ABSTRACT
Pulmonary MR angiography (MRA) is a useful alternative to computed tomographic angiography (CTA) for the study of the pulmonary vasculature. For pulmonary hypertension and partial anomalous pulmonary venous return, a cardiac MR imaging and the pulmonary MRA are useful for flow quantification and planning treatment. For the diagnosis of pulmonary embolism (PE), MRA-PE has been shown to have non-inferior outcomes at 6 months when compared with CTA-PE. Over the last 15 years, pulmonary MRA has become a routine and reliable examination for the workup of pulmonary hypertension and the primary diagnosis of PE at the University of Wisconsin.
Subject(s)
Hypertension, Pulmonary , Pulmonary Embolism , Humans , Magnetic Resonance Imaging/methods , Magnetic Resonance Angiography/methods , Contrast Media , Pulmonary Embolism/diagnosisSubject(s)
Breast Neoplasms , Lung Neoplasms , Humans , Female , Overdiagnosis , Early Detection of Cancer , Lung Neoplasms/diagnosis , Medical Overuse , Mass Screening , MammographyABSTRACT
Defective collagen biosynthesis in Marfan syndrome predisposes to dural defects such as dural ectasia, meningocele, and pseudomeningocele; thus, an increased index of suspicion for these conditions should be present in the clinical setting of Marfan syndrome. The authors describe a young woman with Marfan syndrome who was being treated with anticoagulants for a prosthetic heart valve and who presented with a spontaneous retroperitoneal hemorrhage requiring surgical evacuation. No CSF leak was encountered at surgery, but she developed progressively more severe positional headaches over the following year. She then experienced the sudden onset of acute urinary obstruction, at which time CT revealed a 17 × 15 × 13-cm presacral pseudomeningocele communicating with the thecal sac through a sacral bone defect. An anterior surgical approach was used for drainage of the pseudomeningocele as well as for primary closure of the dural defect with a bovine pericardial patch and autologous subcutaneous fat graft. After a short period of lumbar subarachnoid drainage of the CSF, the patient was able to resume normal activity without recurrent symptoms. To the authors' knowledge, such a pseudomeningocele in a patient with Marfan syndrome has been reported only twice, and this case features the largest pseudomeningocele to date. They also review the pertinent literature regarding presentation, diagnosis, and management of these lesions.
Subject(s)
Marfan Syndrome/complications , Meningocele/complications , Ureteral Obstruction/etiology , Drainage , Female , Humans , Magnetic Resonance Imaging , Meningocele/diagnosis , Meningocele/surgery , Myelography , Sacrum/abnormalities , Stents , Tomography, X-Ray Computed , Ureteral Obstruction/diagnosis , Ureteral Obstruction/surgery , Young AdultABSTRACT
Minimally invasive surgery for resection of colon tumors is being utilized with increasing frequency making accurate preoperative tumor localization essential to proper surgical planning and patient positioning. Traditional endoscopic localization techniques such as lesion distancing from the anal verge are adequate in the majority of patients. Patients with a significantly tortuous and redundant colon, however, are at increased risk for ambiguous and incorrect lesion localization. The use of endoscopic submucosal marking by injection to tattoo the site of interest may increase the accuracy of tumor localization, but its efficacy can be technique dependent. We present a novel technique for endoscopic tumor localization using endoscopic clip placement, followed by immediate abdominal radiograph, to accurately locate a colonic lesion in preparation for laparoscopic colonic resection.
Subject(s)
Colon/surgery , Colonoscopy/methods , Colorectal Neoplasms/diagnosis , Laparoscopy/methods , Preoperative Care/methods , Tattooing/methods , Colorectal Neoplasms/surgery , Humans , Male , Middle Aged , Reproducibility of ResultsSubject(s)
Decompression, Surgical/methods , Duodenal Obstruction/etiology , Endoscopy, Gastrointestinal/methods , Enteral Nutrition/methods , Gastric Outlet Obstruction/etiology , Gastroplasty/adverse effects , Laparoscopy/adverse effects , Adult , Diagnosis, Differential , Duodenal Obstruction/diagnosis , Duodenal Obstruction/therapy , Female , Follow-Up Studies , Gastric Outlet Obstruction/diagnosis , Gastric Outlet Obstruction/therapy , Humans , Postoperative Complications , Reoperation , Superior Mesenteric Artery Syndrome , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Generation of robust cell-mediated immune responses at mucosal surfaces while reducing overall inflammation is a primary goal for vaccination. Here we report the use of a recombinant nanoparticle as a vaccine delivery platform against mucosal infections requiring T cell-mediated immunity for eradication. METHODOLOGY/PRINCIPAL FINDINGS: We encapsulated an immunogenic protein, the major outer membrane protein (MOMP) of Chlamydia muridarum, within hollow, vault nanocapsules (MOMP-vaults) that were engineered to bind IgG for enhanced immunity. Intranasal immunization (i.n) with MOMP-vaults induced anti-chlamydial immunity plus significantly attenuated bacterial burden following challenge infection. Vault immunization induced anti-chlamydial immune responses and inflammasome formation but did not activate toll-like receptors. Moreover, MOMP-vault immunization enhanced microbial eradication without the inflammation usually associated with adjuvants. CONCLUSIONS/SIGNIFICANCE: Vault nanoparticles containing immunogenic proteins delivered to the respiratory tract by the i.n. route can act as "smart adjuvants" for inducing protective immunity at distant mucosal surfaces while avoiding destructive inflammation.
