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Objective: To investigate the roles of donor alveolar macrophages and the recipient circulating neutrophils in early-stage reperfusion injury of lung allograft, and to study the interaction between the 2 kinds of cells. Methods: Twenty pairs of size- and weight-matched adult mongrel dogs were randomly assigned to 4 groups: C (control), D (leukocyte-depleted blood reperfusion), M (macrophage inhibition) and DM (leukocyte-depleted plus macrophage inhibition). The 20 cases of left lung transplantations were performed by the same surgeon. All procedures were identical, except that the donors in Group M and DM received the macrophage inhibitor gadolinium chloride (14 mg/kg) intravenously 24 h before operation, and that the recipients in Group D and DM underwent initial 10 rain reperfusion with leukocyte-depleted blood collected from donors' inferior vena cava. All lung allografts were reperfused for 2 h. Results: Compared with Group D and C, macrophage inhibition ameliorated PO2/FiO2 and mean pulmonary arterial pressure (mPAP) consistently after 30 rain reperfusion in Group M and DM; the parameters of lung reperfusion injury (malonaldehyde activity, wet/dry ratio) at 120 min after reperfusion were also significantly improved (P<0.05). Initial leukocyte-depleted reperfusion had no remarkable influence on allograft reperfusion injury, although it reduced pulmonary leukostasis (myeloperoxidase activity) significantly at 120 min after reperfusion. There were no significant interactions between leukocyte-depletion and macrophage inhibition in oxygenation, mPAP, wet/ dry ratio, malonaldehyde and myeloperoxidase activity. Conclusion: It is the donor alveolar macrophages, not the recipient circulating neutrophils that can aggravate the inflammatory cascade in lung allografts during 2 h after reperfusion and no interaction is detected between them.
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<p><b>OBJECTIVE</b>To investigate the clinical features of postoperative ventilator-associated pneumonia (VAP) after lung surgery.</p><p><b>METHODS</b>Of 104 patients who had undergone lung surgery and been treated with ventilator in our surgical intensive care unit between January 2003 and March 2005, 35 patients met with the criteria of both VAP and postoperative pneumonia (POP), and 41 cases had no evidences of pneumonia. The clinical and laboratory data of all 76 cases were recorded and analyzed by a statistical software package (SPSS).</p><p><b>RESULTS</b>The diagnosis of postoperative VAP was established clinically in 35 patients (46.1%), and etiologically in 33 cases. Compared to the patients without postoperative VAP, the patients with postoperative VAP had a significantly longer mean interval between intubation and operation [(2.7 +/- 2.9) days vs. (1.6 +/- 1.7) days, P = 0.039], a longer duration of mechanical ventilation [(32.2 +/- 37.7) days vs. (4.2 +/- 2.9) days, P < 0.001], and higher morbidity (20.0% vs. 2.4%, P = 0.013). There was a significant difference in mean duration of mechanical ventilation between the 15 cases of early-onset VAP and 20 cases of late-onset VAP (17 +/- 15 days vs. 43 +/- 46 days, P = 0.042). Among the initially detected pathogen, Staphylococcus aureus remains the most common Gram-positive coccus whereas Acinetobacter Baumannii took the place of Pseudomonas aeruginosa as the top Gram-negative rod.</p><p><b>CONCLUSION</b>Postoperative VAP after lung surgery has different clinical features from VAP in medical ICU.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Pneumonia, Ventilator-Associated , Diagnosis , Epidemiology , Postoperative Complications , Pulmonary Surgical Procedures , Respiration, Artificial , Retrospective Studies , Risk Factors , Time FactorsABSTRACT
<p><b>BACKGROUND</b>To investigate whether neoadjuvant chemotherapy (MVP) could influence the safety of perioperative patients with non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>The regimen of chemotherapy was MVP (mitomycin+vindesine+cisplatin) for all patients. The patients undergoing 2 cycles of neoadjuvant chemotherapy, radical resection and 2 cycles of postoperative chemotherapy were compared with those undergoing similar resections and 4 cycles of similar postoperative chemotherapy.</p><p><b>RESULTS</b>Of the 107 eligible patients, 66 patients were in the neoadjuvant-chemotherapy group and 41 in control group. There was no statistical difference between these two groups in the distributions of gender, age, tumor staging and pathology. The neoadjuvant-chemotherapy group had longer operative duration (P=0.262), more operative blood loss (P=0.704), more amount of operative transfusion (P=0.811) and total amount of perioperative transfusion (P=0.074), and less amount of post-operative drainage (P=0.061) than those of the control group, but no statistical difference was found among them. No statistical difference was detected between two groups in the mortality (P=0.674) and the morbidity such as arrhythmia (P=0.608), bronchial parietal fistula (P= 0.378 ), pneumonia (P=0.622) and respiratory failure (P=0.285).</p><p><b>CONCLUSIONS</b>Neoadjuvant chemotherapy does not exert significant influence on the safety of perioperative patients with NSCLC.</p>
ABSTRACT
Objective:To investigate the roles of donor alveolar maerophages and the recipient circulating neutrophils in early-stage reperfusion injury of lung allograft,and to study the interaction between the 2 kinds of cells.Methods:Twenty pairs of size-and weight-matched adult mongrel dogs were randomly assigned to 4 groups:C(control),D(leukocyte-depleted blood reperfusion),M(maerophage inhibition)and DM(leukocyte-depleted plus macropbage inhibition).The 20 cases of left lung transplantations were performed by the same surgeon.All procedures were identical,except that the donors in Group M and DM received the macrophage inhibitor gadolinium chloride(14 mg/kg)intravenously 24 h before operation,and that the recipients in Group D and DM underwent initial 10 min reperfusion with leukocyte-depleted blood collected from donors'inferior vena cava. All lung allografts were reperfused for 2 h.Results:Compared with Group D and C,macrophage inhibition ameliorated PO_2/FiO_2 and mean pulmonary arterial pressure(mPAP)consistently after 30 min reperfusion in Group M and DM;the parameters of lung reperfusion injury(malonaldehyde activity,wet/dry ratio)at 120 min after reperfusion were also significantly improved(P