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Respiratory Medicine Mar 2018Subatmospheric pleural pressure (Ppl), which is approximately -3 to -5 cmHO at functional residual capacity (FRC) makes pleura a unique organ in the human body. The... (Review)
Review
Subatmospheric pleural pressure (Ppl), which is approximately -3 to -5 cmHO at functional residual capacity (FRC) makes pleura a unique organ in the human body. The negative Ppl is critical for maintaining the lungs in a properly inflated state and for proper blood circulation within the thorax. Significant and sudden pleural pressure changes associated with major pleural pathologies, as well as therapeutic interventions may be associated with life-threatening complications. The pleural pressure may show two different values depending on the measurement method applied. These are called pleural liquid pressure and pleural surface pressure. It should also be realized that there are significant differences in pleural pressure distribution in pneumothorax and pleural effusion. In pneumothorax, the pressure is the same throughout the pleural space, while in pleural effusion there is a vertical gradient of approximately 1 cm HO/cm in the pleural pressure associated with the hydrostatic pressure of the fluid column. Currently, two main methods of pleural pressure measurement are used: simple water manometers and electronic systems. The water manometers are conceptually simple, cheap and user-friendly but they only allow the estimation of the mean values of pleural pressure. The electronic systems for pleural pressure measurement are based on pressure transducers. Their major advantages include precise measurements of instantaneous pleural pressure and the ability to display and to store a large amount of data. The paper presents principles and details of pleural pressure measurement as well as the rationale for its use.
Topics: Electronics, Medical; Equipment Design; Humans; Lung Diseases; Manometry; Pleura; Pleural Effusion; Pneumothorax; Pressure
PubMed: 29501243
DOI: 10.1016/j.rmed.2018.01.013 -
Physiological Reviews Apr 2004The pleural space separating the lung and chest wall of mammals contains a small amount of liquid that lubricates the pleural surfaces during breathing. Recent studies... (Review)
Review
The pleural space separating the lung and chest wall of mammals contains a small amount of liquid that lubricates the pleural surfaces during breathing. Recent studies have pointed to a conceptual understanding of the pleural space that is different from the one advocated some 30 years ago in this journal. The fundamental concept is that pleural surface pressure, the result of the opposing recoils of the lung and chest wall, is the major determinant of the pressure in the pleural liquid. Pleural liquid is not in hydrostatic equilibrium because the vertical gradient in pleural liquid pressure, determined by the vertical gradient in pleural surface pressure, does not equal the hydrostatic gradient. As a result, a viscous flow of pleural liquid occurs in the pleural space. Ventilatory and cardiogenic motions serve to redistribute pleural liquid and minimize contact between the pleural surfaces. Pleural liquid is a microvascular filtrate from parietal pleural capillaries in the chest wall. Homeostasis in pleural liquid volume is achieved by an adjustment of the pleural liquid thickness to the filtration rate that is matched by an outflow via lymphatic stomata.
Topics: Animals; Body Fluids; Humans; Hydrostatic Pressure; Lung; Models, Biological; Pleura; Pleural Cavity; Respiratory Mechanics
PubMed: 15044678
DOI: 10.1152/physrev.00026.2003 -
International Journal of Molecular... Mar 2020Malignant mesothelioma is an infrequent tumor that initiates from the mesothelial cells lining of body cavities. The great majority of mesotheliomas originate in the... (Review)
Review
Malignant mesothelioma is an infrequent tumor that initiates from the mesothelial cells lining of body cavities. The great majority of mesotheliomas originate in the pleural cavity, while the remaining cases initiate in the peritoneal cavity, in the pericardial cavity or on the tunica vaginalis. Usually, mesotheliomas grow in a diffuse pattern and tend to enclose and compress the organs in the various body cavities. Mesothelioma incidence is increasing worldwide and still today, the prognosis is very poor, with a reported median survival of approximately one year from presentation. Thus, the development of alternative and more effective therapies is currently an urgent requirement. The aim of this review article was to describe recent findings about the anti-cancer activity of curcumin and some of its derivatives on mesotheliomas. The potential clinical implications of these findings are discussed.
Topics: Antineoplastic Agents; Curcumin; Humans; Mesothelioma, Malignant; Phytochemicals; Pleura; Pleural Neoplasms; Prognosis
PubMed: 32155978
DOI: 10.3390/ijms21051839 -
Advances in Respiratory Medicine 2018Castleman's disease is a rare benign lymphoproliferative disorder of unknown etiology. The disease occurs in two clinical forms with different prognoses, treatments and... (Review)
Review
INTRODUCTION
Castleman's disease is a rare benign lymphoproliferative disorder of unknown etiology. The disease occurs in two clinical forms with different prognoses, treatments and symptoms: a unicentric form (UCD), which is solitary, localized, and a multicentric form characterized by generalized lymphadenopathy and systemic symptoms. This article aims to review the current literature to consolidate the evidence surrounding the curative potential of surgical treatment to the unicentric type.
MATERIAL AND METHODS
A systematic review of English-language literature was performed and databases (Medline, Pubmed, the Cochrane Database and grey literature) were searched to identify articles pertaining to the treatment of unicentric form of Castleman's disease. Each article was critiqued by two authors using a structured appraisal tool, and stratified according to the level of evidence.
RESULTS
After application of inclusion criteria, 14 studies were included. There were no prospective randomized control studies identified. One meta-analysis including 278 patients with UCD reported that resective surgery is safe and should be considered the gold standard for treatment. Seven retrospective studies enhance this standpoint. Radiotherapy (RT) has been used in six studies with controversial results.
CONCLUSIONS
We conclude that surgical resection appears to be the most effective treatment for Unicentric Castleman's Disease of the thoracic cavity. Radiotherapy can also achieve clinical response and cure in selected patients.
Topics: Castleman Disease; Humans; Pleura; Thoracic Cavity
PubMed: 29490420
DOI: 10.5603/ARM.2018.0008 -
Journal of Vascular Surgery. Venous and... May 2020This study evaluated swine and bovine pulmonary visceral pleura (PVP) as a vascular patch. Venous patches are frequently used in surgery for repair or reconstruction of...
OBJECTIVE
This study evaluated swine and bovine pulmonary visceral pleura (PVP) as a vascular patch. Venous patches are frequently used in surgery for repair or reconstruction of veins. Autologous patches are often limited by the number and dimension of donor tissue and can result in donor complications. Bovine pericardium is the most common heterologous patch used by vascular surgeons. Researchers, however, are continually seeking to improve heterologous and synthetic patches for improved outcome.
METHODS
The PVP was peeled from swine and bovine lungs and cross-linked with glutaraldehyde. After sterilization and rinsing, the PVP patches were implanted in the jugular vein (10 × 35 mm) of pigs and dogs. Patency was evaluated by ultrasound, and animals were euthanized at 2 and 4 months. Neoendothelium and neomedia were evaluated by histologic analysis.
RESULTS
The jugular vein patched by PVP in pigs and dogs remained patent at 2 and 4 months with no adhesions, inflammation, or aneurysm in the patches. The biomarkers of endothelial cells-factor VIII, platelet/endothelial cell adhesion molecule 1, and endothelial nitric oxide synthase-were detected in the neoendothelial cells. The expression of vascular smooth muscle cell (VSMC) α-actin was robust in the neomedia at 2 and 4 months. Neomedia composed of VSMCs developed to nearly double the thickness of adjacent jugular vein. The circumferential orientation of VSMCs in neomedia further increased in the 4-month group.
CONCLUSIONS
The cross-linked swine and bovine PVP patch has a nonthrombogenic surface that maintains patency. The PVP patch may overcome the pitfall of compliance mismatch of synthetic patches. The proliferation of vascular cells assembled in the neoendothelium and neomedia in the patches may support long-term patency.
Topics: Animals; Autografts; Bioprosthesis; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Cattle; Cross-Linking Reagents; Dogs; Fixatives; Glutaral; Heterografts; Jugular Veins; Materials Testing; Neointima; Pleura; Swine; Swine, Miniature; Time Factors; Vascular Patency; Vascular Remodeling
PubMed: 31837973
DOI: 10.1016/j.jvsv.2019.09.011 -
Scientific Reports May 2021Birt-Hogg-Dubé syndrome (BHDS), an autosomal dominant inheritance disease caused by folliculin (FLCN) mutations, is associated with lung cysts and spontaneous...
Birt-Hogg-Dubé syndrome (BHDS), an autosomal dominant inheritance disease caused by folliculin (FLCN) mutations, is associated with lung cysts and spontaneous pneumothorax. The possibility of FLCN haploinsufficiency in pleural mesothelial cells (PMCs) contributing to development of pneumothorax has not yet been clarified. Electron microscopy revealed exposed intercellular boundaries between PMCs on visceral pleura and decreased electron density around the adherens junctions in BHDS. To characterize cellular function of PMCs in BHDS patients (BHDS-PMCs), during surgery for pneumothorax, we established the flow cytometry-based methods of isolating high-purity PMCs from pleural lavage fluid. BHDS-PMCs showed impaired cell attachment and a significant decrease in proliferation and migration, but a significant increase in apoptosis compared with PMCs from primary spontaneous pneumothorax (PSP) patients (PSP-PMCs). Microarray analysis using isolated PMCs revealed a significant alteration in the expression of genes belonging to Gene Ontology terms "cell-cell adhesion junction" and "cell adhesion molecule binding". Gene set enrichment analysis demonstrated that CDH1, encoding E-cadherin, was identified in the down-regulated leading edge of a plot in BHDS-PMCs. AMPK and LKB1 activation were significantly impaired in BHDS-PMCs compared with PSP-PMCs. Our findings indicate that FLCN haploinsufficiency may affect the E-cadherin-LKB1-AMPK axis and lead to abnormal cellular function in BHDS-PMCs.
Topics: Adult; Apoptosis; Birt-Hogg-Dube Syndrome; Bronchoalveolar Lavage Fluid; Cell Movement; Cell Proliferation; Epithelial Cells; Female; Gene Expression Profiling; Gene Expression Regulation; Haploinsufficiency; Humans; Male; Microscopy, Electron; Middle Aged; Oligonucleotide Array Sequence Analysis; Pleura; Primary Cell Culture; Proto-Oncogene Proteins; Tumor Suppressor Proteins; Young Adult
PubMed: 34031471
DOI: 10.1038/s41598-021-90184-9 -
Minerva Anestesiologica Sep 2009Ultrasonographic scanning of the lung is gaining ever-growing recognition as a diagnostic and monitoring imaging technique. Its role in trauma assessment has already... (Review)
Review
Ultrasonographic scanning of the lung is gaining ever-growing recognition as a diagnostic and monitoring imaging technique. Its role in trauma assessment has already been established as an extension of the focused assessment of trauma with sonography for the diagnosis of pneumothorax. As more centers are discovering the advantages of ultrasound and conducting experimental and comparative studies, its use for diagnosing many other lung pathologies is becoming even more important. In-depth studies and innovative ideas are needed to explore the possibilities of this technology. We believe that, ultimately, the advantages for the patient will far outweigh the disadvantages of ultrasonography. Here, we review all possible applications of lung ultrasonography used thus far in Intensive Care Units, where a readily available and biologically non-invasive imaging technique may make the difference in diagnosis. In addition, we describe how the non-invasive nature of ultrasonography allows it to be used as a monitoring device of disease progression vs the healing process. We also provide a detailed explanation of the methods and materials necessary and a few indications towards unanswered questions in this field of research.
Topics: Critical Care; Humans; Intensive Care Units; Lung; Lung Diseases; Monitoring, Physiologic; Pleura; Point-of-Care Systems; Ultrasonography
PubMed: 19644435
DOI: No ID Found -
Anales Del Sistema Sanitario de Navarra 2005Malign mesothelioma is a pleural neoplasia related to the occupational exposure to asbestos, although other factors can be involved; its incidence is increasing in...
Malign mesothelioma is a pleural neoplasia related to the occupational exposure to asbestos, although other factors can be involved; its incidence is increasing in Western Europe. Pain in the thorax and dyspnoea are its most frequent clinical manifestations. An important role in the evaluation of the disease is played by imaging techniques, of which CAT is the most widely used, although MR and PET are suggested as techniques that can provide additional information in the diagnosis and prognosis of these patients. Survival is short and there is no consensus in the literature that would orientate treatment of these patients. This is due to a lack of data that would confirm an increase of survival with any therapeutic method, although recent efforts have led to the development of new treatments that could change the present pessimistic view of the disease held by doctors and patients.
Topics: Adult; Aged; Asbestos; Europe; Female; Humans; Incidence; Magnetic Resonance Imaging; Male; Mesothelioma; Middle Aged; Occupational Diseases; Occupational Exposure; Pleura; Pleural Neoplasms; Positron-Emission Tomography; Tomography, X-Ray Computed
PubMed: 15915169
DOI: No ID Found -
BMC Cancer Aug 2022There are increasing numbers of studies of pleural tags (PTs). The purpose of this case series was to classify the PTs in patients with peripheral pulmonary...
OBJECTIVES
There are increasing numbers of studies of pleural tags (PTs). The purpose of this case series was to classify the PTs in patients with peripheral pulmonary adenocarcinoma based on radiologic-pathologic comparison and to study the prognosis.
METHODS
The clinical, imaging, pathological and prognostic data of 161 patients with peripheral pulmonary adenocarcinoma in three hospitals were analyzed retrospectively. We classified PTs using computed tomography (CT) for pathologic comparison.
RESULTS
According to the relationship between tumors and pleural on CT images, PTs were classified into four types: type 1, one or more linear pleural tag; type 2, one or more linear pleural tag with soft tissue component at the pleural end; type 3, one soft tissue cord-like pleural tag; type 4, directly abutting the visceral pleura, pulling or pushing the visceral pleura. In these PTs, the incidence of visceral pleural invasion (VPI) was high in type 2 (46.88%) and type 3 (56.41%) of PTs. Our prognostic analysis showed that micropapillary or solid histological subtype (HR = 5.766, 95% CI: 1.435-23.159, P = 0.014) and type 3 of PTs (HR = 11.058, 95% CI: 1.349-90.623, P = 0.025) were two independent risk factors for tumor progression.
CONCLUSIONS
PT is a risk factor for poor prognosis in patients with peripheral pulmonary adenocarcinoma, the presence of which on CT images can remind us to provide patients with a more reasonable treatment.
Topics: Adenocarcinoma; Adenocarcinoma of Lung; Humans; Lung Neoplasms; Neoplasm Invasiveness; Neoplasm Staging; Pleura; Prognosis; Retrospective Studies
PubMed: 36008784
DOI: 10.1186/s12885-022-09977-4 -
Journal of Bronchology & Interventional... Jul 2021
Topics: Chest Tubes; Drainage; Humans; Pleura; Pleural Effusion
PubMed: 33234800
DOI: 10.1097/LBR.0000000000000735