Expression des Angiotensin converting enzyme (ACE) bei pulmonaler Hypertonie

We studied angiotensin I converting enzyme (ACE) expression in lung tissue from patients with different forms of pulmonary hypertension (PH) in comparison with that from morphologically normal lung specimens. ACE antigen expression was analysed by immunohistochemistry in morphologically normal lung tissue from 33 patients (19 males, 32-77 years; 14 females, 34-93 years) and compared to that in specimens from 94 patients (67 males, 30-97 years; 27 females: 27-90 years) with different clinically proven forms of PH (according to Venedig classification). Type specific vessel expression pattern as described for normal lung tissue was generally intensified in arteries, arterioles and capillaries of the lung specimens with PH. Specimens with PH due to left heart disease and chronic obstructive pulmonary disease (COPD) showed only very weak or no augmented arterial ACE expression, while PH due to collagenoses or interstitial lung disease showed significantly higher ACE expression. In human PH there is--comparable to animal models--a raised ACE expression in pulmonary lung vessels, with differences between the various forms of PH. These differences in ACE expression may be relevant for subtly differentiated therapeutic anti-ACE therapy regimes.     

Lung cancer--differences of incidence between the sexes

During the last decade increasing incidence of lung cancer among women have been observed in Poland. The aim of the study was to demonstrate differences among men and women with lung cancer. Lung cancer was diagnosed in 785 female and 4619 male in 1995 in Pulmonary Outpatients Departments. Women were younger than man when all histologic types of lung cancer were analysed (59.7 vs 61.9 years p. < 0.001). Particularly younger subjects were those with adenocarcinoma and small cell lung cancer (56.9 and 57.4 years for women and for men respectively 60.2 and 59.6 years, p < 0.001). Although squamous lung cancer was the most prevalent histological type among men (43.7%) and women (24.7%), about two times higher percentage of men had this neoplasm (p. < 0.001). Adenocarcinoma (18% vs 6.6%, p. < 0.001) and small cell lung cancer (18.5% vs 15.5% p. < 0.001) were prevalent in significantly higher percentage among female than male. Nonsmokers were more frequently noticed among women then men (20.4% vs. 1.9%, p. < 0.001), particularly those with adenocarcinoma. Also women smoked less intensively (33.6 pack/years vs. 42.3 pack/years, p < 0.001) except those with squamous cancer. The higher incidence of cancer was observed among mothers (7% vs 3.8% p. < 0.001) and fathers (7.1% vs 5.6%, p. < 0.001) of women than men with lung cancer.     

Effect of growth and aging on the static mechanical lung properties

Quasi-static expiratory pressure-volume curves were obtained in 119 healthy subjects 7 to 64 years old. Lung recoil pressures were measured at six fixed percentages of TLC between 100 percent and 50 percent. In children and adolescents lung recoil pressures increased with growth till about the age of fifteen and there were no differences between sexes. In adults less than 40 years old there was also no sex difference in lung recoil pressures, whereas in subjects more than 40 years old, females had lower recoil pressures than males at every level of TLC. Both in males and females, aging is associated with a marked decrease of lung recoil pressures. Smoking had no detectable effect on lung recoil in males. During growth the evolution of static compliance was closely related to height, whereas in adults this relationship was less evident particularly in males. There was no sex differences in specific compliance which tended to increase slightly with aging.     

Effects of smoking on the mortality of lung cancer in Korean men

Few studies have examined the effects of smoking on the morbidity and mortality of lung cancer in Korean men. In Korea, where the prevalence of smoking is among the highest in the world, the morbidity and mortality of lung cancer are rapidly escalating. The objectives of this study were to prospectively examine the effects of smoking on lung cancer and to determine the combined effects of the amount, duration and age that smoking was started. The design was a prospective cohort study with a follow-up period of six years (1993-1998). The subjects included a total of 305,687 Korean men from 35 to 64 years of age who received health insurance from the Korea Medical Insurance Corporation and who had biennial medical evaluations in 1992. The main outcome measures were deaths from lung cancer. As a baseline, 58.2% were current cigarette smokers. Between 1993 and 1998, 891 lung cancer events (34.4/100,000 people per year) occurred. In multivariate Cox proportional hazards models controlling for age, exercise and alcohol use, current smoking increased the risk of lung cancer (risk ratio [RR], 5.6; 95% confidence interval [CI], 4.2 - 7.3). There were significant dose-response relationships to the amount, duration of smoking and age that smoking was started. Compared with nonsmokers, the RR from current smokers who smoked 20 cigarettes per day for over 30 years was 8.2 (5.9 - 11.3), the RR from current smokers who smoked for over 30 years and were less then 19 years of age when they started smoking was 7.8 (5.2 - 11.9), and the RR for those who smoke 20 cigarettes per day and were less than 19 years of age when they started smoking was 8.3 (5.9 -11.6). This study demonstrates that in Korea smoking is a major independent risk factor for lung cancer, and that the risk increases with an increased amount, longer duration, and younger starting age.     

人非小细胞肺癌中HIF-1α的表达与血管生成和细胞凋亡的关系及意义

目的 探讨缺氧诱导因子1α(HIF-1α)在非小细胞肺癌(NSCLC)中的表达及其与血管生成和细胞凋亡的关系,评估它在NSCLC发生发展过程中的作用.方法 采用免疫组织化学的方法检测HIF-1α在正常肺组织、良性病变、癌前病变、原位癌、非小细胞肺癌及肺癌转移淋巴结中的表达,及血管内皮生长因子(VEGF)在NSCLC中的表达;采用TUNEL法检测部分NSCLC中细胞凋亡指数AI.结果 HIF-1α在支气管黏膜非典型增生、原位癌、NSCLC及肺癌转移淋巴结中的阳性表达率相似,总阳性表达率为40.0%(68/170),其在正常及良性病变中的总阳性表达率为6.0%(4/67),两组间有显著差异(P＜0.01).HIF-1α在NSCLC中的表达与各项临床病理特征均无明显相关性,仅与患者术后生存时间明显正相关(P＜0.01).VEGF在NSCLC中的表达与HIF-1α的表达呈正相关(P＜0.01),与患者预后呈负相关(P=0.027).凋亡指数(AI)在各组织类型和各分化程度的Ⅰ期肺癌中无明显差异,但生存期≥5年的肺癌患者AI明显高于生存期＜5年的患者(P=0.004).AI与HIF-1α的表达明显正相关(P=0.004).结论 HIF-1α在非小细胞肺癌组织中的表达较正常及良性病变肺组织明显上调,其与肿瘤血管生成及细胞凋亡均密切相关,在NSCLC生长中的作用具有多向性.HIF-1α可以作为评估患者预后的重要指标.     

肺癌磁共振扩散加权成像与肿瘤细胞密度的相关性研究

目的利用表观扩散系数（ADC）来评价肺癌的组织学特征。方法28例肺癌患者，其中男性18例，女性10例，年龄25～79岁．平均年龄52岁。行扩散加权成像（DWI）检查并测量病灶的ADC，方差分析比较不同组织学类型肺癌ADC问的差别。对11例外科切除的肺癌病灶ADC与细胞密度进行相关性分析。结果鳞癌、腺癌、小细胞癌平均ADC分别为（1．67±020）×10^-3mm2／s、（2．08±0128）×10^-3mm2／s、（1．76±0.21）×10^-3mm2／s，腺癌的ADC明显高于鳞癌及小细胞癌（P〈Q05）。肺癌ADC与细胞密度呈显著负相关（r=-0．71，P=0．015）。结论腺癌的ADC明显高于其他类型肺癌；ADC似乎可以鉴别肺癌的组织学类型。     

基于多层螺旋CT影像对胸骨后组织随年龄变化特征的观察

目的:基于多层螺旋CT（MSCT）影像探讨胸骨后解剖结构随年龄的变化特征。方法:回顾性研究。纳入青岛大学附属泰安市中心医院2020年8—12月行胸部MSCT检查的1 000例受检者的影像学资料。男500例、女500例,年龄0.5～100（50.23±28.49）岁。按每10岁进行分组,共分为10组,观察和统计在胸骨柄后...     

Lung involvement in systemic lupus erythematosus (SLE)--own experience

Pulmonary disorders in systemic lupus erythematosus are frequent and sometimes they are the first symptoms of the disease. SLE may cause a variety of clinical presentations and pathologic patterns, which can be difficult to diagnose. We observed 11 patients (9 women and 2 men) with pulmonary manifestations of SLE during last 18 years in our department. Mean age of patients was 47.7 +/- 13.4 years. There were no patients with drug induced SLE. Interstitial lung diseases (7/11) acute or chronic and pleural involvement (5/11) were the most frequent clinical presentation. In three cases airway disease presented as reduction of FEV1%VC index was detected. In one case "shrinking lung" syndrome was confirmed by muscle function (diaphragm relaxation time) and lung function tests. Pulmonary hypertension confirmed by echocardiography, was associated with interstitial lung disease or vasculitis. Six cases representing different lung involvement pattern of SLE were described in details.     

Analysis of indications and results of surgical treatment for patients with pulmonary metastasis

Ninety-three patients with pulmonary metastases (PM) were operated on between 1983 and 1997. Surgical complications occurred in 8 (9%) of patients. Two (3%) of patients died in hospital, 7 were operated on again due to further PM. An average survival after lung metastasis surgery was 40 months, median 22 months. 44% and 35% of patients survived respectively 3 and 5 years. Thanks to lung metastasis surgery the overall survival was longer; an average overall survival was 87 months (median 58 months). 58% and 38% of patients survived respectively 5 and 10 years. Time between treatment of primary tumour (PT) and lung metastasis surgery (disease free interval DFI) was on average 4 years, median 41 months. The patients who showed DFI-longer than 2 years had tendency to live longer (p = 0.086). Patients with PM are recommended to be operated on, even if further PM occur.     

Role of percutaneous fine needle aspiration cytology (FNAC) in detection of lung, pleural and mediastinal tumours--a study of 162 cases.

Percutaneous fine needle aspiration cytology (FNAC) was employed in 162 cases of lung, pleural and mediastinal tumours without the aid of fluoroscopy. There were 143 males and 19 females. Analysis of results showed that the age of the patients ranged from 3 years to 85 years. 135 cases were lung tumours, 25 cases were mediastinal tumours and 2 cases were malignant pleural mesotheliomas. Correlation with histopathology showed diagnostic accuracy of malignant lung and pleural tumours was 97.1% while the accuracy of the exact categorisation of the lesion was 92%. Diagnostic accuracy of mediastinal lesions was 96%. There was no false positive report. No complication was encountered in this procedure.     

Pulmonary fibrosis in young patients with hypersensitivity pneumonitis

Hypersensitivity pneumonitis (HP) is more common in middle-aged individuals but has been also diagnosed in patients of all ages including infants and children. Host risk factors are poorly characterized. The aim of this paper is presentation of 6 young patients in whom HP was diagnosed at the stage of lung fibrosis. There were 5 females at the age of 16-35 years and 1 male at the age of 28 years. All of them were exposed to organic dust for many years. Three of them were asthenic with scoliosis, 5 had clubbing. All patients were released from sport exercises in school due to fatigue but the diagnostic procedures were started at that time only in 2 patients. One woman had been ill from early childhood (recurrent pneumonia was recognised). In the another girl (16 years old) the spontaneous pneumothorax was the cause of the first chest X-ray examination. In the next woman (21 years old) marked dyspnea was connected with pregnancy and massive fibrotic lesions were recognised after delivery of her child. The only man was diagnosed before change of his job; he had no complaints. Two oldest women (34 and 35 years old) were diagnosed in childhood but avoidance of antigen exposure and corticotherapy were not effective. In all patients precipitins against farmer's lung and pigeon fancier's lung antigens were found. In all patients chest X-ray showed features of advanced lung fibrosis. All patients were treated with steroids without improvement. Two patients died during corticotherapy. CONCLUSIONS: 1) HP could be taken into consideration during differential diagnosis of interstitial lung diseases, 2) Cough and dyspnea on exertion could be the first symptoms of chronic HP in children also.     

肺移植后影响患者长期生存的危险因素

背景：国内肺移植开展数量较少,移植后长期生存时间较其他器官移植短,其原因尚不完全清楚。 目的：分析影响肺移植后患者长期生存因素。 方法：回顾分析61例终末期肺疾病患者接受肺移植的临床资料,根据随访生存时间将患者分为两组。观察组生存时间>3年29例,对照组生存时间<1年32例,对两组患者的一般特征、术式(单、双肺移植)、肺动脉压力、是否应用体外膜氧合等进行多因素逻辑回归分析比较。 结果与结论：统计学分析显示,年龄(≥50岁)、肺移植前肺动脉高压、急性排斥和肺部严重感染是影响患者肺移植后长期生存的独立风险因素。提示肺移植治疗终末期肺病,选择合适肺移植患者,移植前控制肺动脉压,移植中严格把握体外膜氧合转流适应证,移植后预防肺部感染,严格免疫抑制剂治疗是延长患者生存时间重要措施。     

Plasminogen activator inhibitor type 1 (PAI-1) in blood and tissue extracts of patients with non-small cell lung cancer

Clinical and experimental studies provide evidence that the plasminogen activation system plays a pivotal role in the pathogenesis of tumor growth and metastatic spread. The aim of the present study was to evaluate plasminogen activator inhibitor type I (PAI-1) in plasma and tumor extracts in patients with non-small cell lung cancer (NSCLC). The study group consisted of 146 patients (18 females, 128 males), aged 33-76 years with squamous cell carcinoma (107), adenocarcinoma (19), and mixed type of lung carcinoma (20) in pTNM stage I (72), stage II (30) and stage III (44) and 50 healthy volunteers as a control group (15 females, 35 males) aged 25-69 years. Blood for analysis was collected in the morning, 1-2 days before operation. Lung cancer and normal lung tissue specimens were obtained during surgery and homogenized in liquid nitrogen. The tissue extracts and plasma were assayed for concentration of PAI-1 with ELISA method. Significantly higher plasma level of PAI-1 was observed in patients with lung cancer than in control group. Concentration of PAI-1 in tumor tissues was significantly higher compared to normal lung tissue and was irrelevant from plasma level. Positive correlation between tumor level of PAI-1 and stage of lung cancer was noticed. Therefore it can be assumed that PAI-1 has an influence on the lung cancer progression.     

2014~2016年广西肿瘤医院肺癌患者流行病学及病理分布特征分析

目的 描述2014~2016年广西肿瘤医院收治肺癌患者的临床流行病学特征及病理类型特征,为广西肺癌的预防和控制提供参考依据。方法 对筛选出肺癌患者数据资料进行统计分析,描述肺癌患者的临床流行病学特征及病理类型特征。结果 共收集肺癌病例3510例,男性患者多于女性,男女性别比为1.99。肺癌患者主要集中在老年组（≥60岁）中,占肺癌患者总人数的50.11%,农村居民构成比超过50%。肺癌的主要病理类型为腺癌,鳞状细胞癌次之。腺癌的构成比呈上升趋势（P＜0.05）,男性、女性、中年组、老年组、城市居民以及农村居民的腺癌构成比上升（P＜0.05）。结论 60岁以上老年人,农村居民以及男性是肺癌防治的重点对象,尤其是符合多项条件的人群。     

Farmer's lung—a 5-year follow-up of eighty-six patients

We studied the clinical course of eighty-six patients with fanner's lung for a period of 5 years. The patients were first evaluated at an acute or sub-acute stage of the disease and 1, 3, 6, 12 and 60 months thereafter. Special attention was paid to the development of lung function and radiological findings with reference to corticosteroid treatment and antigen contact during the follow-up. Many of the patients were severely ill at the acute stage of the disease. Most of the recovery took place during the first month. Significant improvement of lung function happened up to 6 months, thereafter the improvement was insignificant. After 5 years, respiratory symptoms were reported by 65% and minor respiratory dysfunction (lowered diffusing capacity) was observed in about 40% of the farmers. Thirty-two per cent of the patients showed diffuse opacities in chest X-ray. Corticosteroid treatment had no effect on long term prognosis. There was no difference in the recovery of lung function between those who returned to work compared with those who did not. Exacerbations happened in 8% of the patients during the follow-up. We conclude that respiratory symptoms, minor airway dysfunction and mild radiological fibrosis are common findings after 5 years of an acute or sub-acute stage of the farmer's lung. However, in Finland two-thirds of the patients return back to their previous occupation of farming and cattle feeding.     

Mustard lung secrets: long term clinicopathological study following mustard gas exposure

Considering the undefinite nature of lung pathology in patients exposed to sulfur mustard (SM) many years after exposure, we conducted this study to document and quantify lung disease in this setting. In a cross sectional study, we selected 23 patients exposed to SM gas approximately 14 years ago during the Iran-Iraq war (1980-1988). We studied their clinical history, physical examination, pulmonary function test (PFT), high-resolution computed tomography scan (HRCT) of the chest, bronchoscopy, and bronchoalveolar lavage (BAL) sampling, and transbronchial lung biopsies. Other potential causes of lung disease, including smoking of cigarettes, were excluded. All 23 patients were symptomatic with cough, dyspnea, and/or felt tight in the chest. All of them had significant air trapping in HRCT and a marked increase of residual volume in PFT. The most common inflammatory cell in BAL fluid was neutrophil (88%). Of the 23 cases, there was sufficient tissue for detailed evaluation in 22. Histologically, 11 cases showed airway epithelial injury, and nine of the 14 lung biopsies with alveoli had histopathological changes diagnosable as organizing pneumonia (OP) or bronchiolitis obliterans OP (BOOP). Two out of 14 cases showed changes suggestive of OP. Inhalation of SM can lead to persistant and clinically significant lung disease, including bronchial mucosal injury and OP, many years after exposure.     

Spontaneous pulmonary neoplasms in cynomolgus monkeys (Macaca fascicularis) — A report of two cases —

The first lung tumour-bearing animal was a 7 years and 3 months old cynomolgus monkey. Microscopic examination revealed a neoplastic mass under the pleura that consisted of squamous islands with little keratinization, multifocal mineralization of the keratin, inflammatory cell and foreign body-type giant cell infiltration. It was classified as pulmonary squamous cell carcinoma. In a second cynomolgus monkey (2 years and 10 months old) a lung mass was observed at necropsy. Microscopically the tumour consisted of numerous islands of cartilage with glandular structures lined by a cuboidal epithelium between them. The neoplasm was classified as cartilaginous hamartoma.     

Morphogenesis of bronchiectasis in children of preschool age]

Surgical material from 24 children aged 2-6.5 years was investigated for studying morphological features and morphogenesis of bronchiectatic disease (BED) associated with lung immaturity. Leading role in the development of BED belongs to the deficiency of the lung defense at the time of the disease onset and premorbid background. Purulent-destructive alterations of the lung are the basis of grave persistent recurring BED.     

Low socio-economic status, smoking, mental stress and obesity predict obstructive symptoms in women, but only smoking also predicts subsequent experience of poor health

This study was conducted among female subjects to assess the possible association between selected risk factors and lung function as well as airway symptoms in a 32-year perspective. The Prospective Population Study of Women was initiated in 1968-1969 in G?teborg, Sweden (population about 450,000) with follow-ups in 1974-1975, 1980-1981, 1992-1993 and 2000-2001. Women born in 1930, representative of women of the same age in the general population in 1968, were selected. Initially, 372 participants were included in the cohort. In 2000-2001, 231 of these women (73%), now 70 years old, underwent lung function tests. The main outcome measures were lung function values, airway symptoms and health outcome in 2000-2001 in relation to self-reported exposures in 1968-1969 including smoking status. Smoking in 1968-1969 was associated with self-reported chronic bronchitis, obstructive symptoms and poor health 32 years later as well as lower lung function values, compared to non-smokers. Obesity, low socio-economic status and self-reported mental stress in 1968-1969 were associated with obstructive symptoms 32 years later. There are only a few longitudinal studies concerning women's health problems in this field and epidemiological studies of lung function impairment in women and risk factors in a long-term perspective are scarce. The results of the study suggest that life-style factors such as mental stress, obesity and smoking among women are related to airway symptoms and also quality of life many years later.     

Histiozytosis X

Summary Since 1963 we have observed a patient with Hand-Schüller-Christian disease with involvement of the skeleton, skin and hypophysis/hypothalamus with diabetes insipidus. The diabetes insipidus was successfully treated initially with chlorpropamid and later with carbamazepin.Alterations of the lung parenchyma were seen radiologically in 1966, and two years later the patient complained of exertional dyspnea. The lung disease was progressive with the deterioration of lung function despite corticosteroid and D-penicillamine treatment. The patient now has marked dyspnea even at rest. The osteolytic lesions have not changed in recent years.

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Abkürzungen ACTH Adrenocorticotropes Hormon - ADH Antidiuretisches Hormon - BSG Blutkörperchensenkungsgeschwindigkeit - PA Pulmonalarteriendruck - PC pulmonaler Capillardruck