先天性肺囊性疾病

先天性肺囊性疾病是较少见的先天性肺部疾病,是肺组织胚胎发育异常所形成的畸形。囊性病变包括囊性腺瘤样畸形、支气管源性肺囊肿、先天性大叶性肺气肿、肺隔离症。此类疾病的临床表现相似,但发生机制及病理改变有各自的特点。囊性腺瘤样畸形是由于细支气管发育停滞,以肺泡不发育为代价引起的肺间质大量增生,目前根据病理类型分成5型。支气管源性肺囊肿是胚胎发育时期支气管树某段的异常出芽形成的。先天性大叶性肺气肿是支气管内阻外压以及支气管壁的病变造成的气体陷闭,肺泡腔扩张。肺隔离症是部分肺组织与正常的支气管肺组织无交通,供血来自体循环,病变肺无正常功能,分叶内型和叶外型。     

Complications during root canal irrigation--literature review and case reports

LITERATURE REVIEW AND CASE REPORTS: The literature concerning the aetiology, symptomatology and therapy of complications during root canal irrigation is reviewed. Three cases of inadvertent injection of sodium hypochlorite and hydrogen peroxide beyond the root apex are presented. Clinical symptoms are discussed, as well as preventive and therapeutic considerations.     

SD大鼠肺气肿模型的建立及全反式维甲酸干预作用探讨

目的观察不同浓度的全反式维甲酸(all-transretinoicacid,ATRA)对猪胰蛋白酶复制的大鼠肺气肿模型的治疗作用。方法建立猪胰蛋白酶(porcine pancreatic elastase,PPE)复制的大鼠肺气肿模型,将体重170~220 g的60只SD大鼠随机分为生理盐水对照组(N)、模型组(P)、小剂量ATRA治疗组(R1)、中剂量ATRA治疗组(R2)、大剂量AT-RA治疗组(R3)、棉籽油组(C)各10只。后5组向大鼠气管内滴注1U·g-1PPE,N组同样滴注等量生理盐水,饲养76d,治疗组和棉籽油组分别向大鼠腹腔内连续注入大、中、小剂量ATRA和棉籽油14 d。测量干预前后的大鼠肺体积,血气分析和病理形态学图像分析了解不同浓度ATRA对于PPE复制的大鼠肺气肿模型的治疗效果。结果R1、R2、R3组、P组、C组的大鼠肺体积明显大于N组(P<0.01),C组和P组的肺体积无差异,各治疗组的肺体积较P组有差异,各治疗组之间的肺体积无差异。肺泡形态学结果显示R1、R2、R3组、P组、C组与N组比较,每个视野内的肺泡数(Na)明显减少,平均肺泡面积(MAA)增大,平均内衬间隔(MLI)较大,差异有显著性(P<0.05);R1、R2组相对于P组Na增加,MAA减少,差异有统计学意义,但两组之间无差别;R3组、C组和P组的各指标无明显差别。血气分析结果P组、R1、R2、R3组和C组的二氧化碳分压(PaCO2)比N组升高,P组、C组和R3组的氧分压(PaO2)、氧饱和度(SaO2)值明显低于N组,R1、R2组的PaO2、SaO2值与N组无差异,与P组也无差异。结论中、低剂量组的ATRA对肺气肿模型的治疗在肺泡修复上明显效果,但肺功能的改善不明显;大剂量组ATRA治疗后效果不明显。     

Congenital lung disease: a plea for clear thinking and clear nomenclature

Antenatal ultrasound has allowed the discovery of abnormalities which in the past often escaped detection. It may be unclear what advice to offer. Many large lung malformations seen at the routine 20-weeks gestation scan have largely disappeared at term. There is now even more confusion in terms of how these malformations should be described. The nomenclature of congenital lung disease was never very clear, with terms such as sequestrated segment, cystic adenomatoid malformation, hypoplastic lung, and malinosculation being used to describe often overlapping abnormalities. However, today these terms are used inconsistently in the ante- and postnatal periods. For example, congenital cystic adenomatoid malformation (CCAM) is used prenatally to describe a lesion which may well disappear before birth, but is used postnatally to describe an abnormality which may require lobectomy. CCAM may have a pulmonary arterial supply, or be supplied like a sequestration from the aorta, and histological features of both lesions may coexist. Thus, a complete reappraisal of the nomenclature of congenital lung disease is timely; this review does not discuss treatment options.     

Ehlers-Danlos syndrome with bladder diverticula

We describe an Indian man with the unusual association of classical cutaneous features of Ehlers-Danlos syndrome, a marfanoid habitus, bladder diverticula and multiple emphysematous bullae.     

Functional assessment of a new staple line reinforcement in lung resection

BACKGROUND: A major complication of lung resection is prolonged leaking at the staple line. Staple-line reinforcement is performed routinely during these procedures using bovine pericardium (peri-strips) and expanded polytetrafluorethylene. Both materials have been shown previously to increase staple-line durability and reduce the overall incidence of prolonged air leaking after lung resection, specifically in lung volume-reduction surgery. Small intestinal submucosa (SIS) has had many applications in human tissues consequent to its absorption and healing profile, which are well documented in human and animal models. However, it had not been studied in reinforcement of pulmonary staple lines. MATERIALS AND METHODS: We hypothesized that SIS reinforcement of staple lines in healthy lung tissue would increase durability, as determined by leak rates at increased airway pressures as compared to nonreinforced staple lines. Eight healthy juvenile Yorkshire-cross pigs were subjected to bilateral apical lung resections; one side was reinforced with SIS. The lungs were then inflated to sequentially increase intrabronchial pressures (5-75 cm H2O) for 60-second intervals while the chest was filled with saline under direct visualization monitoring for air leak. RESULTS: Staple lines reinforced with porcine small intestinal submucosa had significantly better durability as determined by Kaplan-Meier survival calculations with respect to leak rate as a function of pressure. CONCLUSION: Reinforcement of staple lines with SIS allows pulmonary staple lines to tolerate significantly higher intrabronchial pressures without demonstrating air leak at the staple line.     

Lung transplantation for emphysema. Lung hyperinflation: incidence and outcome

Lung transplantation, single or bilateral sequential, is the final option for patients with emphysema. This study analyzed the outcome of lung transplants for emphysema (single or double), and evaluates the incidence, predictive factors and prognosis of lung hyperinflation (LHI) in unilateral transplants. We prospectively studied patients undergoing lung transplantation for emphysema. On admission to the Intensive Care Unit (ICU) and at 12, 24, 48 and 72 h we tested the patients respiratory function, oxygen arterial pressure (P_aO₂) and mean pulmonary arterial pressure (MPAP) before transplantation. LHI incidence, duration of mechanical ventilation and hypoxemia, ICU stay and mortality was also analyzed. We studied 34 consecutive patients undergoing lung transplantation for emphysema, 14 single and 20 bilateral. Single-lung transplantation had a higher mortality (50%) than double-lung transplantation (11%), with an odds ratio of 9.0 (1.3--48.7). Of the 14 patients who received a single graft, 9 patients (64%) developed LHI. No predictive factors for LHI could be established. Duration of mechanical ventilation (22 vs 3 days) and ICU stay (36 vs 6 days) was much longer in patients with LHI; however, only ICU stay reached statistical significance (P=0.011). Mortality in patients with LHI was higher, 67% vs 20% (NS). We conclude that single-lung transplant in emphysema patients has a worse prognosis than bilateral transplant, with a 9-fold higher mortality rate. LHI is a common event in single-lung transplant for emphysema and is associated in our patients with a longer stay at the ICU.Supported by Red GIRA, G03/063, Instituto de Salud Carlos III, SpainThe authors wrote this article on behalf of The Lung Transplant Team of the Hospital Vall dHebron, Barcelona, Spain     

Detection of mild emphysema by computed tomography density measurements

Purpose: To assess the ability of a conventional density mask method to detect mild emphysema by high-resolution computed tomography (HRCT); to analyze factors influencing quantification of mild emphysema; and to validate a new algorithm for detection of mild emphysema.

Material and Methods: Fifty-five healthy male smokers and 34 never-smokers, 61-62 years of age, were examined. Emphysema was evaluated visually, by the conventional density mask method, and by a new algorithm compensating for the effects of gravity and artifacts due to motion and the reconstruction algorithm. Effects of the reconstruction algorithm, slice thickness, and various threshold levels on the outcome of the density mask area were evaluated.

Results: Forty-nine percent of the smokers had mild emphysema. The density mask area was higher the thinner the slice irrespective of the reconstruction algorithm and threshold level. The sharp algorithm resulted in increased density mask area. The new reconstruction algorithm could discriminate between smokers with and those without mild emphysema, whereas the density mask method could not. The diagnostic ability of the new algorithm was dependent on lung level. At about 90% specificity, sensitivity was 65-100% in the apical levels, but low in the rest of the lung.

Conclusion: The conventional density mask method is inadequate for detecting mild emphysema, while the new algorithm improves the diagnostic ability but is nevertheless still imperfect.     

Pneumomediastinum in labour -- probably not caused by a lumbar epidural anaesthesia

We describe a case of pneumomediastinum and subcutaneous emphysema during labour. The patient had previously received an epidural anaesthesia to alleviate labour pain. We found several reports of subcutaneous emphysema and pneumomediastinum (or pneumothorax) possibly caused by or related to epidural anaesthesia use, but conclude that the epidural anaesthesia was probably not a cause in our case.     

肺减容术治疗重度肺气肿的临床研究

目的评估肺减容术对重度肺气肿患者的疗效及定量CT对术后肺功能的预测价值。方法87例重度肺气肿患者行肺减容手术，双侧66例，单侧21例。术前行胸部定量CT检查，计算其CT肺气肿比例（CTR），并以CTR=2．5为分界点进行分组，比较两组间肺功能改善情况。术前和术后3、6、12、18、24、36个月分别测量肺功能、6分钟步行距离（6-MWD）、呼吸困难指数，并对其结果进行比较分析。结果87例中手术死亡1例，余均痊愈出院；术后3、6、12、18、24、36个月的FEVI、6-MWD较术前有明显提高（P〈0．05）；临床症状明显改善，呼吸困难指数再分级，40例术前Ⅳ级中8例转为Ⅰ级，32例转为Ⅱ级；18例术前Ⅴ级中2例转为Ⅰ级，2例转为Ⅱ级，12例转为Ⅲ级，2例转为Ⅳ级；CTR≥2．5的患者FEV1的改善较CTR＜2．5的患者更加明显（P〈0．05）。结论肺减容术能改善重度肺气肿患者肺功能，缓解呼吸困难，提高运动能力。定量CT对术后肺功能的预测价值较高。