of IgG4-positive lymphoplasmacytic cells. The probable diagnosis was IgG4-related sclerosing disease of the stomach. We herein describe a rare case of probable IgG4-related sclerosing disease which presented as a gastric submucosal tumor. PET/CT is a useful imaging technique for the diagnosis and follow-up of this disease.

  8. Whole inactivated avian Influenza H9N2 viruses induce nasal submucosal dendritic cells to sample luminal viruses via transepithelial dendrites and trigger subsequent DC maturation.

    Science.gov (United States)

    Qin, Tao; Yin, Yinyan; Wang, Xiaoqing; Liu, Haofei; Lin, Jian; Yu, Qinghua; Yang, Qian

    2015-03-10

    Nasal mucosal barrier is a key impediment for the absorption of influenza whole inactivated virus (WIV) intranasal vaccine. Yet it is still unclear how WIV cross the epithelial cells (ECs) in nasal cavity. Here, in vitro, a coculture system was well established, consisting of surrogate nasal ECs (Calu-3) and dendritic cells (DCs). After adding H9N2 WIV on the apical side of ECs, we found that submucosal DCs extended their transepithelial dendrites (TEDs) and sampled luminal viruses. However, ECs were not involved in the transepithelial transport of viruses. Subsequently, the phenotypic and functional maturation of DCs were also enhanced, whereas they were attenuated after blocking of TED formation by anti-JAM1 antibody. In vivo, we confirmed that H9N2 WIV were capable of inducing nasal submucosal DCs to sample luminal viruses via TEDs in the nasal passage but not nasal-associated lymphoid tissue (NALT). CD103(+) and CD103(-) DC subsets participated in this process. Of note, chemokine CCL20, released from the H9N2 WIV-induced ECs, played a vital role in DC recruitment and TED formation. Taken together, our findings indicated that TEDs played a critical role in facilitating viral transport across the epithelial barrier, which may guide the design of novel nasal mucosal vaccine strategies.

  9. Does laparoscopic and endoscopic cooperative surgery for gastric submucosal tumors preserve residual gastric motility? Results of a retrospective single-center study.

    Directory of Open Access Journals (Sweden)

    Yohei Waseda

    Full Text Available Laparoscopic and endoscopic cooperative surgery (LECS is a minimally invasive surgical technique used to resect gastric submucosal tumors with intraluminal growth. Endoscopic submucosal dissection is used to determine the appropriate resection line from within the stomach lumen as it minimizes the stomach wall resection area and prevents postoperative stomach deformity. Although LECS is intended to preserve gastric function, few reports have evaluated postoperative residual gastric motility. Therefore, we conducted a retrospective analysis of patients who underwent LECS to determine the effects of LECS on residual gastric motility.Twenty-two patients underwent endoscopy 3 to 12 months after LECS. Patients were evaluated for endoscopic evidence of gastric motility disorder, namely food residue and occurrence/exacerbation of reflux esophagitis. We considered patients with new onset of gastric symptoms and endoscopic evidence of gastric motility disorder to have clinically relevant gastric motility disorder. We described patient characteristics, tumor location, and surgical findings.Two of 22 patients developed clinically relevant gastric motility disorder after LECS. In one of these patients, the symptoms were not severe; only one had reduced dietary intake and had lost weight. We identified clinically relevant gastric motility disorder in two patients with gastrointestinal stromal tumors located in the lesser curvature of the stomach. The major axis of these two tumors was 34 mm and 38 mm.Many patients did not have clinically relevant gastric motility disorder after LECS. Further investigation is required to identify predisposing factors for gastric motility disorder.

  10. The transcription factor PU.1 promotes alternative macrophage polarization and asthmatic airway inflammation.

    Science.gov (United States)

    Qian, Feng; Deng, Jing; Lee, Yong Gyu; Zhu, Jimmy; Karpurapu, Manjula; Chung, Sangwoon; Zheng, Jun-Nian; Xiao, Lei; Park, Gye Young; Christman, John W

    2015-12-01

    The transcription factor PU.1 is involved in regulation of macrophage differentiation and maturation. However, the role of PU.1 in alternatively activated macrophage (AAM) and asthmatic inflammation has yet been investigated. Here we report that PU.1 serves as a critical regulator of AAM polarization and promotes the pathological progress of asthmatic airway inflammation. In response to the challenge of DRA (dust mite, ragweed, and Aspergillus) allergens, conditional PU.1-deficient (PU/ER(T)(+/-)) mice displayed attenuated allergic airway inflammation, including decreased alveolar eosinophil infiltration and reduced production of IgE, which were associated with decreased mucous glands and goblet cell hyperplasia. The reduced asthmatic inflammation in PU/ER(T)(+/-) mice was restored by adoptive transfer of IL-4-induced wild-type (WT) macrophages. Moreover, after treating PU/ER(T)(+/-) mice with tamoxifen to rescue PU.1 function, the allergic asthmatic inflammation was significantly restored. In vitro studies demonstrate that treatment of PU.1-deficient macrophages with IL-4 attenuated the expression of chitinase 3-like 3 (Ym-1) and resistin-like molecule alpha 1 (Fizz-1), two specific markers of AAM polarization. In addition, PU.1 expression in macrophages was inducible in response to IL-4 challenge, which was associated with phosphorylation of signal transducer and activator of transcription 6 (STAT6). Furthermore, DRA challenge in sensitized mice almost abrogated gene expression of Ym-1 and Fizz-1 in lung tissues of PU/ER(T)(+/-) mice compared with WT mice. These data, all together, indicate that PU.1 plays a critical role in AAM polarization and asthmatic inflammation.

  11. Overexpression of mclca3 in airway epithelium of asthmatic murine models with airway inflammation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hui-lan; HE Li

    2010-01-01

    Asthma is a worldwide prevalent disease that is a considerable health burden in many countries.1 In recent years, the airway epithelium is increasingly recognized as a central contributor to the pathogenesis of asthma.2 One of the most highly induced genes in epithelial cells in experimental allergic airway disease is the third murine calcium-activated chloride channel homologue (mclca3, alias gob-5). Its human homology protein is hCLCA1,3,4 which has been identified as clinically relevant molecules in diseases with secretory dysfunctions including asthma and cystic fibrosis. In initial studies, mclca3 was thought to be a member of calcium-activated chloride channel (CaCCs) family,whereas some new interesting reports suggest that the two mclca3 cleavage products cannot form an anion channel on their own but may instead act as extracellular signaling molecules with as yet unknown functions and interacting partners.5

  12. Neutron therapy for salivary and thyroid gland cancer

    Science.gov (United States)

    Gribova, O. V.; Musabaeva, L. I.; Choynzonov, E. L.; Lisin, V. A.; Novikov, V. A.

    2016-08-01

    The purpose of this study was to analyze the results of the combined modality treatment and radiation therapy using 6.3 MeV fast neutrons for salivary gland cancer and prognostically unfavorable thyroid gland cancer. The study group comprised 127 patients with salivary gland cancer and 46 patients with thyroid gland cancer, who received neutron therapy alone and in combination with surgery. The results obtained demonstrated that the combined modality treatment including fast neutron therapy led to encouraging local control in patients with salivary and thyroid gland cancers.

  13. Aquaporins in Salivary Glands: From Basic Research to Clinical Applications

    Directory of Open Access Journals (Sweden)

    Christine Delporte

    2016-01-01

    Full Text Available Salivary glands are involved in saliva secretion that ensures proper oral health. Aquaporins are expressed in salivary glands and play a major role in saliva secretion. This review will provide an overview of the salivary gland morphology and physiology of saliva secretion, and focus on the expression, subcellular localization and role of aquaporins under physiological and pathophysiological conditions, as well as clinical applications involving aquaporins. This review is highlighting expression and localization of aquaporins in human, rat and mouse, the most studied species and is pointing out possible difference between major salivary glands, i.e., parotid, submandibular and sublingual glands.

  14. Inducible HSP70 Protects Radiation-Induced Salivary Gland Damage

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hae-June; Lee, Yoon-Jin; Kwon, Hee-Choong; Lee, Su-Jae; Bae, Sang-Woo; Lee, Yun-Sil [Korea Institute of Radiological Medical Sciences, Seoul (Korea, Republic of); Kim, Sung-Ho [Chonnam National University, Gwangju (Korea, Republic of)

    2006-07-01

    Irradiation (IR) delivered to the head and neck is a common treatment for malignancies. Salivary glands in the irradiation field are severely damaged, and consequently this resulted in marked salivary hypofunction. While the exact mechanism of salivary gland damage remains enigmatic, fluid secreting acinar cells are lost, and saliva output is dramatically reduced. Previously we have reported that inducible heat shock protein 70 (HSP70i) induced radioresistance in vitro. Moreover, HSP70i localized to salivary glands by gene transfer has great potential for the treatment of salivary gland. Herein, we investigated whether HSP70 can use as radio protective molecules for radiation-induced salivary gland damage in vivo.

  15. Measurement of intraindividual airway tone heterogeneity and its importance in asthma.

    Science.gov (United States)

    Brown, Robert H; Togias, Alkis

    2016-07-01

    While airways have some degree of baseline tone, the level and variability of this tone is not known. It is also unclear whether there is a difference in airway tone or in the variability of airway tone between asthmatic and healthy individuals. This study examined airway tone and intraindividual airway tone heterogeneity (variance of airway tone) in vivo in 19 individuals with asthma compared with 9 healthy adults. All participants underwent spirometry, body plethysmography, and high-resolution computed tomography at baseline and after maximum bronchodilation with albuterol. Airway tone was defined as the percent difference in airway diameter after albuterol at total lung capacity compared with baseline. The amount of airway tone in each airway varied both within and between subjects. The average airway tone did not differ significantly between the two groups (P = 0.09), but the intraindividual airway tone heterogeneity did (P = 0.016). Intraindividual airway tone heterogeneity was strongly correlated with airway tone (r = 0.78, P tone heterogeneity and conventional lung function outcomes. Intraindividual airway tone heterogeneity appears to be an important characteristic of airway pathophysiology in asthma.

  16. Airway smooth muscle phenotype and function : interactions with current asthma therapies

    NARCIS (Netherlands)

    Halayko, A J; Tran, T; Ji, S Y; Yamasaki, A; Gosens, R

    2006-01-01

    Asthma incidence has climbed markedly in the past two decades despite an increased use of medications that suppress airway inflammation and repress contraction of smooth muscle that encircles the airways. Asthmatics exhibit episodes of airway inflammation that potentiates reversible airway smooth mu

  17. L-ornithine derived polyamines in cystic fibrosis airways.

    Directory of Open Access Journals (Sweden)

    Hartmut Grasemann

    Full Text Available Increased arginase activity contributes to airway nitric oxide (NO deficiency in cystic fibrosis (CF. Whether down-stream products of arginase activity contribute to CF lung disease is currently unknown. The objective of this study was to test whether L-ornithine derived polyamines are present in CF airways and contribute to airway pathophysiology. Polyamine concentrations were measured in sputum of patients with CF and in healthy controls, using liquid chromatography-tandem mass spectrometry. The effect of spermine on airway smooth muscle mechanical properties was assessed in bronchial segments of murine airways, using a wire myograph. Sputum polyamine concentrations in stable CF patients were similar to healthy controls for putrescine and spermidine but significantly higher for spermine. Pulmonary exacerbations were associated with an increase in sputum and spermine levels. Treatment for pulmonary exacerbations resulted in decreases in arginase activity, L-ornithine and spermine concentrations in sputum. The changes in sputum spermine with treatment correlated significantly with changes in L-ornithine but not with sputum inflammatory markers. Incubation of mouse bronchi with spermine resulted in an increase in acetylcholine-induced force and significantly reduced nitric oxide-induced bronchial relaxation. The polyamine spermine is increased in CF airways. Spermine contributes to airways obstruction by reducing the NO-mediated smooth muscle relaxation.

  18. Coupled cellular therapy and magnetic targeting for airway regeneration.

    Science.gov (United States)

    Ordidge, Katherine L; Gregori, Maria; Kalber, Tammy L; Lythgoe, Mark F; Janes, Sam M; Giangreco, Adam

    2014-06-01

    Airway diseases including COPD (chronic obstructive pulmonary disease), cystic fibrosis and lung cancer are leading causes of worldwide morbidity and mortality, with annual healthcare costs of billions of pounds. True regeneration of damaged airways offers the possibility of restoring lung function and protecting against airway transformation. Recently, advances in tissue engineering have allowed the development of cadaveric and biosynthetic airway grafts. Although these have produced encouraging results, the ability to achieve long-term functional airway regeneration remains a major challenge. To promote regeneration, exogenously delivered stem and progenitor cells are being trialled as cellular therapies. Unfortunately, current evidence suggests that only small numbers of exogenously delivered stem cells engraft within lungs, thereby limiting their utility for airway repair. In other organ systems, magnetic targeting has shown promise for improving long-term robust cell engraftment. This technique involves in vitro cell expansion, magnetic actuation and magnetically guided cell engraftment to sites of tissue damage. In the present paper, we discuss the utility of coupling stem cell-mediated cellular therapy with magnetic targeting for improving airway regeneration.

  19. The airway epithelium is central to the pathogenesis of asthma.

    Science.gov (United States)

    Holgate, Stephen T

    2008-03-01

    Asthma is an inflammatory disorder principally involving the conducting airways and characterised by infiltration of the airway wall with a range of inflammatory cells driven in large part by activation of Th2-type lymphocytes, mast cells and eosinophils. However a key component of asthma is the structural change that involves all of the elements of the airway wall. Here evidence is presented to suggest that the airway epithelium in asthma is fundamentally abnormal with increased susceptibility to environmental injury and impaired repair associated with activation of the epithelial-mesenchymal trophic unit (EMTU). In addition to adopting an activated phenotype, the barrier function of the epithelium is impaired through defective tight junction formation thereby facilitating penetration of potentially toxic or damaging environmental insults. Activated and repairing epithelial cells generate a range of growth factors that are involved in the early life origins of this disease as well as its progression in the form of mucous metaplasia and airway wall remodeling. By placing the epithelium at the forefront of asthma pathogenesis, different approaches to treatment can be devised focused more on protecting vulnerable airways against environmental injury rather than focusing on suppressing airway inflammation or manipulating the immune response.

  20. Classification of pulmonary airway disease based on mucosal color analysis

    Science.gov (United States)

    Suter, Melissa; Reinhardt, Joseph M.; Riker, David; Ferguson, John Scott; McLennan, Geoffrey

    2005-04-01

    Airway mucosal color changes occur in response to the development of bronchial diseases including lung cancer, cystic fibrosis, chronic bronchitis, emphysema and asthma. These associated changes are often visualized using standard macro-optical bronchoscopy techniques. A limitation to this form of assessment is that the subtle changes that indicate early stages in disease development may often be missed as a result of this highly subjective assessment, especially in inexperienced bronchoscopists. Tri-chromatic CCD chip bronchoscopes allow for digital color analysis of the pulmonary airway mucosa. This form of analysis may facilitate a greater understanding of airway disease response. A 2-step image classification approach is employed: the first step is to distinguish between healthy and diseased bronchoscope images and the second is to classify the detected abnormal images into 1 of 4 possible disease categories. A database of airway mucosal color constructed from healthy human volunteers is used as a standard against which statistical comparisons are made from mucosa with known apparent airway abnormalities. This approach demonstrates great promise as an effective detection and diagnosis tool to highlight potentially abnormal airway mucosa identifying a region possibly suited to further analysis via airway forceps biopsy, or newly developed micro-optical biopsy strategies. Following the identification of abnormal airway images a neural network is used to distinguish between the different disease classes. We have shown that classification of potentially diseased airway mucosa is possible through comparative color analysis of digital bronchoscope images. The combination of the two strategies appears to increase the classification accuracy in addition to greatly decreasing the computational time.