A number of adhesion molecules on neutrophils and the pulmonary capillary endothelium mediate the neutrophil accumulation in the lungs at the onset of adult respiratory distress syndrome or acute lung injury (ALI). P-selectin, located on both vascular endothelial cells and platelets, has been shown to be one of these neutrophil-endothelial cell adhesion molecules. In this study, we measured the soluble form of P-selectin in plasma (PPS) from 19 patients (surviving, 11; deceased, 8) with ALI due to various causes and assessed the clinical significance of this measurement. Twelve healthy subjects and 29 patients with other pulmonary diseases, including idiopathic pulmonary fibrosis (IPF) (n = 8), sarcoidosis (n = 5), pneumonia (n = 8), and sepsis without ALI (n = 8) were also studied for comparison. PPS in patients with ALI (474.5 +/- 366.8 ng/ml, mean +/- SD) were significantly higher than those in control subjects (98.8 +/- 39.7, p < 0.01) and in patients with IPF (210.4 +/- 76.6, p < 0.05), sarcoidosis (135.2 +/- 71.5, p < 0.05), pneumonia (225.3 +/- 81.0, p < 0.05), and sepsis without ALI (271.8 +/- 46.5, p < 0.05). There was no significant difference in PPS levels between seven patients with and 12 patients without multiple organ failure. Lung injury scores correlated significantly with the PPS level (r = 0.605, p < 0.05). PPS levels of deceased patients with ALI (841.0 +/- 252.4) were significantly higher than those of surviving patients with ALI (208.0 +/- 109.2, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
We experienced a case of reexpansion pulmonary edema (RPE) after surgical treatment of pneumothorax. In this case, protein leakage and polymorphonuclear leukocyte (PMN) accumulation were observed in the reexpanded lung. Interleukin-8 and leukotriene B4 in edema fluid were increased at the onset of RPE. PMN elastase was also increased, though its peak was delayed. The plasma level of P-selectin, which mediates adhesion between PMN and endothelium, was elevated. We speculate that some of these fluid mediators may play important roles in chemotaxis and activation of PMN in the development of RPE.
Gas transfer rates for O2 and CO2 through freshly excised respiring rat abdominal muscle were measured. The tissue separated as a thin membrane two chambers, one of which was ventilated with a constant gas mixture. The other chamber was closed and the time course of changes of PO2 and PCO2, initially set at varied levels, was followed by electrodes. A plot of rate of change of PO2 and PCO2 in the closed chamber against the partial pressure difference across the tissue yielded both Krogh's diffusion constant, KO2 and KCO2, and metabolic rate of tissue, i.e. specific O2 consumption and CO2 production, mo2 and mco2. The mean values at 37 degrees C, KO2 = 1.31 x 10(-9) mMol-cm-1-min-1-torr-1 and KCO2 = 28.0 x 10(-9) mMol-cm-1-min-1-torr-1, did not differ significantly from values determined by other authors in various tissue preparations in which metabolism had been suppressed. Average O2 consumption, mo2 = 0.87 mMol-min-1-L-1, was not different from the values obtained in the same tissue by the Warbung manometric method, 0.74 mMol-min-1-L-1. The mean respiratory quotient, calculated as the ratio of mean CO2 production and mean O2 consumption, was 0.85.
Background -7S collagen, an N-terminal peptide of type IV collagen, is a primary constituent of the basement membrane. To evaluate whether the serum concentration of 7S collagen reflects the severity of inflammatory lung disease, the serum concentration of 7S collagen was measured in patients with adult respiratory distress syndrome (ARDS) and idiopathic pulmonary fibrosis (IPF). Methods -A radioimmunoassay was used for the measurement of 7S collagen. Gas exchange abnormality was expressed as the arterial oxygen tension (PaO2) divided by the fractional concentration of inspired oxygen (FiO2). Results -The mean (SD) concentration of 7S collagen was 2-7 (0 9) ng/ml in 10 healthy subjects, 5 0 (1P5) ng/ml in 11 patients with IPF, and 14-8 (9 7) ng/ml in 13 patients with ARDS. Significant differences were observed between the patients with ARDS and both healthy subjects and the patients with IPF. In the patients with ARDS serum concentrations of 7S collagen were strongly related to PaO2/FiO2 (r= -0-61). Moreover, the mean (SD) serum concentration of 7S collagen in the eight patients with ARDS who died (19-5 (10-2) ng/ml) was considerably higher than that of the five who survived (7-1 (2'1) ng/ml).Conclusion -These results suggest that serum levels of the 7S fragment of type IV collagen may have some prognostic value in ARDS. (Thorax 1994;49:144-146) Type IV collagen is a major constituent of all basement membranes where it forms a network structure, partly because of interactions between the N-terminal domains of adjacent molecules. These domains, known as 7S collagen,' are known to be comparatively resistant to proteases. It has therefore been proposed that serum concentrations of 7S collagen reflect degradation or synthesis of the basement membrane, or both.2'As type IV collagen exists in the basement membrane of pulmonary capillaries and alveoli, we hypothesised that serum concentrations of 7S collagen in patients with inflammatory lung disease may reflect the extent of damage to the pulmonary basement membrane. In this study serum concentrations of 7S collagen were measured in patients with adult respiratory distress syndrome (ARDS) and those with idiopathic pulmonary fibrosis (IPF), and the use of 7S collagen in assessing the severity of these diseases was evaluated.
To develop a simple noninvasive method for detecting tracheal stenosis, tracheal sounds were analyzed using fast-Fourier transform. The subjects were all female and included 5 normal volunteers and 13 patients with tracheal stenosis mostly secondary to thyroid cancer (11 extrathoracic and 2 intrathoracic lesions). Tracheal sounds were recorded during spontaneous breathing and were digitized with an analog-to-digital converter. Pulmonary functions, including forced expiratory volume in 1 s (FEV1) expressed as percentage of vital capacity, peak expiratory flow rate (PEFR), the ratio of FEV1 to PEFR (Empey's index), and the ratio of expiratory to inspiratory flow rates at 50% vital capacity, were measured. A computed tomography scan was used to obtain the tracheal minimum cross-sectional area. Whereas PEFR demonstrated a weak correlation with the stenotic area, FEV1%, Empey's index, and the ratio of expiratory to inspiratory flow rates at 50% vital capacity did not. The power of the fast-Fourier transform spectrum of normal tracheal sounds decreased as the frequency increased up to 500 Hz. A small spectral peak was observed at approximately 1 kHz. Patients with significant tracheal stenosis demonstrated an increase in the peak spectral power at approximately 1 kHz and in the mean spectral power from 600 to 1,300 Hz in their tracheal sounds. In patients with extrathoracic lesions, the peak and mean spectral powers correlated well with the area of the stenosis as defined by computed tomography scan. In patients with intrathoracic lesions, abnormalities in the pulmonary functions as well as tracheal sound spectra appeared more evident despite milder stenoses.(ABSTRACT TRUNCATED AT 250 WORDS)
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