Mechanical injuries to the ipsilateral non-diseased lobes(s) during pulmonary resection--another factor causing postoperative complications

BACKGROUND

The occurrence of complications after major pulmonary resection is known to be related to various factors. However, peri-surgical injuries to the ipsilateral non-diseased lobes(s) occurring during resection have never been mentioned in the literature. This study aimed to verify the injury in cases after lobectomy and wedge resection.

METHODS

Data from eighteen patients who underwent lobectomy or wedge resection for malignant tumor between January 2003 and January 2004 were collected. All patients had pre- and postoperative examinations of alveolar-capillary membrane (A/C) permeability using 99m TC-DPTA radioaerosol.

RESULTS

Ten lobectomies and eight wedge resection were performed. Using the paired t-test with each patient's pre-operative A/C permeability as his own control data, the postoperative A/C permeability of the ipsilateral non-diseased lobe(s) was found to be significantly increased. The degree of increase in the lobectomy group was the same as that in the wedge resection group. However, no significant change was found on the contralateral side in both groups.

CONCLUSION

The degree of increase of permeability was the same in both groups, indicating that the effects of stretch on the surviving lung are not a contributing factor to the change in A/C permeability. The mechanical injuries during the pulmonary surgical procedure alter the permeability, which could be a possible factor causing postoperative pulmonary complications.

Using 99mTc-DTPA radioaerosol inhalation lung scan as compared with computed tomography to detect lung injury in blunt chest trauma

BACKGROUND

Detection of pulmonary contusion in patients with blunt chest trauma is very important so as to commence therapy immediately to avoid irreversible damage. The purpose of our study was to evaluate the efficacy of technetium-99m diethylene triamine pentaacetic acid (99mTc-DTPA) aerosol inhalation lung scintigraphy in comparison with chest computed tomography (CT) in the diagnosis of pulmonary contusion at acute blunt chest trauma.

METHODS

Twenty-nine patients with isolated blunt chest trauma were referred to the emergency department of our hospital, and nine healthy people participated in this study. Sixteen patients who had pulmonary contusion on CT scans were referred to as group 1, and 13 patients who had normal CT scans as group 2. Nine healthy people comprised a control group. 99mTc-DTPA aerosol inhalation lung scintigraphy was performed on the first day in all patients.

RESULTS

The mean half time (T1/2) and penetration index values of 99mTc-DTPA clearance were significantly lower in groups 1 and 2 compared with the control group. Among the three groups, there were no significant differences in arterial blood gas analysis except for PO2. The mean T1/2 value of 99mTc-DTPA clearance did correlate with PO2 values but not with pH, PCO2, or HCO3 values.

CONCLUSIONS

99mTc-DTPA radioaerosol inhalation lung imaging may serve as a useful adjunct and supportive method to chest CT scanning for detecting mild pulmonary contusion.

Ca2+ channels and pulmonary endothelial permeability: insights from study of intact lung and chronic pulmonary hypertension

Phenotypic heterogeneity in pulmonary vascular endothelial cells extends to regulation of endothelial permeability, a process which often depends upon Ca2 + entry from the extracellular space. Scanning electron microscopy of vascular corrosion casts has documented distinct patterns of barrier disruption. Store depletion and activation of Ca2 + entry via canonical transient potential channels (TRPC1 and TRPC4) disrupts the barrier in extraalveolar vessels. In contrast, numerous other models of acute lung injury, including high vascular pressure- or epoxyeicosatrienoic acid-induced injury, specifically disrupt the alveolar septal barrier. This review discusses Ca2 + permeant channels which potentially could be involved in regulation of barrier integrity in the alveolar septal compartment: transient receptor potential channels, cyclic nucleotide gated channels, purinergic (P2X) channels, and T-type voltage gated channels. The evidence for the vanilloid transient receptor potential channel TRPV4 in regulating septal barrier function is discussed. Adaptations in barrier function in chronic pulmonary hypertension are reviewed, notably the loss of a store depletion-dependent permeability response in the intact lung. Finally, the authors propose that since specific disruption of the alveolar septal barrier will have deleterious functional consequences, such as alveolar flooding and impairment of gas exchange, identification of specific molecular targets for Ca2 + entry-dependent regulation of barrier function in this compartment is needed.

Methods to prevent ventilator-associated lung injury: a summary

Mechanical ventilation can cause ventilator-associated lung injury (VALI). This may manifest itself in various forms such as pneumothorax or, at the most extreme level, multi-system organ failure. The exact mechanisms by which the injury occurs are not known but appear to involve the conversion of mechanical stimulation of alveolar membranes into intracellular signalling, with subsequent upregulation of inflammatory mediators that produce the damage. This has been termed biotrauma. Furthermore, disruption of alveolar-capillary membranes may allow the release of these mediators into the systemic circulation that underpins the systemic inflammatory response syndrome. Various protective ventilatory strategies may be employed in order to reduce the lung damage and shall be discussed in this paper.

Air-blood barrier injury during cardiac operations with the use of cardiopulmonary bypass (CPB). An old story? A morphological study

OBJECTIVE

In spite of the advances in technology and surgical techniques, cardiac surgical operations with the use of cardiopulmonary bypass (CPB) are still associated with pulmonary morbidity and mortality. The purpose of this study is to morphologically analyze the structure of air-blood barriers in patients who underwent coronary artery bypass grafting (CABG) with use of CPB.

DESIGN

The investigation involved 50 patients aged 48-75 who underwent CABG with the use of extracorporeal circulation (ECC). Lung tissue specimens, which were taken before and after CPB, were observed with light and electron microscopy.

RESULTS

Both light and electron microscopic observations of pre-pump specimens did not show any pathological changes within the terminal part of the respiratory system. Morphological observations of tissue samples obtained after CPB revealed features of air-blood barrier injury and presence of surfactant within the alveolar capillaries.

CONCLUSION

Whatever the mechanism of the aforementioned changes one should be aware that the presented results indicate that air-blood barriers become leaky after CABG is performed with the aid of ECC.