参麦注射液抗肝缺血再灌注损伤的研究

目的：研究参麦注射液对肝缺血再灌注损伤的保护作用。方法：将３７只成年雄性ＳＤ大鼠随机分成假手术对照组（ＳＯＣ）、缺血再灌注组（Ｉ／Ｒ）、缺血再灌注加参麦组（Ｉ／Ｒ＋ｓｈｅｎｍａｉ）。通过阻断大鼠肝门３０ｍｉｎ后再开放建立肝缺血再灌注损伤模型,在肝脏再灌注９０ｍｉｎ时测肝组织丙二醛（ＭＤＡ）、超氧化物歧化酶（ＳＯＤ）和测血ＡＬＴ、ＡＳＴ、ＬＤＨ,并取肝组织作光镜及电镜观察。结果：再灌注９０ｍｉｎ时Ｉ／Ｒ＋Ｓｈｅｎｍａｉ组的肝组织ＭＤＡ生成,ＳＯＤ消耗,血清ＡＬＴ、ＡＳＴ、ＬＤＨ升高值均少于Ｉ／Ｒ组（Ｐ＜０．０１）,且Ｉ／Ｒ＋Ｓｈｅｎｍａｉ组的肝细胞显微、超微结构损害的改变较Ｉ／Ｒ组轻。结论：参麦注射液能清除肝缺血再灌注过程中产生的氧自由基,对鼠肝缺血再灌注所致肝细胞的结构和功能损伤有保护作用     

急症腹部手术后并发急性肺损伤的防治

目的：探讨腹部急症手术后肺损伤的预防和治疗。方法：回顾性分析４０例外科危重病人（ＡＰＡＣＨＥⅡ＞８分）首次手术后２４小时内的ＰａＯ２／ＦｉＯ２、ＡａＤＯ２和呼吸频率（ＢＲ）与急性肺损伤（ＡＬＩ）的关系,分为ＡＲＤＳ组（ Ⅰ组,１２例）和急性肺功能不全组（Ⅱ组,２８例）,同时分析液体治疗和机械通气模式在防治ＡＲＤＳ中的作用,并计算死亡率。结果： Ⅰ组的ＰａＯ２／ＦｉＯ２、ＡａＤＯ２、ＢＲ和死亡率分别为１８．２±４．5ｋＰａ、２６８．７±４１．３ｍｍＨｇ、３３．７±６．９次／分和４１．７％（５／１２）;Ⅱ组则分别为２３．０±５．9ｋｐａ、２４３．８±５３．１ｍｍＨｇ、２６．９±７．６次/分和３．６％（１／２８）。结论：外科危重病人术后２４小时内往往伴有不同程度的急性肺损伤,极易发生ＡＲＤＳ;ＰａＯ２／ＦＩＯ２和呼吸频率是早期发现ＡＲＤＳ的临床指标;控制补液量、早期给予激素和尽早加用ＰＥＥＰ（呼气末正压）是防治ＡＲＤＳ的三大重要措施。     

PAI—1和tPA与II型糖尿病血管病变关系探讨

目的：以整体的观点，探讨Ⅱ型糖尿病血管病变与纤溶酶原激活物（ｔＰＡ）及抑制物（ＰＡＩ－１）之间的关系。方法：选取４６例正常人，７１例Ⅱ型糖尿病患者，采用酶联免疫吸附法（ＥＬＩＳＡ）定量测定ｔＰＡ及ＰＡＩ－１水平。结果：单纯糖尿病组（ＤＭ组），ＰＡＩ－１正常；并发血管病变各组，ＰＡＩ－１比对照组升高，差异显著；合并大血管病变组（ＤＭ＋Ａｔｈ组），ＰＡＩ－１比ＤＭ组升高，差异显著；合并微血管病变组（Ｄ     

慢性肾功能衰竭患者的凝血纤溶功能紊乱

目的：观察尿毒症未透析组（ＣＲＦ）、血透（ＨＤ）、腹透（ＣＡＰＤ）治疗组凝血、纤溶功能的变化。方法：采用ＥＬＩＳＡ方法检测１２例ＨＤ、ＣＲＦ、ＣＡＰＤ各１０例患者的凝血、纤溶参数ＴＡＴ（凝血酶－抗凝血酶Ⅲ复合物）、ＰＡＰ（纤溶酶－α２抗纤溶酶复合物）、Ｄ－二聚体体的水平,并与１０例健康者对照。结果：所有尿毒症患者ＴＡＴ、Ｄ－二聚体均显著长高,ＣＡＰＤ组升高最为显著,ＨＤ与ＣＲＦ组无显著差异。ＰＡＰ     

几种激素对茶愈伤组织合成茶氨酸的影响

根据生长素（ＩＡＡ），吲哚丁酸（ＩＢＡ），萘乙酸（ＮＡＡ），以及２，４－二氯苯氧乙酸（２，４－Ｄ）和６－卞艹基腺嘌呤（６－ＢＡ），激动素（ＫＴ），玉米素（ＺＴ）及三十烷醇（ＴＡ）等的不同浓度和不同组合，测定茶愈伤组织生长和茶氨酸的积累情况，以求得茶愈伤组织生长和茶氨酸积累的较佳培养条件。试验证明，以４ｍｇ／Ｌ６－ＢＡ＋２ｍｇ／ＬＩＡＡ或３ｍｇ／Ｌ６－ＢＡ＋１．５ｍｇ／ＬＩＡＡ＋２ｍｇ／ＬＴＡ的组合，添加于ＭＳ培养基上，茶愈伤组织生长和茶氨酸积累均良好，茶氨酸含量最高可达１７０ｍｇ／ｇ．     

交通事故伤致死性并发症相关因素及防治

目的探讨交通事故伤致死性并发症的相关因素、发展趋势和有关的防治问题。方法对１０６例在交通事故伤中发生致死性并发症伤员的创伤严重度计分（ＡＩＳ－ＩＳＳ）、临床反应时间、并发症发生特点等资料行Ｒｉｄｉｔ分析和Ｑ检验。结果交通事故伤致死性并发症伤员ＩＳＳ比其他伤员高,临床反应时间也较长。其主要并发症种类与时间进程显著相关,据此可将伤员病程分为脑疝休克期（急性期）、过渡期、感染期和多脏器功能障碍综合征（ＭＯＤＳ）期。脑疝伤员的颅脑ＡＩＳ较高。休克伤员ＩＳＳ明显高于其他伤员。感染常发生于四肢伤的伤员中。ＭＯＤＳ多与感染并存。结论交通事故伤各种致死性并发症的发生与不同的伤情（创伤部位及严重性）有关,其变化趋势随时间进程有明显规律性,临床救治在不同时期有不同的防治工作重点。     

急性呼吸窘迫综合征国内外诊断标准的对比研究

目的：以欧美现行的急性肺损伤（ＡＬＩ）和急性呼吸窘迫综合征（ＡＲＤＳ）诊断标准为准,比较国内现行诊断标准的相似准确度。方法：回顾性地将１９９６年１月至１９９９年１０月瑞金医院外科ＩＣＵ收治的１８９例病人按有无可诱发ＡＲＤＳ的危险因素分为高危组和对照组,收集患者病史中动脉血气分析、胸部Ｘ线、呼吸频率、心功能、诊断时间和ＡＰＡＣＨＥ　Ⅱ评分等临床资料,并据此将我国的广州ＡＲＤＳ诊断标准与欧美的ＡＬＩ、ＡＲＤＳ标准作比较。结果：在高危组中,广州标准的灵敏度为８９％,特异性为８０％,准确度为８４％,但假阳性率为３４％,其主要原因是欧美标准诊断ＡＲＤＳ要求有胸部Ｘ线资料;在对照组中,广州标准的灵敏度为零。凭广州标准确定诊断时,距发病平均为３７．６ｈ±３２．２ｈ,而欧美标准为５２．２ｈ±４４.８ｈ（ＡＲＤＳ）和４９.１ｈ±４２．３ｈ（ＡＬＩ）。结论：广州标准与欧美ＡＬＩ标准近似,但有助于更早地确立诊断。我们认为广州标准不凭胸部Ｘ线资料就可诊断ＡＲＤＳ是恰当的。     

高原地区创伤和感染性急性呼吸窘迫综合征94例死亡原因分析

目的探索高原地区急性呼吸窘迫综合征（ＡＲＤＳ）发病特征、诊断标准。方法 通过病案复习,对近１０年２．３２５例院内死亡病例进行初筛,排除因恶性肿瘤、心脑血管病、慢性阻塞性肺疾病等所致慢性多器官衰竭,按照国内ＡＲＤＳ诊断标准,参照全身炎症反应综合征／多器官功能障碍综合征（ＳＩＲＳ／ＭＯＤＳ）诊断模式（１９９１年美国）和欧美联席会议１９９２年ＡＲＤＳ诊断标准进行死亡原因的回顾性分析。结果 ９４例（４．０     

严重创伤患者白细胞介素—2及其受体变化与多器官功能障碍综合 …

目的 探讨血清白介素－２（ＩＬ－２）与可溶性白介素－２受体（ｓＩＬ－２Ｒ）在创伤后多器官功能障碍综合征（ＭＯＤＳ）发生、发展中的作用机制。方法 应用ＥＬＩＳＡ法动态监测５９例严重创伤患者血清ＩＬ－２与ｓＩＬ－２Ｒ水平变化,比较ＭＯＤＳ与非ＭＯＤＳ组间ＩＬ－２、ｓＩＬ－２Ｒ变化之差异。结果 ５９例患者血甭ｓＩＬ－２Ｒ水平显著升颃是ＩＬ－２明显下降,且升 峰值与降低之谷值在ＭＯＤＳ组更为明显,与非ＭＯ     

抗癌药物对乳腺癌细胞动力学及凋亡基因Bc1-2/Bax的影响

探讨抗癌药物对乳腺癌细胞动力学及凋亡基因Ｂｃｌ－２／Ｂａｘ的影响。方法用流式细胞术测定乳腺癌细胞核ＤＮＡ含量（ＤＩ）、Ｓ期细胞比率（ＳＰＦ）、细胞凋亡指数（ＡＩ）、凋亡基因Ｂｃｌ－２、Ｂａｘ的表达及雌激素受体（ＥＲ）等进行定量分析。结果①用药组与对照组相比,ＤＩ、ＳＰＦ及Ｂａｘ明显低于对照组（Ｐ＜０．０１）,而ＡＩ（Ｐ＜０．０５）、Ｂｃｌ－２（Ｐ＜０．００１）则高于对照组,ＥＲ于两组间无统计学差异;②ＡＩ与ＳＰＦ、Ｂｃｌ－２及ＥＲ的表达均呈正相关,而与Ｂａｘ无明显相关关系。结论抗癌药物主要通过细胞凋亡而发挥作用,用药后的生物学指标可表现为ＡＩ及Ｂｃｌ－２升高,ＳＰＦ、ＤＩ值及Ｂａｘ下降;ＡＩ与ＳＰＦ、Ｂｃｌ－２及ＥＲ均呈正相关。根据这些指标可判定药物的疗效,并可用于预后的预测。     

高原低氧应激对兔睾丸组织的损害

目的 观察高原不同海拔地区低氧应激对兔睾丸组织及生精的损害.方法 将平原兔12只随机分为4组,每组3只.A组为对照组,B、C、D组为平原兔在48 h内直接迁饲到海拔4320 m后,1、7、30 d组.随机将6只饲养在海拔2260 m高原兔分为2组,每组3只.E组为高原对照组,F组为高原兔24 h内迁饲到4320m后1 d.各组宰杀后行睾丸组织病理学观察.结果 从平原急进高原4320 m地区后,病理检查发现,睾丸组织内大部分曲细精管的各级生精细胞减少,以初级母细胞减少明显;精子细胞明显减少,与对照组比较差异有统计学意义(P<0.05),睾丸间质内血管充血,间质细胞明显减少,无成堆现象.曲细精管内细胞计数C、D组分别为390.40±158.94、580.80±167.32,A组868.80±293.98(P<0.05).精子密度减少,C、D组分别为0.0027±0.0011、0.004±0.0017,A组0.006±0.002(P<0.05).曲细精管内生精细胞与支持细胞的比率降低,支持细胞计数A、B、C、D、E、F组分别为113、191、187、48、112、162.曲细精管内生殖细胞与支持细胞比率:A、B、C、D、E、F组分别为7.69、6.91、2.09、12.10、8.54、5.26,与对照组比较差异有统计学意义(P<0.05).结论 从平原急进高原地区可致兔睾丸组织受损,表现为各级生精细胞及间质细胞减少.当大气氧分压突然较大幅度降低时,不同大气压环境下生存的动物引起睾丸组织损害的病理组织学改变大致相同.     

高原低氧应激对肾脏的影响

目的 观察高原不同海拔地区低氧应激对人和兔肾脏的影响.方法 将平原兔12只随机分为4组,每组3只.A组为对照组,B、C、D组为平原兔在48 h内直接迁饲到海拔4320 m后1、7、30 d组.E组为饲养在海拔2260 m地区的高原兔(高原对照组),F组为海拔2260 m高原兔24 h内迁饲到4320 m后1 d.各组宰杀后行肾脏组织病理学观察.将进入高原2730 m不同时间(G组<6 m,250人,H组2 Y,110人)的健康青年共350人行尿生化及尿微量蛋白检测,设平原健康青年100人为对照组(Ⅰ组).结果 从平原急进4320 m地区后兔肾脏的改变为肾小球毛细血管内皮细胞肿胀、变性、结构不清,间质内毛细血管明显充血,肾小管上皮细胞水样变性.G组和H组尿生化总阳性率28.9%,对照Ⅰ组7%(P<0.01),且G组32.8%～(82/250)高于H组25.0%(25/100,P<0.01),α1微球蛋白G组(48.89±27.23)mg/L,H组(10.14±0.59)mg/L,均高于参考值5.86±4.50(P<0.01).结论 从平原急进入高原地区可致肾小球和肾小管同时受损,表现为尿生化和尿微球蛋白检测阳性.当大气氧分压突然较大幅度降低时,不同大气压环境下生存的动物均可引起肾小球和肾小管应激性损害,其组织病理学改变基本相同.     

青海高原地区全麻和硬膜外阻滞前后SpO2变化与平原地区的比较

４０例久居高海拔心肺正常行胆囊切除术患者，被随机分为硬膜外阻滞及全麻两组，分别行围术期６ｄ脉搏血氧饱和度监测，将结果与天津同类数据进行比较。结果显示，受海拔低氧环境影响，所有数值均低于天津，术后４ｈ至２４ｈ为最低，其后逐渐回升，约７２ｈ后恢复术前水平。     

高原低氧环境对由平原到高原地区健康青年肾脏的影响

目的 :探讨从平原到高原地区健康青年在低氧环境下肾脏的适应代偿状况。方法 :对急进高原地区(海拔 2 730 m)的平原兔行肾组织病理观察 ,对进入高原 (海拔 2 730 m)不同时间 (A组 6个月以内 ,B组 2 4个月 )的健康青年 35 0人的肾脏形态、尿微量蛋白、尿生化及肾功能指标进行检测 ,设平原地区对照组 (C组 10 0人 ) ,并进行综合分析。结果 :1动物实验结果 :光镜下可见肾小球毛细血管和间质内血管扩张充血 ,肾小管上皮细胞水样变性 ;2 A、B组尿生化检测的阳性率明显高于对照组 (P <0 .0 1) ,且 A组高于 B组 (P <0 .0 1) ;3各组肾体积对比 ,差异无显著性意义 (P >0 .0 5 )。4A、B两组血肌酐 THB均有异常现象 ,其中 B组血肌酐异常人数 15人(4 4.1% ) ,且明显高于 A组 (P <0 .0 1) ;5 A、B组均小于平原地区参考值 (P <0 .0 1) ,两组间对比 ,差异有极显著性意义 (P <0 .0 1)。A、B两组 β2 微球蛋白均高于参考值 (P <0 .0 1) ,组间对比 ,差异无显著性意义 (P >0 .0 5 )。A、B两组 α1 微球蛋白均低于参考值 (P <0 .0 1) ,而 B组高于 A组 (P <0 .0 1)。结论 :高原低氧环境对由平原进入高原地区健康男性青年肾脏有损害 ,表现为尿生化和尿微量蛋白检测阳性 ,显示肾小管和肾小球同时受损 ,肾功能指标有异常改变 ,但     

Plasma surfactant protein levels and clinical outcomes in patients with acute lung injury

BACKGROUND: Because injury to the alveolar epithelial barrier is a characteristic feature of acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS), plasma surfactant protein levels may have prognostic value. To test this hypothesis plasma surfactant proteins A and D (SP-A and SP-D) levels were measured in patients with ALI or ARDS enrolled in the NHLBI sponsored multicentre ARDS Network randomised controlled trial of a 6 ml/kg v 12 ml/kg tidal volume strategy. METHODS: Data from 565 participants in the clinical trial were used. Plasma levels of SP-A and SP-D were measured at baseline and on day 3 after the start of the mechanical ventilation protocol. The longitudinal impact of baseline plasma surfactant protein levels on clinical outcomes was examined by multivariate analysis, controlling for mechanical ventilation group, APACHE III score, and other clinical covariates. The effect of 6 ml/kg tidal volume ventilation on plasma SP-A and SP-D levels was evaluated using analysis of covariance. RESULTS: Baseline plasma SP-A levels were not related to any clinical outcome. In contrast, higher baseline plasma SP-D levels were associated with a greater risk of death (OR 1.21 per 100 ng/ml increment; 95% CI 1.08 to 1.35), fewer ventilator-free days (mean decrease -0.88 days; p=0.001), and fewer organ failure-free days (mean decrease -1.06 days; p<0.0001). The 6 ml/kg tidal volume strategy had no effect on the rise in plasma SP-A levels (p=0.91) but attenuated the rise in plasma SP-D levels (p=0.0006). CONCLUSIONS: Early in the course of ALI/ARDS an increased level of plasma SP-D is associated with a worse clinical outcome. The 6 ml/kg tidal volume strategy attenuated the rise of SP-D early in the clinical course. Taken together, these observations indicate that plasma SP-D, a product of alveolar type II cells, is a valuable biomarker in ALI/ARDS.     

Pharmacogenetic treatment of acute respiratory distress syndrome

Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) occur due to systemic inflammatory disorders or direct injury to the lung. The occurrence of ALI/ARDS is sporadic and is not reliably predicted by the type or severity of injury. A combination of patient characteristics and mechanism of injury are responsible for the sporadic nature of ALI/ARDS and its observed phenotypic variability. Research on the pathophysiology and genetics of ALI/ARDS continues to advance, revealing critical molecular pathways in disease development and specific genetic factors that alter the expression of disease. Despite these advances, pharmacologic therapies have yet to be developed for the prevention or treatment of disease. We anticipate that continued improvement of our understanding of the genetic and pathophysiologic mechanisms underlying ALI/ARDS combined with future clinical trials will allow pharmacogenetic therapies for ALI/ARDS to be developed.     

Short-term cardiorespiratory effects of proportional assist and pressure-support ventilation in patients with acute lung injury/acute respiratory distress syndrome

BACKGROUND: Recent data indicate that assisted modes of mechanical ventilation improve pulmonary gas exchange in patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). Proportional assist ventilation (PAV) is a new mode of support that amplifies the ventilatory output of the patient effort and improves patient-ventilator synchrony. It is not known whether this mode may be used in patients with ALI/ARDS. The aim of this study was to compare the effects of PAV and pressure-support ventilation on breathing pattern, hemodynamics, and gas exchange in a homogenous group of patients with ALI/ARDS due to sepsis. METHODS: Twelve mechanically ventilated patients with ALI/ARDS (mean ratio of partial pressure of arterial oxygen to fractional concentration of oxygen 190 +/- 49 mmHg) were prospectively studied. Patients received pressure-support ventilation and PAV in random order for 30 min while maintaining mean airway pressure constant. With both modes, the level of applied positive end-expiratory pressure (7.1 +/- 2.1 cm H2O) was kept unchanged throughout. At the end of each study period, cardiorespiratory data were obtained, and dead space to tidal volume ratio was measured. RESULTS: With both modes, none of the patients exhibited clinical signs of distress. With PAV, breathing frequency and cardiac index were slightly but significantly higher than the corresponding values with pressure-support ventilation (24.5 +/- 6.9 vs. 21.4 +/- 6.9 breaths/min and 4.4 +/- 1.6 vs. 4.1 +/- 1.3 l . min . m, respectively). None of the other parameters differ significantly between modes. CONCLUSIONS: In patients with ALI/ARDS due to sepsis, PAV and pressure-support ventilation both have clinically comparable short-term effects on gas exchange and hemodynamics.     

高原低氧环境下大鼠肾脏水通道蛋白2的表达及意义

目的 研究高原低氧环境下大鼠肾脏内髓水通道蛋白2（AQP2）mRNA及蛋白的表达。 方法 将40只雄性SD大鼠随机分为24 h、48 h、72 h及1周组，同时设立对照组（西宁地区）。将4个实验组由西宁地区（2260 m）带至青海大学可可西里高原医学研究基地(4600 m)，在不同时间点处死取材。用放射免疫法检测血浆抗利尿激素(AHD)浓度，Western印迹、实时定量PCR、免疫荧光等方法检测AQP2蛋白及mRNA的表达。 结果 暴露于高原低氧环境后，大鼠AHD水平首先呈下降趋势，24 h为（142.46±10.57）；48 h时达到最低水平，仅为对照组的28.5%[（86.94±6.49） μg/L比（302.53±10.48） μg/L]；后逐渐上升，72 h组为（169.65±11.15） μg/L，与对照组差异均有统计学意义（均P < 0.01）；1周时为（306.46±11.14） μg/L达到对照组水平。AQP2 mRNA的表达与AHD水平的变化相一致，初入高原后呈下降趋势，48 h时达到最低水平，后逐渐上升，24 h、48 h、72 h组与对照组差异均有统计学意义（分别为0.04±0.005，0.03±0.002，0.04±0.003比0.09±0.008，均P < 0.01），1周时为（0.09±0.01），达到对照组水平。AQP2蛋白表达与mRNA的表达变化一致。免疫荧光结果显示，对照组及1周组大鼠肾脏荧光强度表达一致，其余各组较低，48 h组荧光强度最低。 结论 在高原低氧环境下大鼠肾脏内髓AQP2 mRNA和蛋白的表达在缺氧早期呈下降趋势，后逐渐上升到正常水平，其改变可能和机体对缺氧的程度和高原低氧的习服过程有关。     

In vitro and in vivo effects of salbutamol on neutrophil function in acute lung injury

BACKGROUND: Intravenous salbutamol (albuterol) reduces lung water in patients with the acute respiratory distress syndrome (ARDS). Experimental data show that it also reduces pulmonary neutrophil accumulation or activation and inflammation in ARDS. AIM: To investigate the effects of salbutamol on neutrophil function. METHODS: The in vitro effects of salbutamol on neutrophil function were determined. Blood and bronchoalveolar lavage (BAL) fluid were collected from 35 patients with acute lung injury (ALI)/ARDS, 14 patients at risk from ARDS and 7 ventilated controls at baseline and after 4 days' treatment with placebo or salbutamol (ALI/ARDS group). Alveolar-capillary permeability was measured in vivo by thermodilution (PiCCO). Neutrophil activation, adhesion molecule expression and inflammatory cytokines were measured. RESULTS: In vitro, physiological concentrations of salbutamol had no effect on neutrophil chemotaxis, viability or apoptosis. Patients with ALI/ARDS showed increased neutrophil activation and adhesion molecule expression compared with at risk-patients and ventilated controls. There were associations between alveolar-capillary permeability and BAL myeloperoxidase (r = 0.4, p = 0.038) and BAL interleukin 8 (r = 0.38, p = 0.033). In patients with ALI/ARDS, salbutamol increased numbers of circulating neutrophils but had no effect on alveolar neutrophils. CONCLUSION: At the onset of ALI/ARDS, there is increased neutrophil recruitment and activation. Physiological concentrations of salbutamol did not alter neutrophil chemotaxis, viability or apoptosis in vitro. In vivo, salbutamol increased circulating neutrophils, but had no effect on alveolar neutrophils or on neutrophil activation. These data suggest that the beneficial effects of salbutamol in reducing lung water are unrelated to modulation of neutrophil-dependent inflammatory pathways.     

Frequency and mortality of acute lung injury and acute respiratory distress syndrome after pulmonary resection for bronchogenic carcinoma.

OBJECTIVE: We reviewed the frequency and mortality of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in our population of patients submitted to pulmonary resection for primary bronchogenic carcinoma. METHODS: From January 1993 to December 1999, a total of 1221 patients received pulmonary resection for primary bronchogenic carcinoma. Of these, 27 met the criteria of post-operative ALI/ARDS. There were 24 men and three women with a mean age of 64 years (range 45--79). Pre-operatively, predicted mean of PaO(2), PaCO(2) and %FEV1 were 72 mmHg (57--86), 37 mmHg (33--42) and 80% (37--114), respectively. Associated cardiac risk factors were present in eight patients. Three patients (11%) had pre-operative radiotherapy. Surgical-pathologic staging included 14 patients at Stage I, 8 patients at Stage II, four patients at Stage IIIa and one patient at Stage IIIb. RESULTS: ALI/ARDS occurred in 2.2% of our operated lung cancer patients. ALI was diagnosed in 10 patients and ARDS in 17 patients. The mean time of presentation following surgery was 4 days (range 1--10) and 6 days (1--13) for ALI and ARDS, respectively. According to the type of operation, the frequency was highest following right pneumonectomy (4.5%), followed by sublobar resection (3.2%), left pneumonectomy (3%), bilobectomy (2.4%), and lobectomy (2%). The frequency following extended operations was 4%. No differences were found between the ALI/ARDS group and the total population of resected lung cancer patients (control group) with respect to sex, mean age, pre-operative blood gases, %FEV1, surgical--pathologic staging and the use of pre-operative radiotherapy. Four patients with ALI (40%) and 10 patients with ARDS (59%) died. Mortality was highest following right pneumonectomy, extended operations and sublobar resections. Hospital mortality of the total population of operated lung cancer patients in the same period was 2.8% (34 patients). ALI/ARDS accounted for 41% of our hospital mortality. CONCLUSIONS: (1) ALI/ARDS is a severe complication following resection for primary bronchogenic carcinoma. (2) We did not detect any significant difference between the ALI/ARDS group and the control group regarding age, pre-operative lung function, staging and pre-operative radiotherapy. (3) ALI/ARDS is associated with high mortality, the highest mortality rates having been observed following right pneumonectomy and extended operation; it currently represents our leading cause of death following pulmonary resection for lung carcinoma. (4) ALI/ARDS may also occur after sublobar resections with an associated high mortality rate.