extravasation

• n.

• 血管外漏出、血管外遊走、血管外遊出、溢血

　 　

WordNet

1. an extravasated liquid (blood or lymph or urine); the product of extravasation
2. the process of exuding or passing out of a vessel into surrounding tissues; said of blood or lymph or urine
3. force out or cause to escape from a proper vessel or channel
4. geology: cause molten material, such as lava, to pour forth
5. the leakage of blood from a vessel into tissues surrounding it; can occur in injuries or burns or allergic reactions

PrepTutorEJDIC

1. 脳卒中

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/06/06 06:00:36」(JST)

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[Wiki en表示]

Extravasation is the leakage of a fluid out of its container. In the case of inflammation, it refers to the movement of white blood cells from the capillaries to the tissues surrounding them (leukocyte extravasation), also known as diapedesis. In the case of malignant cancer metastasis it refers to cancer cells exiting the capillaries and entering organs. It is frequently used in medical contexts, either referring to urine, or to blood.

More specifically, it can refer to:

• Extravasation (intravenous)
• Extravasation of infusates
• Extravasation of irrigation fluid
• Extravasation of urine
• Leukocyte extravasation

Extravasation of irrigation fluid

Extravasation of irrigation fluid is the unintended migration of irrigation fluid (e.g. saline) introduced into a human body. This may occur in a number of types of endoscopic surgery, such as minimally invasive orthopedic surgery, i.e. arthroscopy, TURP (trans-urethral resection of the prostate) and TCRE (trans-cervical resection of the endometrium).

In arthroscopy, fluid under pressure is used to inflate and distend a joint and make a working surgical space. Arthroscopy is typically performed on shoulder and knee joints; however, hip arthroscopy is becoming more popular. Arthroscopy is done by making surgical portals or puncture wounds into the joint. A surgical instrument called an arthroscope is used to introduce irrigation fluid under pressure to distend the joint. The arthroscope includes a small (typically 4 mm in diameter) optic scope rod to view the joint. Other portals or puncture wounds are made to introduce surgical instruments to perform cutting or repair procedures.

If the joint is surrounded by soft tissue, as in the shoulder and hip, fluid under pressure may leak out of the joint space through the surgical portals and collect in the patient's soft tissue. A typical arthroscopy can result in 1–3 liters of irrigation fluid being absorbed into the patient's interstitial tissue. This buildup of irrigation fluid in the soft tissue may cause edema. This swelling can interfere with the arthroscopic procedure by collapsing the surgical space, or migrating into the patient's neck and causing airway blockage. In hip arthroscopy, a feared complication is abdominal flooding where the irrigation fluid leaks from the hip joint capsule and drains into the abdominal cavity. Risk factors for fluid extravasaton include procedure length (> 90–120 min), obesity, and age (> 45–50) with accompanying lack of muscle tone.

Shoulder arthroscopy is typically limited to about 90–120 minutes before the swelling from fluid extravasation interferes with the procedure, and presents a potential risk to the patient. Typically, fluid extravasation is managed by controlling fluid pressure, or hastening the procedure.

Arthroscopic instrumentation such as the newer Extravastat devices to drain extravasated fluid from the soft tissue during shoulder and hip arthroscopy has been reported to be beneficial in reducing fluid extravasation and swelling.

Extravasation of infusates

Extravasation may also refer to the leakage of infused substances from the vasculature into the subcutaneous tissue. The leakage of high osmolarity solutions or chemotherapy agents can result in significant tissue destruction, and significant complications.

See also

• Arthroscopy
• Intravasation

Notes

References

• Complications in Orthopaedics: Shoulder Arthroscopy, chapter "Severe Edema During Shoulder Arthroscopy" pp 9–16, Xavier A. Duralde, MD, editor.
• Immediate postoperative fluid retention and weight gain after shoulder arthroscopy. LoIK, Burkhart SS. Arthroscopy. 2005 May; 21(5):605–610.
• Life Threatening Airway Edema Resuling From Prolonged Shoulder Arthroscopy, Steven L. Orebaugh, M.D. Anesthesiology, V 99, No. 6, December 2003.
• Severe Airway Obstruction During Arthroscopic Shoulder Surgery, Stephan Blumenthal, M.D., Marco Nadig, M.D., Christian Gerber, M.D., Alain Borgeat, M.D. Anesthesiology, V 99, No. 6, December 2003.
• Complete Airway Obstruction During Shoulder Arthroscopy, Hynson, J.M., Tung, A., Guevara, J.E., et al. Anesthesiology Analg, 76:875–878, 1993.
• Complications of hip arthroscopy, Sampson, T.G. Clin Sports Med. 20(4):831–835, October 2001.

External links

• Monograph on Complications in Shoulder Arthroscopy published by the American Association of Orthopedic Surgeons (AAOS)
• British National Health Service page on complications from extravasation of infusates.
• Cannuflow Research archive on extravasation in shoulder arthroscopy
• Cannulae with Outflow Reduces Fluid Gain in Shoulder Arthroscopy Hasan M. Syed, Seth B. Gillham, Christopher M. Jobe, Wesley P. Phipatanakul and Montri D. Wongworawat

UpToDate Contents

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English Journal

• Intraluminal crawling versus interstitial neutrophil migration during inflammation.

• Pick R, Brechtefeld D, Walzog B.SourceWalter Brendel Centre of Experimental Medicine, Ludwig-Maximilians-University, Munich, Germany. robert.pick@lrz.uni-muenchen.de
• Molecular immunology.Mol Immunol.2013 Aug;55(1):70-5. doi: 10.1016/j.molimm.2012.12.008. Epub 2013 Jan 10.
• Site-directed trafficking of polymorphonuclear neutrophils (PMN) to their target regions within the tissue is an important prerequisite for efficient host defense during the acute inflammatory response. This process requires intraluminal crawling of PMN on the activated endothelial cells to their ex
• PMID 23312337

• Vascular permeability changes involved in tumor metastasis.

• García-Román J, Zentella-Dehesa A.SourceUnidad de Bioquímica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga No. 15, Colonia Sección XVI, Delegación Tlalpan, CP 04510 México City, Mexico.
• Cancer letters.Cancer Lett.2013 Jul 28;335(2):259-69. doi: 10.1016/j.canlet.2013.03.005. Epub 2013 Mar 14.
• Cancer cell extravasation resembles the leukocyte recruitment during inflammation. Evidence suggests that cancer cells need to weaken the interendothelial junctions in order to cross the endothelial barrier. Several tumor-derived vasoactive compounds have been pointed out to drive this increase in v
• PMID 23499893

• Cavitation-enhanced delivery of a replicating oncolytic adenovirus to tumors using focused ultrasound.

• Bazan-Peregrino M, Rifai B, Carlisle RC, Choi J, Arvanitis CD, Seymour LW, Coussios CC.SourceInstitute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; Department of Oncology, University of Oxford, Oxford OX3 7DQ, UK; Institut d'Investigacio Biomedica de Bellvitge, Gran Via 199, L'Hospitalet de Llobregat, 08908 Barcelona, Spain. Electronic address: miriam.bazan-peregrino@balliol.oxon.org.
• Journal of controlled release : official journal of the Controlled Release Society.J Control Release.2013 Jul 10;169(1-2):40-7. doi: 10.1016/j.jconrel.2013.03.017. Epub 2013 Apr 4.
• Oncolytic viruses (OV) and ultrasound-enhanced drug delivery are powerful novel technologies. OV selectively self-amplify and kill cancer cells but their clinical use has been restricted by limited delivery from the bloodstream into the tumor. Ultrasound has been previously exploited for targeted re
• PMID 23562636

Japanese Journal

• 右肝動脈結紮を要したⅢb型肝損傷の治療経験

• 日本外傷学会雑誌 31(1), 13-16, 2017
• NAID 130005295583

• 墜落外傷による左心房破裂の１救命例

• 日本外傷学会雑誌 31(1), 36-40, 2017
• NAID 130005295564

• Pheochromocytoma Multisystem Crisis Behaving Like Interstitial Pneumonia: An Autopsy Case

• Internal Medicine 56(2), 149-152, 2017
• NAID 130005290638

• 先天性門脈欠損症に合併した肝細胞癌破裂の1例

• 日本消化器外科学会雑誌 50(2), 130-138, 2017
• NAID 130005242998

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• extravasation - definition of extravasation by Medical dictionary

extravasation /ex·trav·a·sa·tion/ (ek-strav″ah-za´shun) 1. a discharge or escape, as of blood, from a vessel into the tissues; blood or other substance so discharged. 2. the process of being extravasated. extravasation [ikstrav′əsā′shən] ...

Related Pictures

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★リンクテーブル★

リンク元	「白血球」「apoplexy」「漏出」「extravasate」「溢血」

「白血球」

　　[★]

英

leukocyte, leucocyte (Z), white blood cell (Z), WBC, white corpuscle, white cell

関

赤血球、血球、血液

白血球

• 顆粒球

• 好中球
• 好塩基球
• 好酸球

• 単球
• リンパ球

基準値

• 4000-9000 (/μl)　(2007前期解剖学授業プリント)

異常値の出るメカニズム第5版

• 5000- 8400 (/μl) (健常者の2/3)
• 4500-11000 (/μl) (95%範囲)

年齢との関連

• 新生児期>幼児期>成人期(20歳までに成人値)
• 妊婦でも増加(妊娠#妊娠による変化)

生理的な変動

• 精神的ストレス↑　　→　交感神経の刺激により好中球の血管壁遊離が促進されるため
• 午前↓、午後↑

基準値

			07解	異メ	流マ		HIM.A-1
顆粒球	好中球	桿状核球	40～70	44～66	40～60	4～14	0～5
		分葉核球				43～59	40～70
	好酸球		2～4	0～ 4	2～4		0～6
	好塩基球		0～2	0～0.5	0～2		0～2
無顆粒球	リンパ球		25～40	30～38	26～40		20～50
	単球		3～6	0～ 5	3～6		4～8

• 07解: 2007前期解剖学授業プリント
• 異メ: 異常値の出るメカニズム第5版 p.91
• 流マ: 流れが分かる実践検査マニュアル上巻 p.10

血管外滲出 extravasation (SMB.37 BPT.37)

(margination)

• 1. 赤血球は軽く早く流れるので血管の中央をながれ、白血球は血管のへりを流れている

(rolling)

• 2. IL-1, TNFで血管内皮細胞が活性化し、血管内腔にE-selectinを発現する
• 3. P-selectinはヒスタミンやトロンビンの働きにより、血管内腔に発現する
• 4. 白血球と血管内皮細胞の接着分子で接着することで、白血球がrollingを始める
• 3. 次第にselectinによる接着はdown regulateされる

(adheresion & arrested)

• 4. 炎症部位から出されたケモカインが血管内皮細胞の表面ののペプチドグリカンに結合し、白血球に提示される
• 5. 白血球表面のインテグリンが活性化し、血管内皮細胞のICAM-1, VCAM-1と強く結合する

(transmigration)

• 6. 白血球と血管内皮細胞に発現しているPECAM-1(CD31)がお互い接着し、白血球が血管内皮細胞の間隙を通って細胞外マトリックスに入る

血管内皮細胞		白血球
Rolling
E-selectin	－	糖鎖(SLex)
P-selectin	－	糖鎖
糖鎖(GlyCAM-1)(=CD34)	－	L-selectin
Adhestion
ICAM-1	－	LFA-1 integlin(CD11a/CD18), Mac-1 integlin(CD11b/CD18)
VCAM-1	－	VLA-1 integlin
transmigration
PECAM-1(CD31)	－	PECAM-1(CD31)

白血球の染色

• ギムザ染色

• 好酸性：赤く染まる→ヘモグロビン
• 好塩基性：青く染まる→リボソーム、核内のヒストン蛋白
• 好酸性でも好塩基性でもない：淡いピンクに染まる

• MPO myeloperoxidase反応（染色）

• MPOをもつ：顆粒球（前骨髄球～分葉核球）、単球（前単球～単球）
• MPOをもたない：リンパ球系細胞

• エステラーゼ esterase

• 好中球：長鎖エステルを分解
• 単球：短鎖エステルを分解

関節液

• 　　炎症 感染
• 200 2000 20000
• 500 5000 50000

臨床関連

• LAD(leukocyte adhesion deficiency)症候群 (SMB.37)

白血球のインテグリンが欠損または減少する先天性疾患

反復性の細菌皮膚感染

• 白血球減少症 leukopenia
• 白血球増加症 leukocytosis

• SIRSの診断基準：＜4,000/ul or ＞12,000/ul

「apoplexy」

　　[★]

• n.

• (医)卒中、卒中発作

関

acute stroke、apoplectic、apoplectic stroke、apoplexia、apoplexia cerebri、cerebral apoplexy、cerebral stroke、cerebrovascular accident、cerebrovascular stroke、CVA、extravasation、stroke

同

apoplexia

　

「漏出」

　　[★]

英

transudate, diapedesis, diapiresis, emigration, extravasation, transmigration

同

血管外遊出

• 血管内皮を通って、静水圧と膠質浸透圧の差の圧力に従って血漿が組織に移行すること

「extravasate」

　　[★]

• vt.

• (血液、リンパ液などを)管外に遊出させる

• vi

• (血液、リンパ液などを)管外に遊出する

• n.

• 遊出物、溢出物

関

diapedesis、extravasation

　 　

「溢血」

　　[★]

英

apoplexy、extravasation

関

血管外遊出、血管外遊走、卒中、脳卒中、脳血管障害、一動作、急性脳卒中、脳血管発作