A case of pleural involvement followed by idiopathic retroperitoneal fibrosis

We report a rare case of pleural involvement followed by idiopathic retroperitoneal fibrosis in a 55-year-old man. He complained of right chest pain and his chest radiogram showed pleural thickening and calcification. Chest X-ray computed tomogram (CT) also showed a mass-like pleural thickening and a soft tissue density lesion surrounding the thoracic aorta, suggesting fibrosis. By open pleural biopsy, the mass-like pleural lesion was diagnosed as chronic pleuritis. Three years later, the patient experienced difficulty in urination, and bilateral hydronephrosis which was probably due to a retroperitoneal lesion was detected. Abdominal X-ray CT revealed a retroperitoneal lesion of soft tissue density comprised of a smooth and clearly delineated mass which encased the large vessels and ureters, compatible with retroperitoneal fibrosis. Although it was not possible to biopsy the retroperitoneal lesion, the lesion was clinically and radiologically thought to be retroperitoneal fibrosis. We could not determine the etiology of these findings, but such a case of pleural involvement followed by idiopathic retroperitoneal fibrosis was considered to be very rare.     

Malignant pleural mesothelioma

The incidence of malignant pleural mesothelioma (MPM) has risen for some decades and is expected to peak between 2010 and 2020. Up to now, no single treatment has been proven to be effective and death usually occurs within about 12-17 months after diagnosis. Perhaps because of this poor prognosis, early screening has incited little interest. However, certain forms may have a better prognosis when diagnosed early and treated by multimodal therapy or intrapleural immunotherapy. Diagnosis depends foremost on histological analysis of samples obtained by thoracoscopy. This procedure allows the best staging of the pleural cavity with an attempt to detect visceral pleural involvement, which is one of the most important prognostic factors. Although radiotherapy seems necessary and is efficient in preventing the malignant seeding after diagnostic procedures in patients, there has been no randomized phase III study showing the superiority of any treatment compared with another. However, for the early-stage disease (stage I) a logical therapeutic approach seems to be neoadjuvant intrapleural treatment using cytokines. For more advanced disease (stages II and III) resectability should be discussed with the thoracic surgeons and a multimodal treatment combining surgery, radiotherapy and chemotherapy should be proposed for a randomized controlled study. Palliative treatment is indicated for stage IV. In any case, each patient should be enrolled in a clinical trial.     

Overcoming apoptosis: new methods for improving protein-expression systems

This study was designed to further discriminate alpha1-adrenoceptor subtypes in rat aorta and prostate using functional experiments. Responses induced by phenylephrine were equilibrated in both tissues. The pA2 values and slope factors of several alpha1-antagonists were assessed using concentration-response curves. The antagonists used were prazosin, WB-4101, 5-methylurapidil (5-MU), HV-723, and tamsulosin. In addition, the effects of chloroethylclonidine (CEC) and nifedipine on phenylephrine-induced contractions were investigated. A high pA2 value for prazosin was observed in both tissues (aorta 9.84, prostate 9.19) and the ranking of each drug's pA2 value is as follows: tamsulosin > prazosin > WB-4101 > HV-723 > 5-MU in the aorta, and tamsulosin > prazosin > 5-MU > WB-4101 = HV-723 in the prostate. A significant difference between the pA2 value of each drug except for tamsulosin in the aorta and in prostate was observed (p < 0.01). Inhibition of contraction by pretreatment with CEC was 83.9 +/- 2.42% in the aorta, and 6.17 +/- 0.94% in the prostate. On the other hand, inhibition of maximal response by pretreatment with nifedipine (1 micromol/l) was 35.1 +/- 2.2% in the aorta and 24.5 +/- 3.1% in the prostate. A good correlation between these pA2 values and pKi values for recombinant human alpha1b-adrenoceptor expressed in CHO cells (aorta) and alpha1a-subtypes of CEC pretreated rat hippocampus (prostate) were observed. In conclusion, these results suggest that: (1) the contraction of these two tissues is mediated by alpha1H-adrenoceptor with a high affinity for prazosin; (2) alpha1H-adrenoceptors correspond to alpha1b-(aorta) and alpha1a-subtypes (prostate), and (3) each alpha1-adrenoceptor subtype in the aorta and prostate may be alpha1b-(aorta) and alpha1a-subtypes (prostate), respectively.     

D2 receptors in the ventrolateral striatum are involved in feeding behavior in rats

The alpha1-adrenoceptor subtypes mediating contraction of rabbit aorta and urethra were pharmacologically characterized using an isolated organ bath technique. Although aorta was as sensitive as urethra to the contractile action of methoxamine, phenylephrine was about 10 times more potent as a contractile agonist on aorta than on urethra. In aorta, the rank order of agonist sensitivity was norepinephrine > phenylephrine > clonidine > methoxamine whereas the rank order in urethra was clonidine > methoxamine > or = phenylephrine > norepinephrine. A lack of significant correlation between the potency of different alpha1-adrenoceptor antagonists tested against the phenylephrine-induced contraction in aorta and in urethra indicated that different alpha1-adrenoceptor subtypes mediated the contractile response in the two preparations. The potency of different alpha1-adrenoceptor antagonists tested in rabbit urethra was significantly correlated with their affinity for the cloned human alpha1c-, but not alpha1a- or alpha1b-, adrenoceptor subtype. Such a clear correlation with the potency of different alpha1-adrenoceptor antagonists tested in rabbit aorta and their affinity for one subtype of cloned human alpha1-adrenoceptor was not found. Chlorethylclonidine, which produced a 10 000-fold rightward shift in the phenylephrine concentration-response curve for rat aorta, had a weak inhibitory effect in rabbit aorta and urethra as well as in other rabbit tissues (spleen, fundus, renal artery, saphenous artery). The results indicate that significant heterogeneity exists among alpha1-adrenoceptor in rabbit aorta and urethra (alpha1c-adrenoceptor). However, chlorethylclonidine does not seem to be a suitable tool for the differentiation of alpha1-adrenoceptor subtypes in the rabbit.     

Benign postpartum pleural effusion

The conditions of labour appear to favour the development of pleural effusion. The frequency of postpartum pleural effusion was investigated in this study using thoracic ultrasonography. Thirty one postpartum and 22 healthy nonpregnant women of the same age-group were examined, both supine and seated, via an intercostal approach. Seven of the 31 (23%) postpartum women had pleural effusion within 1-24 h of normal delivery. None of the nonpregnant women had pleural effusion. No correlation was found between postpartum pleural effusion and age, weight-gain during pregnancy, duration of labour, use of intravenous fluid, or oxytocin administration. Pleural effusion seems to be a common finding postpartum, but of no clinical significance.     

Retinoic acid receptor expression abnormalities in lung cancer: important clues or major obstacles?

We have developed a cine display of postprocessed 3D MR images of the thoracic aorta. Maximum intensity projection (MIP) images of the thoracic aorta in each phase were reconstructed from consecutive 2D-cine MR data sets, and displayed in a cine loop. The postprocessed 3D MR images clearly showed the relationship between major cervical branches and aortic pathologies such as aneurysms, and cine display presented the flow pattern in the aorta. 3D-cine MR angiography seems to be useful for follow-up studies of thoracic aortic diseases especially in patients with renal dysfunction.     

Echocardiographic diagnosis of the dissection of the thoracic aorta

Nine patients with aortic root dilatation without dissection and four patients with a dissecting aneurysm of the ascending aorta were studied with single-plane echocardiography. Previously reported echocardiographic findings, which have been shown to be similar in these two groups of patients, are confirmed. In addition to (a) aortic root dilatation, (b) thickening of the anterior and/or the posterior aortic wall, and (c) the multiple parallel echoes within the widened aortic walls, which are all considered to be not specific signs of dissection, the authors outline the presence of some specific echocardiographic patterns in patients with a dissecting hematoma of the ascending aorta. These include: 1) the loss of contiguity between the inner borders of the anterior aortic wall and the interventricular septum when the dissection is confined to the anterior wall of the aorta; 2) the loss of contiguity between the inner and/or outer borders of the posterior aortic wall and the mitral anulus if the hematoma extends to the posterior wall of the aorta.     

Surgical repair of a dissecting aortic aneurysm with entry at proximal descending aorta through left thoracotomy--a case report

A 45-year-old man underwent a distal arch and descending aortic replacement through a left thoracotomy. His chronic type A dissecting aortic aneurysm had the entry at the proximal descending aorta. After 9 years of his first dissection, he suffered from a second dissection. In computerized tomogram (CT), the ascending and descending aorta enlarged to 6.0 cm and 7.0 cm in diameter, respectively and descending aorta showed a three channeled dissection. The open proximal anastomosis technique was used under the deep hypothermic circulatory arrest (HCA) followed by selective cerebral perfusion (SCP). Surgical repair included the obliteration of the proximal false lumen at the level between the left carotid and subclavian artery. A thrombosed retrograde dissection in the ascending aorta was revealed in postoperative evaluation, and decreased in size at follow up CT.     

Finite element modeling of three-dimensional pulsatile flow in the abdominal aorta: relevance to atherosclerosis

The infrarenal abdominal aorta is particularly prone to atherosclerotic plaque formation while the thoracic aorta is relatively resistant. Localized differences in hemodynamic conditions, including differences in velocity profiles, wall shear stress, and recirculation zones have been implicated in the differential localization of disease in the infrarenal aorta. A comprehensive computational framework was developed, utilizing a stabilized, time accurate, finite element method, to solve the equations governing blood flow in a model of a normal human abdominal aorta under simulated rest, pulsatile, flow conditions. Flow patterns and wall shear stress were computed. A recirculation zone was observed to form along the posterior wall of the infrarenal aorta. Low time-averaged wall shear stress and high shear stress temporal oscillations, as measured by an oscillatory shear index, were present in this location, along the posterior wall opposite the superior mesenteric artery and along the anterior wall between the superior and inferior mesenteric arteries. These regions were noted to coincide with a high probability-of-occurrence of sudanophilic lesions as reported by Cornhill et al. (Monogr. Atheroscler. 15:13-19, 1990). This numerical investigation provides detailed quantitative data on hemodynamic conditions in the abdominal aorta heretofore lacking in the study of the localization of atherosclerotic disease.     

A case of complete circumferential aortic rupture due to blunt chest trauma

A case of complete circumferential rupture of the thoracic aorta due to blunt chest trauma is presented. A 30-year-old man was admitted after a traffic accident. The admission chest X-ray film demonstrated mediastinal widening. About 6 hours after the traffic accident, chest CT scanning demonstrated mediastinal hematoma, left pleural effusion and partial aortic dissection. Diagnoses of aortic rupture and liver injury were made, and surgery for the thoracic aorta was performed immediately. The aorta was found to be completely disrupted for the length of 2 cm, and a vascular prosthesis was interposed between the two ends of the aorta under partial cardiopulmonary bypass. We conclude that the enhanced chest CT scanning is helpful for diagnosis, and that if other organ injuries are not severe, the emergency operation should be performed.     

Aortic aneurysm complicated with coarctation of the aorta and Turner syndrome

A 23-year-old female with Turner syndrome and horse-shoe kidney underwent the operation of the coarctation of the aorta associated with the thoracic aortic aneurysm. The aortic aneurysm was located between the left carotid artery and the coarctation of the aorta, and the subclavian artery which was branched away from the aortic aneurysm was also aneurysmal. Aneurysmectomies and the reconstruction of the descending thoracic aorta and the left subclavian artery were performed with knitted Dacron grafts under assisting of the left atriodescending thoracic aortic bypass with Bio-pump. The disease was rare and such a case was not reported previously.     

Stress at the pleural surface

The transmission of forces between the visceral and parietal pleural is modelled as being mediated by two distinct pathways: (a) a contact pressure (Pcon) acting on an area of contact (Acon) and (2) a pleural liquid pressure (Pliq) acting on the area of liquid anfractuosities (Aliq). Summation of the forces yields a new equation relating pleural surface pressure (Ppl) to Pcon, Acon, Pliq, and Aliq. A complete solution of the equation is restricted by present limitations on measurement technology. However, assuming that the volume of pleural liquid is constant during tidal breathing, analysis of the model explains the findings that tidal swings in Pliq (deltaPliq) are sometimes greater than tidal swings in Ppl (deltaPpl). It also predicts that the influence of a change of lung elastic recoil on Pliq may be different in magnitude than its effect on Ppl. Therefore deltaPliq is not necessarily equivalent to deltaPpl.     

An experience of the modified Norwood's operation for hypoplastic left heart syndrome with aberrant origin of right subclavian artery and persistent left superior vena cava--the procedure without total circulatory arrest and cardiac arrest

We reported a successful case of the modified Norwood operation for a 21-day-old neonate with hypoplastic left heart syndrome (MS and AS) associated with an aberrant right subclavian artery and a persistent left superior vena cava. The modified Norwood operation was performed without total circulatory arrest and Cardiac arrest. A 4 mm Gore-Tex graft, which was anastomosed between the right carotid artery and the right pulmonary artery for systemic-pulmonary shunt, was used for cerebral perfusion during aortic arch reconstruction. Coronary perfusion was performed with a small cannula placed on the relatively large ascending aorta during anastomosis between the main pulmonary artery and the ascending aorta. Equine pericardial patch was used for aortic arch reconstruction and the ascending aorta was directly anastomosed to a part of the main PA. Postoperative course was uneventful and postoperative MRI revealed no stenosis of the aortic arch and the pulmonary artery.     

Extension of the "elephant trunk" technique in complex aortic pathology: the "bidirectional" option

BACKGROUND: The "elephant trunk" technique, using a free-floating vascular prosthesis, was originally described to facilitate a subsequent operation on the downstream aorta. We developed an additional refinement of this technique, called the "bidirectional elephant trunk." This option may represent an interesting tool in more complex aortic operations, especially when the descending aorta has to be replaced first in patients with concomitant pathology of the ascending aorta or of the aortic arch. METHODS: The initial operation is performed through a left thoracotomy. The proximal elephant trunk is created by invaginating the future aortic arch graft into the descending aortic graft. The proximal anastomosis between the doubled graft and the proximal descending aorta is performed first. During construction of the distal anastomosis, a distal elephant trunk may be inserted likewise. If the aortic arch and ascending aorta have to be replaced later, this second step is performed through a median sternotomy. The free-floating arch graft is pulled out of the proximal descending aorta with a nerve hook, unfolded, and used for total arch replacement. RESULTS: This technique was used successfully in 3 patients without mortality. No major complications were observed excepted persistent hoarseness in a patient with preoperative paresis of the recurrent nerve. No perfusion problems due to the unfolding of the free-floating graft occurred during the second operation. CONCLUSIONS: The bidirectional elephant trunk technique is an interesting option that may be suitable for patients presenting with a complex pathology of the whole thoracic aorta when the descending segment has to be replaced first.     

Relationship between the thickness of the aortic adventitia and the fat content of blood and the aortic wall

10 rabbits underwent a cholesterol feeding. 10 rabbits were used as control animals. After 12 weeks in the tissue extract of the intima-media-complex of the aorta as well as in the serum the total lipids and the total cholesterol were determined. On histological preparations the thickness of the adventitia of the aorta was measured. In comparison to the control group the animals fed with cholesterol showed a significant increase of the lipid values in the serum and the aorta as well as of the thickness of the adventitia. However, no connections could be proved between the parameters of the serum lipids and the morphological changes of the adventitia.     

Cytokine production by dengue virus antigen-responsive human T lymphocytes in vitro examined using a double immunocytochemical technique

In rabbits, the pulmonary artery and the aorta are susceptible to atherosclerosis. However, susceptibility of the pulmonary artery, compared with the aortic arch, to atherosclerosis and the relationship between the accumulation of cholesterol during the early stages of atherogenesis and the development of atheromatous lesions for these arterial regions remain to be clarified. Cholesterol concentrations for the pulmonary artery and aorta were measured in normal rabbits and in rabbits fed a 0.5% cholesterol diet for 8, 12, and 16 days and 17 weeks. In normal rabbits, the rank order of arterial cholesterol concentrations was pulmonary artery>aortic arch>descending thoracic aorta, with concentrations of total and nonesterified cholesterol 17% and 25% (both P<.05) greater, respectively, for the pulmonary artery than for the descending thoracic aorta. Rank order remained the same during 16 days of cholesterol feeding, but differences between arterial regions were exaggerated. After rabbits were fed cholesterol for 16 days, total and esterified cholesterol concentrations were 57% and 920% (both P<.01) greater, respectively, for the pulmonary artery than for the descending thoracic aorta, with much smaller differences between the aortic regions. In contrast, after rabbits were fed cholesterol for 17 weeks, concentrations of total, esterified, and nonesterified cholesterol were similar for the pulmonary artery and aortic arch, but these forms of cholesterol were increased 100%, 130%, and 53% (all P<.03), respectively, for the aortic arch compared with the descending thoracic aorta. Cholesterol concentrations for the pulmonary artery were positively associated with those for the aortic regions during the first 16 days of cholesterol feeding, but for rabbits fed cholesterol for 17 weeks the associations were either negative or absent. These results indicate that relative rates of cholesterol accumulation in the pulmonary artery and aorta differ at different stages of atherogenesis and suggest that the balance between processes that deliver cholesterol to, and remove cholesterol from, the artery may change in different ways in these arterial regions during atherogenesis.     

Rat aorta and mesenteric artery respond differently to serotonin

The sensitivity (EC50) of the ring segment of the mesenteric artery to serotonin (4.84 +/- 0.53 x 10(-7) mol.l-1) was 17x greater than that of the aortic ring segment (5.29 +/- 0.46 x 10(-6) mol.l-1). Incubation of the ring segments in physiological salt solution (PSS) containing methylene blue greatly potentiated the sensitivity of both the aorta and mesenteric artery to serotonin. The degree of potentiation was higher in the aorta than mesenteric artery. L-NAME also increased the sensitivity of both the aorta and mesenteric artery to serotonin and there was no difference in the degree of potentiation of the responses between the aorta and the mesenteric artery. Indomethacin inhibited the contractile responses of the aorta and the mesenteric artery to serotonin. Phenoxybenzamine reduced the contractile responses of both the aorta and the mesenteric artery by the same magnitude. Captopril (10(-4) mol.l-1) significantly attenuated the responses of the mesenteric artery more than the aorta, while methysergide (10(-8) mol.l-1) completely abolished the difference in the responses (EC50 for aorta = 3.50 +/- 0.55 x 10(-5) mol.l-1 vs 5.00 +/- 0.49 x 10(-5) mol.l-1 for mesenteric artery). This study demonstrates that rat aorta and mesenteric artery respond differently to serotonin and the differential response is due to a methylene blue sensitive factor and differences in either the receptor population or sensitivity.     

A case of malignant mesothelioma of the pleura and the peritoneum detected by sudden onset of back pain and pleural effusion and ascites

A case of malignant mesothelioma of the pleura and the peritoneum is reported. In April 1996, a 40-year-old men noticed sudden onset of back pain. Radiographic examinations and MRI revealed pleural effusions, ascites, ringed enhanced tumorous lesions in the right posterior diaphragm along the abdominal aorta, and marked thickening of the right diaphragm with moderate signal intensity. On thoracoscopic surgery, there were white small nodules on the intercostal parietal pleura. Tumor cells of a tubulopapillary pattern had large rounded nuclei and eosinophilic cytoplasms in a partially glandlike arrangement. Cytoplasms of tumor cells stained for alcian blue disappeared after hyaluronidase digestion. Immunohistochemical examinations showed positive staining for keratin but negative for CEA. Electron micrographs showed numerous long thin microvilli, desmosomes and intermediate tonofilaments. From these findings, malignant mesothelioma was diagnosed. The malignant mesothelioma cells of the pleura in this case were considered to disseminate the peritoneum directly through the diaphragm or its lymphatic canals. MRI and thoracoscopic surgery were useful for the demonstration of the pleural disseminations and abdominal invasions.     

Paxillin

Umbilical arterial catheters in the high position reduce the lumen of the aorta and may thereby impair blood supply to the intestine. Thirty-two preterm and three term infants were studied with an umbilical arterial catheter by colour and duplex Doppler sonography. The diameter of the aorta at the level of the coeliac axis was measured to calculate the reduction of the cross-sectional area of the aorta by the catheter. Blood-flow velocities were measured in the coeliac axis, the superior mesenteric artery and the anterior cerebral artery before and after removal of the catheter. The umbilical arterial catheter reduced the cross-sectional area of the aorta by 3.4-27.2% (mean 10.1%). There was no difference between blood-flow velocities in the coeliac axis and the superior mesenteric artery before and after removal of the umbilical arterial catheter, indicating that the catheter did not impair blood supply to the intestine.