Retrograde flush following topical cooling is superior to preserve the non-heart-beating donor lung

Objective: The use of non-heart-beating donors (NHBD) has been propagated as an alternative to overcome the scarcity of pulmonary grafts. Formation of microthrombi after circulatory arrest, however, is a major concern for the development of reperfusion injury. We looked at the effect and the best route of pulmonary flush following topical cooling in NHBD. Methods: Non-heparinized pigs were sacrificed by ventricular fibrillation and divided into three groups (n = 6 per group). After 1 h of in situ warm ischaemia and 2.5 h of topical cooling, lungs in group I were retrieved unflushed (NF). In group II, lungs were explanted following an anterograde flush (AF) through the pulmonary artery with 50 ml/kg Perfadex^® (6 °C). Finally, in group III, lungs were retrieved after an identical but retrograde flush (RF) via the left atrium. Flush effluent was sampled at intervals to measure haemoglobin concentration. Performance of the left lung was assessed during 60 min in our ex vivo reperfusion model. Wet-to-dry weight ratio (W/D) of both lungs was calculated as an index of pulmonary oedema. IL-1ß and TNF- protein levels in bronchial lavage fluid from both lungs were compared between groups. Results: Haemoglobin concentration (g/dl) was higher in the first effluent in RF versus AF (3.4 ± 1.1 vs 0.6 ± 0.1; p < 0.05). Pulmonary vascular resistance (dynes × s × cm⁻⁵) was 975 ± 85 RF versus 1567 ± 98 AF and 1576 ± 88 NF at 60 min of reperfusion (p < 0.001). Oxygenation (mmHg) and compliance (ml/cmH₂O) were higher (491 ± 44 vs 472 ± 61 and 430 ± 33 NS, 22 ± 3 vs 19 ± 3 and 14 ± 1 NS, respectively) and plateau airway pressure (cmH₂O) was lower (11 ± 1 vs 13 ± 1 and 13 ± 1 NS) after RF versus AF and NF, respectively. No differences in cytokine levels or in W/D ratios were observed between groups after reperfusion. Histology demonstrated microthrombi more often present after AF and NF compared to RF. Conclusion: Retrograde flush of the lung following topical cooling in the NHBD results in a better washout of residual blood and microthrombi and subsequent reduced pulmonary vascular resistance upon reperfusion.     

成人先天性肺内支气管囊肿的影像学诊断

目的:探讨成人先天性肺内支气管囊肿在CT、MRI表现上的特征。方法:37例经手术及病理证实的肺内支气管囊肿;男25例,女12例,年龄18～63岁,平均35岁。均行X胸片,24例行CT平扫及增强扫描,13例行MRI检查。结果:分布在右肺16例,左肺21例。形态以圆形为主,可以呈葫芦状、长条状或不规则形。22例囊肿含有液体,8例含气体,6例含有气液面,4例含有曲菌球,囊壁钙化7例,呈点状和弧线状。囊壁见有轻-中度强化,其中以含液囊肿较明显,囊肿周围气肿15例。结论:大部分成人先天性肺内支气管囊肿的CT、MRI表现有一定的特征,有助于术前诊断。     

蛇毒治疗不能解释肺动脉高压的研究

本通过对不能解释的肺动脉高压患，进行右心导管测定肺动脉平均压（ＰＡＭＰ）作为主要对照指标，观察蛇毒制品（精制溶栓酶）的急性药物试验和近期药物试验。发现该药物在近期有理想的降低ＰＡＭＰ作用，症状及胸片、超声心动图异常也明显取得改善，提示其可能为治疗该病的理想药物。     

Catheter embolization of pulmonary arteriovenous fistulas in an infant

Summary An infant with pulmonary arteriovenous fistulas is described. Surgical ligation of the fistulas and limited resection of paraenchyma from the right lung was followed at 11 months of age, by successful steel coil embolization of residual fistulas.     

肺性脑病与多器官功能障碍临床分析

目的：分析43例肺性脑病与多器官功能障碍的关系，以便早期采取预见性防治措施。方法：把43例肺性脑病时伴发的功能障碍器官个数与死亡率的关系及酸碱、电解质测定进行统计列表分析，结果：肺性脑病100％并发器官功能障碍，最常受损器官：肺、心、脑、肝或肾，受损器官数目越多，病情越严重，肺性脑病时，呼酸代酸，低钠，低氯血症明显增多。结论：肺性脑病100％伴发多器官功能障碍，随功能障碍器官数目的增加，死亡率亦增加，酸碱失衡及电解质紊乱与多器官功能障碍有关。     

Histometric analysis of the distal pancreas in pancreatic head cancer

To clarify the histological status of the pancreas tail after pancreatoduodenectomy (PD), fibrosis, islets of Langerhans, and A, B, and D cells were examined histometrically in surgical cases of pancreatic cancer. The same investigations were also performed during an autopsy examination of the pancreas tail of survivors of surgery who had received either PD or total pancreatectomy with segmental autotransplantation (SAT). In the surgical cases, fibrosis and the islet percentage compared with nonpancreatic cancer cases were significantly higher while the B cell ratio was significantly lower. In addition, in pancreatic cancer patients, the fibrosis and islet ratio in the group with a blocked pancreatic duct were higher while the B cell ratio was lower than in the group with an open pancreatic duct. A direct relationship between the islet ratio and the degree of fibrosis, and an inverse relationship between the B cell ratio and the degree of fibrosis, were thus found. From the autopsy cases, the fibrosis progressed and the islet ratio increased following PD, but after SAT only the islet ratio increased compared to the time of surgery. The progression of fibrosis after PD thus suggests the presence of some problems in both the surgical method and postoperative management.     

A nocturnal nasogastric feeding programme in cystic fibrosis adults

Fourteen adult patients (mean age 22.5 years, range 18–35) with cystic fibrosis undertook nocturnal nasogastric feeding for a mean period of 14.7 (range 6–18) months consuming an average of 1042 ml of a high energy feed on five nights of each week. Following this protocol all patients gained weight (mean weight gain 5.4 kg, range 2–17). For the group as a whole, lung function remained stable during the period of feeding; however a significant correlation between improvement in lung function and weight gain was demonstrated. Hyperglycaemia during feeding in this adult population was common (9/14, 64%) but was easily controlled with insulin therapy.     

心导纳微分环,肺导纳微分环最大向量正常值及其临床意义

本文报道３－５０岁２１４例心导纳微分环（ＣＡＤＬ）和肺导纳微分环（ＰＡＤＬ）最大向量振幅及方位正常值，结果随增龄变化振幅递减，方位递增，多数男＞女，部分组间有差异。４８例左向右分流先心病环体最大向量与肺动脉压之间呈平行关系，并探讨其临床意义。     

棉尘对工人肺功能的影响

目的　评价棉尘对工人肺功能的影响。方法　对 14 6名接棉尘工人和 12 5名对照工人的肺活量(FVC)和第 1秒时间肺活量 (FEV1 0 )进行了检查。结果　前纺、后纺和细纱作业场所空气中的棉尘浓度几何均值分别为 (7 1± 8 7) ,(2 5± 1 7) ,(2 2± 2 4 )mg/m3 ,样品超标率 16 8%。接触组前纺、后纺工人的急性肺功能改变 (APFC)和前纺工人的慢性肺功能改变 (CPFC)检出率较对照组明显增高 (P <0 0 5 ) ,OR及 95 %CI分别为 4 7(1 4～ 16 3) ,4 5 (1 3～ 15 6 ) ,5 6 (1 1～ 2 9 8) ;4 0～岁年龄段接棉尘工人APFC检出率高于对照工人 (P <0 0 5 ) ,OR及 95 %CI为 9 0 (1 1～ 73 8) ;接棉尘女工APFC检出率也比对照女工高 (P <0 0 1)。结论　棉尘有损害肺通气功能的作用 ,以急性改变更为明显