Bronchopulmonary dysplasia in the adult.
ABSTRACT We describe 3 patients with adult respiratory distress syndrome that eventuated in a pathologic picture of honeycomb lung and a radiographic picture of variably cystic lung super-imposed on a background of diffuse alveolar infiltrates. All 3 patients had been treated with unusually high pressures of PEEP as well as high concentrations of oxygen for long periods of time (3 to 7 wk). Microscopically, the cystic structures in our patients appeared to be derived from collapse and fibrosis of the alveolar parenchyma with dilatation of the alveolar ducts. We suggest that this process is morphologically and radiographically similar to bronchopulmonary dysplasia as seen in the newborn.
SourceAvailable from: Larry Lands[Show abstract] [Hide abstract]
ABSTRACT: Bronchopulmonary dysplasia (BPD) and the longterm respiratory consequences of prematurity are unfamiliar to adult respirologists and remain under-recognized entities to adult caregivers. In Canada, the incidence of preterm births and its main chronic respiratory complication, BPD, have increased over the past 25 years. To describe the posthospitalization morbidity, medication use, health care use and pulmonary function tests of a large cohort of individuals with preterm birth complicated by BPD. A retrospective review of the hospital records of 322 preterm infants with BPD was conducted. Outcome variables were compared across levels of disease severity. Differences between groups were tested with one-way ANOVA for continuous variables and the Mantel-Haenszel chi-squared test for ordinal variables. Outcomes after the initial hospitalization that were associated with the initial severity of BPD were as follows: hospital readmissions in the first two years of life, the presence of developmental delay, forced expiratory volume in 1 s and forced vital capacity on pulmonary function tests in patients between eight and 15 years of age. Initial BPD severity was an important predictor of pulmonary function abnormality and health care use during childhood.Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2011; 18(5):265-70. · 1.66 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Animal studies have demonstrated that mechanical ventilation with high peak inspiratory pressure (PIP) results in acute lung injury characterised by hyaline membranes, granulocyte infiltration and increased pulmonary and systemic vascular permeability. This can result in progressive respiratory failure and death. In surfactant deficient lungs this occurs with tidal volumes (Vt) as low as 12 ml/kg, and PIP as low as 25 cm H2O, values which are frequently used clinically. The mechanisms resulting in this form of ventilator induced lung injury are not clear, but it appears to result from global or regional overdistension of the lung or terminal airways. It can be prevented or reduced in severity in some animal models by the use of PEEP. It is suggested that the use of high PIP in some patients may result in progressive deterioration of their ARDS, possibly contributing to mortality both from respiratory failure and other causes. It may be very important to limit PIP by reducing Vt even if this results in hypercapnia and a deterioration of oxygenation in the short term.Intensive Care Medicine 02/1990; 16(4):219-26. DOI:10.1007/BF01705155 · 5.54 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: The tracheal mucosa of the Syrian golden hamster has been extensively employed as a model system for respiratory tract cell renewal, injury, and carcinogenesis. However, baseline cell kinetic data are not available for normal juvenile and adolescent animals in which the mucosa and cartilage are rapidly enlarging. The objective of this research was to elucidate alterations in cell kinetics, epithelial morphology, and gene expression in the trachea of hamsters at different ages. Cell kinetics were examined by 3H-thymidine labeling indices, morphology by light and electron microscopic examination, and gene expression by slot blot analysis. Results showed that mucosal epithelium of the young and adolescent hamster undergoes cyclic necrosis and cell shedding, exposing portions of the elastic basal lamina. Epithelial shedding was associated with hyperplasia and squamous metaplasia. Additionally, the labeling indices of mucosal epithelial cells and chondroblasts also exhibited variable patterns which were associated with a cyclic pattern of expression of c-fos and c-erbB2 proto-oncogenes and epidermal growth factor receptor.The Anatomical Record 06/1992; 233(2):261-9. DOI:10.1002/ar.1092330209