双侧脑室引流、冲洗结合腰穿救治高血压脑出血破入全脑室患者的临床观察

目的 观察双侧脑室冲洗、引流结合腰穿治疗高血压脑出血破入全脑室的有效性和安全性.方法 将高血压脑出血破入全脑室的83例分成双管组(n=57)和单管组(n=26),双管组采用双侧脑室引流、冲洗结合腰穿的方法治疗(57例);单管组用单管引流治疗(26例),将两组治疗结果进行统计学分析和比较.结果 双管组:良好和中残35例(61.4%)、重残11例(19.3%)、植物生存2例(3.5%)、死亡9例(15.8%),单管组分别为6例(23.1%)、6例(23.1%)、1例(3.8%)、13例(50.0%),以双管组的疗效为优(P＜0.01);且双管组的病死率明显低于单管组(P＜0.01).双管组的脑脊液廓清时间为3～6(4.2±1.3)d,明显短于单管组的6～15(8.6±2.1)d(P＜0.01).结论 双管引流比单管引流更容易保持引流通畅,脑脊液廓清迅速,并发症减少,能降低病死率,提高生存质量,是一种安全、有效治疗全脑室出血的方法.     

Unguided bronchoalveolar lavage techniques and residual effects in dogs

Objectives To investigate the use of unguided bronchoalveolar lavage techniques in dogs without fibreoptic bronchoscopy, using an adapted single vascular catheter and a double-lumen catheter made from two single vascular catheters.
Animals Sixty-nine dogs were examined with the single-catheter technique and 110 dogs with the double-catheter technique.
Design A prospective study.
Procedure Sixty-nine and 220 samples, collected with the single catheter and the double catheter respectively, were examined cytologically Lungs of 69 dogs were examined grossly and histologically. Radiographic examination was performed on 11 dogs.
Results The double-catheter technique produced samples with significantly higher cellularity (P < 0.01) and fewer red blood cells (P < 0.01) than the single-catheter technique. Repeat samples collected with a double catheter were not significantly different (P > 0.01) in any value. A reference range for nucleated cell counts of 62 to 1210 – 10⁶/L was calculated from 57 clinically and histologically normal dogs. The major residual effects of the technique were localised pulmonary oedema, and alveolar distension with collapse and congestion of distant parenchyma. Thoracic radiographs revealed increased lung opacity for at least up to 7 h after the procedure.
Conclusions The cellularity of the bronchoalveolar lavage fluid obtained was adequate and sufficient fluid was retrieved when the single catheter was located in a proper position. However, the double catheter obtained better samples more quickly and easily, with less damage to the respiratory tract.     

Calcospherite-like bodies and caseous necrosis in tracheal mucus from a dog with tuberculosis

A 3-year-old Wirehaired Fox Terrier was presented to the University Veterinary Hospital, University College Dublin, for evaluation of chronic cough of 8-months duration. Bronchoscopy showed a severely dilated collapsed left principal bronchus filled with highly viscous white mucus. Cytologically, globular lipid-like material and round concentrically laminated crystalline structures were evident within the proteinaceous mucus. These findings resembled the calcospherites and granular caseous debris often observed in human tuberculous patients. A Ziehl-Neelsen-stained cytocentrifuged preparation of material obtained by bronchoalveolar lavage revealed a few acid-fast rods within macrophages, suggestive of tuberculosis. At necropsy, granulomas with caseous necrosis were present in the lung parenchyma, bronchial and mediastinal lymph nodes, liver, pancreas, and mesentery. Granulomas were adherent to both kidney capsules and to the diaphragm. Histologically, there was evidence of mild calcification within caseous granulomas, which was confirmed by von Kossa's stain. Using Ziehl-Neelsen stain, acid-fast rods were identified within granulomas; bacterial culture was positive for Mycobacterium bovis. The cytologic findings in this case have not been reported previously in dogs and demonstrate a possible correlation between tuberculosis and calcospherite-like bodies with caseous, globular material in bronchial mucus, similar to that described in human patients.     

The equine alveolar macrophage: Functional and phenotypic comparisons with peritoneal macrophages

Alveolar macrophages (AMs) constitute the first line of defence in the lung of all species, playing a crucial role in the regulation of immune responses to inhaled pathogens. A detailed understanding of the function and phenotype of AMs is a necessary pre-requisite to both elucidating their role in preventing opportunistic bacterial colonisation of the lower respiratory tract and developing appropriate preventative strategies. The purpose of the study was to characterise this important innate immune cell at the tissue level by making functional and phenotypic comparisons with peritoneal macrophages (PMs). We hypothesised that the tissue of origin determines a unique phenotype of AMs, which may constitute an appropriate therapeutic target for certain equine respiratory diseases. Macrophages isolated from the lung and the peritoneal cavity of 9 horses were stimulated with various toll like receptor (TLR) ligands and the production of nitrite, tumour necrosis factor alpha (TNFα), interleukin (IL) 10 and indoleamine 2,3-dioxygenase (IDO) were measured by the Griess reaction and enzyme linked immunosorbent assay (ELISA) and/or quantitative polymerase chain reaction, respectively. Cells were also compared on the basis of phagocytic-capacity and the expression of several cell surface markers. AMs, but not PMs, demonstrated increased TNFα release following stimulation with LPS, polyinosinic polycytidylic acid (Poly IC) and heat-killed Salmonella typhinurium and increased TNFα and IDO mRNA expression when stimulated with LPS. AMs showed high expression of the specific macrophage markers cluster of differentiation (CD) 14, CD163 and TLR4, whereas PMs showed high expression of TLR4 only. AMs, but not PMs, demonstrated efficient phagocytic activity. Our results demonstrate that AMs are more active than PMs when stimulated with various pro-inflammatory ligands, thus supporting the importance of the local microenvironment in the activation status of the macrophage. This information provides a valuable knowledge base on which to improve our understanding of the role of macrophages and their microenvironment in equine innate immunity.     

Using urea dilution to standardise components of pleural and bronchoalveolar lavage fluids in the dog

AIM: To develop a technique to estimate the volume of epithelial lining fluid (ELF) obtained during bronchoalveolar lavage (BAL) and pleural lavage (PL) in the dog, using the urea dilution method.

METHODS: BAL and PL fluids were obtained by saline lavage of pulmonary and pleural cavities of nine clinically healthy mixed-breed dogs immediately after euthanasia. Cell counts in the BAL and PL fluids were measured using standard techniques. The concentration of ELF in each lavage fluid was calculated from the relative concentration of urea in plasma and in each type of lavage fluid. Cell counts in ELF were then calculated.

RESULTS: There were substantially higher cell counts in ELF compared to BAL or PF fluid. However, nucleated cell counts in ELF could not be predicted from cell counts in BAL or PL fluid.

CONCLUSIONS AND CLINICAL RELEVANCE: These results suggest that accurate assessment of cellular or non-cellular components in lavage fluids should include a calculation of the proportion of ELF recovered, using a method such as urea dilution.     

The effect of topical treatment on esophageal pH during acid reflux in dogs

OBJECTIVE: To determine the effect of suction, lavage and instillation of sodium bicarbonate solution on esophageal pH during acidic gastro-esophageal reflux (GER) in anesthetized dogs. STUDY DESIGN: Prospective, clinical trial. ANIMALS: Ten healthy dogs, 4.8 +/- 2.4 years old, and weighing 37.1 +/- 7.9 kg. METHODS: Dogs were admitted to the study if they were under general anesthesia and regurgitation occurred. A sensor-tipped catheter was used to measure esophageal pH. On study entry the esophagus was suctioned. After an interval of at least 5 minutes, if the esophageal pH was still less than 4 the esophagus was lavaged with tap water and again suctioned. In 6 dogs 20 mL of dilute bicarbonate solution was instilled into the esophageal lumen. RESULTS: Suctioning fluid from the esophagus did not change the pH significantly. Lavage with tap water caused the pH to increase above 4 in four dogs, with the average pH increasing from 1.2 +/- 0.5 to 3.5 +/- 4.9. In all dogs where dilute bicarbonate solution was instilled, esophageal pH increased to above 6 for up to 180 (mean +/- SD, 89 +/- 81) minutes. CONCLUSIONS AND CLINICAL RELEVANCE: Suctioning refluxate from the esophagus does not change the pH of the esophageal lumen. Instillation of a small volume of bicarbonate solution predictably increased the pH above 4 following an episode of acidic GER. Care must be taken that fluid is instilled into the lumen of the esophagus, and not into the trachea.