Infant, Newborn ; Female ; Humans ; Amniotic Fluid ; Perinatal Death ; Pneumonia, Aspiration/etiology* ; Arteries

OBJECTIVETo observe the effect of early bronchoscopic sputum suction in elderly patients with acute heart and lung failure due to aspiration pneumonia.

METHODSComprehensive treatments were administered for 52 elderly patients with acute heart and lung failure resulting from aspiration pneumonia, and in 27 of the patients, bronchoscopic sputum suction was performed with the other 25 serving as the control group. The indices of the heart and lung functions (central venous pressure, left ventricular ejection fraction, arterial blood partial pressures of oxygen and carbon dioxide) were measured after the treatment and compared between the two groups.

RESULTSPatients receiving bronchoscopic suction showed faster recovery of normal central venous pressure and left ventricular ejection fraction and more rapid increment of arterial partial pressure of oxygen and reduction of carbon dioxide partial pressure than those without the suction (P<0.01).

CONCLUSIONEarly bronchoscopic sputum suction can be one of the effective emergency measures for rescuing acute heart and lung failure due to aspiration pneumonia.

Aged ; Aged, 80 and over ; Bronchoscopy ; Cerebral Infarction ; complications ; Female ; Heart Failure ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Pneumonia, Aspiration ; complications ; therapy ; Respiratory Insufficiency ; etiology ; therapy ; Sputum ; Suction ; methods

OBJECTIVETo study the clinicopathologic characteristics of organizing pneumonia of the autopsies in elder and to analyze the possible underlying etiologic factors.

METHODSNinety-five cases of organizing pneumonia were found from 635 elderly autopsy reports of the Beijing Hospital since 1980. The morphologic and imaginal features were analyzed.

RESULTSThe foci of organizing pneumonia in our series were often small, patchy, scattered and adjacent to other lung lesion. There were, however, some variations in cases with different underlying conditions. The conditions associated with organizing pneumonia, as detected in our series, were: (1) 36 cases with suppurative inflammation, lung abscesses and chronic relapsing pneumonia; (2) 17 cases with fungal or viral infection; (3) 16 cases with aspiration pneumonia; (4) 5 cases with radiation pneumonia. We observed that it was not uncommon for organizing pneumonia coexisting with atelectasis and chronic pleuritis. The image of organizing pneumonia was varied.

CONCLUSIONSOrganizing pneumonia is a common finding in autopsies of the elder. It occurs in association with many diseases and the basic pathologic changes are similar. All of which represent secondary phenomenon. Possible etiologic factors include infection (due to bacteria, fungi or virus), aspiration and radiation. The possibility of organizing pneumonia should be considered if the shadow of lung is undisappeared in imagin.

Aged ; Cryptogenic Organizing Pneumonia ; etiology ; pathology ; Humans ; Lung ; diagnostic imaging ; pathology ; Lung Abscess ; complications ; pathology ; Lung Diseases, Fungal ; complications ; pathology ; Middle Aged ; Pneumonia, Aspiration ; complications ; pathology ; Radiography ; Retrospective Studies

OBJECTIVETo evaluate effects of inhaled nitric oxide (iNO) on the expression of lung neutrophil adhesion molecule CD(11b) in experimental meconium aspiration pneumonia treated with conventional mechanical ventilation under room air or 100% O(2).

METHODSRabbits were randomly allocated to 10 groups (n = 60), 6 of each group. Control or meconium aspiration pneumonia model groups were inhaled with room air or 100% O(2). Six treatment groups were treated with continuous NO inhalation at the doses of 6 x 10(-6), 10 x 10(-6) and 20 x 10(-6), respectively for 12 hours under room air or 100% O(2). The ratio of wet/dry (W/D) lung weight, alveolar septal width (ASW), myeloperoxidase (MPO) activity and lung injury score were measured. The expression of CD(11b) in neutrophils of the bronchoalveolar lavage fluid (BALF) was detected with flow cytometry.

RESULTSAfter 12 hours ventilation, the oxygenation was maintained better in treatment groups under different O(2) concentrations than that in model groups. Inflammatory evidence was found in lungs from all the model groups and treatment groups, which was characterized by serious inflammatory cell infiltration in alveolar space and hyaline membrane formation. The lung inflammation was decreased in all groups with nitric oxide inhalation. The ratio of W/D lung weight and ASW among different groups had no significant difference. MPO activities were significantly decreased in groups treated with 10 x 10(-6) and 20 x 10(-6) iNO compared with the model groups [with the concentration of 21% O(2), (1.8 +/- 0.2) U/g vs (4.4 +/- 0.5) U/g and (2.0 +/- 0.1) U/g vs (4.4 +/- 0.5) U/g;with the concentration of 100% O(2), (1.7 +/- 0.4) U/g vs (2.8 +/- 0.5) U/g and (1.4 +/- 0.3) U/g vs (2.8 +/- 0.5) U/g, P < 0.05, respectively]. MPO activities in the 20 x 10(-6) iNO group under 100% O(2) were significantly reduced compared with those under 21%O(2) [(1.4 +/- 0.3) U/g vs (2.0 +/- 0.1) U/g, P < 0.05]. Nitric oxide inhalation with the doses of 10 x 10(-6) and 20 x 10(-6) significantly decreased the expression of CD(11b) (MFI) in neutrophils of the BALF compared with the expressions in model groups without NO treatment (with 21% O(2), 121 +/- 20 vs 392 +/- 204 and 112 +/- 30 vs 392 +/- 204; with 100% O(2), 113 +/- 24 vs 293 +/- 65 and 102 +/- 14 vs 293 +/- 65, P < 0.05, respectively). Under the same iNO dose (10 x 10(-6) or 20 x 10(-6)) no statistic difference was found between groups of different inspired oxygen concentrations (21% and 100%).

CONCLUSIONSInhaled nitric oxide with the doses of 10 x 10(-6) to 20 x 10(-6) could significantly down-regulate the CD(11b) expression in neutrophil of the BALF and reduce the neutrophil sequestration and MPO activity in rabbit lungs, which may decrease the lung inflammation process in meconium aspiration pneumonia.

Administration, Inhalation ; Animals ; CD11b Antigen ; analysis ; Disease Models, Animal ; Female ; Flow Cytometry ; Lung ; drug effects ; metabolism ; pathology ; Male ; Meconium ; chemistry ; Neutrophils ; chemistry ; pathology ; Nitric Oxide ; administration & dosage ; therapeutic use ; Peroxidase ; analysis ; Pneumonia, Aspiration ; etiology ; physiopathology ; therapy ; Rabbits ; Random Allocation