DOCSLIB.ORG

Pathological Findings and Pulmonary Dysfunction After Acute Respiratory Distress Syndrome for 5 Years

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pathological Findings and Pulmonary Dysfunction After Acute Respiratory Distress Syndrome for 5 Years □ CASE REPORT □ Pathological Findings and Pulmonary Dysfunction after Acute Respiratory Distress Syndrome for 5 Years Chihiro Miwa 1, Shinichiro Koyama 1, Yasutaka Watanabe 1, Hiroyoshi Tsubochi 2, Shunsuke Endo 2, Mitsuhiro Nokubi 3 and Yoshinori Kawabata 4 Abstract We report the pathological findings of the lung after acute respiratory distress syndrome (ARDS), and pul- monary function tests during five years of follow-up. A 39-year-old woman, treated for acute myelogenous leukemia, developed ARDS. She recovered from ARDS but suffered from pulmonary aspergillosis. Her asper- gilloma was removed surgically. Her lung function tests and diffusing capacity of the lung for carbon monox- ide (DLCO) improved but diffusion impairment remained five years after recovery. Pathological examination of the resected material showed sclerosis in lobular septa and scattered fibrosis in alveolar ducts except for the aspergillosis. These fibrotic changes may be causally associated with her loss of DLCO. Key words: acute respiratory distress syndrome, pulmonary function tests, diffusing capacity of the lungs, pathological findings in ARDS (Inter Med 49: 1599-1604, 2010) (DOI: 10.2169/internalmedicine.49.3404) and nail deformation due to chemotherapy. Other physical Introduction findings and blood examination were normal (Table 1). There were no abnormalities in bone marrow and cerebro- The acute respiratory distress syndrome (ARDS) is char- spinal fluid. The chest X-ray appeared normal (Fig. 1a). She acterized by acute lung damage, arterial hypoxemia, reduced had neutropenia in her peripheral blood from 8 to 30 days total thoracic compliance, and diffuse bilateral infiltrates on after chemotherapy. Twelve days after completion of chemo- chest radiograph due to increased-permeability pulmonary therapy she had a high fever and α-streptococcus was de- edema (1, 2). Survivors of ARDS are often found to have tected in her blood culture. The resulting septic shock and chronic pulmonary fibrosis, reduced pulmonary function, disseminated intravascular coagulation (DIC) were treated and diminished health-related quality of life (3-5). Further- by antibacterial drugs, γ-globulin, urinastatin, granulocyte more, there are few studies of pathological findings after colony-stimulating factor (G-CSF) and gabexate mesilate. ARDS. Here we report the pathological findings of the lung Sixteen days post chemotherapy her respiratory condition after ARDS, and this patient’s pulmonary function tests over worsened and her chest X-ray revealed bilateral diffuse pul- the five years after recovery. monary infiltrates with air-bronchograms (Fig. 1b). Arterial oxygen pressure was 47.5 Torr with 15 L/min O2 flow via Case Report reservoir mask. LDH, AST, ALT and CRP increased to 327 IU/L 111 IU/L, 121 IU/L, and 21.7 mg/dL, respectively. She A 39-year-old woman was diagnosed with acute myeloge- was diagnosed with ARDS and intubated for mechanical nous leukemia (AML) in February, 2002. After induction ventilation. As part of multiple organ failure, her renal func- therapy for AML she received four courses of consolidation tion deteriorated and extracorporeal dialysis was begun. therapy at our hospital. On admission, she had loss of hair Subsequently, her temperature and arterial oxygenation im- １Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama, ２Department of Thoracic Surgery, Jichi Medi- cal University Saitama Medical Center, Saitama, ３Department of Pathology, Jichi Medical University Saitama Medical Center, Saitama and ４De- partment of Pathology, Saitama Cardiovascular and Respiratory Center, Kumagaya Received for publication January 18, 2010; Accepted for publication April 5, 2010 Correspondence to Dr. Chihiro Miwa, [email protected] 1599 Inter Med 49: 1599-1604, 2010 DOI: 10.2169/internalmedicine.49.3404 proved gradually, as did the chest X-ray. By 110 days post at this magnification (Fig. 3b). Microscopic sections of the chemotherapy she recovered sufficiently to become free of lung area away from aspergillosis, with stained with supplementary oxygen (Fig. 1c). elastica-Masson revealed scattered fibrosis in alveolar ducts On that same day (110 days) a fungus ball in a left lung and alveolar septa (Fig. 3c). cavity was recognized on her chest CT (Fig. 2). We checked After completion of treatment for AML, she was followed her sputum culture, and identified Aspergillus niger in a for five years. Over this period pulmonary function tests in- sputum sample and β-D-glucan was positive. A pulmonary cluding carbon monoxide diffusion capacity (DLCO)bysin- aspergilloma was diagnosed and treated with itraconazole. gle breath method and arterial blood gas analysis were per- Then, we added micafungin, because no improvement was formed according to standards recommended by the Ameri- shown on chest X-ray. However, her chest CT did not im- can Thoracic Society. Arterial blood gases returned to nor- prove and subsequently a new lesion appeared on the oppo- mal early in recovery from ARDS (Table 2). However, her site side of the lung. She therefore underwent excision of lung function tests showed a restrictive pattern of impair- the aspergilloma at 6 months after the onset of ARDS while ment at 2 years after recovery post ARDS. Thereafter her treatment of AML continued. pulmonary function tests gradually reached normal ranges Pathological examination of the resected material showed (Table 3). Following recovery from ARDS, DLCO was less sclerosis in thickened lobular septa and the cuff of pulmo- than the normal range for 5 years (Table 3). As showing nary arteries, while slightly active bronchiolitis with intralu- corrected DLco,DLco for five years did not affect by her he- minal exudative material probably associated with recent as- moglobin (Hb). pergillosis was observed in the left lobule (Fig. 3a). There was also sclerosis in lobular septa and an arterial cuff. It ap- Discussion peared that air-space was mostly preserved in the left lobule The case-fatality rate of ARDS has decreased during the 1990s but still may exceed 30 percent (7, 8). The reasons Table 1. Laboratory Findings on Admission for the increased survival rate are unclear, but probably are Hematology Biochemistry related to improved supportive care and ventilator strate- WBC 5130/μL TP 6g/dL gies (9). Low tidal volume ventilation improves survival in Nuetro 82% Alb 4.3g/dL patients with ARDS (10), although no correlation has been Lymph 11% T-bil 0.63mg/dL demonstrated between ventilatory strategies and long-term Mono 3% AST 16mU/mL Eosino 1% ALT 11mU/mL pulmonary function or health-related quality of life (5, 11). Baso 2% LDH 166mU/mL There is limited information regarding the pathological find- Blast 0% ALP 191IU/L ings of the lung and pulmonary function post ARDS. 4 RBC 323×10 /μL BUN 11mg/dL Many studies of patients with ARDS have focused on Hb 10.4g/dL Cr0.55mg/dL Ret 2.8% Na 143mmol/dL pulmonary morbidity and have shown that pulmonary func- Plt 30.3×104 /μL K 3.7mmol/dL tion most often returns to normal or is nearly normal by six Cl 105mmol/dL months to one year, with the exception of a persistent reduc- UA 4.5mg/dL tioninDLCO (12). However, Kian-Cheung et al (13) reported CRP <0.2mg/dL Patient’s blood examination was normal. that, one year after recovery from ARDS, persistent pulmo- nary function impairment was found in about one third of a b c Figure 1. a: Patient’s chest X ray on admission. b: Patient’s chest X ray showed bilateral dif- fuse pulmonary infiltrates with an air-bronchogram 16 days after chemotherapy. c: At 110 days after chemotherapy the patient had recovered completely and did not need supplementary oxygen. 1600 Inter Med 49: 1599-1604, 2010 DOI: 10.2169/internalmedicine.49.3404 Figure 2. At 110 days a fungus ball was recognized in the lung cavity on the chest CT. a b c Figure 3. a: Low power photo of a Hematoxylin and Eosin stained section. Sclerosis in thickened lobular septa (4 arrows), and cuffs around pulmonary arteries are noted (2 arrow heads). Slightly active bronchiolitis with intraluminal exudative material (circle), probably associated with recent aspergillosis, is observed in the lobule on the left. b: Low power figure of another Hematoxylin and Eosin stained section. There is also sclerosis in lobular septa (3 arrows) and arterial cuff (1 ar- row head). It seems that air-space is mostly preserved in the lobules on the left (2 asterisks) at this magnification. c: Microscopic view of the square framed lung area in Fig. 3 b, after elastica-Mas- son staining. There is scattered fibrosis in alveolar ducts and alveolar septa. 1601 Inter Med 49: 1599-1604, 2010 DOI: 10.2169/internalmedicine.49.3404 Table 2. Arterial Blood Gas Analysis Time from ARDS the onset of symptoms 5months 10months 5 years Inhalation O2 100% (intubated) room air room air room air pH 7.426 7.396 7.389 7.431 PaO2 (mmHg) 62.5 91.8 84.4 122.5 PaCO2 (mmHg) 57.8 46.6 46.7 37.3 HCO3- (mmol/L) 37.2 28 27.6 24.3 SaO2 (%) 94 97.7 97.3 99.3 Arterial blood gases returned to normal early in recovery from ARDS. Table 3. Lung Function Tests Time from ARDS 5 months 1.5 years 2 years 3 years 4 years 5 years VC (L) 1.83 1.96 1.92 2.17 2.15 2.28 %VC (%) 70.4 75.7 74.1 84.4 84 89.8 FEV1.0 (L) 1.74 1.8 1.81 1.96 1.96 1.92 FEV1.0% (%) 95.1 91.4 96.3 92.5 89.5 87.7 DLCO(mL/min/mmHg) 6.72 11.29 12.79 8.11 10.21 9.46 correctdDLCO 8.32 11.83 13.81 8.38 10.7 10.06 (mL/min/mmHg) (11.6) (13.7) (13.3) (13.9) (13.7) (13.5) (Hb(g/dL)) %DLCO (%) 50 74.5 85 52.6 66.7 59.8 DLCO/VA(mL/min/mmHg/L) 2.65 4.02 4.37 5.24 3.99 3.85 %DLCO/VA (%) 46.6 75.8 82.5 62.4 76.6 74.3 The restrictive pattern of impairment seen at 5 months after clinical recovery gradually improved through the next 4.5 years.
Load more

Recommended publications
  • Oral Health and Respiratory Infection
    C LINICAL P RACTICE Oral Health and Respiratory Infection • Philippe Mojon, DMD, PhD • Abstract The oral cavity has long been considered a potential reservoir for respiratory pathogens. The mechanisms of infec- tion could be aspiration into the lung of oral pathogens capable of causing pneumonia, colonization of dental plaque by respiratory pathogens followed by aspiration, or facilitation by periodontal pathogens of colonization of the upper airway by pulmonary pathogens. Several anaerobic bacteria from the periodontal pocket have been isolated from infected lungs. In elderly patients living in chronic care facilities, the colonization of dental plaque by pulmonary pathogens is frequent. Notably, the overreaction of the inflammatory process that leads to destruc- tion of connective tissue is present in both periodontal disease and emphysema. This overreaction may explain the association between periodontal disease and chronic obstructive pulmonary disease, the fourth leading cause of death in the United States. These findings underline the necessity for improving oral hygiene among patients who are at risk and those living in long-term care institutions. MeSH Key Words: aged; periodontal diseases/epidemiology; pneumonia, aspiration/epidemiology; pneumonia, aspiration/ prevention & control © J Can Dent Assoc 2002; 68(6):340-5 This article has been peer reviewed. he anatomical continuity between the lungs and the different for the 2 types. CAP is a frequent illness, with an oral cavity makes the latter a potential reservoir of incidence rate estimated at about 8 cases per 1,000 inhabi- Trespiratory pathogens. Yet an infective agent must tants per year in industrialized countries. The mortality rate defeat sophisticated immunological and mechanical is about 7% in hospitalized patients.1 Streptococcus pneumo- defence mechanisms to reach the lower respiratory tract.
    [Show full text]
  • Diffuse Alveolar Hemorrhage Syndrome Secondary to Bocavirus
    Case report Diffuse alveolar hemorrhage syndrome secondary to bocavirus and rhinovirus infection in a pediatric patient Síndrome de hemorragia alveolar difusa secundaria a coinfección por Rhinovirus y Bocavirus en un paciente pediátrico Carlos Eduardo Reina1 , Sandra Patricia Concha2, Rubén Eduardo Lasso2, Fernando Bermúdez2, María Teresa Agudelo3 Abstract The diffuse alveolar hemorrhage syndrome is characterized by the presence of blood in the pulmonary alveolus from arterioles, venules and pulmonary Date correspondence: capillaries, as a consequence of the lesion of the alveolar wall and without an Received: February 20, 2015. endobronchial alteration. Its presentation includes a classic triad of hemopty- Revised: September 11, 2017. sis, anemia and diffuse alveolar infiltrates. It´s a rare but potentially fatal entity Accepted: October 31, 2017. and there are no clear data on its real incidence in the pediatric population. We present the case of a previously healthy pediatric patient, immunocompetent, How to cite: who presented diffuse alveolar hemorrhage syndrome with secondary venti- Reina CE, Concha SP, Lasso RE, latory failure. After discarding all possible etiologies, coinfection by Rhinovirus Bermudez F, Agudelo MT. Diffuse and human Bocavirus was detected through the polymerase chain reaction, alveolar hemorrhage syndrome determining them as causal factors of the event. Recently, viral infections secondary to Rhinovirus and have been postulated as causing serious lung disease, especially coinfec- Bocavirus coinfection in a tion in immunocompromised patients, in this case Rhinovirus and human pediatric patient. Rev CES Bocavirus; however there are no reports on the syndrome caused by these Medicina. 2018; 32(1): 53-60. viruses. Open access Keywords: Diffuse alveolar hemorrhage; Respiratory failure; Rhinovirus; © Derecho de autor Human Bocavirus.
    [Show full text]
  • Lipid–Protein and Protein–Protein Interactions in the Pulmonary Surfactant System and Their Role in Lung Homeostasis
    International Journal of Molecular Sciences Review Lipid–Protein and Protein–Protein Interactions in the Pulmonary Surfactant System and Their Role in Lung Homeostasis Olga Cañadas 1,2,Bárbara Olmeda 1,2, Alejandro Alonso 1,2 and Jesús Pérez-Gil 1,2,* 1 Departament of Biochemistry and Molecular Biology, Faculty of Biology, Complutense University, 28040 Madrid, Spain; [email protected] (O.C.); [email protected] (B.O.); [email protected] (A.A.) 2 Research Institut “Hospital Doce de Octubre (imasdoce)”, 28040 Madrid, Spain * Correspondence: [email protected]; Tel.: +34-913944994 Received: 9 May 2020; Accepted: 22 May 2020; Published: 25 May 2020 Abstract: Pulmonary surfactant is a lipid/protein complex synthesized by the alveolar epithelium and secreted into the airspaces, where it coats and protects the large respiratory air–liquid interface. Surfactant, assembled as a complex network of membranous structures, integrates elements in charge of reducing surface tension to a minimum along the breathing cycle, thus maintaining a large surface open to gas exchange and also protecting the lung and the body from the entrance of a myriad of potentially pathogenic entities. Different molecules in the surfactant establish a multivalent crosstalk with the epithelium, the immune system and the lung microbiota, constituting a crucial platform to sustain homeostasis, under health and disease. This review summarizes some of the most important molecules and interactions within lung surfactant and how multiple lipid–protein and protein–protein interactions contribute to the proper maintenance of an operative respiratory surface. Keywords: pulmonary surfactant film; surfactant metabolism; surface tension; respiratory air–liquid interface; inflammation; antimicrobial activity; apoptosis; efferocytosis; tissue repair 1.
    [Show full text]
  • Respiratory System
    RESPIRATORY SYSTEM Dept.Dept. ofof HistologyHistology andand EmbryologyEmbryology 周莉周莉 教授教授 Respiratory System Nose Pharynx Larynx Trachea Bronchus Lung NASAL CAVITY 1. Mucosa：epithelium and lamina propria 1.1 Vestibular Region: 1.2 Respiratory Region： pseudostratified ciliated columnar epithelium, mixture glands (nasal glands), abundant blood vessels and lymphoid tissue in lamina propria 1.3 Olfactory Region (1) Olfactory epithelium: pseudostratified ciliated columnar epithelium A. supporting cells B. olfactory cells C. basal cells (2) Lamina Propria: olfactory glands (serous type) Olfactory epithelium TRACHEA AND BRONCHUS Mucosa: Pseudostratified ciliated columnar epiothelium Lamina propia Submucosa：LCT Advantitia: cartilage tissue and CT 1. Mucosa 1.11.1 PseudostratifiedPseudostratified ciliatedciliated columnarcolumnar epitheliumepithelium (1)(1) ciliatedciliated cellscells (2)(2) gobletgoblet cellscells (3)(3) basalbasal cellscells (4)(4) brushbrush cellscells (5)(5) diffusediffuse neuroendocrineneuroendocrine cellscells (small(small granulegranule cells)cells) Tracheal Sueface (SEM) Pseudostratified ciliated columnar epithelium(LM) 1.21.2 LaminaLamina PropriaPropria ThickThick basementbasement membrane,membrane, CTCT，， immuneimmune cellscells 2.2. SubmucosaSubmucosa：：LCTLCT TrachealTracheal glandsglands (( mixturemixture type)type)，， mucousmucous barrierbarrier lymphoidlymphoid tissuetissue thethe effectseffects ofof sIgAsIgA Tracheal wall 3. Advantitia C- shaped rings of hyaline cartilage and LCT membrane portion：ligament rich in
    [Show full text]
  • Investigation on Microparticle Transport and Deposition Mechanics in Rhythmically Expanding Alveolar Chip
    micromachines Article Investigation on Microparticle Transport and Deposition Mechanics in Rhythmically Expanding Alveolar Chip Jun Dong 1,† , Yan Qiu 1,†, Huimin Lv 1, Yue Yang 2,* and Yonggang Zhu 2,* 1 School of Science, Harbin Institute of Technology, Shenzhen 518055, China; [email protected] (J.D.); [email protected] (Y.Q.); [email protected] (H.L.) 2 School of Mechanical Engineering and Automation, Harbin Institute of Technology, Shenzhen 518055, China * Correspondence: [email protected] (Y.Y.); [email protected] (Y.Z.) † These authors contributed equally to this work. Abstract: The transport and deposition of micro/nanoparticles in the lungs under respiration has an important impact on human health. Here, we presented a real-scale alveolar chip with movable alveolar walls based on the microfluidics to experimentally study particle transport in human lung alveoli under rhythmical respiratory. A new method of mixing particles in aqueous solution, instead of air, was proposed for visualization of particle transport in the alveoli. Our novel design can track the particle trajectories under different force conditions for multiple periods. The method proposed in this study gives us better resolution and clearer images without losing any details when mapping the particle velocities. More detailed particle trajectories under multiple forces with different directions in an alveolus are presented. The effects of flow patterns, drag force, gravity and gravity directions are evaluated. By tracing the particle trajectories in the alveoli, we find that the drag force contributes to the reversible motion of particles. However, compared to drag force, the gravity is the decisive factor for particle deposition in the alveoli.
    [Show full text]
  • Synchrotron X-Ray Imaging of Pulmonary Alveoli in Respiration In
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE OPEN Synchrotron x-ray imaging of pulmonary SUBJECT AREAS: alveoli in respiration in live intact mice RESPIRATION Soeun Chang1,2*, Namseop Kwon1,3*, Jinkyung Kim1, Yoshiki Kohmura4, Tetsuya Ishikawa4, IMAGING TECHNIQUES Chin Kook Rhee5, Jung Ho Je1,2,4 & Akira Tsuda6 IMAGING 1X-ray Imaging Center, Pohang University of Science and Technology, San 31, Hyoja-dong, Pohang, 790-784, Korea, 2Department Received of Materials Science and Engineering, Pohang University of Science and Technology, San 31, Hyoja-dong, Pohang, 790-784, Korea, 3School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, San 31, Hyoja- 19 September 2014 4 5 dong, Pohang, 790-784, Korea, RIKEN SPring-8 Center, 1-1-1 Kouto, Sayo-cho, Sayo, Hyogo, 679-5198, Japan, Division of Accepted Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic University of Korea, 6 3 February 2015 505 Banpo-dong, Seocho-Gu, Seoul, 137-701, Korea, Harvard School of Public Health, Boston, Massachusetts, USA. Published 4 March 2015 Despite nearly a half century of studies, it has not been fully understood how pulmonary alveoli, the elementary gas exchange units in mammalian lungs, inflate and deflate during respiration. Understanding alveolar dynamics is crucial for treating patients with pulmonary diseases. In-vivo, real-time visualization of the alveoli during respiration has been hampered by active lung movement. Previous studies have been Correspondence and therefore limited to alveoli at lung apices or subpleural alveoli under open thorax conditions. Here we report requests for materials direct and real-time visualization of alveoli of live intact mice during respiration using tracking X-ray should be addressed to microscopy.
    [Show full text]
  • Regulation of Silica-Induced Pulmonary Inflammation
    University of Montana ScholarWorks at University of Montana Graduate Student Theses, Dissertations, & Professional Papers Graduate School 2014 Regulation of silica-induced pulmonary inflammation Rupa Biswas The University of Montana Follow this and additional works at: https://scholarworks.umt.edu/etd Let us know how access to this document benefits ou.y Recommended Citation Biswas, Rupa, "Regulation of silica-induced pulmonary inflammation" (2014). Graduate Student Theses, Dissertations, & Professional Papers. 4394. https://scholarworks.umt.edu/etd/4394 This Dissertation is brought to you for free and open access by the Graduate School at ScholarWorks at University of Montana. It has been accepted for inclusion in Graduate Student Theses, Dissertations, & Professional Papers by an authorized administrator of ScholarWorks at University of Montana. For more information, please contact [email protected]. Regulation of silica-induced pulmonary inflammation By Rupa Biswas At University of Montana Department of Biomedical and Pharmaceutical Sciences Center for Environmental Health Sciences Advisory Committee Members Andrij Holian, Ph.D., Chair Department of Biomedical and Pharmaceutical Sciences Kevan Roberts, Ph.D. Department of Biomedical and Pharmaceutical Sciences Howard Beall, Ph.D. Department of Biomedical and Pharmaceutical Sciences Christopher Migliaccio, Ph.D. Department of Biomedical and Pharmaceutical Sciences Stephen Lodmell, Ph.D. Division of Biological Sciences 1 Rupa Biswas Ph.D., June 2014 Toxicology Abstract Title: Regulation of silica-induced pulmonary inflammation Chairperson: Andrij Holian, Ph.D. Abstract Inhalation of crystalline silica for an extended period of time results in inflammation in the lungs, which plays a pivotal role in the development of silicosis, a progressive, inflammatory and fibrotic pulmonary disease. Inhaled silica particles are encountered by alveolar macrophages (AM) in the lungs.
    [Show full text]
  • 数字 Accessory Bronchus 副気管支 Accessory Fissure 副葉間裂
    数字 accentuation 亢進 accessory 副の 数字 accessory bronchus 副気管支 accessory fissure 副葉間裂 10-ｙear survival 10年生存 accessory lobe 副肺葉 18F-fluorodeoxy glucose (FDG) 18F-フルオロデオキシグルコース accessory lung 副肺 2,3-diphosphoglycerate (2,3-DPG) 2,3ジフォスフォグリセレート accessory nasal sinus 副鼻腔 201TI (thallium-201) タリウム accessory trachea 副気管 5-fluorouracil（FU) 5-フルオロウラシル acclimation 順化 5-HT3 receptor antagonist 5-HT3レセプター拮抗薬 acclimation 馴化 5-hydroxytryptamine 5-ヒドロオキシトリプタミン acclimatization 気候順応 5-year survival 5年生存 acclimatization 順化 99mTc-macroaggregated albumin (99mTc-MAA) 99mTc標識大 acclimatization 馴化 凝集アルブミン accommodation 順応 accommodation 調節 accommodation to high altitude 高所順（適）応 A ACE polymorphism ACE遺伝子多型 acetone body アセトン体 abdomen 腹部 acetonuria アセトン尿［症］ abdominal 腹部［側］の acetylcholine(ACh) アセチルコリン abdominal breathing 腹式呼吸 acetylcholine receptor (AchR, AChR) アセチルコリン受容体（レセプ abdominal cavity 腹腔 ター） abdominal pressure 腹腔内圧 acetylcholinesterase (AchE, AChE) アセチルコリンエステラーゼ abdominal respiration 腹式呼吸 achalasia アカラシア abdominal wall reflex 腹壁反射 achalasia 弛緩不能症 abduction 外転 achalasia ［噴門］無弛緩［症］ aberrant 走性 achromatocyte (achromocyte) 無血色素［赤］血球 aberrant 迷入性 achromatocyte (achromocyte) 無へモグロビン［赤］血球 aberrant artery 迷入動脈 acid 酸 aberration 迷入 acid 酸性 ablation 剥離 acid base equilibrium 酸塩基平衡 abnormal breath sound(s) 異常呼吸音 acid fast 抗酸性の abortive 早産の acid fast bacillus 抗酸菌 abortive 頓挫性（型） acid-base 酸―塩基 abortive 不全型 acid-base balance 酸塩基平衡 abortive pneumonia 頓挫［性］肺炎 acid-base disturbance 酸塩基平衡異常 abrasion 剥離 acid-base equilibrium 酸塩基平衡 abscess 膿瘍 acid-base regulation 酸塩基調節 absolute
    [Show full text]
  • Quantification of the Tissue Changes in the Human Lung with Chronic Lung Disease Using a Combination of Computed Tomography and Stereology
    QUANTIFICATION OF THE TISSUE CHANGES IN THE HUMAN LUNG WITH CHRONIC LUNG DISEASE USING A COMBINATION OF COMPUTED TOMOGRAPHY AND STEREOLOGY by HARVEY OWEN COXSON B.Sc, The University of British Columbia, 1986 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIRMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE STUDIES (Department of Experimental Medicine) We a^ept this thesis as>GOTTfl7rfning ;te>fhe required standard THE UNIVERSITY OF BRITISH COLUMBIA April 1998 © Harvey Owen Coxson, 1998 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of The University of British Columbia Vancouver, Canada DE-6 (2/88) ABSTRACT Idiopathic pulmonary fibrosis (IPF) and pulmonary emphysema are chronic lung diseases exhibiting progressive deterioration in pulmonary function as the lung architecture is remodeled. This thesis quantifies these tissue changes using a novel combination of computed tomography (CT) and quantitative histology. Pre-operative CT scans were obtained from patients with IPF, patients receiving lung volume reduction surgery for diffuse emphysema and from patients with minimal to mild emphysema undergoing lobectomy for a small peripheral • •• • • • j. tumour. Total lung volume was calculated using the pixel dimensions on the CT scan while airspace and tissue volume as well as the regional lung expansion were estimated using the X- ray attenuation values.
    [Show full text]
  • Characterization of Air Flow and Lung Function in the Pulmonary Acinus by Fluid-Structure Interaction in Idiopathic Interstitial Pneumonias
    RESEARCH ARTICLE Characterization of air flow and lung function in the pulmonary acinus by fluid-structure interaction in idiopathic interstitial pneumonias 1 2 Long Chen , Xia ZhaoID * 1 College of Aerospace Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, China, 2 Department of Rheumatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China * [email protected] a1111111111 a1111111111 a1111111111 Abstract a1111111111 a1111111111 Background and objective The idiopathic interstitial pneumonias (IIPs) are diffuse parenchymal lung disorders that are associated with substantial morbidity and mortality. Early diagnosis and disease stratifica- OPEN ACCESS tion of IIP patients are important because these are related with the treatment and progno- Citation: Chen L, Zhao X (2019) Characterization of sis. Idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonia (NSIP) are air flow and lung function in the pulmonary acinus by fluid-structure interaction in idiopathic interstitial two major distinctive pathologic patterns of pulmonary fibrosis. We researched the applica- pneumonias. PLoS ONE 14(3): e0214441. https:// tion of the fluid-structure interaction (FSI) to the respiratory system and compared the pul- doi.org/10.1371/journal.pone.0214441 monary acinus mechanics and functions in healthy and IIP models. Editor: Josue Sznitman, Technion Israel Institute of Technology, ISRAEL Methods Received: October 26, 2018 The human pulmonary alveolus is idealized by a three-dimensional honeycomb-like geome- Accepted: March 13, 2019 try, and a fluid-structure interaction analysis is performed to study the normal and diseased Published: March 28, 2019 breathing mechanics. The computational domain consists of two generations of alveolar Copyright: © 2019 Chen, Zhao. This is an open ducts within the pulmonary acinus, with alveolar geometries approximated as closely access article distributed under the terms of the packed 14-sided polygons.
    [Show full text]
  • Type 2 Alveolar Cells Are Stem Cells in Adult Lung Christina E
    Research article Type 2 alveolar cells are stem cells in adult lung Christina E. Barkauskas,1 Michael J. Cronce,2 Craig R. Rackley,1 Emily J. Bowie,2 Douglas R. Keene,3 Barry R. Stripp,1 Scott H. Randell,4 Paul W. Noble,1 and Brigid L.M. Hogan2 1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. 2Department of Cell Biology, Duke University, Durham, North Carolina, USA. 3Shriners Research Center, Portland, Oregon, USA. 4Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA. Gas exchange in the lung occurs within alveoli, air-filled sacs composed of type 2 and type 1 epithelial cells (AEC2s and AEC1s), capillaries, and various resident mesenchymal cells. Here, we use a combination of in vivo clonal lineage analysis, different injury/repair systems, and in vitro culture of purified cell populations to obtain new information about the contribution of AEC2s to alveolar maintenance and repair. Genetic lineage-tracing experiments showed that surfactant protein C–positive (SFTPC-positive) AEC2s self renew and differentiate over about a year, consistent with the population containing long-term alveolar stem cells. Moreover, if many AEC2s were specifically ablated, high-resolution imaging of intact lungs showed that individual survivors undergo rapid clonal expansion and daughter cell dispersal. Individual lineage-labeled AEC2s placed into 3D culture gave rise to self-renewing “alveolospheres,” which contained both AEC2s and cells expressing multiple AEC1 markers, including HOPX, a new marker for AEC1s. Growth and differentiation of the alveolospheres occurred most readily when cocultured with primary PDGFRα+ lung stromal cells.
    [Show full text]
  • Silicosis and Smoking: Intrinsic Phenomenon in the Respiratory System
    Advances in Applied Sociology, 2018, 8, 659-667 http://www.scirp.org/journal/aasoci ISSN Online: 2165-4336 ISSN Print: 2165-4328 Silicosis and Smoking: Intrinsic Phenomenon in the Respiratory System Diemen Delgado Garcia1*, Nayab Mahmood Sultan2, Oscar Ramirez Yerba3, Sofia Jimenez Castro4, Enmanuel Agila Palacios5, Ashley Delgado Cano1 1Research Institute for Safety and Health at Work, University of Guadalajara, Guadalajara, Mexico 2Department of Environmental Sciences and Earth, University of Birmingham, Birmingham, UK 3Occupational Medicine and the Environment, Scientific University of the South, Lima, Peru 4Occupational Medicine, University of Manchester, Manchester, UK 5Faculty of Security and Risks, University of the Armed Forces of Ecuador, Quito, Ecuador How to cite this paper: Garcia, D., Sultan, Abstract N. M., Yerba, O. R., Castro, S. J., Palacios, E. A., & Cano, A. D. (2018). Silicosis and Purpose of the Review: Some physiopathological mechanisms that could Smoking: Intrinsic Phenomenon in the support the relationship between tobacco and silicosis have been postulated Respiratory System. Advances in Applied but exact pathogenesis remains unknown. Recent Findings: Local inflamma- Sociology, 8, 659-667. https://doi.org/10.4236/aasoci.2018.810039 tion in workers with silicosis is a complex process characterized by an infil- tration of inflammatory cells in the respiratory alveolus, accompanied by an Received: July 31, 2018 increase in the expression of cytokines, chemokines, enzymes, growth factors Accepted: September 27, 2018 and adhesion molecules. Although in smokers without silicosis a similar pat- Published: September 30, 2018 tern of inflammation can be observed, in workers with silicosis this process Copyright © 2018 by authors and seems to be characterized by more pronounced increases in structural dam- Scientific Research Publishing Inc.
    [Show full text]