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Lung hyperpermeability and changes in biochemical constituents in bronchoalveolar lavage fluids following X irradiation of the thorax.

Groups of rats were administered different doses of X rays (7.5 and 15 Gy), and the effect on the permeability of their lungs was evaluated during a time frame within which radiation pneumonitis develops. Sham-exposed animals served as controls. End points surveyed included lung weight and increases in the total protein in the lavage fluid. To obtain more detailed information about hyperpermeability and to examine some specific protein changes that occur in the lung's fluid in response to X irradiation, the lavage fluids were subjected to a reverse-phase HPLC technique that resolves 11 fractions quantitatively, including transferrin, albumin, and immunoglobulins derived from blood, as well as eight other protein and nonprotein constituents that appear to be derived from the lung (fractions 1, 2, 6-11). The earliest change following the 7.5-Gy dose was a decrease in fraction 6 at 1 week after exposure. As of Week 5, the lung weight and total protein in the lavage fluid were all normal, while the HPLC analyses revealed significant and equivalent increases in the amount of transferrin, albumin, and immunoglobulins in the lavage fluid; fraction 6 was no longer diminished. At 9 and 13 weeks, hyperpermeability could no longer be detected, while fraction 6 was again decreased at week 13. Fraction 6 was also decreased 1 week after the 15-Gy dose. At 5 weeks, when the weight of the lungs and the total protein in the lavage fluid were elevated, lavage fractions 1, 2, 10, and 11 were all increased, and transferrin, albumin, and immunoglobulins were increased approximately 1500, 1000, and 500%, respectively, and fractions 6 and 9 were decreased. By Week 7, the weight of the lungs returned to control limits, while total protein in the lavage fluid remained elevated. The hyperpermeability was characterized by increases in transferrin and albumin in the lavage fluid, but not immunoglobulins. Fractions 1, 2, 10, and 11 returned to within normal limits, whereas fraction 9 decreased further. Increases in transferrin and albumin were components of a persisting hyperpermeability observed at the last 9-week time point. All other fractions were normal, with the exception of fraction 6, which remained decreased.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Selection and identification of standard cardiac views from three-dimensional volume scans of the fetal thorax.

The feasibility of fetal echocardiographic examination using three-dimensional ultrasonography was investigated in 54 healthy pregnant women with uncomplicated pregnancies between 17 and 37 weeks of gestation. In 46 cases (85.2%), good quality three-dimensional volumes of the fetal heart were obtained from both apical and lateral four-chamber views. By reslicing apical volumes, the reformatted sections of the long axis view of the left ventricle and the aortic crest were seen in 40 (87%) and 38 (83%) of 46 cases, respectively. The short axis was seen in 26 (57%) and ductal arch in 30 (65%) cases. The examination of lateral volumes was much less successful. The short axis was seen in 11 (24%) cases, and the aortic crest in 22 (48%), whereas the analysis of the longitudinal views was not possible. The best results were obtained at a gestational age between 22 and 27 weeks. Three-dimensional fetal echocardiography allowed the examination of the four chambers of the heart and left outflow tract during the late second trimester. The technique may become useful for the screening and diagnosis of congenital cardiac defects in the future.

Aorta↗

Thoracoscopy vs conventional autopsy of the thorax. A promising perspective.

OBJECTIVE: To analyze the sensitivity and specificity of thoracoscopic autopsy compared with that of conventional postmortem examination. DESIGN: Consecutive sampling, case-series study. SETTING: A general community referral center and the local Institute of Forensic Medicine. PARTICIPANTS: A consecutive sample of 20 fresh cadavers (less than 24 hours old), victims of motor vehicle crashes, gunshot wounds, in-hospital deaths. INTERVENTIONS: Introduction of the thoracoscope through the fourth or fifth intercostal space, anterior or midaxillary line. The pleural cavity and mediastinum were examined. Formal postmortem examination was then performed, and the findings of both procedures were recorded, compared, and analyzed. MAIN OUTCOME MEASURES: Prior to the beginning of the study, it was hypothesized that thoracoscopic autopsy would reach an overall sensitivity and specificity of at least 85% and enable accurate inspection of the thoracic cavity and mediastinum in search of trauma-related abnormalities in trauma victims or cause of death in in-hospital patients. RESULTS: There was an 85% correlation of both procedures in all cases. The sensitivity of thoracoscopic autopsy was 87% and overall specificity reached 72%. CONCLUSIONS: Thoracoscopic autopsy is accurate and easy to perform. It is highly sensitive, especially in deaths due to trauma and following thoracic surgery. Thoracoscopic autopsy is an important tool that allows the diagnosis of major chest abnormalities as well as ruling out postoperative catastrophe, information that is invaluable for the surgeon, as well as all the medical staff and families. Thoracoscopic postmortem examination should be offered to mourning families as a cosmetic and reliable option when informed consent for conventional autopsy is lacking.

Autopsy↗