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EN
The aim of the study was to assess the relationship between intraoperatively observed macroscopic pathologic findings in the left lung and the chosen clinical factors. The factors analyzed in the study were the following: neonatal gestational age and body weight, the age of the neonate at the time of surgery, the history of intrauterine infection and/or presence of active infection in the neonate, the history of ibuprofen treatment, and intraoperative diameter of the arterial duct.Material and methods. The authors included a group of 126 preterm infants with body weight less than 1000 g undergoing surgical treatment for PDA in the 2nd Department of Cardiac and General Pediatric Surgery between January 2000 and May 2006 and analyzed the macroscopic intraoperative left lung appearance.The average body weight of the neonates who participated in the study was 765.2 g, with the average gestational age 25.68 Hbd. According to the results of intraoperative macroscopic lung assessment, the neonates were classified into one of the following three groups:0 - normal lungs or partially stiff lungs with emphysema focuses,1 - limited macroscopic findings, focuses of limited atelectasis, lung congestion,2 - severe pathologic findings in the pulmonary tissue, pulmonary hematomas, bleeding pulmonary surface, disseminated atelectasis, liver-like pulmonary tissue.In the study, the statistical analysis of the relationship between pathological pulmonary findings (groups 0, 1, 2) and investigated factors was performed by the comparison of mean values (or median) of the investigated factor in the analyzed groups. The Kruskal-Wallis and the Mann-Whitney tests were used dependent of the analyzed factor. Additionally, for chosen factors (the infection presence and PDA diameter), their relationship with the lung macroscopic appearance was assessed with the use of the Spearman test.Results. The pathological findings in the lungs were observed in the majority of the neonates (54%). The statistical analysis did not show any relationship between the pulmonary disorders and the majority of investigated factors.Conclusions. 1. The authors found that a duct diameter of ≥ 4 mm correlates with the development of more severe disorders in the pulmonary tissue. 2. The authors emphasized the good results of surgical treatment of PDA and the lack of death in the perioperative period in that group of patients.
EN
The effects of cyclosporin A (CsA), a potent immunosuppressive drug with antiparasitic activity, on the innate immunological response in guinea pig lungs during an early period (6th and 14th days) after T. spiralis infection were studied. CsA treatment of T. spiralis-infected guinea pigs caused a significant attenuation of immunological response in lungs by decreasing lymphocyte infiltration into pulmonary alveolar space, inhibiting alveolar macrophage superoxide anion production and lowering both the production of NO metabolites measured in bronchoalveolar lavage fluid and expression of the iNOS protein in lung homogenates, allowing us to speculate that the T. spiralis-dependent immunological response is dependent on lymphocyte T function. Interestingly, CsA itself had a pro-inflammatory effect, promoting leucocyte accumulation and macrophage superoxide production in guinea pig lungs. This observation may have a relevance to the situation in patients undergoing CsA therapy. Macrophage expression of the iNOS protein, evaluated by immunoblotting was not influenced by treatment of animals with CsA or anti-TGF-antibody, indicating different regulation of the guinea pig and murine enzymes.
EN
Hemorrhagic shock provokes a number of changes in the lungs, which may result in acute respiratory distress syndrome (ARDS). The underlying cause is a multiorgan inflammation also affecting the lungs. Inflammatory mediators involved in pathomechanisms of pulmonary damage are mainly produced in the intestine during shock-induced ischaemia. They are responsible for accumulation of inflammatory cells in the lung tissue, thickening of alveolar septa, and oedema due to increased microvascular permeability. Overexpression of adhesion molecules on pulmonary epithelial cells leads to enhanced interaction with inflammatory cells. This, in turn, accelerates epithelial apoptosis, thus causing epithelial cell dysfunction. Priming neutrophils, capable of generating respiratory burst, are characterized by prolonged survival resulting in longer duration of pulmonary inflammation. Experimental data suggest that during hemorrhagic shock, lung tissue can be protected by hypertonic (7.5%) NaCl solution, antioxidants (N-acetylcysteine, vitamin E), allopurinol, 17β-estradiol as well as neutrophil elastase inhibitor – sivelestat. Studies are being carried out with the use of surfactant protein A, nitrous oxide, and small interfering Fas-RNA in hemorrhagic shock.
PL
Podczas wstrząsu krwotocznego dochodzi w płucach do morfologicznych i czynnościowych zmian, które mogą prowadzić do ostrego zespołu niewydolności oddechowej. U podłoża tych zjawisk leży proces zapalny, rozwijający się jednoczasowo w wielu narządach, w tym również w płucach. Czynniki prozapalne odgrywające istotną rolę w patomechanizmach uszkodzenia płuc wytwarzane są głównie w niedokrwionym w czasie wstrząsu przewodzie pokarmowym. Wynikiem ich działania jest gromadzenie komórek zapalnych w tkance płucnej, pogrubienie przegród pęcherzykowych oraz obrzęk płuc na skutek wzmożonej przepuszczalności naczyń włosowatych. Z powodu zwiększonej ekspresji cząstek adhezyjnych na powierzchni komórek śródbłonka naczyń płucnych dochodzi do nasilonej interakcji z komórkami zapalnymi. Skutkuje to zaburzeniem ich funkcji i przyspieszoną apoptozą komórek nabłonkowych. Pobudzone neutrofile, zdolne do nadmiernego generowania reaktywnych form tlenu w okresie reoksygenacji, charakteryzują się dłuższą przeżywalnością, co prowadzi do wydłużenia czasu trwania procesu zapalnego w płucach. Badania doświadczalne wskazują, że do czynników działających ochronnie na tkankę płucną podczas wstrząsu krwotocznego należą hipertoniczny (7,5%) roztwór NaCl, antyoksydanty (N-acetylocysteina, witamina E), allopurynol, 17β-estradiol oraz inhibitor elastazy neutrofilowej – sivelestat. Na etapie badań doświadczalnych jest stosowanie białka A surfaktantu, podtlenku azotu oraz krótkiego interferującego RNA dla Fas.
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