Estimation of the filtration variables in the rat lung

The filtration variables, filtration coefficient (K), perimicrovascular pressure (Ppmv) and reflection coefficient (sigma) were estimated independently in previous reports using the Starling Equation or the micropuncture method. We estimated these variables simultaneously. We measured filtration rate by a gravimetric method in isolated rat lung lobes in zone 1 conditions (alveolar pressure = 20 cmH2O) at two vascular pressures, Pvasc = 15 or 8 cmH2O and perfused the lobes with plasma containing a low or high concentration of protein. By extrapolating the log of the rate of weight gain to time = 0, we obtain the initial filtration rate. Assuming that protein filtered into perimicrovascular space only by convection, we substituted into the Starling Equation as follows: Q = K[(Pmv-Ppmv)-sigma 2 pi mv], where Pmv and pi mv are hydrostatic and plasma protein osmotic pressures in microvascular space. pi mv was estimated by Yamada's equation. We obtained K = 26.3 +/- 8.7 mg/(min.cmH2O.g), PPMV = 6.2 +/- 0.7 cmH2O, sigma = 0.46 +/- 0.07. The chief advantages of this method are that it does not require a separate estimation of isogravimetric pressure or a direct measurement of interstitial pressure, and that all variables are obtained simultaneously.     

Seltene Erkrankungen in den Daten sichtbar machen – Kodierung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Seltene Erkrankungen (SE) werden durch die im deutschen Gesundheitssystem verwendete Diagnosenklassifikation ICD-10-GM...     

Present condition of lung transplantation candidates in eastern Japan]

We investigated the present condition of lung transplant candidates and the familiarity of doctors in eastern Japan by questionnaire. We shipped questionnaires to 614 hospitals in the Hokkaido district, the Tohoku district, the Kanto district and Niigata Prefecture, a received responses from 216 departments (200 hospitals). The percentage of respondents was 32.6%. There were 191 lung transplant candidates, 97 men and 94 women, in the past two years. Moreover, there were 45 patients with primary pulmonary hypertension (PPH), 38 with idiopathic pulmonary fibrosis, 23 with pulmonary emphysema, 20 with pulmonary lymphangiomyomatosis, among others. Currently, however, there are 88 patients who are lung transplant candidates, a large number, in eastern Japan. On the other hand, only 38 of 68 departments had informed their patients about lung transplantation. It was a lamentable result for transplant surgeons, and points urgently to the importance of giving information about lung transplantation.     

Migration of neutrophils from the lung into the pleural space after lung resection in humans and rabbits.

The origin of neutrophils that are found in pleural effusions after pulmonary resection is unknown. We measured neutrophil counts in pleural effusion sequentially for 48 h in patients who had undergone partial resection or pneumonectomy. Additionally, we measured neutrophil counts in the pleural effusions separately from the visceral pleura and parietal pleura in rabbits. In humans, we found that the maximum neutrophil counts in pleural effusion occurred more often in the patients who underwent partial resection (11.7 +/- 6.0 x 10(4) cells/microL) than in the patients who underwent pneumonectomy (3.7 +/- 1.2 x 10(4) cells/microL). There was no difference between neutrophil counts in blood of pneumonectomy group and that of the partial resection group. In rabbits, neutrophil counts were 1.5 times greater in the pleural effusion derived from the lung than in that derived from the parietal pleura. We conclude that movement of neutrophils occurs primarily from the lung into the pleural space after lung resection in humans and rabbits.     

MDM2 expression is associated with progress of disease and WAF1 expression in resected lung cancer

Although MDM2, p21/WAF1, and p53 are considered as regulating each other based on in vitro studies, the relation in human lung cancer is not fully understood. The expressions of these proteins were examined immunohistochemically in 112 resected non-small cell lung cancer specimens and the correlation between them were analyzed. MDM2 was expressed in 45% of all lung cancers. In advanced stage, MDM2-positive cases were observed more frequently than in early stage, showing significant difference. No significant difference was observed in the prognosis of the patients regardless of the expression of any protein. Although no correlation was observed between MDM2 expression and p53 expression, or between p21/WAF1 expression and p53 expression, MDM2 expression was strongly related with p21/WAF1 expression. Therefore, MDM2 expression may relate to the progress of the stage of lung cancer, and MDM2 expression and p21/WAF1 expression may be associated not through the p53-related pathway.     

Localized malignant mesothelioma in the stomach and mediastinum

Localized malignant mesothelioma is rare. It has a histological pattern identical to diffuse malignant mesothelioma but without diffuse serosal spread. Localized malignant mesothelioma typically originates from the pleura, peritoneum or pericardium, but can occasionally develop from organs. Our cases represent what might be the largest mediastinal localized malignant mesothelioma described and the first presentation of the epithelioid type in the stomach of an adult.     

Functional evaluations for pulmonary resection for lung cancer in octogenarians. Investigation from postoperative complications.

We have reviewed the records of our twenty-four patients aged 80 years or older who underwent lung resections for bronchogenic carcinoma between 1983 and 1997 in our department. Eighteen patients were male and six were female. Adenocarcinoma was the histology in more than half of the cases (13 patients), along with 8 squamous cell carcinoma, 2 large cell carcinoma, and one small cell lung carcinoma. More than single lobectomy was performed in each patient. Unilateral pulmonary occlusion tests were employed in patients with impairment in pulmonary functions. Every patient, who underwent the unilateral pulmonary occlusion test, was certified that the total pulmonary vascular resistance index during unilateral pulmonary arterial occlusion test was less than 700 dyne.sec.cm-5.m2. Postoperative cardiovascular complications, such as paroxysmal atrial tachycardia, premature atrial contraction, premature ventricular contraction or atrial fibrillation, were seen in 10 patients. Postoperative respiratory complications, namely, sputa retention, retained secretions or atelectasis, were seen in 7 patients. The extent of dissection of mediastinal lymph node was not correlated to the postoperative pulmonary complications. However, the incidence of arrhythmias in the patients who received R2 mediastinal lymphnode dissection was much higher than in those who received R1 or R0 dissection. Complete blood counts and serum biochemical analysis performed at about three weeks after operations revealed leukocytosis and increases in levels of serum transaminase. These phenomena in leukocytosis and increases in the levels of serum transaminase in these patients were similar to those in younger patients. There was no operative death. We conclude that some patients over 80 years are candidates for lung resection after careful preoperative cardiopulmonary evaluation.     

Pigmented freckles on the sole of acral lentiginous melanoma in situ

We report a rare case presenting a very early, non-invasive stage of acral lentiginous melanoma (ALM). A 67-year-old male patient came to our clinic 4 days after he noticed the presence of a pigmented lesion on the sole of his right heel. The lesion exhibited an irregular, asymmetrical outline and haphazard combination of colors ranging from tan to brown black; it measured 3.2 times 2.1 cm in its greatest dimensions. It was not elevated. It was surgically removed. Histopathologically, serial sections of the lesion revealed an increase in large atypical melanocytes. These abnormal cells with irregular in shape and relatively hyperchromatic nuclei, were mainly located in the basal layer, resulting in the proliferation of lentiginous type. These findings are clinically and histopathologically identical to those found in ALM in situ.     

Using failure mode and effects analysis to plan implementation of smart i.v. pump technology.

PURPOSE: Failure mode and effects analysis (FMEA) was used to evaluate a smart i.v. pump as it was implemented into a redesigned medication-use process. SUMMARY: A multidisciplinary team conducted a FMEA to guide the implementation of a smart i.v. pump that was designed to prevent pump programming errors. The smart i.v. pump was equipped with a dose-error reduction system that included a pre-defined drug library in which dosage limits were set for each medication. Monitoring for potential failures and errors occurred for three months postimplementation of FMEA. Specific measures were used to determine the success of the actions that were implemented as a result of the FMEA. The FMEA process at the hospital identified key failure modes in the medication process with the use of the old and new pumps, and actions were taken to avoid errors and adverse events. I.V. pump software and hardware design changes were also recommended. Thirteen of the 18 failure modes reported in practice after pump implementation had been identified by the team. A beneficial outcome of FMEA was the development of a multidisciplinary team that provided the infrastructure for safe technology implementation and effective event investigation after implementation. With the continual updating of i.v. pump software and hardware after implementation, FMEA can be an important starting place for safe technology choice and implementation and can produce site experts to follow technology and process changes over time. CONCLUSION: FMEA was useful in identifying potential problems in the medication-use process with the implementation of new smart i.v. pumps. Monitoring for system failures and errors after implementation remains necessary.