Endothelial nitric oxide synthase mediates protective effects of hypoxic preconditioning in lungs

To elucidate the protective mechanism of whole-body hypoxic preconditioning (WHPC) on pulmonary ischemia-reperfusion injury focussing on nitric oxide synthases (NOS), mice were placed in a hypoxic chamber (FIO(2)=0.1) for 4h followed by 12h of normoxia. Then, pulmonary ischemia for 1h followed by 5h of reperfusion was performed by clamping the left hilum in vivo (I/R). WHPC protected WT mice from pulmonary leukocyte infiltration as assessed by myeloperoxidase (MPO) activity, associated with a mild further increase in endothelial permeability (Evans Blue extravasation). When all NOS isoforms were inhibited during WHPC by L-NAME, mortality and MPO activity after I/R markedly increased. To determine the responsible NOS isoform, quantitative RT-PCR was performed for eNOS and iNOS mRNA, showing that only eNOS was upregulated in response to WHPC. While eNOS total protein expression remained unchanged, the amount of phosphorylated eNOS also increased. The WHPC/IR experiments were then repeated with eNOS knockout mice. Here, we found that the protective effect of WHPC on pulmonary leukocyte sequestration was abrogated, and endothelial leakage was further exacerbated. We conclude that WHPC limits neutrophil sequestration via an eNOS-dependent mechanism, and that eNOS helps preserve endothelial permeability during hypoxia and I/R.     

Lung cysts in chronic paracoccidioidomycosis

On HRCT scans, lung cysts are characterized by rounded areas of low attenuation in the lung parenchyma and a well-defined interface with the normal adjacent lung. The most common cystic lung diseases are lymphangioleiomyomatosis, Langerhans cell histiocytosis, and lymphocytic interstitial pneumonia. In a retrospective analysis of the HRCT findings in 50 patients diagnosed with chronic paracoccidioidomycosis, we found lung cysts in 5 cases (10%), indicating that patients with paracoccidioidomycosis can present with lung cysts on HRCT scans. Therefore, paracoccidioidomycosis should be included in the differential diagnosis of cystic lung diseases.     

Chirurgisches Vorgehen bei kolorektalen Lungenmetastasen

Context

Pulmonary metastasectomy is associated with low morbidity and mortality and might provide a survival advantage for selected patients.

Objective

The aim of this study was an evidence-based systematic review of the current status of the diagnostics and therapy of pulmonary metastases arising from malignant colorectal cancer.

Material and methods

A systematic literature search was performed in PubMed, Medline, current guidelines and by manual searching. Relevant publications from the last 20 years were analyzed and the results are summarized in a structured review.

Results

The indications for metastasectomy should be discussed in an interdisciplinary tumor board. Even in the absence of pre-metastasectomy chemotherapy, an observation period of at least 2 months should be recommended for assessment of the tumor biology. The 5-year survival rate ranges between 40 % and 68 % for patients undergoing pulmonary metastasectomy. Positive prognosticators for survival might be complete resection, low carcinoembryonic antigen (CEA) levels, few metastases, long disease-free interval, localization of the primary tumor in the colon, no lymph node metastases and regression or stable disease after preoperative chemotherapy and/or observation interval. Rectal cancer represents a different tumor entity compared to colon cancer even in metastasectomy patients. Rectal cancer is associated more often with multiple metastases, higher prevalence of thoracic lymph node metastases and shorter disease-free interval. Resectable liver and lung metastases or the prevalence of thoracic lymph node metastases are not a contraindication for surgery.

Conclusion

Pulmonary metastasectomy for colorectal cancer is an established treatment within multimodal treatment concepts. The indications for metastasectomy should be discussed in an interdisciplinary tumor board. Rectal cancer represents a different tumor entity compared to colon cancer even in metastasectomy patients. Resectable liver and lung metastases or the presence of thoracic lymph node metastases are not a contraindication for surgery per se.     

Stellenwert der Manschettenresektion am Bronchial- und Gefäßbaum der Lunge beim nichtkleinzelligen Lungenkarzinom

Background

Centrally located non-small cell lung cancer (NSCLC) can be resected by either pneumonectomy or parenchyma-sparing sleeve resection. The questions of local radicalness, significance in advanced nodal disease and the functional outcome after sleeve resection are still under discussion.

Objective

The aim of this study was an evidence-based systematic review of the current status and comparison of both resection techniques in the treatment of centrally located NSCLC.

Material and methods

A systematic literature search was performed in Pubmed, Medline, current guidelines and by manual searching. Relevant publications from the last 15 years were analyzed and the results are summarized in a structured review.

Results and discussion

Sleeve resection is performed less often than pneumonectomy. Bronchovascular sleeve resection can be performed with low morbidity and mortality. Theses methods do not have a worse prognosis compared with isolated bronchial sleeve resection. The weighted average for local recurrence is 16.1?% for sleeve resection and 27.8?% for pneumonectomy. Even in the case of multilevel N1/N2 disease the local recurrence rate is low. In nodal negative and nodal positive disease, pneumonectomy does not result in better long-term survival. Sleeve resection can safely be performed in older patients (>?70 years). Quality of life is better after sleeve resection than after pneumonectomy. Lung perfusion and forced expiratory volume per second 6 months after sleeve resection are similar to preoperative values. The loss of function after sleeve resection is comparable to lobectomy. Whenever technically and ontologically reasonable, sleeve resection should be preferred.     

Ätiologie und Pathogenese

Ohne Zusammenfassung     

Blut,Serologie, Immunität

Ohne Zusammenfassung     

Zelle,Gewebelehre, Mikrobiologie,Strahlenkunde

Ohne Zusammenfassung