Showing papers by "Ochsner Medical Center published in 2007"
TL;DR: Efficacy parameters including angina frequency, nitroglycerine usage, exercise time, and Canadian Cardiovascular Society class showed trends that favored CD34+ cell–treated patients versus control subjects given placebo, providing evidence for feasibility, safety, and bioactivity.
Abstract: Background— A growing population of patients with coronary artery disease experiences angina that is not amenable to revascularization and is refractory to medical therapy. Preclinical studies have indicated that human CD34+ stem cells induce neovascularization in ischemic myocardium, which enhances perfusion and function. Methods and Results— Twenty-four patients (19 men and 5 women aged 48 to 84 years) with Canadian Cardiovascular Society class 3 or 4 angina who were undergoing optimal medical treatment and who were not candidates for mechanical revascularization were enrolled in a double-blind, randomized (3:1), placebo-controlled dose-escalating study. Patients received granulocyte colony-stimulating factor 5 μg · kg−1 · d−1 for 5 days with leukapheresis on the fifth day. Selection of CD34+ cells was performed with a Food and Drug Administration–approved device. Electromechanical mapping was performed to identify ischemic but viable regions of myocardium for injection of cells (versus saline). The tot...
537 citations
TL;DR: Alcohol should not be universally prescribed for health enhancement to nondrinking individuals owing to the lack of randomized outcome data and the potential for problem drinking.
402 citations
TL;DR: Hmox1 is unique in that it is proposed to be directly regulated by all four of these stress-responsive transcription factors, and analysis of the data supporting this proposition is provided.
Abstract: The ability to communicate with the environment and respond to changes--particularly those of an adverse nature--within that environment is critical for cell function and survival. A key component of the overall cellular stress response includes adjustments in the gene expression program in favor of proteins that manifest activities capable of frustrating and eventually eliminating the molecular constituents of the stress condition. One protein providing such cytoprotective activity is heme oxygenase-1 (HO-1), an enzyme that catalyzes the rate-limiting reaction in heme catabolism (i.e., the oxidative cleavage of b-type heme molecules to yield equimolar quantities of biliverdin IXalpha, carbon monoxide, and iron). Because of the potent antioxidant, anti-inflammatory, and signaling properties of the reaction products, the HO-1 gene (hmox1) is frequently activated under a variety of cellular stress conditions. Cells use multiple signaling pathways and transcription factors to fine-tune their response to a specific circumstance. Among these factors, members of the heat-shock factor, nuclear factor-kappaB, nuclear factor-erythroid 2, and activator protein-1 families are arguably the most important regulators of the cellular stress response in vertebrates. Although there is functional overlap between individual families, each broadly regulates different aspects of the cellular stress response and thus, with some exceptions, modulates the expression of different sets of targets genes. To the best of our knowledge, hmox1 is unique in that it is proposed to be directly regulated by all four of these stress-responsive transcription factors. In this article we provide a review and analysis of the data supporting this proposition.
353 citations
TL;DR: In this article, the authors evaluated the impact of cardiac rehabilitation on depression and its associated mortality in coronary patients and found that depressive symptoms decreased 63% following rehabilitation, from 17% to 6% (P P =.0004) compared with control depressed subjects who did not complete rehabilitation.
295 citations
TL;DR: HIF-1&agr; therapy in patients with critical limb ischemia was well tolerated, supporting further, larger, randomized efficacy trials and suggesting adenoviral delivery of a constitutively active form of the transcription factor hypoxia-inducible factors into the lower extremity of patients with critically ill patients might result in a durable clinical response.
Abstract: Background— Critical limb ischemia, a manifestation of severe peripheral atherosclerosis and compromised lower-extremity blood flow, results in a high rate of limb loss. We hypothesized that adenoviral delivery of a constitutively active form of the transcription factor hypoxia-inducible factor-1α (ie, Ad2/HIF-1α/VP16 or HIF-1α) into the lower extremity of patients with critical limb ischemia would be safe and might result in a durable clinical response. Methods and Results— This phase I dose-escalation program included 2 studies: a randomized, double-blind, placebo-controlled study and an open-label extension study. In total, 34 no-option patients with critical limb ischemia received HIF-1α at doses of 1×108 to 2×1011 viral particles. No serious adverse events were attributable to study treatment. Five deaths occurred: 3 in HIF-1α and 2 in placebo patients. In the first (randomized) study, 7 of 21 HIF-1α patients met treatment failure criteria and had major amputations. Three of the 7 placebo patients ro...
183 citations
TL;DR: Familiarity with the clinical and pathophysiologic features of cardiac tamponade and correlation with the associated CT findings are essential for early and accurate diagnosis.
Abstract: Cardiac tamponade is a life-threatening condition that results from slow or rapid heart compression secondary to accumulation of fluid, pus, blood, gas, or tissue within the pericardial cavity. This condition can be associated with multiple causes including trauma, inflammation, scarring, or neoplastic involvement of the pericardial space among others. The main pathophysiologic event leading to tamponade is an increase in intrapericardial pressure sufficient to compress the heart with resultant hemodynamic impairment, which leads to limited cardiac inflow, decreased stroke volume, and reduced blood pressure. These events result in diminished cardiac output, which manifests clinically as a distinctive form of cardiogenic shock. Although cardiac tamponade is a clinical diagnosis, imaging studies play an important role in assessment and possible therapeutic intervention. Computed tomographic (CT) findings associated with cardiac tamponade include pericardial effusion, usually large, with distention of the superior and inferior venae cavae; reflux of contrast material into the azygos vein and inferior vena cava; deformity and compression of the cardiac chambers and other intrapericardial structures; and angulation or bowing of the interventricular septum. Familiarity with the clinical and pathophysiologic features of cardiac tamponade and correlation with the associated CT findings are essential for early and accurate diagnosis.
160 citations
TL;DR: In this article, the authors evaluated 30,920 patients with preserved ejection fraction, including 11,792 obese patients and 19,128 nonobese patients to determine the impact of 4 LV geometric patterns, including normal structure, concentric remodeling (CR), as well as eccentric or concentric hypertrophy and obesity on mortality during an average followup of 3.2 ± 1.4 years.
Abstract: Left ventricular (LV) geometry predicts cardiovascular events. Although obesity is a risk factor for cardiovascular diseases, studies have noted a paradox regarding obesity and prognosis. To our knowledge no studies have determined the impact of obesity on LV geometry as well as mortality in patients with preserved ejection fraction. We evaluated 30,920 patients with preserved ejection fraction, including 11,792 obese patients as well as 19,128 nonobese patients to determine the impact of 4 LV geometric patterns, including normal structure, concentric remodeling (CR), as well as eccentric or concentric hypertrophy and obesity on mortality during an average follow-up of 3.2 ± 1.4 years. Abnormal LV geometry occurred more commonly in obese than nonobese patients (49% vs 44%, p <0.0001 for the difference in the 4 patterns). In obese patients, CR was the most prevalent abnormal pattern (34%), with eccentric and concentric LV hypertrophy occurring in 7% and 8%, respectively, compared with nonobese patients (32%, 6%, and 6%, respectively). Overall mortality was considerably lower in obese than nonobese (3.9% vs 6.5%, p <0.0001). In both groups, progressive increases in mortality compared with normal structure occurred with CR, eccentric and concentric LV hypertrophy (obese patients 2.8%, 4.8%, 5.3%, and 6.9%, respectively; and nonobese patients 4.3%, 8.4%, 9.6%, and 11.8%, respectively). In conclusion, although an obesity paradox exists, in that obesity is associated with higher prevalence of structural abnormalities but lower mortality than in nonobese patients, our data demonstrate that LV geometric abnormalities are prevalent in both obese and nonobese patients with normal ejection fraction and are associated with progressive increases in mortality.
126 citations
TL;DR: A 58-year-old, previously healthy mail carrier reports cramping pain in his right calf when he walks that has progressively worsened over the past 6 months and now forces him to rest after walking half a block on level ground at a normal pace.
Abstract: Copyright © 2007 Massachusetts Medical Society. A 58-year-old, previously healthy mail carrier reports cramping pain in his right calf when he walks. The discomfort has progressively worsened over the past 6 months and now forces him to rest after walking half a block on level ground at a normal pace. The pain is interfering with his ability to perform his job. He has a normal right femoral pulse and a diminished right popliteal pulse; the right ankle and foot pulses are absent. How should this patient be evaluated and treated? Should he undergo revascularization?
113 citations
TL;DR: The normal lungs implanted into CF patients had significantly higher susceptibility to Pseudomonas infections than those into non-CF patients, suggesting that defective innate immunity outside the lungs contributes to CF lung pathogenesis.
Abstract: Background Cystic fibrosis (CF) lung disease is the major cause of mortality in CF patients. Lung transplantation remains a valid therapeutic option. It is unknown whether CF patients receiving healthy lungs have an equal susceptibility to infections when compared with non-CF lung transplant patients. Herein we present the largest analyses to date of the post-operative infection profiles of 60 CF and 60 non-CF lung transplant patients. Methods Bilateral allogeneic lung transplantations and post-transplant management were performed according to standard clinical procedures. Post-operative infections were diagnosed by conventional methods based on clinical symptoms and laboratory cultures. Results Sixty CF lung-transplant patients developed 278 post-operative respiratory infections, from which 307 pathogens were isolated. Pseudomonas aeruginosa predominantly occupied 60.3%, followed by Mycobacteria spp (7.2%), Aspergillus spp (5.9%) and Staphylococcus spp (5.5%). However, 60 non-CF transplant patients had 154 respiratory infections with 165 pathogens isolated. Pseudomonas aeruginosa was noted in 38.2%, followed by Aspergillus spp (9.7%), Staphylococcus spp (9.7%) and Mycobacteria spp (9.1%). The CF group demonstrated a significantly higher frequency of Pseudomonas respiratory infections than the non-CF group. Interestingly, no significant differences were detected in any infections from other systems including blood, sinuses, skin, wounds, oral cavity, bowel, eyes, peritoneal cavity and urinary tract. Moreover, the CF lung transplant patients had significantly less time free from Pseudomonas infections. Conclusions The normal lungs implanted into CF patients had significantly higher susceptibility to Pseudomonas infections than those into non-CF patients, suggesting that defective innate immunity outside the lungs contributes to CF lung pathogenesis.
71 citations
TL;DR: The Nitinol BioFlex dynamic stabilization system can achieve stabilization and simultaneously allow physiological movement, which can in turn decrease the degeneration of adjacent segments, and the fusion rate can be expected to increase.
Abstract: Object The purpose of this study was to analyze the usefulness of the BioFlex, a Nitinol spring rod dynamic stabilization system, and the Nitinol shape memory loop (KIMPF-DI Fixing System) as a posterior dynamic stabilization system in surgery for low-back pain. Methods The 103 patients who underwent treatment with the BioFlex system were divided into two groups: Group 1, dynamic stabilization with or without posterior lumbar interbody fusion (PLIF); and Group 2, rigid fixation (PLIF + BioFlex system only). A total of 66 segments were treated with only the BioFlex system; in these the preoperative range of motion (ROM) was 10.0 ± 4.3°, which changed to 4.1 ± 1.9° after surgery. Adjacent-segment ROM changed from 8.4 ± 3.4° to 10.7 ± 3.2° in Group 1 and from 6.5 ± 3.2° to 10.5 ± 4.6° in Group 2 postoperatively. A total of 110 segments received both BioFlex and PLIF, with a fusion rate of 90.0%. The visual analog scale score for back pain improved from 7.3 ± 3.1 to 1.4 ± 1.8 in Group 1 and from 7.4 ± 2.4 to ...
64 citations
TL;DR: These data provide an updated infection profile in the ganciclovir era after lung transplantation, when compared with pre-transplant cytomegalovirus infection incidence has notably declined, with filamentous fungi emerging as prevalent pathogens in its place.
Abstract: Background Infections are common after lung transplantation. This report analyzes infections and associated pathogens identified in 202 lung transplant recipients. Methods Infections were tallied according to sites of infection and associated pathogen(s). Infection events were also categorized by post-operative Days 0 to 100, 101 to 365, and after 365, and normalized to 100 patient-days before and after bronchiolitis obliterans syndrome (BOS). Results From November 1990 to November 2005, 202 patients received 208 lung transplants. The follow-up was 702.4 patient-years. A total of 178 lung transplant patients developed 859 infections, with 944 pathogens identified. Infections were in the lung in 559 (65.1%), mucocutaneous (skin, wound, catheter-related, and oral) in 88 (10.2%), in the blood in 85 (9.8%), and in other sites (urine, bowel, eye, and peritoneum) in 127 (14.8%). Most lung pathogens were bacterial (83.6%), and 57.9% were Pseudomonas aeruginosa . Fungi comprised 10.6%, with Aspergillus spp the most common (67.1%) isolate. Cytomegalovirus pneumonitis was seen in 4.3% of respiratory infections. BOS was diagnosed in 87 patients (43.1% of the total). Of all infections seen in the BOS population, there were 0.42 episodes/100 patient-days and 0.70 episodes/100 patient-days before and after BOS, respectively ( p = 0.5). Conclusions These data provide an updated infection profile in the ganciclovir era after lung transplantation. When compared with pre-ganciclovir times, post-transplant cytomegalovirus infection incidence has notably declined, with filamentous fungi emerging as prevalent pathogens in its place. Such findings are important for refining management of infections in order to offer more stringent treatment against aggressive pathogens.
TL;DR: In conclusion, intestinal activation of p70(S6K) was not inhibited by malnutrition but was strongly activated during an active state of mucosal regeneration, mainly in the crypt.
Abstract: Recent identification of the mammalian target of rapamycin (mTOR) pathway as an amino acid-sensing mechanism that regulates protein synthesis led us to investigate its role in rotavirus diarrhea. W...
University of Milan1, University of California, Davis2, Columbia University3, California State University4, Tufts University5, Baylor College of Medicine6, Mayo Clinic7, University of Michigan8, Icahn School of Medicine at Mount Sinai9, University of California, San Francisco10, Rutgers University11, Northwestern University12, Scripps Health13, Yeshiva University14, California Pacific Medical Center15, Thomas Jefferson University16, Stanford University17, University of Washington18, University of Vermont19, University of Minnesota20, University of Iowa21, Virginia Commonwealth University22, Ochsner Medical Center23, University of Texas Southwestern Medical Center24, University of Nebraska–Lincoln25, Duke University26
TL;DR: The data showed that patients with PBC were more likely than controls to have significant articular symptoms, a reduced ability to perform household chores, and the need for help with routine activities.
TL;DR: A bariatric fellowship and/or extended mentoring are not required to safely initiate a bariatric program for surgeons with advanced laparoscopic skills, but morbidity and mortality remain low even early in the learning curve.
Abstract: The reported learning curve for laparoscopic Roux-en-Y gastric bypass (LRYGB) is 20–100 cases. Our aim was to investigate whether advanced laparoscopic skills could decrease the learning curve for LRYGB with regard to major morbidity. The senior author performed all operations in this series. His training included a laparoscopic fellowship without bariatric surgery, six years in surgical practice focusing on upper abdominal laparoscopic surgery, two courses on bariatric surgery at national meetings, one week of observing a bariatric program, and two mentored LRGBY cases. A comprehensive obesity program was put in place before the program began. Data were collected prospectively and reviewed at the series’ end. Results are presented as mean ± standard deviation and standard statistical analysis was applied. Between December 2003 and February 2005, 107 LRYGB operations were performed. Mean operative time decreased significantly with experience (p < 0.0001) and was 154 ± 29, 132 ± 40, 127 ± 29, and 114 ± 30 min by quartile. Mean length of stay was 2.9 ± 1.6 days. Mean excess weight loss was 45.3% (n = 41) at six months. There were no conversions to an open procedure, no anastomotic leaks, no pulmonary embolisms, and no bowel obstructions. The five major complications (3 in the first 50 and 2 in the last 57 cases, p = NS) were two cases of biliopancreatic limb obstruction, two cases of significant gastrointestinal bleeding from anastomotic ulcer, and one case of gastric volvulus of the remnant stomach. A bariatric fellowship and/or extended mentoring are not required to safely initiate a bariatric program for surgeons with advanced laparoscopic skills. Operative time decreases significantly with experience, but morbidity and mortality remain low even early in the learning curve. A comprehensive obesity program seems necessary for success.
01 May 2007
TL;DR: Administration of supplemental oxygen during cesarean delivery with neuraxial anesthesia does not decrease the incidence or severity of intraoperative or postoperative nausea or vomiting.
Abstract: BACKGROUND: Supplemental oxygen may reduce postoperative nausea and vomiting after general anesthesia. We designed this study to evaluate the efficacy of supplemental oxygen administration for reducing nausea and vomiting in women having neuraxial anesthesia for cesarean delivery.METHODS: We conducted a prospective, randomized, double-blind study of women. having standardized neuraxial anesthesia and postoperative analgesia for cesarean delivery. After umbilical cord clamp, women were randomized to receive either. 70% or 21% oxygen for surgery. Nausea and vomiting were recorded at three time intervals: induction until delivery, delivery until the end of surgery, and at 24 postoperative hours. chi(2) and Student's t-tests were used to determine significant differences.RESULTS: The study groups were similar with respect to demographic and procedural variables. There was no significant difference between groups in the overall incidences of nausea and vomiting. The incidence of severe nausea (rated by mothers) in the oxygen group predelivery, postclelivery, and postoperatively was 3%, 7%, and 9%, respectively, and in the medical air group was 3%, 9%, and 7%, respectively. Severe vomiting (> 2 episodes) in both the oxygen and medical air groups were 0%, 2%, and 4% at the corresponding time intervals. These differences were not statistically significant.CONCLUSION: Administration of supplemental oxygen during cesarean delivery with neuraxial anesthesia does not decrease the incidence or severity of intraoperative or postoperative nausea or vomiting.
TL;DR: Although obesity causes anomalies in diastolic and systolic functioning and although it might be expected to increase the risk of mortality in patients with established heart failure, the group and others have shown that, paradoxically, BMI is inversely related to mortality over the long term in Patients with chronic heart failure.
Abstract: Obesity is a well-known independent risk factor for heart failure 1 and has now reached epidemic proportions: the World Health Organization calculates that there are over 1000 million overweight adults worldwide and that 300 million of them are clinically obese. The incidence and prevalence of obesity and heart failure are so high that it is not unusual to find both conditions in the same patient. In fact, several cohort studies of heart failure patients have shown that 15%-35% of those patients are obese and that 30%-60% are overweight. 2 Epidemiological studies have clearly shown a close relationship between obesity and an increased risk of cardiovascular disease (CVD) and mortality in the general population. However, in some of those studies a U- or J-curve was observed, indicating that mortality is higher in individuals with a low body mass index (BMI). 2-4 Uncovering the relationship between obesity and heart failure is turning out to be complex. A recent epidemiological study derived from the Framingham Heart Study clearly showed that obesity and overweight are highly predictive of later clinical heart failure. Although obesity causes anomalies in diastolic and systolic functioning and although it might be expected to increase the risk of mortality in patients with established heart failure, our group and others have shown that, paradoxically, BMI is inversely related to mortality over the long term in patients with chronic heart failure. 2,3,5-11 BMI is not the only conventional risk factor to present a paradoxical association with clinical outcomes in heart failure patients. High concentrations of low density lipoproteins and total cholesterol have also been associated with a survival advantage in heart failure patients. These systematic findings for different risk factors in heart failure patients justify the use of the term “reverse epidemiology.” 10
TL;DR: After successfully managed the department of radiology at the Ochsner Clinic Foundation during the recent events of Hurricane Katrina, it would be valuable to share and discuss key information regarding management during a catastrophe.
Abstract: 1All authors: Department of Radiology, Ochsner Clinic Foundation, Ochsner Medical Center, 1514 Jefferson Hwy., New Orleans, LA 70121. Address correspondence to E. I. Bluth. aving successfully managed the department of radiology at the Ochsner Clinic Foundation during the recent events of Hurricane Katrina, we thought it would be valuable to share and discuss key information regarding management during a catastrophe. Management during a catastrophe can be divided into three components: preplanning, managing the actual event, and modifying the emergency plan according to lessons learned from the previous event. The Ochsner Clinic Foundation is a 532-bed tertiary care academic medical center with 20 radiologists, 22 residents and fellows, and more than 300 other personnel within the radiology department on the main campus. Before Hurricane Katrina, we had had many previous hurricane alerts at Ochsner, and we updated our emergency plan regarding equipment, personnel, emergency power, and communications annually. The overall institutional plan called for key individuals to stay in the institution for 2 days after the hurricane struck and then evacuate by helicopter to safety. This plan had previously been communicated to and accepted by the whole institution, including the radiology department.
TL;DR: This article presents a 25-year experience of management of NTOS patients, at the Louisiana State University Health Sciences Center, which have been divided into 2 subcategories of “disputed NTOS” or “true NTOS.”
Abstract: Neurogenic thoracic outlet syndrome (NTOS) is the most common variant of thoracic outlet syndrome. This article presents a 25-year experience of management of 133 operative NTOS patients, at the Louisiana State University Health Sciences Center, which have been divided into 2 subcategories of “disputed NTOS” or “true NTOS.” The clinical presentations, results of neurologic examinations, radiologic evaluations, operative procedures, intraoperative findings, and nerve action potential results and outcomes of the management are evaluated.
Journal Article•
TL;DR: A 37-year-old woman was referred to the endocrine clinic for management of her long-standing hypothyroidism with main complaints were muscle aches and pains that started about a year ago and progressed to generalized muscle weakness.
Abstract: A 37-year-old woman was referred to our endocrine clinic for management of her long-standing hypothyroidism. Her main complaints were muscle aches and pains that started about a year ago. The symptoms progressed to generalized muscle weakness. She described difficulty in getting out of her chair and in climbing stairs. She had an extensive work-up done by her neurologist and rheumatologist, including nerve-conduction studies and a muscle biopsy. The evaluation was normal, and she was diagnosed with fibromyalgia. She had gastric bypass surgery in 1998 and lost 150 pounds since the operation. She also has had lactose intolerance and a compression fracture without trauma. Her weight was 314 pounds. She had proximal muscle weakness. The rest of her physical examination was normal. Serum laboratory values are listed in Table 1. Based on the laboratory values, she was diagnosed as having severe vitamin D deficiency. She was started on 50,000 IU of vitamin D2 (Ergocalciferol) once a week for 6 months. Now her 25 hydroxyvitamin D level is 40 ng/mL, and her muscle strength has improved.
TL;DR: This paper serves to document the current anatomic, radiologic, and diagnostic aspects of TOS, as well as recent neurophysiologic and surgical techniques, which will ultimately result in a better outcome for patients with TOS and its subdivisions.
Abstract: This article is a review of the current literature regarding thoracic outlet syndrome (TOS). There is a paucity of papers exhibiting a clear separation of the broad TOS category into the subgroups of the neurogenic, vascular, and traumatic variants. A compilation of recent TOS series and case reports has been documented and then analyzed. This paper also serves to document the current anatomic, radiologic, and diagnostic aspects of TOS, as well as recent neurophysiologic and surgical techniques. All of these aspects contribute to a better diagnostic and treatment acumen, which will ultimately result in a better outcome for patients with TOS and its subdivisions.
Journal Article•
TL;DR: Improving outcomes for patients requiring CRRT will ultimately save hospitals more money than the short-sighted gains from critical care nurses performing tasks outside of universally-applied critical care RN processes.
Abstract: Although critical care nurses are fully capable of learning CRRT, there are substantial, irrefutable challenges to achieving and sustaining proficiency. There is also diminished opportunity and motivation for critical care nurses to advance CRRT practice through quality initiatives, education, or research when it is a small piece of their practice. Consequently, I believe that it is incumbent upon acute care nephrology nurses to clarify the magnitude and value of what we do and to support our critical care colleagues in doing what they do best. The debate as to who should perform CRRT began in an effort to explore the better opportunity for cost-saving; but, in the end, it really boils down to the better opportunity for life-saving. I suspect improving outcomes for patients requiring CRRT will ultimately save hospitals more money than the short-sighted gains from critical care nurses performing tasks outside of universally-applied critical care RN processes.
TL;DR: The results of the present study do not provide evidence in support of a role of a functional COX-3 (COX-1b) isoform, or an acetaminophen-sensitive pathway, in the generation of vasoactive prostanoids or in the modulation of responses to vasoconstrictor hormones in the intact-chest rat.
Abstract: In contrast to nonsteroidal anti-inflammatory drugs (NSAIDs), the nonopioid analgesics phenacetin, acetaminophen and dipyrone exhibit weak anti-inflammatory properties. An explanation for this differe
Journal Article•
TL;DR: In the presence of ascites noted by echocardiography, the FL is usually noted within the ascites, but the FL will be noted most often in the subcostal window only.
Abstract: Figure 1. The falciform ligament (falc. lig.: horizontal black arrow) connects the parietal peritoneum with the anterior surface of the liver. It obliquely attaches to the abdominal surface of the diaphragm (white arrow denotes attachment site). Note the close proximity of the falciform ligament with the diaphragmatic surface of the pericardium (pericardial sac: vertical black arrow). (Reproduced and modified with permission from Reference 4). of the liver denotes the junction of its right and left lobes.1,2 Following the FL from the liver superiorly reveals it to end transversely into the abdominal surface of the diaphragm.3 Anatomically, the diaphragmatic surface of the pericardium lies in close proximity to the FL (Fig. 1). In the presence of ascites noted by echocardiography, the FL is usually noted within the ascites. Ascites is visualized from both parasternal and subcostal windows,5 but the FL will be noted most often in the subcostal window only.
TL;DR: A restricted T cell repertoire that is maintained over time is observed in the setting of lung transplantation, and the molecular profile mirrors the restricted clonal T cell infiltrates seen in autoimmune disease.
Abstract: the identical T cell profile was maintained over time from a few months up to two years between sequential biopsy samples. The Fox P3 immunohistochemistry stain demonstrated staining of 10 to 15% of the infiltrate. Conclusions: A restricted T cell repertoire that is maintained over time is observed in the setting of lung transplantation. The molecular profile mirrors the restricted clonal T cell infiltrates seen in autoimmune disease. Regulatory T cells may play some role in reducing the extent of the emerging clonal T cell infiltrates; he main implicated cell in biopsies of cellular rejection are not of the regulatory T cell subset. The nature of the T cell epitope specifically in regards to self-antigen versus alloantigen remains to be determined.