Radiographic visualization of lymphatic drainage of heart muscle and pericardial sac in the dog

Assessing functional status of cardiac lymphatics: From macroscopic imaging to molecular profiling

Here we describe various techniques for visualization of the lymphatic vasculature, particularly in the heart. Addressing macro-, microscopic, and molecular levels of lymphatic organization, we give examples of how to explore the roles of specific antigens/markers expressed in lymphatic vessels and their extracellular matrix as structural and functional elements involved in various biological functions of lymphatics. Some obstacles and technical challenges related to lymphatic visualization are also discussed.

Complete AV block following mediastinal radiation therapy: electrocardiographic and pathologic correlation and review of the world literature

The clinical, features, serial electrocardiograms, and autopsy findings of a patient with symptomatic complete AV block, who had received mediastinal radiation therapy 8 1/2 years previously, are presented. The cardiac histopathology disclosed immense fibrosis of the conduction system and of the atria and ventricles. The enormous amount of fibrosis was similar in location and intensity to that observed in our previously reported patient (Cohen et al., Arch Intern Med 1981; 141:676-679) who had undergone mediastinal radiation. We conclude that the severe fibrosis was primarily due to radiation, rather than secondary to atherosclerotic coronary artery disease, which also has been described as a consequence of mediastinal radiotherapy. This patient's serial electrocardiograms disclosed evidence of complete block both in the AV nodal area and infra His system, which correlated well with the histopathology. The characteristic clinical features of patients with symptomatic complete AV block post mediastinal radiation therapy are presented, along with a review of the world literature.

Tolerance of normal tissue to therapeutic irradiation

The importance of knowledge on tolerance of normal tissue organs to irradiation by radiation oncologists cannot be overemphasized. Unfortunately, current knowledge is less than adequate. With the increasing use of 3-D treatment planning and dose delivery, this issue, particularly volumetric information, will become even more critical. As a part of the NCI contract N01 CM-47316, a task force, chaired by the primary author, was formed and an extensive literature search was carried out to address this issue. In this issue. In this manuscript we present the updated information on tolerance of normal tissues of concern in the protocols of this contract, based on available data, with a special emphasis on partial volume effects. Due to a lack of precise and comprehensive data base, opinions and experience of the clinicians from four universities involved in the contract have also been contributory. Obviously, this is not and cannot be a comprehensive work, which is beyond the scope of this contract.

Cardiac tamponade as a presentation of extracardiac malignancy

Three cases of adenocarcinoma of the lung manifesting as acute pericardial effusion with tamponade are presented and the medical literature concerning this unusual manifestation of extracardiac malignancy is reviewed. We have found 22 cases of carcinoma and 4 cases of sarcoma. Of the carcinomas, 14 of 19 (74%) with known primary are pulmonary and 13 of 18 (72%) with tissue diagnosis are adenocarcinomas. Daignosis was made by cytologic examination of pericardial fluid in 14 of 16 cases (87%) in which it was performed. The lymphatic drainage of the heart renders some anatomical explanations for the prevalence of carcinoma of the lung as the cause of cardiac tamponade and the discrepancy of finding tumor cells in the pericardial fluid but not in the pericardium. Patients treated with pericardiectomy with or without ancillary radio- or chemotherapy survived longer than those treated with periocardiocentesis or radio- or chemotherapy alone.

A study of the routes by which protein passes from the pericardial cavity to the blood in rabbits

The routes by which radioiodinated serum albumin placed in the pericardial cavity gains access to the circulation have been investigated in rabbits. 1. Eighty per cent of pericardial cavity protein passes through the parietal pericardium and into the circulation through the thoracic duct. 2. A small amount of protein is drained through the right lymph duct; this is probably derived from protein passing from the pericardial cavity into the pleural cavity. 3. There is no apparent movement of protein directly into blood vessels of the parietal pericardium. For theoretical reasons movement of protein across the visceral pericardium and into the blood vessels of the myocardium is also unlikely. 4. A small amount of protein enters the circulation when both major lymphatics are ligated. It is proposed that lymphatic uptake may continue and secondary lymphovenous junctions will open as a result of raised intralymphatic pressure.