Pressure-Wire-Guided Percutaneous Transluminal Pulmonary Angioplasty A Breakthrough in Catheter-Interventional Therapy for Chronic Thromboembolic Pulmonary Hypertension

AbstractObjectivesThis study sought to prove the safety and effectiveness of pressure-wire-guided percutaneous transluminal pulmonary angioplasty (PTPA).BackgroundPTPA has been demonstrated to be effective for treatment of chronic thromboembolic pulmonary hypertension. However, a major and occasionally fatal complication after PTPA is reperfusion pulmonary edema. To avoid this, we developed the PEPSI (Pulmonary Edema Predictive Scoring Index). The pressure wire has been used to detect insufficiency of flow in a vessel.MethodsWe included 350 consecutive PTPA sessions in 103 patients with chronic thromboembolic pulmonary hypertension from January 1, 2009 to December 31, 2013. During these 5 years, 140 PTPA sessions were performed without guidance, 65 with guidance of PEPSI alone, and 145 with both PEPSI and pressure-wire guidance. Each PTPA session was finished after achieving PEPSI scores of <35.4 with PEPSI guidance and each target lesion achieving distal mean pulmonary arterial pressure <35 mm Hg with pressure-wire guidance.ResultsThe occurrence of clinically critical reperfusion pulmonary edema and vessel injuries were lowest in the group using the guidance of both pressure wire and PEPSI (0% and 6.9%, respectively). Furthermore, the group guided by pressure wire and PEPSI accomplished the same hemodynamic improvements with fewer numbers of target lesions treated and sessions performed.ConclusionsThe combined approach using pressure wire and PEPSI produced more efficient clinical results and greatly reduced reperfusion pulmonary edema and vessel complications. This is further evidence that PTPA is an alternative strategy for treating chronic thromboembolic pulmonary hypertension

Intestinal Undifferentiated Carcinoma in a Red-Crowned Crane (Grus japonensis)

A 33-year-old red-crowned crane (Grus japonensis) had a diffuse intestinal thickening from the duodenum to colon. Microscopically, neoplastic cells were arranged in sheets and occasionally nests or cords without gland or squamous differentiation. Metastatic tumor cells were found in the lungs, heart, kidneys and adrenal glands. Immunohistochemically, the neoplastic cells were strongly positive for pan-cytokeratin and cytokeratin 8 and 18 and only partly positive for E-cadherin antibodies. Immunostaining for CD3 was positive in normal lymphocytes, and NSE was also positive in normal nerve fibers. But, the neoplastic cells were not immunoreactive to CD3 and NSE. Based on the histological features and the epithelial characteristics in the immunohistochemical stain, the present case was diagnosed as undifferentiated carcinoma originating from the intestine. Interestingly, the neoplastic cells showed a unique growth pattern; they never invaded the submucosa or muscularis throughout the intestine, whereas they spread lymphogenously or hematogenously to other organs

Physical Body Parameters of Red-Crowned Cranes Grus japonensis by Sex and Life Stage in Eastern Hokkaido, Japan

Red-crowned (or Japanese) cranes Grus japonensis are native to eastern Hokkaido, Japan—the island population, and mainland Asia—the continental population that migrates from breeding grounds along the Amur River Basin to winter in east China and the Korean Peninsula. The island population was reduced to about 50-60 birds in early part of the 20th century. Since 1950s, the population has increased to more than 1,300 as a consequence of human-provided food in winter, resulted in change of their habitats and food resource. From the carcasses of 284 wild cranes from the island population, collected in Hokkaido since 1976 until 2010, we measured six physical parameters (body weight and lengths of body, wing, tarsus, tail and exposed culmen) and divided into groups by sex and three developmental stages (juvenile, yearling and adult). All parameters of males were larger than those of females at the same stage. Total body length of females tends to grow up earlier than males, in contrast to body weight. Obvious time trends were not observed in these all parameters during 34 years for these six categories measured, except total length of male juveniles, which showed a significant increasing trend. These results provide the first extensive data on body size and mass in the wild red-crowned cranes