Variation in Number and Drainage Pattern of Pulmonary Veins Draining into the Left Atrium

Pulmonary veins carry oxygenated blood from the lungs to the left atrium of the heart. The variation in the number and drainage pattern of pulmonary veins is frequent and this knowledge is valuable for various procedures involving the pulmonary veins. The present study is done on 29 hearts obtained from formalin fixed cadavers from the dissecting room of department of anatomy, MAMC, Agroha, Hisar. The left atrium of these hearts was studied from external aspect for the number of pulmonary veins draining into left atrium and from internal aspect for the drainage pattern. In 13 out of 29 hearts (44.8%), variation in number of pulmonary vein was observed. In the present study the most common variation of right pulmonary veins is three veins with two ostia (10.3%) and the most common variation of left pulmonary veins is a single vein with a single ostium (17.2%).The variations of pulmonary veins are quite common with an equivocal variability in right-sided and left-sided drainage patterns. A classification is proposed to describe these variations to facilitate communication with referring clinicians.     

左肺上、下舌段静脉的多层螺旋CT研究

目的：探讨活体左肺上、下舌段静脉在多层螺旋CT上的配布规律。方法：利用Volume Wizard图像后处理工作站对160例成年男性肺部多层螺旋CT图像进行重建,并分析左肺上叶上、下舌段及其亚段静脉的属支数目、类型和毗邻关系。结果：上舌段静脉（V4）和下舌段静脉（V5）共干形成舌静脉干（V4＋5）者占61.2％,二者单独汇入左上肺静脉者占38.8％;V4、V5的属支一般有1-5条,多注入V4＋5或单独注入左上肺静脉。另有少数V4注入V3,少数V5汇入左下肺静脉。结论：多层螺旋CT是活体研究肺静脉的理想方法;上、下舌段静脉的属支数目和走行差异较大。舌静脉干和v。多为上、下舌段的段间支,是上、下舌段的分界标志。     

Potential Immune Mechanisms Associated with Anemia in Plasmodium vivax Malaria: a Puzzling Question

The pathogenesis of malaria is complex, generating a broad spectrum of clinical manifestations. One of the major complications and concerns in malaria is anemia, which is responsible for considerable morbidity in the developing world, especially in children and pregnant women. Despite its enormous health importance, the immunological mechanisms involved in malaria-induced anemia remain incompletely understood. Plasmodium vivax, one of the causative agents of human malaria, is known to induce a strong inflammatory response with a robust production of immune effectors, including cytokines and antibodies. Therefore, it is possible that the extent of the immune response not only may facilitate the parasite killing but also may provoke severe illness, including anemia. In this review, we consider potential immune effectors and their possible involvement in generating this clinical outcome during P. vivax infections.     

Puzzling out the COVID-19: Therapy targeting HLA-G and HLA-E

SARS-CoV2 might conduce to rapid respiratory complications challenging healthcare systems worldwide. Immunological mechanisms associated to SARS-CoV2 infection are complex and not yet clearly elucidated. Arguments are in favour of a well host-adapted virus. Here I draw a systemic immunological representation linking actual SARS-CoV2 infection literature that hopefully might guide healthcare decisions to treat COVID-19. I suggest HLA-G and HLA-E, non classical HLA class I molecules, in the core of COVID-19 complications. These molecules are powerful in immune tolerance and might inhibit/suppress immune cells functions during SARS-CoV2 infection promoting virus subversion. Dosing soluble forms of these molecules in COVID-19 patients’ plasma might help the identification of critical cases. I recommend also developing new SARS-CoV2 therapies based on the use of HLA-G and HLA-E or their specific receptors antibodies in combination with FDA approved therapeutics to combat efficiently COVID-19.     

Bilateral Pulmonary Emboli in a Collegiate Gymnast: A Case Report

Objective:

To characterize the diagnosis of pulmonary embolism in collegiate student-athletes and to raise awareness among sports medicine providers of the possibility of this potentially fatal disease in the student-athlete population.

Background:

An 18-year-old, previously healthy National Collegiate Athletic Association Division I female gymnast complained of intense pain, bilaterally, deep in her chest. The athlete was referred to her team physician, who identified normal vital signs but referred her to the emergency room because of significant pain. The student-athlete was diagnosed with bilateral pulmonary emboli in the emergency room.

Differential Diagnosis:

Pneumonia, renal calculi, upper urinary tract infection, intercostal muscle strain or rib fracture, pancreatitis, gall bladder disease, gastritis, ulceration, esophagitis, infection, tumor, pulmonary embolism.

Treatment:

The student-athlete was immediately placed on anticoagulants for 6 months. During that time, she was unable to participate in gymnastics and was limited to light conditioning.

Uniqueness:

Documented cases of female student-athletes developing a pulmonary embolism are lacking in the literature. Two cases of pulmonary embolism in male high school student-athletes have been documented, in addition to many cases in elderly and sedentary populations.

Conclusions:

All health care providers, including sports medicine professionals, should be aware that this condition may be present among student-athletes. During the initial evaluation, prescreening should include questions about any previous or family history of pulmonary embolism or other blood clots. Athletes who answer positively to these questions may have a higher likelihood of pulmonary embolism and should be referred for testing.     

A rare aspect of Crohn's disease: Pulmonary involvement in a child

Crohn''s disease (CD), known as the disease of gastrointestinal system, is a granulamatous systemic disorder with extraintestinal manifestations including the respiratory system. The resemblance in the embriological origins and the immunities of both organ systems'' mucosae, also the circulating immune complexes and the autoantibodies are accepted as contributing factors. The shift of inflammation may become prominent when the colon is removed after colectomy and independent of the bowel disease activity; pulmonary involvement may be exarbecated. In the pediatric population, CD associated pulmonary involvement is very rare, mainly in the form of subclinical alterations and the data are limited mostly to case reports. Therefore, it is possibly overlooked since the diagnosis relies on suspicion. We represent a 5-year-old CD patient with previous bronchiolitis episodes that might have resulted from CD-associated pulmonary involvement; whom later developed severe pneumonia resulting in acute respiratory distress syndrome and bronchiectasia following a colectomy operation.     

Heparan Sulfates in the Lung: Structure,Diversity, and Role in Pulmonary Emphysema

There is an emerging interest in the extracellular matrix (ECM) of the lung, especially in the role it plays in development and disease. There is a rapid change from the classical view of the ECM as a supporting structure towards a view of the ECM as a regulatory entity with profound effects on proliferation, migration, and differentiation of pulmonary cells. In the ECM, a variety of molecules is present in a highly organized pattern. Next to the abundant fiber‐forming molecules such as collagens and elastin, a large number of less abundant molecules are part of the ECM, including proteoglycans. In this review, we will focus on one class of proteoglycans, the heparan sulfate proteoglycans. We will particularly address the structure, biosynthesis, and function of their saccharide moiety, the heparan sulfates, including their role in development and (patho)physiology. Anat Rec, 293:955–967, 2010. © 2010 Wiley‐Liss, Inc.     

Morphological Changes in Varicocele Veins: Ultrastructural Study

Background: Varicocele consists of dilatation of the pampiniform venous plexus and the internal spermatic veins. It is present in 15% of male population and is a common cause of male infertility. Objective: To describe the normal structure of the internal spermatic vein and the morphological changes in grade 3 varicocele. Methods: The authors dissected and analyzed a 2- to 3-cm tract of the pampiniform venous plexus of 20 patients undergoing varicocelectomy for left varicocele and of 10 consecutive patients undergoing surgery for left inguinal hernia. The histological examination was performed with hematoxylin–eosin and Masson trichrome stains. The ultrastructural evaluation was done using both scanning and transmission electron microscopy. Results: Compared with normal internal spermatic veins, varicocele veins showed narrowing and/or obliteration of the lumens, destruction of the endothelial cells, invagination of the intima, and deposition of collagen bundles in the media (light microscopy). The ultrastructural changes in varicocele veins included elongation of the endothelial cells with features of cellular damage, loss of the internal elastic lamina, and the appearance of ghost bodies and degenerative vacuoles in the subendothelial layer. Conclusions: The authors believe this is the first report analyzing ultrastructual changes in normal human internal spermatic vein samples and in varicocele. The underlying molecular mechanisms of these changes await further studies.     

心包内处理肺静脉根部或切除部分左房在晚期肺癌手术中的应用

目的:探讨切开心包处理肺静脉或切除部分左心房对提高晚期肺癌患者的外科手术切除率及提高手术疗效的作用.方法:对21例晚期肺癌患者施行肺叶或全肺切除时,在心包内处理肺静脉或切除部分左心房.其中左肺下叶切除6例、左全肺切除4例、右肺中下叶切除6例、右肺下叶切除3例、右全肺切除2例.结果:21例均手术顺利;术后并发心律失常2例,肺炎2例,均治愈.本组1年生存率61.9%(13/21)、3年生存率38.1%(8/21),其中2例生存＞5 a.结论:晚期肺癌累及肺静脉根部或左心房时,通过切开心包处理肺静脉或同时切除部分左心房可提高肿瘤的根治率.     

Pulmonary Tumor Thrombotic Microangiopathy in a Patient of Gastric Carcinoma: A Rare Entity

How to cite this article: Choudhury S, Mishra SB, Panda S. Pulmonary Tumor Thrombotic Microangiopathy in a Patient of Gastric Carcinoma: A Rare Entity. Indian J Crit Care Med 2022;26(6):763–764.     

Pulmonary sequestration—a diagnostic pitfall: A case report

Pulmonary sequestration is defined as a congenital malformation of abnormal lung tissue that does not communicate with the airway system and that receives blood supply from anomalous arteries. The majority of these sequestrations are encountered in the pediatric population. Surgical excision is the treatment of choice, with excellent prognosis. We studied a case of an extralobar pulmonary sequestration in a young adult, presenting as an intrathoracic mass; it was aspirated twice, final diagnosis being rendered after surgical resection. The cytologic findings and the accompanying diagnostic difficulties to our knowledge have never been reported. Diagn. Cytopathol. 16:353–357, 1997. © 1997 Wiley-Liss, Inc.