血清可溶性尿激酶型纤溶酶原激活物受体对老年慢性阻塞性肺疾病急性加重期临床诊断的意义

目的探讨血清可溶性尿激酶型纤溶酶原激活物受体对老年慢性阻塞性肺疾病急性加重期(AECOPD)的诊断价值。方法选取本院2015年1月至2018年6月收治的老年慢性阻塞性肺疾病(COPD)患者158例,其中AECOPD患者(急性组)93例,COPD稳定期患者(稳定组)65例;同时选取同期健康体检老年人群79例作为对照组。检测血清可溶性尿激酶型纤溶酶原激活物受体(suPAR)、降钙素原(PCT)和C反应蛋白(CRP)水平、肺功能及CAT评分;同时分析suPAR、PCT、CRP水平与肺功能和CAT评分的相关性,并应用受试者工作曲线(ROC)评分suPAR、PCT、CRP水平对老年慢性阻塞性肺疾病急性加重期的诊断价值。结果急性组和稳定组血清suPAR、CRP、PCT水平高于对照组( P <0.05);稳定组血清suPAR、CRP、PCT水平和CAT评分低于急性组( P <0.05)。急性组和稳定组FEV1%pred和FEV1/FVC水平低于对照组( P <0.05);稳定组FEV1%pred和FEV1/FVC水平高于急性组( P <0.05)。血清suPAR、PCT和CRP水平与FEV1%pred和FEV1/FVC呈负相关( P <0.05),与CAT评分呈正相关( P <0.05)。ROC曲线分析显示,血清suPAR对COPD急性加重期的诊断价值优于PCT和CRP。结论老年COPD急性加重期患者血清suPAR水平明显上升,与肺功能指标密切相关,可作为诊断老年COPD急性加重期的标志物。     

N-乙酰半胱氨酸对COPD大鼠Clara细胞及CC16的影响

目的：观察抗氧化剂N-乙酰半胱氨酸(NAC)干预对大鼠慢性阻塞性肺疾病（COPD）模型Clara细胞数量及其分泌蛋白CC16表达的影响。方法:单纯熏香烟法建立Wistar大鼠COPD模型。将大鼠随机分为对照组、COPD组和NAC干预组,每组10只。应用透射电镜观察COPD大鼠肺组织Clara细胞超微结构的变化。免疫组织化学方法检测各组大鼠肺组织Clara细胞数量。酶联免疫吸附法检测支气管肺泡灌洗液(BALF)和血清中CC16含量。RT-PCR法检测肺组织中CC16mRNA的含量。结果:COPD组大鼠终末细支气管上皮Clara细胞占上皮细胞的百分比明显低于对照组（P<0.01）；NAC干预组明显高于COPD组（P<0.01）。COPD组大鼠BALF和血清中CC16蛋白水平明显低于对照组（P<0.01）；NAC干预组明显高于COPD组（P<0.05）。COPD组大鼠肺组织中CC16 mRNA的含量明显低于对照组和NAC干预组（均P<0.01）。结论:COPD大鼠的气道炎症可导致Clara细胞数量及CC16的合成及分泌量减少,抗氧化剂NAC可通过促进CC16的合成和分泌抑制气道炎症反应。     

慢性阻塞性肺病患者血清TNF-α水平与肺功能的关系探讨

目的:探讨慢性阻塞性肺病(COPD)患者血清肿瘤坏死因子-α(TNF-α)水平与其肺功能各参数之间的相关性。方法:选择我院收治的COPD患者60例和健康体检者35例。采用ELISA方法测定COPD患者和健康体检者血清TNF-α,同时测量其肺功能指标。结果:COPD组急性加重期、稳定期及正常对照的血清TNF-α水平呈下降趋势,三组间比较存在显著性差异(P0.01)。COPD组急性加重期和稳定期患者的各项肺功能指标FEV1、FVC、FEV1/FVC和MMEF均明显低于对照组(P0.01),且稳定期患者各肺功能指标均明显高于急性加重期患者(P0.01)。血清TNF-α水平与FEV1、FVC、FEV1/FVC及MMEF均呈负相关(r=-0.586,-0.714,-0.527,-0.639,P0.05)。结论:TNF-α与COPD的气道炎症反应和发病过程有关,并对肺功能产生重要影响。     

慢性阻塞性肺疾病患者和吸烟肺功能正常者体内HIF-1α表达及意义

目的探讨低氧诱导因子-1α(HIF-1α)在慢性阻塞性肺疾病(COPD)患者和吸烟肺功能正常者肺组织和血清中表达及其临床意义。方法肺组织标本取自手术治疗的周围型肺癌患者,共32例,检测术前肺功能,将其分为吸烟COPD稳定期组(COPD组,n=10),吸烟肺功能正常组(n=12),不吸烟肺功能正常组(n=10)。术前清晨空腹取血清,术后取癌旁肺组织,ELISA检测血清和肺组织匀浆HIF-1α含量,免疫组织化学方法检测肺组织HIF-1α的表达,并分析HIF-1α表达水平与肺功能指标的相关关系。结果 COPD稳定期组、吸烟肺功能正常组、不吸烟肺功能正常组患者血清HIF-1α含量分别为(73.25±6.12)pg/mL、(60.30±8.00)pg/mL、(47.03±8.43)pg/mL;吸烟肺功能正常组和COPD组明显高于不吸烟肺功能正常组(P0.01),COPD组明显高于吸烟肺功能正常组(P0.01)。COPD稳定期组、吸烟肺功能正常组、不吸烟肺功能正常组患者肺组织匀浆HIF-1α含量分别为(2.04±0.24)pg/μg、(1.67±0.34)pg/μg、(1.12±0.33)pg/μg;吸烟肺功能正常组和COPD组明显高于不吸烟肺功能正常组(P0.01),COPD组明显高于吸烟肺功能正常组(P0.01)。HIF-1α广泛表达于COPD组肺泡和气道上皮细胞、肺小动脉壁的炎症细胞以及巨噬细胞中。血清和肺组织匀浆中HIF-1α含量均与第1秒用力呼气容积与用力肺活量比(FEV1/FVC)、第1秒钟用力呼气容积占预计值百分比(FEV1%pred)呈显著负相关。结论 COPD患者和吸烟肺功能正常者肺组织和血清HIF-1α的表达增加,与气流受限有关。     

COPD合并Ⅱ型呼吸衰竭患者血清HSP27、CyPA与预后的关系

目的 探讨慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者血清热休克蛋白27(HSP27)、亲环素A(CyPA)水平变化及其与患者预后的关系.方法 选取2017年1月至2019年11月我科收治的COPD患者180例,其中COPD合并Ⅱ型呼吸衰竭患者90例(COPD合并呼吸衰竭组)、无呼吸衰竭患者90例(COPD组),另选健康体检者90例(对照组).检测各组血清HSP27、CyPA水平;分析COPD合并呼吸衰竭患者血清HSP27、CyPA水平与FEV1％pred、FEV1/FVC和APACHEⅡ评分的相关性;采用COX比例风险回归分析COPD合并呼吸衰竭患者预后的影响因素.结果 COPD合并呼吸衰竭组患者血清HSP27、CyPA高于COPD组及对照组,COPD组患者血清HSP27、CyPA高于对照组,差异有统计学意义(P＜0.05).死亡组患者的血清HSP27、CyPA高于存活组(P＜0.05).Pearson相关性分析示:患者血清HSP27、CyPA水平与FEV1％pred和FEV1/FVC呈负相关,与APACHE Ⅱ评分呈正相关(P＜0.05).COX回归分析示:APACHEⅡ评分、HSP27和CyPA是影响COPD合并呼吸衰竭患者预后的独立危险因素.ROC曲线示:HSP27、CyPA联合检测预测COPD合并呼吸衰竭患者预后的灵敏度和特异性分别为0.837和0.829.结论 COPD合并呼吸衰竭患者血清HSP27、CyPA明显升高,与患者的病情进展及预后密切相关,对患者的病情监测和预后评估具有一定临床价值.     

肝素结合蛋白、1,25-二羟基维生素D3、白三烯B4及炎性指标与慢性阻塞性肺疾病急性加重期患者肺功能的相关性研究

目的 探讨肝素结合蛋白、1,25-二羟基维生素D3、白三烯B4及炎性指标与慢性阻塞性肺疾病急性加重期患者肺功能的相关性研究.方法 选取360例2016年4月至2017年5月期间到我院呼吸科诊治的COPD和AECOPD患者作为研究对象.其中COPD患者167例,作为稳定组,AECOPD患者193例,作为加重组.选取同期进行体检的健康人300例作为对照组.比较3组受试者HBP、1,25-(OH)2D3、LTB4、TNF-α、IL-8和IL-6水平.比较稳定组和加重组肺功能指标.分析HBP、1,25-(OH)2D3、LTB4、TNF-α、IL-8和IL-6与患者肺功能相关性.结果 稳定组、加重组患者HBP和LTB4水平显著高于对照组,1,25-(OH)2D3显著低于对照组,加重组患者HBP和LTB4水平显著高于稳定组,1,25-(OH)2D3显著低于稳定组(P<0.05).稳定组、加重组患者TNF-α、IL-8和IL-6水平显著高于对照组,加重组患者TNF-α、IL-8和IL-6水平显著高于稳定组(P<0.05).加重组患者各肺功能指标(FEV1% Pred、FEV1/Fvc%、MMEF% Pred、V50% Pred、V25%Pred)均显著高于稳定组(P<0.05).经过Pearson相关性分析,HBP、LTB4、TNF-α、IL-8、IL-6与患者肺功能呈负相关, 1,25-(OH)2D3与患者肺功能呈正相关.结论 HBP、1,25-(OH)2D3、LTB4及炎性指标与AECOPD患者肺功能指标密切相关,可以评估患者的病情严重程度,指导临床治疗.     

老年COPD患者血清MMP-9、SAA、SOD和ET-1水平与病情急性发作的相关性分析

目的:探讨老年COPD患者四项血清炎性指标测定的临床价值。方法:血清MMP-9、SAA、SOD和ET-1测定均采用双抗体夹心ABC-ELISA测定。结果:老年COPD急性期组患者血清MMP9、SAA和ET-1水平均显著高于稳定期组和正常对照组(P<0.05,P<0.01),SOD水平则低于稳定期组和正常对照组(P<0.05,P<0.01),而两组患者的肺功能指标显示显著降低(P均<0.01)。血清MMP-9、SAA、SOD和ET-1水平与FEV1%pred的相关性分析均呈显著相关和负相关关系(r=-0.761、r=-0.902、r=0.534、r=-0.698,P<0.01,P<0.05)。结论:四项血清指标的变化与老年患者COPD的急性发作关系密切。     

COPD 患者Th17 细胞和Treg 细胞介导的免疫应答变化及免疫失衡与肺功能的关系研究

目的:探讨慢性阻塞性肺疾病(COPD)患者外周血Th17 细胞和调节性T 细胞(Treg)及其介导的免疫应答变化与患者肺功能的关系。方法:选取本院呼吸内科收治的90 例COPD 患者(COPD 组)和同期年龄、性别基本匹配的45 例健康体检对象作为对照组,并根据COPD 病情进行亚组分析,分别测定各组研究对象肺功能指标、Th17 细胞、Treg 细胞及血清炎症因子水平。结果:在COPD 患者间,随着病情加重,FEV1%、FVC%、FEV1/ FVC 比值中度COPD 组<重度COPD 组<极重度组(P<0.05);在COPD 患者间,随着病情加重,外周血中Th17 细胞、Th17/ Treg 比值中度COPD 组<重度COPD 组<极重度组(P<0.05),外周血Treg 细胞比值中度COPD 组>重度COPD 组>极重度组(P<0.05),且外周血Th17 细胞、Treg 细胞相关细胞因子变化具有一致性;COPD 患者的肺功能指标FEV1%、FVC%、FEV1/ FVC 与外周血中Th17 细胞、Th17/ Treg 比值呈显著的负相关关系(P<0.05),肺功能指标FEV1%、FVC%、FEV1/ FVC 与外周血Treg 比值呈显著的正相关关系(P<0.05)。结论:COPD外周血Th17/ Treg 比值与患者肺功能下降具有显著的相关性。     

舒利迭治疗慢性阻塞性肺疾病的疗效观察

目的 观察舒利迭治疗慢性阻塞性肺疾病(COPD)的疗效.方法 将200例COPD患者随机分为观察组和对照组各100例;分别测定基础肺功能.对照组给予常规治疗,观察组在此基础上给吸入舒利迭.于第15天测吸药后1h的肺功能参数FEV1/FEC(%)、FEV1、FEV1占预计值(%),同时观察呼吸困难评分,比较两组患者肺功能及呼吸困难改善情况.结果 治疗后观察组肺功能及呼吸困难症状均有显著改善,差异有显著性(P＜0.05).结论 舒利迭能显著改善COPD患者肺功能及呼吸困难症状,是治疗COPD疗效较为理想的药物.     

老年COPD患者血清SP-D、NE、IL-8和α-HBD水平的变化与病情进展的关系

目的:探讨血清四项指标浓度的变化与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者病情进展的关系和临床价值.方法:血清肺泡表面活性蛋白D(surfactant protein D,SP-D),中性粒细胞弹性蛋白酶(neutronphil elastase,NE)采用酶联免疫法(ELISA)检测,白细胞介素8(interleukin 8,IL-8)含量则采用放射免疫分析(RIA),α-羟丁酸脱氢酶(alpha-hydroxybutyric dehydrogenase,α-HBDH)测定采用全自动生化分析法(ACA).结果:临床及测定结果:两组间除性别和平均年龄两项临床记录指标外,余五项指标均存在显著性差异(P<0.05,P<0.01).血清指标中SP-D水平Ⅰ级组较正常对照组略升高,但无显著性差异(P>0.05),Ⅱ、Ⅲ级组水平则均显著高于正常对照组(P<0.05,P<0.0),患者分级组间比较也存在显著性差异(P<0.05).IL-8水平则于Ⅰ级组已显著高于正常对照组(P<0.05),Ⅱ、Ⅲ级组水平则均显著高于正常对照组(P均<0.01),患者分级组间比较也存在显著性差异(P均<0.05).NE水平的变化统计结果同IL-8.α-HBDH活性的变化Ⅰ、Ⅱ级两组较正常对照组皆无显著统计学差异(P均>0.05),Ⅲ级组水平则显著高于Ⅱ级组和正常对照组(P<0.05,P<0.01).相关分析结果:血清指标与患者呼吸功能指标FEV1的相关性分析显示,FEV1 与SP-D水平Ⅰ级组无显著相关性(r=-0.26,P>0.05),Ⅱ级组呈弱相关(r=-0.36,P=0.05),Ⅲ级组则呈显著负相关(r=-0.76,P<0.05).FEV1 与IL-8水平Ⅰ级组呈显著负相关(r=-0.55,P<0.05),Ⅱ级组呈显著负相关(r=-0.65,P<0.05),Ⅲ级组则呈显著负相关(r=-0.70,P<0.05).FEV1 与NE水平Ⅰ级组呈显著正相关(r=-0.60,P<0.05),Ⅱ级组呈显著负相关(r=-0.65,P<0.05),Ⅲ级组则呈显著负相关(r=-0.70,P<0.05).FEV1 与α-HBDH水平Ⅰ级组无显著相关性(r=-0.30,P>0.05),Ⅱ级组也无显著相关(r=-0.15,P>0.05),Ⅲ级组则呈弱相关(r=-0.41,P=0.05).结论:血清四项指标浓度的变化与COPD患者病情进展的关系密切;其测定对于老年COPD患者病情的了解和预后评估有一定的临床价值.     

Pulmonary Blastoma

Three cases of pulmonary blastoma exhibiting biphasic epithelial and stromal patterns, and a case of fetal lung type adenocarcinoma, were examined by immunohisto-chemistry and electron microscopy (EM) and compared with fetal bronchial epithelium in order to explore the multidirectional differentiation of their epithelial components. The glandular cells of all four tumors resembled fetal bronchial epithelial cells in the pseudoglandular stage. Neuroendocrine (NE) cells were also present: they were argyrophilic and expressed pan NE markers, neurose-cretory granules and peptide hormones. The neural cell adhesion molecule (NCAM) was strongly expressed on the cell membranes of glandular cells, as in the case of proximal bronchial epithelial cells at the pseudoglandular stage in fetal lung. Sialosylated Lewis^X was also expressed, indicating that the epithelial cells were possibly of endodermal origin. Two of the four cases showed considerable immunoreactivity for alpha fetoprotein (AFP). The epithelial cells of pulmonary blastomas may occasionally de-differentiate into cells functionally resembling fetal hepatic, foregut and yolk sac cells expressing AFP. Tumor examination by immunohistochemistry and EM suggested that the glandular cells of the tumors may differentiate to some extent like those of fetal large bronchi at the pseudoglandular stage, but there was concordance and discordance in the expression of neuroendocrine and oncofetal markers between blastomatous tumors and fetal bronchial epithelium. Acta Pathol Jpn 42: 884–892, 1992.     

Acute Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hypertension: Clinical and Serial CT Pulmonary Angiographic Features

In acute pulmonary embolism (PE), circulatory failure and systemic hypotension are important clinically for predicting poor prognosis. While pulmonary artery (PA) clot loads can be an indicator of the severity of current episode of PE or treatment effectiveness, they may not be used directly as an indicator of right ventricular (RV) failure or patient death. In other words, pulmonary vascular resistance or patient prognosis may not be determined only with mechanical obstruction of PAs and their branches by intravascular clot loads on computed tomography pulmonary angiography (CTPA), but determined also with vasoactive amines, reflex PA vasoconstriction, and systemic arterial hypoxemia occurring during acute PE. Large RV diameter with RV/left ventricle (LV) ratio > 1.0 and/or the presence of occlusive clot and pulmonary infarction on initial CTPA, and clinically determined high baseline PA pressure and RV dysfunction are independent predictors of oncoming chronic thromboembolic pulmonary hypertension (CTEPH). In this pictorial review, authors aimed to demonstrate clinical and serial CTPA features in patients with acute massive and submassive PE and to disclose acute CTPA and clinical features that are related to the prediction of oncoming CTEPH.     

血清降钙素原与C-反应蛋白联合检测在肝硬化并肺部感染患者中的诊断价值

目的 探讨血清降钙素原(procalcitonin,PCT)与C-反应蛋白(C-reactive protein,CRP)联合检测在肝硬化并肺部感染患者中的诊断价值及临床意义.方法 选取2014年8月至2016年5月在本院入院治疗的肝硬化并肺部感染患者83例作为研究对象,根据病原学检测结果将其分为肝硬化细菌致肺部感染组(观察组)42例与肝硬化非细菌致感染组(对照组)41例,另选本院同期进行体检健康者40例作为健康组,检测并记录各组PCT、CRP,并采用SPSS21.0软件对所得数据进行处理.结果 治疗前观察组PCT水平均显著高于对照组和健康组,差异具有统计学意义(均P＜0.05);治疗后观察组PCT水平略高于对照组,差异不具有统计学意义(t=1.524,P＞0.05);观察组治疗后PCT水平显著低于治疗前,差异具有统计学意义(t=11.291,P ＜0.05);对照组治疗后PCT水平略高于治疗前,差异不具有统计学意义(t=0.928,P＞0.05).治疗前观察组CRP水平均显著高于对照组和健康组,差异具有统计学意义(P＜0.05);治疗后观察组CRP水平与对照组相比差异不具有统计学意义(t=0.825,P ＞0.05);观察组治疗后CRP水平显著低于治疗前,差异具有统计学意义(t =6.032,P＜0.05);对照组治疗后CRP水平略高于治疗前,差异不具有统计学意义(t=1.853,P＞0.05).观察组患者PCT、CRP单独检测以及PCT、CRP联合检测的阳性检出率均显著高于对照组,差异具有统计学意义(t值依次为8.517、14.624、5.433,均P＜0.05).PCT、CRP联合检测的特异性、灵敏度、阳性预测值与阴性预测值均显著高于PCT、CRP单独检测,差异具有统计学意义(均P ＜0.05).结论 肝硬化患者存在肺部感染风险,通过对肝硬化患者进行血清PCT与CRP联合检测,对肺部感染疾病的早期鉴别诊断具有积极意义.     

Open Pulmonary Thromboembolectomy in Patients with Major Pulmonary Thromboembolism

Purpose

We retrospectively analyzed open pulmonary thromboembolectomy in patients with acute and chronic pulmonary thromboembolism.

Materials and Methods

Between August 1990 and May 2005, 12 consecutive patients with acute and chronic pulmonary thromboembolism underwent open pulmonary thromboembolectomy at Yonsei Cardiovascular Center. Their mean age was 47.5 years, and 7 of the patients were female. Among 12 patients, 5 had acute onset, and 7 had chronic disease, and 9 patients were associated with deep venous thrombosis. Extent of pulmonary embolism was massive in 3 patients with hemodynamic instability, and submassive in 8 patients. Preoperative echocardiogram revealed elevated right ventricular pressure in all patients, and 7 patients were in NYHA functional class III or IV. Pulmonary thromboembolectomy was performed in all patients under total circulatory arrest.

Results

There were 2 hospital deaths (16.7%). Among the patients who survived, mean right ventricular pressure was decreased significantly from 64.3 mmHg to 34.0 mmHg with improvement of NYHA functional class.

Conclusion

Open pulmonary thromboembolectomy is thought to be an immediate and definitive treatment for massive pulmonary embolism with optimal results. Even though operative mortality is still high, early diagnosis and immediate surgical intervention in highly selective patients may improve the clinical outcome.     

Pulmonary Mucormycosis with Fatal Massive Hemoptysis

A case of pulmonary mucormycosis in a 57 year old woman with acute promyelocytic leukemia (APL) who died of massive hemoptysis is reported. Chest radiography revealed changes that began with a small focal infiltration and progressed to a large round nodule with cavity formation. Postmortem examination showed the nodule to be composed mainly of infarcted lung tissue with saprophytic growth of Mucor. An adjacent proximal branch of the left pulmonary artery was thrombosed with mucoraceous hyphae, and it had ruptured into the cavitary space around the necrotic tissue and then into a conducting bronchus. In general, both fatal massive hemoptysis and cavity formation are rare in pulmonary mucormycosis. In our present case, the histological findings suggested that both phenomena were closely related to the pulmonary infarction caused by Mucor invasion of the pulmonary artery.     

贝前列素钠治疗肺源性心脏病肺动脉高压的临床研究

目的:观察贝前列素钠治疗肺源性心脏病(肺心病)肺动脉高压的临床疗效。方法:将68例肺心病急性发作期患者随机分为对照组(n=31)和贝前列素钠组(n=37)。两组患者均给予抗感染、止咳、化痰、平喘、强心利尿等常规治疗,贝前列素钠组在上述治疗的基础上加口服贝前列素钠治疗。比较两组疗效和外周动脉压(PABP)、肺动脉压(PAP)、左室射血分数(LVEF)、血脑钠肽(BNP)、血气[酸碱度(pH),氧分压(PaO2)、二氧化碳分压(PaCO2)、血氧饱和度(SaO2)]及血清C反应蛋白(CRP)、内皮素-1(ET-1)、一氧化氮(NO)水平变化。结果:贝前列素钠组总有效率明显高于对照组(94.59%vs 77.42%,P0.05),显效率也显著高于对照组(48.65%vs 16.12%,P0.01)。治疗后两组PAP、CRP、ET-1、NO、BNP、血气指标较治疗前均明显改善(P0.05或P0.01);贝前列素钠组较对照组PAP、PaCO2、ET-1、BNP降低更明显(P0.01),PaO2、SaO2、NO升高更显著(P0.01)。结论:贝前列素钠可以明显降低肺心病肺动脉高压患者肺动脉压,改善心功能,这可能与其降低ET-1和提高NO水平有关。     

Pulmonary Hypertension after Hematopoietic Stem Cell Transplantation

Pulmonary hypertension (PH) is a potentially fatal complication of hematopoietic stem cell transplantation (HSCT). Given its nonspecific clinical presentation, it is likely that this clinical entity is underdiagnosed after HSCT. Data describing the incidence, risk factors, and etiology of PH in HSCT recipients are minimal. Physicians caring for HSCT recipients should be aware of this severe post-transplant complication because timely diagnosis and treatment may allow improved clinical outcomes. We summarize the pathophysiology, clinical presentation, diagnosis, and management of PH in HSCT recipients.     

Pulmonary glomus tumor

Glomus tumor (GT) is an infrequent but distinct neoplasm. Pulmonary GT is a rare neoplasm with only a few cases reported in the literature. These tumors are usually benign and, although rare, tumors with aggressive behavior have been reported. The tumor size, location, and histomorphological features may be useful in predicting tumor behavior. We present here a case of pulmonary GT that was initially diagnosed as a typical carcinoid tumor. The differential diagnosis as well as the recent classification of GTs is discussed along with a review of literature.     

Pulmonary lymphatics and their spatial relationship to venous sphincters

Background: Pulmonary lymphatics are critical to clearing lung fluid. Although their structure can be shown with light and transmission electron microscopy, scanning electron microscopy of their casts can better show their number, size, shape, distribution, and degree of filling. This technique has identified four forms of lung lymphatics, but these forms have not been fully evaluated by tissue microscopy. A most important site of pulmonary edema formation, the pulmonary capillary, is just upstream from small veins which have focal, smooth muscle tufts termed venous sphincters. Because of their constricting potential, these sphincters may control lung perfusion and cause edema. Methods: With light and transmission electron microscopy of tissue and scanning electron microscopy of casts, the lymphatic forms were explored in relation to the tissue anatomy in rats without pulmonary edema and with mild-to-moderate edema caused by extended vascular rinsing. Results: The edematous lungs had increased sacculo-tubular lymphatics adjacent to the venous sphincters. These lymphatics were in the adventitial connective tissue and were partially endothelialized. As lymphatics became more tubular their endothelium became more complete. Collagen fibers traversed the lumen of these lymphatics even where endothelial cells were present and caused the lines on the surface of the lymphatic casts. Overlapping endothelial cells caused clefts on the casts. Conclusions: Scanning electron microscopy of lymphatic casts better defines their ultrastructure and shows the spatial relationship of veins and their sphincters to venous lymphatics. Sphincter contraction may influence pulmonary lymph production which could affect other aspects of regional lung perfusion. © 1995 Wiley-Liss, Inc.