Partial Lung Research Articles

UNUSUAL PRESENTATION OF MALIGNANT MELANOMA OF ORAL CAVITY IN A YOUNG PATIENT

Malignant melanoma of oral cavity (MMOC) is rare and aggressive condition, representing 0.5% of all oral malignant neoplasms. The hard palate and maxillary alveolar mucosa are the most frequently sites affected. This case reports an MMOC in a 19-year-old woman who presented a painless dark lesion in the upper lip. Biopsy was performed, and the histologic findings were of chronic inflammation (2008). Four years later, the patient presented a pigmented nodule lesion in the upper lip mucosa and maxillary alveolar mucosa. A new biopsy was performed, and the diagnosis of MMOC was established with complaints of lymph nodes metastasis. The patient was submitted to surgery, chemotherapy, and radiotherapy. Two years after treatment, the patient presented lung metastasis and was submitted to partial lung resection. This case emphasizes the importance of the follow-up of black lesions and the early diagnosis for a better prognosis in aggressive lesions such as MMOC. Malignant melanoma of oral cavity (MMOC) is rare and aggressive condition, representing 0.5% of all oral malignant neoplasms. The hard palate and maxillary alveolar mucosa are the most frequently sites affected. This case reports an MMOC in a 19-year-old woman who presented a painless dark lesion in the upper lip. Biopsy was performed, and the histologic findings were of chronic inflammation (2008). Four years later, the patient presented a pigmented nodule lesion in the upper lip mucosa and maxillary alveolar mucosa. A new biopsy was performed, and the diagnosis of MMOC was established with complaints of lymph nodes metastasis. The patient was submitted to surgery, chemotherapy, and radiotherapy. Two years after treatment, the patient presented lung metastasis and was submitted to partial lung resection. This case emphasizes the importance of the follow-up of black lesions and the early diagnosis for a better prognosis in aggressive lesions such as MMOC.

Improving lung aeration in ventilated newborn preterm rabbits with a partially aerated lung.

Preterm newborns commonly receive intermittent positive pressure ventilation (iPPV) at birth, but the optimal approach that facilitates uniform lung aeration is unknown, particularly in a partially aerated lung. As both inflation time and exogenous surfactant facilitate uniform lung aeration, we investigated whether they can improve lung aeration and lung mechanics in a partially aerated lung immediately after birth. Preterm rabbit kittens (29 days of gestation, term ~32 days) were delivered by caesarean section and partial lung aeration was created by intubating and mechanically ventilating the right lung. The tube was then withdrawn to ventilate both lungs using inflation times of 0.2 s or 1.0 s, with or without exogenous surfactant (200 mg/kg; Curosurf) and a tidal volume (Vt) of 8 mL/kg. Simultaneous phase contrast X-ray imaging and plethysmography were used to measure lung aeration and mechanics. Kittens ventilated with longer inflation times (1.0 s) reached their target Vt with fewer inflations, required lower inflation pressures (28.5 ± 1.1 vs. 33.5 ± 1.3 cmH2O, P = 0.01) and had higher dynamic lung compliances (0.54 ± 0.3 vs. 0.40 ± 0.3 cmH2O·mL-1·kg-1, P = 0.003). Surfactant increased functional residual capacity (FRC; 31.9 ± 3.2 vs. 18.0 ± 3.9 mL/kg, P = 0.02) and the proportion of the Vt entering the previously unaerated lung but had no effect on dynamic lung compliance. Combining early surfactant treatment with longer inflation times increases FRC levels, improves dynamic lung compliance, reduces inflation pressures and markedly increases the proportion of the lungs being ventilated during iPPV in preterm kittens with a partially aerated lung.NEW & NOTEWORTHY Preterm newborns commonly receive intermittent positive pressure ventilation (iPPV) at birth, but the optimal approach that facilitates uniform lung aeration is unknown, particularly in a partially aerated lung. Using phase contrast X-ray imaging, we showed that combining a long inflation time (1.0 s) with surfactant improved lung mechanics and aeration in the immediate newborn period. The current clinical practice of using short inflation times during iPPV might be suboptimal and a different approach is needed.

Urgent distal pancreatectomy for intraperitoneal hemorrhage due to the spontaneous rupture of a pancreatic metastatic tumor from synovial sarcoma: a case report

BackgroundSynovial sarcoma is a soft tissue malignancy that frequently affects the extremities, adjacent to the large joints. Synovial sarcoma has a high rate of distant metastasis; however, pancreatic metastasis is extremely rare, and to our knowledge, there has been no report of bleeding due to spontaneous tumor rupture. This study reports the case of a patient with synovial sarcoma pancreatic metastasis causing tumor rupture and bleeding, which was successfully managed with emergent distal pancreatectomy.Case presentationA 27-year-old woman underwent extensive resection of the primary tumor and partial lung resection after chemotherapy for left femoral synovial sarcoma and multiple lung metastases 4 years prior. During the follow-up, a 35-mm tumor was noted in the pancreatic tail on abdominal computed tomography (CT), and no other distant metastases were detected via positron emission tomography CT. Laparoscopic distal pancreatectomy was scheduled for pancreatic metastasis of synovial sarcoma. However, before the scheduled pancreatectomy could be conducted, the patient visited the emergency department because of abdominal pain that occurred after consuming a small amount of alcohol, and CT showed ascites with high CT values and leakage of contrast media. She was diagnosed with intra-abdominal hemorrhage due to a ruptured metastatic pancreatic tumor, and an emergency operation was performed. In total, 1500 mL of blood was evacuated from the abdomen, and the bleeding pancreatic tail tumor was resected. Histopathological findings revealed synovial sarcoma metastasis and a ruptured tumor capsule, and tumor cells were observed in the hematoma. After discharge on postoperative day 18, the patient was carefully monitored and confirmed to be in relapse-free survival, without chemotherapy, at 6 months post-surgery.ConclusionsWhile the rate of tumor growth varies depending on the grade of the tumor, the possibility of rupture should be considered even in metastatic pancreatic tumors. In the case of pancreatic tumor rupture with stable circulation, radiological evaluation for oncology is necessary, and primary resection may be compatible with resectable cases.

Partial lung resection by uniportal video-assisted thoracoscopic surgery: technique and pitfalls.

The use of uniportal video-assisted thoracoscopic surgery (VATS) has increased worldwide. The number of facilities introducing this simple and cost-effective surgical procedure in Japan has also increased. Partial lung resection is performed to diagnose or treat various cases and surgeons are required to flexibly deal with it. This report describes the technique and pitfalls of partial lung resection by uniportal VATS.

Biomimetic collagen biomaterial induces in situ lung regeneration by forming functional alveolar

In situ restoration of severely damaged lung remains difficult due to its limited regeneration capacity after injury. Artificial lung scaffolds are emerging as potential substitutes, but it is still a challenge to reconstruct lung regeneration microenvironment in scaffold after lung resection injury. Here, a 3D biomimetic porous collagen scaffold with similar structure characteristics as lung is fabricated, and a novel collagen binding hepatocyte growth factor (CBD-HGF) is tethered on the collagen scaffold for maintaining the biomimetic function of HGF to improve the lung regeneration microenvironment. The biomimetic scaffold was implanted into the operative region of a rat partial lung resection model. The results revealed that vascular endothelial cells and endogenous alveolar stem cells entered the scaffold at the early stage of regeneration. At the later stage, inflammation and fibrosis were attenuated, the microvascular and functional alveolar-like structures were formed, and the general morphology of the injured lung was restored. Taken together, the functional 3D biomimetic collagen scaffold facilitates recovery of the injured lung, alveolar regeneration, and angiogenesis after acute lung injury. Particularly, this is the first study of lung regeneration in vivo guided by biomimetic collagen scaffold materials, which supports the concept that tissue engineering is an effective strategy for alveolar regeneration.

Особливості клінічного перебігу негоспітальної пневмонії у хворих із супутньою хронічною серцевою недостатністю

SummaryThe purpose of the work is to determine the features of the clinic, diagnosis and course ofcommunity-acquired pneumonia (P) in patients with chronic heart failure (CHF).Material and methods. 88 patients with P were examined, the average age of whichwas (61.3±2.2) years, who were admitted and examined at the pulmonology clinic ofNational Military Medical Clinical Center «The Main Military Clinical Hospital» of theMinistry of Defense of Ukraine. The main group included 45 persons with P and CHF,and the comparison group – 43 persons with P without signs of CHF, matched by ageand sex. In order to determine the place of treatment and the development of adverseeffects of P for all patients, a disease severity index on the PORT (PSI) and CRB-65scales was calculated.Results and discussion. In the main group of patients, a significantly higher body massindex was observed, in the majority of cases compensated or subcompensated type 2 diabetesmellitus, chronic kidney disease of I–II study were found as well as a significantly higherpercentage of persons, who have been taking antibacterial drugs for the past three months. Inthe main group of patients there were no patients with grade 1–2 risk of adverse pneumonia,because all patients had two or more comorbidities. It was found that there were significantly among those who had a severe course of P in the main group with multiple concomitantpathology of two or more systems. According to the results of X-ray chest examination, a -significantly higher percentage of patients with bilateral lesions (35.6%, p<0.05) and multiplesection pneumonic infiltration (22.2%, p<0.05) were found in patients of the main group. At thesame time, the comparison group was characterised by domination of patients with unilateralpneumonic infiltration (62.8%, p<0.05).Conclusions. It was found that the clinical course of P in patients with CHF has ahigher score for risk of death from P by the PSI pneumonia severity scale (r=0.635,p<0.05). Patients with P with concomitant CHF were found to have a higher percentageof severe cases with bilateral (35.6%) or multiple partial lung lesions (22.2%).

A Case of Bilateral Secondary Pneumothorax Shortly after the Completion of Concurrent Chemoradiotherapy for Tongue Cancer

Metastatic lung tumours rarely lead to development of pneumothorax, and no case of bilateral secondary pneumothorax due to lung metastases arising from tongue cancer has been reported. Here, we report a case of a patient with tongue cancer with lung metastases complicated by bilateral secondary pneumothorax soon after the completion of concurrent chemoradiotherapy. A 39-year-old man with cervical lymph node metastases originating from pT2N0M0 tongue cancer underwent neck dissection and postoperative concurrent chemoradiotherapy. Shortly after the completion of chemoradiotherapy, he developed bilateral secondary pneumothorax. Subsequently, he underwent partial lung resection for the pulmonary fistulae for diagnostic and therapeutic purposes; nodular lesions found in both the lungs. The diagnosis of secondary pneumothorax was based on histopathological findings. Although all pulmonary fistulae disappeared after partial lung resection, he died of the primary disease despite our best efforts to control the metastatic pulmonary lesions.

Effects of endothelial progenitor cells on acute lung rejection after lung transplantation

Objective To estimate the effects of endothelial progenitor cell(EPC) on acute rejection after lung transplantation. Methods Twenty-four Wistar rats were randomly divided into three groups (n=8): a sham operation group (opening chest alone, group S), a control group[intravenous injection of phosphate buffer saline (PBS) after orthopedic left lung transplantation, group C] and an endothelial progenitor cell group(intravenous injection of EPC+PBS after orthopedic left lung transplantation, group EPC). The donor was SD rat. Total sixteen SD rats were used. The blood of three groups of recipient rats was collected from femoral artery on Day 7 after operation. Then the oxygenation index (PaO2/FiO2) was measured by blood gas analysis while the concentrations of serum inflammatory factor intercellular cell adhesion molecule-1 (ICAM-1) and lymphocytefunctionassociatedantigen-1 (LFA-1) were measured by ELISA. The lungs of sacrificed rats were taken. Then, partial lung tissues were used to measure the dry and wet tissues specific gravity. other part of lung tissues were used to measure concentrations of inflammatory factors interferon-γ(IFN-γ) and interleukin(IL)-2, IL-10 by enzyme linked immunosorbent assay (ELISA) and to evaluate reject reaction by hematoxylin-eosin (H-E) staining. Results Compared with the group C, PaO2/FiO2 was increased whereas the wet/dry weight ratio and protein concentrations were decreased in group EPC(P<0.05). The levels of serum ICAM-1, LFA, IFN-γ and IL-2 in transplanted lung tissues were down-regulated, but the level of IL-10 was up-regulated in group EPC(P<0.05). The reject reaction score of group C (4.3±1.1) and group EPC(2.4±0.8) were higher than the score in group S(0). Conclusions EPC is able to relieve lung acute reject reaction after lung transplantation. Key words: Lung transplantation; Acute rejection; Endothelial progenitor cell

Analysis of difference in activation or inhibition of cerebral cortex during induction of and emergence from general anesthesia: functional near-infrared spectroscopy

Objective To investigate the brain mechanism of anesthesia-related loss of consciousness and awakening though measuring activation or inhibition of cerebral cortex during induction of and emergence from general anesthesia using functional near-infrared spectroscopy. Methods Twenty-two American Society of Anesthesiologists physical status Ⅰor Ⅱ patients of both sexes, aged 40-80 yr, undergoing thoracoscopic partial lung resection, were selected. The functional near-infrared spectroscopy was used to determine the level of oxyhemoglobin in cerebral cortex before and after anesthesia induction and before and after emergence from anesthesia, and a positive number was considered as activation and a negative number as inhibition. Results Compared with the baseline before anesthesia induction, the level of oxyhemoglobin in the premotor cortex was significantly decreased (P 0.05). Conclusion Frontopolar area is activated, and premotor cortex is inhibited during induction of general anesthesia, indicating that induction of anesthesia may first affect the integrated function of management and execution of the brain, and the motor regulation ability is weakened. Individual difference in brain areas activated during emergence from anesthesia is larger, and activated and inhibited brain regions are not found. Key words: Anesthesia, general; Cerebral cortex; Spectroscopy, near-infrared

Thoracoscopic partial lung resection following pneumonectomy: a report of three cases

BackgroundThe prognosis of patients who undergo unilateral pneumonectomy and subsequently develop a contralateral pulmonary tumor can be improved by tumor resection. Thus, surgery is a treatment option if the patient’s pulmonary function and performance status are satisfactory. To date, there have been only few cases reporting thoracoscopic lung resection for pulmonary tumor after contralateral pneumonectomy because of the difficulty in respiratory management during surgery. Thoracoscopic surgery requires the maintenance of the operative field to allow the lung to collapse, and in partial lung resection we need to identify tumor localization. The identification of a tumor lesion just inferior to the pleura is easy; however, the identification of a tumor lesion in the deep parts is difficult. The tumor in the deep part of the lung segments can be easily located if the tumor-affected lobe is allowed to completely collapse. Therefore, ventilation technique should be modified according to the tumor localization.Case presentationHere, we report three cases of thoracoscopic partial lung resections for pulmonary tumors that developed after contralateral pneumonectomy. Intermittent manual ventilation using a tracheal tube was performed in two cases with a lesion just inferior of the pleura. The tumors in both patients were resected using automatic suturing devices while arresting manual ventilation. The affected lobe was allowed to collapse using a bronchial blocker in one of the cases with a lesion in the deep part. Furthermore, she had contralateral pneumothorax with bullae on the right upper and lower lobes of the lung. The tumor in the deep part of the lung segment and ruptured bullae were easily located and resected using automatic suturing devices. The hemodynamic status of the patients was stable, and the intra- and postoperative courses were uneventful.ConclusionsOur cases demonstrate that thoracoscopic lung resection after contralateral pneumonectomy can be performed if intermittent manual ventilation is utilized when the tumor is located just inferior to the pleura and if selective double ventilation using an intrabronchial blocker is utilized when the tumor is located in the deep part.

NOVEL APPROACH FOR TUMOR LOCALIZATION MARKING WITH ENOUGH SURGICAL MARGIN FOR LUNG NEOPLASMS BY USING FLUORESCENCE-GUIDED SURGERY

SESSION TITLE: Advancing the Decision-Making Process in Lung Cancer SESSION TYPE: Original Investigations PRESENTED ON: 10/22/2019 10:45 AM - 10:45 AM PURPOSE: Recent advances of computer tomography make the increase of early stage lung cancer detection and various methods of tumor localization marking have been reported in minimally invasive surgery. However, precise tumor localization with enough surgical margin has not been well established. We previously developed and reported a novel approach for performing segmentectomy by using an infrared thoracoscopy with transbronchial instillation of indocianine green (ICG) by combining with 3D virtual sublobar resection with enough surgical margin. We applied this method to serve both as tumor localization marking and anatomical partial lung resection with enough surgical margin. The purpose of this study is the feasibility of anatomical partial lung resection by using combination of 3D image analyzer and fluorescence guided surgery. METHODS: From September 2014 to November 2018, 15 cases (9 lung cancers, 7 metastatic lung tumors) were enrolled and attempted anatomical partial resection under the guidance of fluorescence. For each case, several virtual sublobar resections were created by 3D Image Analyzer (Fujifilm Co, Tokyo, Japan) preoperatively. The surgical margin was measured in each simulated sublobar resection and the most appropriate procedure was selected. Surgical resection with matching virtual sublobar resection was performed using infrared thoracoscopy with transbronchial indocyanine green instillation. Ten ml of the 10-fold saline-autologous blood-diluted ICG was instilled into each associated subsubsegmental bronchus under general anesthesia. At the beginning of the surgery, a near-infrared (NIR) thoracoscope (PINPOINT, Stryker, MI, USA) was used to visualize the intersegmental lines and planes. The visceral pleura was marked using electric cautery along the border of ICG fluorescence. During operation, the lung was deeply catted according to the border by electric cautery and staplers. The border clarity of ICG fluorescence was evaluated and the distance from the tumor to the surgical margin was compared to simulation in order to investigate success of ICG injection. RESULTS: The mean diameter of the tumor was 15.5+/-7.4mm. The success rate of transbronchial ICG injections was 100% (15/15), because a targeted tumor was involved in the resected specimen in all cases. The shortest distances to the surgical margin by simulation and by actual measurement were 15.1+/-12.2 mm and 14.1+/-6.5mm, respectively (p=0.6474). CONCLUSIONS: ICG-guided anatomical partial resection by transbronchial ICG instillation based on the preoperative 3D image analysis is feasible and obtain enough surgical margin. CLINICAL IMPLICATIONS: This novel approach is fulfill not only precise tumor localization marking but also enough tumor resection margin for nonpalpable small nodule. DISCLOSURES: no disclosure on file for Hidehisa Hoshino; No relevant relationships by Eitetsu Koh, source=Web Response no disclosure on file for Hodaka Oheda; No relevant relationships by YASUO SEKINE, source=Web Response

Protocolo diagnóstico y terapéutico del neumotórax

Pneumothorax is defined as the presence of air in the pleural space, modifying negative intrapleural pressures and causing total or partial lung collapse. Incidence of pneumothorax varies according with its classification, however the rate is higher in males. Mortality rate is highly variable too (depending on patient characteristics –cardiopulmonary reserve– and pneumothorax type). Diagnosis of pneumothorax is mainly based on chest X-ray. Management requires general treatment measures as well as air- evacuation techniques

A Simple Technique for Partial Transmission Lung Shielding in Pediatric Patients Undergoing TBI for HSCT

Total Body Irradiation (TBI) is generally administered as part of the preparative regimen for pediatric patients undergoing Hematopoietic Stem Cell Transplant (HSCT). In this study, we propose a simple partial transmission lung shielding technique for achieving lung dose reduction to ≤ 8-Gy, as mandated in the COG AALL1331 protocol, while conveniently treating patient in a lateral decubitus position on a stretcher at an extended distance using parallel opposed-pair beam arrangement. A CT-sim with the patient in the lateral decubitus position is performed. The ipsilateral arm is tucked folded under and raised over the head and the contralateral arm is rested along the body. Straight patient lateral body geometry, perpendicular with respect to beam direction (Anterior (A)-Posterior (P) beams) is maintained. The legs are bent at the knees so as to encompass the entire body length in the CT- scan. Right and left lungs are contoured separately on the CT-images and the contours are then converted to multi-leaf-collimation (MLC) shapes simulating lung shields. Treatment fields (AP and PA) are inserted with cross-hair centered at the umbilicus. Beam's-eye-view projection of the MLC shapes at source-to-focus distance of 65.4 cm is printed to custom fabricate the lung shields. The shields are constructed from thin lead sheets (0.4 mm thick) each cut to patient lung shape and stacked to the required thickness. The lung blocks are mounted on a blocking tray and positioned in the accessory mount at the gantry of the linac during treatment. Patients are treated in lateral decubitus position on a stretcher positioned at 515 cm distance to mid-umbilicus from the radiation source, using 15 MV photons and AP/PA oriented beams. Lung shields are positioned by aligning the shadow of lung shield made (by using light field) with lung apexes marked on the patient’s skin (anteriorly and posteriorly). Stretcher is turned around for the 2nd field and the lung shield realigned with lung apex. A 1cm-perspex beam spoiler is positioned along the edge of the stretcher to increase skin dose. A total dose of 12 Gy is prescribed to mid-umbilicus depth at 2 Gy BID administered over 3 days. OSLD in-vivo dose measurements are performed during treatments. In-phantom measurements suggested that 9 mm of lead thickness is required to achieve 70-75% transmission in lung for the 15-MV beam. Additional 1 mm of lead thickness is added for safety. Two pediatric patients (ages 10 and 12) were successfully treated using our lung shielding technique. The average dimensions (mm) of lead shields for each lung were 20 (l) × 12 (w) × 10 (t). Measured fractional doses under the lung shield were in the 1.50-1.55 Gy range. Our method of lung shielding provides a simple solution for achieving partial lung dose reduction during pediatric TBI treatments. The shield size is greatly reduced by positioning the lung shields on a tray at the linac gantry accessory mount level compared to shields placed on or close to patient’s body.

Feasibility and validity of double-arm specimen extraction method after partial lung resection in single-port thoracoscopic surgery.

Few previous reports have evaluated lung specimen extraction method or how to improve lung specimen extraction method, especially with single-port thoracoscopic surgery. We evaluated the feasibility and surgical advantages of double-arm lung specimen extraction method by comparing double-arm vs. single-arm specimen extraction times. We retrospectively analyzed data for 268 patients undergoing partial lung resection via single-port thoracoscopy and specimen extraction using a specimen extractor in the Union Medical College Hospital of Fujian Medical University from November 2017 to June 2018. We divided patients into groups based on the specimen location as an upper-lobe group (group I), lower-lobe group (group II), and lung-segment group (group III). We then performed a subgroup analysis based on the degree of collapse of the lung lobe specimens during extraction as follows: good in group IA and IIA, and poor in group IB and IIB. The double-arm method required statistically significantly less time than the single-arm method: (69.6±31.9 vs. 89.9±47.8 s, respectively, P=0.037). We found no significant difference in lung specimen extraction time for double-arm vs. single-arm extraction in group I, II, or III (P=0.093, P=0.153, P=0.174, respectively). We also found no significant difference in lung specimen extraction time between the two methods in group IA and group IIA (P=0.165, P=0.649, respectively). However, in groups IB and IIB, extraction time with the double-arm method was significantly shorter compared with the single-arm method (64.4±12.3 vs. 89.1±12.1 s, P=0.034 and 113.8±27.1 vs. 160.0±31.8 s, P=0.042, respectively). In single-port thoracoscopic partial lung resection, double-arm specimen extraction method is more convenient and can shorten sample extraction time, especially for upper- and lower-lung lobes with poor degree of collapse. Double-arm specimen extraction method is feasible and effective after single-port thoracoscopic partial lung resection.

Mass spectrometry imaging as a tool for evaluating the pulmonary distribution of exogenous surfactant in premature lambs

BackgroundThe amount of surfactant deposited in the lungs and its overall pulmonary distribution determine the therapeutic outcome of surfactant replacement therapy. Most of the currently available methods to determine the intrapulmonary distribution of surfactant are time-consuming and require surfactant labelling. Our aim was to assess the potential of Mass Spectrometry Imaging (MSI) as a label-free technique to qualitatively and quantitatively evaluate the distribution of surfactant to the premature lamb.MethodsTwelve preterm lambs (gestational age 126-127d, term ~150d) were allocated in two experimental groups. Seven lambs were treated with an intratracheal bolus of the synthetic surfactant CHF5633 (200 mg/kg) and 5 lambs were managed with mechanical ventilation for 120 min, as controls. The right lung lobes of all lambs were gradually frozen while inflated to 20 cmH2O pressure for lung cryo-sections for MSI analysis. The intensity signals of SP-C analog and SP-B analog, the two synthetic peptides contained in the CHF5633 surfactant, were used to locate, map and quantify the intrapulmonary exogenous surfactant.ResultsSurfactant treatment was associated with a significant improvement of the mean arterial oxygenation and lung compliance (p < 0.05). Nevertheless, the physiological response to surfactant treatment was not uniform across all animals. SP-C analog and SP-B analog were successfully imaged and quantified by means of MSI in the peripheral lungs of all surfactant-treated animals. The intensity of the signal was remarkably low in untreated lambs, corresponding to background noise. The signal intensity of SP-B analog in each surfactant-treated animal, which represents the surfactant distributed to the peripheral right lung, correlated well with the physiologic response as assessed by the area under the curves of the individual arterial partial oxygen pressure and dynamic lung compliance curves of the lambs.ConclusionsApplying MSI, we were able to detect, locate and quantify the amount of exogenous surfactant distributed to the lower right lung of surfactant-treated lambs. The distribution pattern of SP-B analog correlated well with the pulmonary physiological outcomes of the animals. MSI is a valuable label-free technique which is able to simultaneously evaluate qualitative and quantitative drug distribution in the lung.

Detection of viral pathogens and allergens in infants and young children at high risk of asthma during a wheezing episode

To investigate the viral etiology and allergen distribution in infants and young children at high risk of asthma during a wheezing episode. A total of 135 infants and young children at high risk of asthma were enrolled who were admitted due to asthmatic bronchitis or asthmatic bronchopneumonia between April 2016 and August 2017. Fluorescent probe PCR was used to measure influenza A (Flu A), respiratory syncytium virus (RSV), adenovirus (ADV), parainfluenza virus (PinF), human rhinovirus (HRV), human partial lung virus (hMPV) and human bocavirus (HBoV) in nasopharyngeal aspirates. ImmunoCAP was used to measure inhaled allergens, food allergens, and total IgE concentration. Among the 135 patients, the overall virus detection rate of nasopharyngeal aspirates was 49.6%, and HRV had the highest detection rate of 25.2%, followed by HBoV (9.6%), RSV (8.1%), PinF (5.9%), Flu-A (3.7%), ADV (1.5%) and hMPV (0.7%). The 1-3 years group had a significantly higher detection rate of HRV than the <1 year group (P<0.05). The positive rate of allergen screening was 59.3%, with 44% for inhaled allergens and 89% for food allergens. Among the inhaled allergens, dust mites had the highest positive rate of 77%, followed by mould (37%), pollen (26%) and animal dander (9%). Among the food allergens, egg white had a positive rate of 73% and milk had a positive rate of 68%. The <1 year group had a significantly higher positive rate of inhaled allergens than the 1-3 years group (P<0.05). The 1-3 years age group had a significantly higher level of T-IgE than the <1 year group (P<0.05). The positive virus group had a significantly higher positive rate of inhaled allergens than the non-virus group (P<0.05). The children with the second wheezing episode had significantly higher positive rates of inhaled allergens and food allergens and level of T-IgE than those with the first wheezing episode (P<0.05). The children with the second wheezing episode also had significantly higher positive rates of dust mites and mould than those with the first wheezing episode (P<0.05). Early HRV infection and inhaled allergen sensitization are closely associated with the development of wheezing in infants and young children at high risk of asthma.

Imaging before and after endoscopic lung volume reduction

The treatment of symptomatic lung emphysema by lung volume reduction has become established over the last 15 years. While surgical partial lung resection has profited from improved and less invasive surgical techniques, various endoscopic interventional procedures have been developed and are now available for use. All treatment approaches are dependent on individual anatomical variants and a regional distribution of the lung emphysema, which is why no procedure can be designated as the gold standard for all patients. High-resolution computed tomography can be qualitatively evaluated and provides decisive information for treatment, which is why radiologists play a particularly important role in treatment planning and aftercare of an intervention for reduction of the lung volume. This article presents the various endoscopic techniques, names the demands of the treating physician on the advising radiologist and finally describes how a treatment decision is derived from the results obtained.

Long-term Histopathologic Follow-up of a Spherical Embolic Agent; Observation of the Transvascular Migration of HepaSphereTM.

Very few studies have been published on the long-term histopathologic follow-up of spherical embolic agents after their injection. To our knowledge, there are no reports in the literature regarding pathological analysis of the transvascular migration of HepaSphere particles. We here report a case of a patient with hepatocellular carcinoma (HCC) who underwent liver transplantation 12 months after drug eluting microsphere transcatheter arterial chemoembolization (DEM-TACE), and long-term histopathologic follow-up of the microspheres was performed. Furthermore, to our knowledge, this is the first report in which transvascular migration of a HepaSphere particle was confirmed histologically. A 60-year-old male with chronic hepatitis B was treated with entecavir and seroconversion was obtained. The patient had decompensated cirrhosis, and desired to undergo living donor liver transplantation (LDLT). However, 2 HCC tumors of 3 cm or less were detected in his liver. The transplantation surgeon proposed DEM-TACE as a bridge therapy. The HCCs were located in the right lobe and lateral segment of the liver. A 1.9 F preshaped microcatheter (ProgreatΣ, Terumo, Japan) was selectively inserted into the A3 and anterior segmental branch, 10 mg of epirubicin was injected into each artery, and the arteries were embolized with 7 mg and 13 mg of HepaSphere loaded with epirubicin, respectively. Two months later, contrast-enhanced CT displayed a complete response. At that time, lung metastasis was suspected, but after partial lung resection, the patient was diagnosed as having inflammatory granuloma. One year after DEM-TACE treatment, LDLT was performed. No cancerous cells were detected in the area where the tumor was present, but 22 HepaSphere particles were detected. All particles were present in the interstitium. Furthermore, the transvascular migration of a HepaSphere particle was histologically confirmed. The largest and smallest HepaSphere diameters were 241.6 ± 52.5 µm and 186.5 ± 41.4 µm, respectively, and deformity was 22.6% ± 13.0 %. All the HepaSpheres detected in the examined pathological specimen were noted to be extravascular.

Isolated Pulmonary Cryptococcosis Confused with Lung Tumor 5 Years After Kidney Transplantation: A Case Report

BackgroundIn transplant recipients, due to the use of immunosuppressive therapy, it is occasionally difficult to distinguish between an infection and malignancy, especially in the case of a lung lesion. Here, we report a case of isolated pulmonary cryptococcosis after kidney transplantation that was difficult to distinguish from a lung tumor. Case reportA 52-year-old man underwent a kidney transplant from his mother when he was 44 years old. Immunosuppression was maintained with tacrolimus, methylprednisolone, and mycophenolate mofetil. His post-transplant course was uneventful and serum creatinine levels were maintained. Five years post-transplantation, a non-contrast computed tomography (CT) examination revealed a nodule measuring 3 mm in diameter in the middle lobe of the right lung. The nodule gradually increased to 12 mm in 2 years. Positron emission tomography/CT examination showed a maximum standardized uptake value of 0.5 for the nodule. Biochemical examination revealed no elevation in total leucocyte count and C-reactive protein levels. However, tumor markers were elevated: serum carcinoembryonic antigen, 5.9 ng/mL; pro-gastrin-releasing peptide, 84.6 pg/mL. Furthermore, the serum cryptococcus antigen was negative. Therefore, thoracoscopic partial lung resection was performed. Pathologically, a number of spherical fungi from the necrotic substance of the tumor were confirmed positive by periodic acid-Schiff and Grocott-Gomori staining. The patient was therefore diagnosed with pulmonary cryptococcosis. Two years later, the patient is alive and has shown no evidence of recurrence. ConclusionsIn lung nodules after kidney transplantation, even if serum cryptococcus antigen is not identified, it is necessary to keep in mind the possibility of pulmonary cryptococcosis.

Management of Postoperative Prolonged Air Leak

Prolonged air leak is one of the most common postoperative complications in thoracic surgery. For elective partial lung resections, postoperative air leak lasting longer than 5 - 7 days is arbitrarily defined as prolonged. There are several predictive factors for the development of prolonged air leak that can be subdivided as either preoperative, such as obstructive pulmonary disease, or intraoperative risk factors, such as pleural adhesions or fused fissures. The treatment of postoperative prolonged air leak is performed on an individual basis for each patient and may vary considerably. Four major treatment options can be varied in sequence and use: intensified conservative therapy, installation of sclerosing agents or autologous blood, endoscopic procedures and surgical revision. Prevention, detection and treatment of postoperative prolonged air leak are common aspects of thoracic surgery with high clinical relevance. In contrast to standardised procedures in risk identification and diagnostic work-up, the treatment of prolonged air leak is performed on an individual basis and requires a great deal of surgical expertise. For effective targeted therapy, it seems advisable to agree on a specific standardised therapy sequence within a clinic.