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4 results on '"Heng Duong"'

1. Progression of Epididymal Maldevelopment Into Hamartoma-like Neoplasia in VHL Disease

Author

Gautam U. Mehta, Sharon B. Shively, Heng Duong, Maxine G.B. Tran, Travis J. Moncrief, Jonathan H. Smith, Jie Li, Nancy A. Edwards, Russell R. Lonser, Zhengping Zhuang, Marsha J. Merrill, Mark Raffeld, Patrick H. Maxwell, Edward H. Oldfield, and Alexander O. Vortmeyer

Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Inactivation of the von Hippel-Lindau (VHL) gene and activation of the hypoxia-inducible factor (HIF) in susceptible cells precedes formation of tumorlets and frank tumor in the epididymis of male VHL patients. We performed detailed histologic and molecular pathologic analysis of tumor-free epididymal tissues from VHL patients to obtain further insight into early epididymal tumorigenesis. Four epididymides from two VHL patients were serially sectioned to allow for three-dimensional visualization of morphologic changes. Areas of interest were genetically analyzed by tissue microdissection, immunohistochemistry for HIF and markers for mesonephric differentiation, and in situ hybridization for HIF downstream target vascular endothelial growth factor. Structural analysis of the epididymides revealed marked deviations from the regular anatomic structure resulting from impaired organogenesis. Selected efferent ductules were represented by disorganized mesonephric cells, and the maldeveloped mesonephric material was VHL-deficient by allelic deletion analysis. Furthermore, we observed maldeveloped mesonephric material near cystic structures, which were also VHL-deficient and were apparent derivatives of maldeveloped material. Finally, a subset of VHL-deficient cells was structurally integrated in regular efferent ductules; proliferation of intraductular VHL-deficient cells manifests itself as papillary growth into the ductular lumen. Furthermore, we clarify that that there is a pathogenetic continuum between microscopic tumorlets and formation of tumor. In multiple locations, three-dimensional reconstruction revealed papillary growth to extend deeply into ductular lumina, indicative of progression into early hamartoma-like neoplasia. We conclude epididymal tumorigenesis in VHL disease to occur in two distinct sequential steps: maldevelopment of VHL-deficient mesonephric cells, followed by neoplastic papillary proliferation.

Published
2008
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3. SHAKEN, NOT STIRRED: HIGH FREQUENCY PERCUSSIVE VENTILATION AS A SALVAGE THERAPY IN SEVERE ARDS DUE TO COVID-19

Author

Amit Gohil, Vibha Mohindra, Neharika Khurana, Eric Hsiao, Umang Barvalia, Weichia Chen, Halley Tsai, Craig Ivie, John H. Wehner, and Heng Duong

Subjects
Pulmonary and Respiratory Medicine, ARDS, Critical Care, Coronavirus disease 2019 (COVID-19), business.industry, Salvage therapy, Critical Care and Intensive Care Medicine, medicine.disease, law.invention, law, Anesthesia, Ventilation (architecture), medicine, Cardiology and Cardiovascular Medicine, business
Published
2021
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4. 287: Prone Positioning in Acute Respiratory Distress Syndrome at Late Pregnancy

Author

Heng Duong, An La, and Soumya Murag

Subjects
medicine.medical_specialty, Pregnancy, ARDS, business.industry, medicine.medical_treatment, Critical Care and Intensive Care Medicine, medicine.disease, medicine.disease_cause, Tachypnea, Intensive care unit, law.invention, Prone position, law, Emergency medicine, medicine, Intubation, medicine.symptom, business, Contraindication, Nasal cannula
Abstract

INTRODUCTION: The high incidence of acute respiratory distress syndrome (ARDS) in coronavirus-19 (COVID-19) has highlighted the use of prone positioning and brought this maneuver to national attention Clinical trials have demonstrated mortality benefits of early prone positioning for patients with ARDS However, pregnant women have been excluded in these trials We report a case of a young woman in her third trimester of gestation admitted for ARDS due to COVID-19 pneumonia and highlight the physiologic and logistical considerations involved in prone positioning in late pregnancy METHODS: A 31-year-old Hispanic G3P2002 27 weeks, 5 day presented for 1 week duration of flu-like symptoms secondary to COVID 19 She was admitted to intensive care unit with tachypnea, tachycardia, and Spo2 84% on 4L NC oxygen Upon admission, she was started on remdesivir, dexamethasone, and venous thromboembolism prophylaxis Within 24 hours of admission, she experienced rapidly worsening hypoxia requiring hi-flo nasal cannula (HFNC) 70% FiO2, 60 LPM A multidisciplinary team of ICU, OB/ GYN, and respiratory therapists devised a plan to prone the patient to prevent intubation She was assisted with proning by 3 nurses, one of which was a L&D nurse and supported by padding, pillows and blankets to support her gravid uterus Patient was proned for at least 8 hours a day There was significant improvement in clinical signs and symptoms within 72 hours of initiation of proning After 10 days, she had improvement in oxygenation down to 3L nasal cannula RESULTS: We successfully avoided intubation in a third trimester pregnant woman with severe hypoxemia with ARDS from COVID-19 by initiating early proning This case demonstrates pregnancy is not a contraindication in prone positioning in an awake patient however great consideration must be given to prevent skin breakdown, pressure ulcers, dislodgment of fetal monitoring, and compression of the gravid uterus Prone positioning is technically difficult particularly in late pregnancy (beyond 24-28 weeks) due to the risk of aortocaval compression but has shown to be safe with a multidisciplinary effort including maternal-fetal medicine, anesthesia, and critical care teams

Published
2020
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