Central Cavitation Research Articles

Cigarette smoking: CT and pathologic findings of associated pulmonary diseases.

The health risks associated with cigarette smoking are well known. Cigarette smoking is the most important causative factor in the development of bronchogenic carcinoma. Pulmonary diseases such as chronic bronchitis, centrilobular and panacinar emphysema, respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), and pulmonary Langerhans cell histiocytosis are also related to cigarette smoking. In adenocarcinoma and squamous cell carcinoma, the most common manifestation at computed tomography (CT) is a solitary pulmonary nodule; in small cell carcinoma, hilar and mediastinal adenopathy secondary to metastases; and in large cell carcinoma, a mass with central necrosis or cavitation in the lung periphery. For chronic bronchitis, the most common CT finding is bronchial wall thickening, but this finding is nonspecific. Emphysema, both centrilobular and panacinar associated with alpha-1-antitrypsin deficiency, usually manifests as areas of decreased attenuation and may involve bullous changes. However, centrilobular emphysema more commonly involves the upper lungs, whereas panacinar emphysema more commonly involves the lower lungs. Most patients with RB-ILD have normal high-resolution CT scans; however, abnormalities may be present, the most common of which are areas of ground-glass attenuation. CT appearance of pulmonary Langerhans cell histiocytosis varies depending on the disease stage: In the early stage, typical CT findings include multiple nodules, usually accompanied by cystic spaces with thin, well-defined walls. As the disease progresses, the cystic spaces become more numerous and the number of nodules decreases.

Infarct Cavities in a Hepatic Allograft

Figure 1. A 49-year-old man underwent liver transplantation in 1989 for alcoholic cirrhosis. In 1994, ischemic cholangitis developed with strictures and signs of ascending cholangitis, leading to a second transplantation. Three weeks later, blood cultures were positive for Clostridium clostridiiforme. Angiography and ultrasonography revealed hepatic-artery thrombosis. A computed tomographic scan (Panel A) of the second allograft showed intrahepatic cavities. A culture from a cavity contained Enterococcus faecalis and coagulase-negative staphylococci. Because of these complications, the second allograft had to be removed. The specimen contained large, multiloculated ischemic infarcts with extensive central cavitation (Panel B). The patient is doing well . . .

Grafts of syngenic cultured, adult dorsal root ganglion-derived Schwann cells to the injured spinal cord of adult rats: preliminary morphological studies

Highly enriched cultures of Schwann cells were obtained from adult rat dorsal root ganglia and implanted (5 × 10 5–9 × 10 5 cells) in the spinal cord of syngenic adult rats at the site of an acute compression lesion produced by a subdural inflatable microballoon. These autografts survived and invaded the host tissue, reducing central cavitation and astrocytic gliosis. They dramatically promoted ingrowth of axons, the majority of which appeared to come from the dorsal roots as judged by their neuropeptide content. Invasion of the transplants by descending, e.g. aminergic fibers, was negligible at survival times of up to 4 months. Nonetheless, autologous Schwann cells, which are readily available in the host, represent a promising material for grafts into the injured spinal cord.

Subpially recorded cervical spinal cord evoked potentials in syringomyelia

Intraoperative spinal cord evoked potentials (SCEPs) to median nerve stimulation were detected subpially from the dorsal surface of the cervical spinal cord in 5 patients with cervical syringomyelia and were compared to normal SCEPs obtained from the unaffected side in 6 patients during intraoperative monitoring of dorsal root entry zone lesion. Normal SCEP began with a positive deflection P9 and a complex N11/N13 with several low amplitude short potentials superimposed on the N11/N13. The complex was followed by a second negative potential N2 and a late prolonged positivity, P. In the 4 patients in whom median nerve somatosensory evoked potentials (SEPs) were present preoperatively, SCEP consisted of the N11 potential and the following low amplitude short (LAS) potentials, while the N13 wave was missing. In the fifth patient, in whom the preoperative median nerve SEP was missing, SCEPs were of much lower amplitude and shorter duration than normal. The potentials N2 and P were not recorded in any of our 5 patients. Changes in N13 wave, N2 and P potentials noted in syringomyelia were presumed to be the result of destruction of the spinal cord dorsal horn neurons caused by spinal cord central cavitation.

Syringomyelia and Syringobulbia: Pathophysiology, Surgical Treatment and Nursing Implications

Syringomyelia (central cavitation of the spinal cord) and syringobulbia (cavitation of the medulla) are relatively rare disorders. These conditions are often found in association with congenital abnormalities such as Chiari malformations, with neoplasms or as sequelae to spinal cord trauma. The pathology progresses from minor sensory changes to weakness and wasting and, in the case of syringobulbia, to respiratory compromise and even death. Surgical treatment involves drainage or decompression of the syrinx cavity with diversion of fluid to the subarachnoid space or peritoneal cavity. Posterior fossa decompression may also be used. These procedures attempt to halt destruction of the nervous system, but will not reverse damage that has already occurred. A case presentation and associated nursing diagnoses are discussed to illustrate current medical and nursing interventions.

MRI下のレーザーセラピー

The authors evaluated the usefulness of percutaneous laser ablation of malignat tumors under magnetic resonance imaging (MRI). A 150m long laser fiber was installed from the Laser Destination Selector (LADESE) to a MRI unit. Experimental percutaneous ablation of liver and muscle tissues in rabbits was done using a Nd-YAG laser fiber placed through a 18-gauge needle. The MRI appearance of the lesion was well correlated with the pathologic findings; a central cavitation, coagulation necrosis and peripheral edema. A patient with advanced breast cancer was treated with laser ablation under MRI. Successful reduction of a massive tumor on the chest wall was achieved without complication while taking a series of MR images before, during, and after the procedure. We conclude that percutaneous laser ablation under MRI is considered to be an useful treatment for deeply situated malignant lesions.

Neuropathology with spinal instrumentation.

Neurohistologic examination of the spinal cord and cauda equina were compared for 28 beagles undergoing anterior and posterior spinal destabilization procedures--Group I (n = 7), destabilized operative controls; Group II (n = 7), posterolateral bone grafting; Group III (n = 7), Harrington distraction instrumentation and posterolateral fusion; and Group IV (n = 7), Luque rectangular instrumentation and posterolateral fusion. All dogs had appeared neurologically intact upon repeated examinations prior to death. Neurohistological abnormalities (Wallerian degeneration of the dorsal columns, corticospinal tracts, and nerve roots, focal cystic degeneration, and intraspinal central cavitation) occurred in only 1 of the 14 animals (7%) in Groups I and II (noninstrumented) and in 9 of the 14 animals (64%) in Groups III and IV (instrumented). This result is statistically significant (p less than 0.001). Transient sensory disturbances and radicular paresthesias have been described in clinical reports of spinal instrumentation. It is probable that subclinical neurologic injuries, such as intraspinal and nerve root infarction in posterior neural tissue, can occur with the use of sublaminar hooks or wires. The chondrodystrophic beagle spinal model in this study should be considered a "worst case situation," and the clinical incidence of neurohistologic changes is expected to be lower.

The histological effects of intracerebral injection or infusion of MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) and MPP + (1-methyl-4-phenylpyridinium) in rat and mouse

Bilateral infusion of MPTP into the substantia nigra, ventral tegmental area of putamen of the rat brain provoked accumulations of leucocytes, but the periphery of nigral lesions showed no significant nerve cell loss. Tyrosine hydroxylase labelling of dopaminergic perikarya showed a normal staining pattern. In contrast, MPP + was more destructive. After one day there was local degeneration of neuronal and glial elements. After one month there was tissue necrosis and central cavitation, but, like MPTP, there was no evidence of selective nigral cell loss. Striatal injection of MPP + also failed to produce retrograde nigral damage. It is concluded that the toxicity of MPP + applied directly to the dopamine system is a consequence of a severe necrotic lesion.

Models of spinal cord injury

Having previously studied a static load model of cord injury in rats, we report here an evaluation of a dynamic (weight drop) technique. Under general anesthesia, Sprague-Dawley rats were subjected to a laminectomy at T12, after which a 10-g weight was dropped onto a force transducer and impounder resting on the spinal cord; the weight drop distances varied in different groups from 0 (control) in increments of 2.5 cm to a maximal height of 17.5 cm. A strain gauge attached to the force transducer yielded an oscilloscopic wave form from which force of impact (peak force and impulse) was calculated. Eighty-six animals were used in this parametric study. The animals were observed for 4 weeks postinjury with two tests of motor recovery (Tarlov score for locomotion and the inclined plane test). After sacrifice at 4 weeks, the spinal cords were removed and, with the use of preset criteria, qualitative histopathological scoring of the extent of tissue damage was carried out. We found that the variable height of weight drop was capable of producing a graded injury that correlated with the force of injury (as measured by the force transducer) and with the outcome parameters of functional recovery and degree of morphological damage in the spinal cord. Histopathologically, there was a tendency to central cavitation of the cord. Both the static load and the dynamic load techniques seem to be valid models of spinal cord injury. Pathologically, however, the tissue damage after static load injury involved primarily the dorsal half of the cord. By contrast, the dynamic load technique produced central cavitation comparable to that observed in human spinal cord injury. In this respect, the dynamic model seems to be superior and its use is therefore recommended for studies of therapeutic intervention for spinal cord injury.

Comparison of continuous-wave and pulsed excitation for interstitial neodymiurn-YAG laser-induced hyperthermia

To investigate the effect of pulsing on neodymium-YAG laser-induced hyperthermia we have exposed rat liver to low-power Nd-YAG laser light delivered via an interstitially inserted fibre. This was either continuous wave excitation or pulsed excitation at 10 or 40 Hz (pulse duration 100μs) with an average power of 1W and exposure durations of 400 s. No differences were seen with respect to overall diameter of the histological damage, diameter of the central cavitation, or intrahepatic temperatures, as measured by an embedded array of microthermocouples. We conclude that with 100-μs pulses, within the range of parameters studied, the pulsing rate does not influence the nature or the extent of damage seen after low-power interstitial Nd-YAG laser hyperthermia.

New observations of soft tissue sarcomas with contrast medium-enhanced computed tomography

Computed tomography examinations were performed on 74 patients who presented to the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania with a known or suspected diagnosis of primary or secondary soft tissue sarcoma. Focal masses were detected on computed tomography study in 59 patients. These masses were classified into three broad categories: centrally necrotic masses with a large predominantly liquefactive center and higher density periphery (29); multilocular, septated masses with distinct linear bands or striations (21); and miscellaneous masses (9). The miscellaneous category included six inhomogeneous and three homogeneous masses. The apparent density differences within these sarcomas were best appreciated on dynamic postcontrast scans. The computed tomography appearance of these sarcomas may be explained by the pathologic findings of cystic degeneration, extensive necrosis, central cavitation, focal hemorrhage, and myxoid changes.

Idiopathic calcifying tenosynovitis

We report the histopathologic findings in two cases of idiopathic calcifying tenosynovitis, one involving the insertion of the right pectoralis minor tendon, and the other the left ring finger proximal interphalangeal joint of a 54-year-old male and a 28-year-old female, respectively. At operation, cream cheese-like material was identified in each case. Sections of tendon in the first case showed numerous circumscribed lesions in various stages of evolution. Early lesions consisted of central granular or globular proteinaceous material surrounded by histiocytes, lymphocytes, and foreign-body giant cells, with a peripheral network of small blood vessels. Larger, more mature lesions contained similar proteinaceous material, but had central cavitation, a thinner reactive inflammatory zone, and a fibrous capsule. The largest lesions were cystic, had no proteinaceous material or significant inflammatory zone, and had a thick fibrous capsule. No calcification was identified in the intratendinous lesions. In contrast, the hyperplastic synovium and other peritendinous tissues contained numerous round psammoma-like calcifications. It is concluded that the synovial and peritendinous psammoma-like calcifications in our cases represent a reaction to a primary tendinous lesion, which may be a consequence of ischemia or persistent mild trauma.

A Human Case Of Ectopic Fascioliasis In Korea.

A case of ectopic fascioliasis involving cecum and ascending colon was reported. This case was a 19-year old Korean female who had a history of postprandial aggravation of intermittent abdominal pain of 3 weeks duration. She was presented with an abdominal mass in the right upper quadrant, for which an operation(right hemicolectomy) was performed. Whole cecum and ascending colon showed multifocal tunnel-like necrotizing granulmas with central cavitations. Numerous Charcot-Leyden crystals were seen along tracts of the worm. The lesion was distributed throughout the entire thickness of the wall. Parasitological examination confirmed the worm found in the intestinal wall to be juvenile form of Fasciola species. Possibilities were discussed on the localization of the fluke and the mode of infection of present case.

High resolution computed tomography in cervical syringomyelia.

Thirty-two cases of documented cervical syringomyelia, 13 of which were already surgically proven, were explored by high resolution computed tomography (CT). A central cavitation was demonstrated in all cases. High resolution CT appears to be more reliable than myelography and should be the examination of choice in cervical syringomyelia.

Multiple Pulmonary Nodules with Central Cavitation

Multiple Pulmonary Nodules with Central Cavitation

Pulmonary Phycomycosis Without Obvious Predisposing Factors

THE PHYCOMYCETES (Mucor, Absidia, andRhizopus) are common saprophytes. Infection with these fungi occurs primarily in patients with severe underlying illness, especially leukemia, lymphoma, and uncontrolled diabetes mellitus.1Our case is note-worthy becauseRhizopuspneumonia occurred without obvious predisposing factors. Report of a Case A 66-year-old man was hospitalized because of cavitary pneumonia. Two months previously, bilateral knee surgery was performed, with cephalothin sodium prophylaxis. Two weeks before admission, fever, chills, pleurisy, and cough with yellow, blood-tinged sputum developed. One week before admission, a chest x-ray film disclosed left lower lobe infiltrate, and penicillin V potassium was given orally. Despite clearing of the initial infiltrate, symptoms worsened, and the chest x-ray film showed a new, left upper lobe infiltrate with central cavitation (Figure). Results of a physical examination on admission were unremarkable except for bibasilar and left axillary rales, decreased knee mobility, and moderate dyspnea. Multichannel (SMA-12) chemistry profiles

The incidence of epithelium in periapical granulomas and the mechanism of cavitation in apical dental cysts in man

In two series of periapical granulomas, approximately one third contained proliferating epithelium, the highest incidence being in the third and fourth decades. Histological observations on the walls of radicular cysts suggest that the cyst wall may result from a three-dimensional proliferation of epithelium. The hypotheses of the mechanism whereby apical cysts undergo central cavitation were investigated histochemically. Proteolytic enzyme activity was detected (a) in the connective tissue within and around the loops of epithelium, suggesting that cavitation may occur owing to connective tissue breakdown, followed by epithelial proliferation and (b) within the epithelium, suggesting that cavitation may be caused by intra-epithelial breakdown.

Cavitating Lung Lesions

<h3>History</h3> A 45-year-old woman was admitted to the hospital for further evaluation of a dry cough and generalized malaise of seven months' duration. Four years ago, the patient had had stage II carcinoma of the cervix that was treated with cobalt therapy and radium-seed implantation. Biannual chest roentgenograms during the interval had been interpreted as normal. Physical examination showed no abnormalities, except for some nondiscrete small lymph nodes palpable in the anterior area of the neck. Tuberculin test as well as skin and serologic tests for fungal diseases were negative. The remainder of the laboratory examinations gave normal results. Admission chest roentgenogram is shown in the Figure. <h3>Diagnosis</h3> Carcinoma of the cervix with cavitary metastases to the lungs. <h3>Comment</h3> The Figure shows three nodular lesions in the lungs, two in the left lung and one in the right, each approximately 2 1/2 cm in diameter. All lesions show central cavitation

The H-reflex in experimental spinal cord trauma.

✓ The H-reflex, the electrical correlate of the monosynaptic stretch reflex, recorded from the median nerve was monitored in cats sustaining controlled impact injuries to the eighth cervical segment of the spinal cord. The H-wave was unchanged in cats that showed only scattered gray matter petechial hemorrhages, whereas the H-wave could not be recorded in cats with central hematoma formation and central cavitation. With intermediate impact injuries that produced a coalescence of gray matter hemorrhages, the H-wave, although initially present, gradually diminished in amplitude and disappeared completely in approximately 2 hours.

Evoked cortical potentials in experimental spinal cord trauma.

✓ The somatosensory cortical evoked response following tibial nerve stimulation was recorded for 4 hours in cats sustaining 100, 300, and 500 gm-cm impact injuries to the posterior thoracic, posterior cervical, and anterior cervical spinal cord. The return of the evoked response could be correlated with the severity of pathological damage to the spinal cord. The evoked potential returned almost immediately in animals sustaining only gray matter petechial hemorrhages, was delayed until 1 hour in animals with perigray white matter hemorrhages, and did not return at all in animals with central cavitation and posterior column fragmentation.