Neurokinin A with K channel blockade potentiates contraction to electrical stimulation in human bronchus

This study investigated the effects of neurokinin A (NKA) on cholinergic neural responses in human bronchus. NKA (0.1 nM) did not alter the contractile response to submaximal electrical field stimulation. However, K⁺ channel blockade with 4-aminopyridine (4-AP) (0.1 mM) potentiated the response to electrical field stimulation (to 182 ± 25% of control, n = 4, P < 0.05) and subsequent addition of NKA in the presence of 4-AP produced further potentiation (to 123 ± 6% of the response to 4-AP n = 4, P < 0.05). Neither 4-AP (0.01 or 0.1 mM) nor NKA in the presence of 4-AP potentiated the actions of exogenous acetylcholine but in these experiments 4-AP itself produced a marked direct contractile response. Thus NKA in the presence of K⁺ channel blockade potentiates cholinergic neural response in human bronchus and this occurs at a prejunctional site.     

食管壁内气-支气管软骨异位症3例报告

食管壁内气-支气管软骨异位症系一罕见先天性疾病,小儿多见,临床上主要表现为进食困难及进食后呕吐。钡餐检查可见食管远端贲门上方呈局限性狭窄及狭窄上扩张。根据本病特点建议命名为“食管壁内气-支气管软骨异位症。”     

Airway Reactivity to Bronchoconstrictor and Bronchodilator: Assessment Using Thin-Section and Volumetric Three-Dimensional CT

Objective

To determine the extent to which thin-section and volumetric three-dimensional CT can depict airway reactivity to bronchostimulator, and to assess the effect of different airway sizes on the degree of reactivity.

Materials and Methods

In eight dogs, thin-section CT scans were obtained before and after the administration of methacholine and ventolin. Cross-sectional areas of bronchi at multiple levels, as shown by axial CT, proximal airway volume as revealed by three-dimensional imaging, and peak airway pressure were measured. The significance of airway change induced by methacholine and ventolin, expressed by percentage changes in cross-sectional area, proximal airway volume, and peak airway pressure was statistically evaluated, as was correlation between the degree of airway reactivity and the area of airways.

Results

Cross-sectional areas of the bronchi decreased significantly after the administration of methacholine, and scans obtained after a delay of 5 minutes showed that normalization was insufficient. Ventolin induced a significant increase in cross-sectional areas and an increase in proximal airway volume, while the effect of methacholine on the latter was the opposite. Peak airway pressure increased after the administration of methacholine, and after a 5-minute delay its level was near that of the control state. Ventolin, however, induced no significant decrease. The degree of airway reactivity did not correlate with airway size.

Conclusion

Thin-section and volumetric spiral CT with three-dimensional reconstruction can demonstrate airway reactivity to bronchostimulator. The degree of reactivity did not correlate with airway size.     

Evaluation of Tracheobronchial Diseases: Comparison of Different Imaging Techniques

Objective

To compare the clinical utility of the different imaging techniques used for the evaluation of tracheobronchial diseases.

Materials and Methods

Forty-one patients with tracheobronchial diseases [tuberculosis (n = 18), bronchogenic carcinoma (n = 10), congenital abnormality (n = 3), post-operative stenosis (n = 2), and others (n = 8)] underwent chest radiography and spiral CT. Two sets of scan data were obtained: one from routine thick-section axial images and the other from thin-section axial images. Multiplanar reconstruction (MPR) and shaded surface display (SSD) images were obtained from thin-section data. Applying a 5-point scale, two observers compared chest radiography, routine CT, thin-section spiral CT, MPR and SSD imaging with regard to the detection, localization, extent, and characterization of a lesion, information on its relationship with adjacent structures, and overall information.

Results

SSD images were the most informative with regard to the detection (3.95±0.31), localization (3.95±0.22) and extent of a lesion (3.85±0.42), and overall information (3.83±0.44), while thin-section spiral CT scans provided most information regarding its relationship with adjacent structures (3.56±0.50) and characterization of the lesion (3.51±0.61).

Conclusion

SSD images and thin-section spiral CT scans can provide valuable information for the evaluation of tracheobronchial disease.     

支气管动脉灌注化疗栓塞术治疗肺癌的护理

目的　探讨预防及减少肺癌患者行支气管动脉灌注化疗栓塞 (BAE)术后并发症的有效护理方法 ,提高其生活质量。方法　对 2 0 0 2年 2月～ 2 0 0 3年 8月 2 0例行BAE的原发性肺癌患者进行术后观察和护理。结论　术前充分合理的准备、术中对化疗药物充分混匀、控制注射速度、术后正确拨管、动态观察局部血运等能有效预防BAE所致胸痛、出血及脊髓损伤等并发症的发生。对局部化疗药物副反应引起恶心呕吐 ,脊髓抑制等现象 ,应严格执行无菌操作 ,采取保护性隔离措施 ,可增强患者机体抵抗力 ,提高生存质量。     

支气管哮喘患儿血清可溶性细胞间粘附分子-1的变化及其临床意义

目的:探讨血清可溶性细胞间粘附分子-1(sICAM-1)在支气管哮喘患儿发病机制中的作用。方法:测定46例支气管哮喘患儿急性发作期血清sICAM-1的水平,其中有28例测定了恢复期血清sICAM-1的水平,同时以20例正常儿童血清sICAM-1作对照。结果:支气管哮喘患儿血清sICAM-1在急性期和缓解期均较正常对照组升高,差异有显著性(P<0.05);哮喘患儿重度发作较轻、中度发作升高更显著(P<0.01)。结论:sICAM-1参与了支气管哮喘的发病,可作为判断病情严重程度的重要指标之一。     

硝普钠诱导体外哮喘大鼠支气管平滑肌细胞凋亡

目的观察一氧化氮(NO)供体硝普钠(SNP)是否诱导哮喘大鼠气道平滑肌细胞(ASMCs)凋亡。方法W istar大鼠10只,用卵白蛋白作为致敏原建立大鼠哮喘模型,分离出大鼠的气道平滑肌细胞,用SNP(NO的供体)干预,通过四甲基偶氮唑蓝(MTT)法测定细胞生长率的变化,用原位末端标记法和流式细胞术检测SNP对哮喘大鼠气道平滑肌细胞细胞凋亡的影响。结果⑴MTT法测定:SNP 哮喘组的细胞抑制率明显高于哮喘组细胞存活率,(n=8,P<0.05),且呈浓度依赖关系。⑵TUNEL(原位末端标记)法检测:SNP 哮喘组的凋亡指数明显高于哮喘组,(n=4,P<0.05)。⑶流式细胞术测定SNP 哮喘组的平滑肌细胞凋亡率明显高于哮喘组,(n=4,P<0.05)。结论硝普钠能抑制哮喘大鼠气道平滑肌细胞的增殖,并且能诱导哮喘大鼠气道平滑肌细胞的凋亡,这种作用可能与治疗哮喘的气道重建有关。     

支气管内膜结核37例临床分析及诊断方法学比较

目的探索支气管内膜结核(EBTB)的纤维支气管镜(纤支镜,FB)下类型及诊断方法学。方法分析37例确诊的EBTB患者的临床表现、胸部X线(CT)、纤支镜检查结果,作单纯痰抗酸杆菌培养、钳取病变部位行病理学检查及刷检病变部位涂片找抗酸杆菌,并(或)作抗酸杆菌培养。结果37例中主要症状包括:咳嗽31例,发热9例,咯血10例,胸痛8例,气促5例,消瘦3例。1例出现喘息。3例的X线表现正常,只有1例的CT检查结果提示EBTB。纤支镜检查示37%的病例有炎症浸润型病变,9%有增殖型病变,27%有狭窄闭塞型病变,16%有溃疡型病变,11%大致正常。37例痰涂片行抗酸染色者中4例阳性,37例行活组织检查者中25例证实为结核,37例行纤支镜刷检涂片找抗酸杆菌检查者中33例阳性,另外4例阴性再经刷检病变组织作抗酸杆菌培养均为阳性。这三种诊断方法的检出率分别为11%,68%,89%经Χ2检验,认为这三种不同检查方法的检出率不同,即FB涂片最高,单纯痰菌涂片最低。结论EBTB缺乏特异性临床表现,胸部X线表现正常不能排除EBTB,CT诊断价值不高,单纯痰抗酸杆菌培养检出率低,确诊主要依靠纤支镜检查。对不明原因低热和呼吸道症状经积极治疗无效者,应怀疑EBTB而及时行纤支镜检查。刷检病变组织作抗酸杆菌培养检出率高,但抗酸杆菌培养时间长;镜下常规刷检找抗酸杆菌和组织活检阳性率较高,且简便快捷,值得推广。     

左支气管内径值对双腔支气管导管型号选择的指导作用

目的探讨左支气管内径值在双腔支气管导管（DLT）型号选择中的指导作用。方法将300例使用左DLT进行单肺通气的择期胸外科手术患者,随机数字表法分为两组,即：A组（传统方法组：根据患者身高、体质量选择左支气管导管型号）、B组（左支气管内径值组：根据螺旋CT测量患者的左支气管内径值选择合适导管）,每组150例。记录每位患者的年龄、性别、身高、体质量、疾病种类、使用的左DLT型号、导管合适度评价指标、肺萎陷质量、术后24h并发症的发生情况,对记录指标进行统计学分析。结果两组年龄、性别、身高、体质量及病种构成差异均无统计学意义（均P〉0．05）;与A组比较,B组使用的左DLT的型号大（0=8．650,P〈0．05）,导管的适合度高（P〈0．01）,肺萎陷质量高（X^2=6．549,P〈0．05）,并且术后24h并发症的发生率低（X^2=3．991,P〈0．05）。结论根据螺旋cT测量左支气管内径值能较准确选择合适的导管型号,在DLT使用中具有指导作用。