Repetitive Aspiration Research Articles

Pulmonary Histopathology in an Experimental Model of Chronic Aspiration Is Independent of Acidity

Gastroesophageal reflux has become a major health concern in industrialized countries, with drugs aimed at blocking acid production being more frequently prescribed than any other drug. Damage to lung tissue as a result of chronic aspiration of gastric fluid is a primary health risk associated with gastro-esophageal reflux, with such aspiration being suspected in the induction or exacerbation of asthma and other lung diseases. In this study, a rodent model of chronic aspiration was used to characterize the pulmonary histopathology produced by repetitive aspiration events and to investigate the pathologic roles of individual gastric fluid components such as acid and particulate food matter. Rats exposed to chronic aspiration of whole gastric fluid developed a pathology distinct from that of acute lung injury, characterized by granulomatous interstitial pneumonitis with prominent formation of multinucleated giant cells. This pattern of injury could be reproduced with chronic aspiration of particulate food matter and with chronic aspiration of pH-neutralized gastric fluid, but not with chronic aspiration of hydrochloric acid. Thus, since acid-neutralizing therapy is currently the mainstay of treatment for patients with reflux-associated respiratory symptoms, these results strongly suggest that alternative therapeutic approaches aimed at preventing chronic-aspiration induced lung injury may be warranted.

Characterization of the innate immune response to chronic aspiration in a novel rodent model

BackgroundAlthough chronic aspiration has been associated with several pulmonary diseases, the inflammatory response has not been characterized. A novel rodent model of chronic aspiration was therefore developed in order to investigate the resulting innate immune response in the lung.MethodsGastric fluid or normal saline was instilled into the left lung of rats (n = 48) weekly for 4, 8, 12, or 16 weeks (n = 6 each group). Thereafter, bronchoalveolar lavage specimens were collected and cellular phenotypes and cytokine concentrations of IL-1alpha, IL-1beta, IL-2, IL-4, IL-6, IL-10, GM-CSF, IFN-gamma, TNF-alpha, and TGF-beta were determined.ResultsFollowing the administration of gastric fluid but not normal saline, histologic specimens exhibited prominent evidence of giant cells, fibrosis, lymphocytic bronchiolitis, and obliterative bronchiolitis. Bronchoalveolar lavage specimens from the left (treated) lungs exhibited consistently higher macrophages and T cells with an increased CD4:CD8 T cell ratio after treatment with gastric fluid compared to normal saline. The concentrations of IL-1alpha, IL-1beta, IL-2, TNF-alpha and TGF-beta were increased in bronchoalveolar lavage specimens following gastric fluid aspiration compared to normal saline.ConclusionThis represents the first description of the pulmonary inflammatory response that results from chronic aspiration. Repetitive aspiration events can initiate an inflammatory response consisting of macrophages and T cells that is associated with increased TGF-beta, TNF-alpha, IL-1alpha, IL-1beta, IL-2 and fibrosis in the lung. Combined with the observation of gastric fluid-induced lymphocyitic bronchiolitis and obliterative bronchiolitis, these findings further support an association between chronic aspiration and pulmonary diseases, such as obliterative bronchiolitis, pulmonary fibrosis, and asthma.

Intra-Thrombus Lytic Therapy May Reduce Complications Of Primary Percutaneous Intervention In Acute Myocardial Infarction And Massive Intracoronary Thrombus Not Treated With Glycoprotein IIb/IIIa Antagonists

Aims: A proportion of acute myocardial infarction (AMI) patients suffer from insufficient coronary reflow, even though percutaneous coronary intervention (PCI) with a Guardwire Plus System® (GPS) has been performed. Therefore, we investigated the clinical usefulness of simultaneously using both intra-thrombus lytic therapy (ITLT) and the GPS in inferior AMI patients. Methods: Forty-four inferior AMI patients with massive evident coronary thrombus detected on coronary angiography were enrolled. Twelve of the 44 underwent primary PCI using ITLT with tissue plasminogen activator via an FC catheter®. Primary coronary stenting was carried out with the GPS alone (Group 1; n=32), or ITLT alone (Group 2; n=5) or ITLT followed by repetitive aspiration of the thrombus burden using the GPS (Group 3; n=7). Results: Eighteen (56%) in group1 had significant complications (distal emboli, n=7; prolonged hypotension, n=4; malignant arrhythmia, n=8; side branch occlusion, n=3; worsened chest pain, n=9). Two of the 7 with distal coronary emboli showed insufficient coronary flow even after additional treatments. In group 2, all patients showed complications (transient distal emboli, n=2; hypotension, n=1; bradycardia, n=1; worsened chest pain, n=3). However, none in group 3 showed significant complications except for transient distal coronary embolisation in 2. Conclusion: In spite of our small study cohort, we showed that intra-thrombus lytic therapy using an FC catheter followed by PCI with a GPS might reduce complications in patients with inferior AMI with massive evident thrombus.

Percutaneous management of lymphocoeles following pelvic lymphadenectomy for cervical carcinoma

Eighteen patients with 26 pelvic lymphocoeles following radical hysterectomy underwent percutaneous therapeutic intervention with either needle aspiration, or catheter drainage. In eight patients a percutaneous needle aspiration under sonographic control was performed. Five out of eight patients were successfully managed with needle aspiration, three of them requiring repetitive aspirations. Thirteen patients, with a total of 21 lymphocoeles underwent catheter drainage. Seventeen of the 21 lymphocoeles completely resolved. Redrainage was performed in four cases and it was successful in two of them. The duration of the catheter drainage was 8 to 34 days. Nine of the lymphocoeles were infected at initial drainage. Two patients underwent surgery because of increased volume of output. Percutaneous drainage is a safe and effective method and should be considered as the initial treatment for all patients with postoperative lymphocoeles.

Brain abscess treated by continuous antibiotic perfusion: technical note.

Between 1982 and 1988, eleven patients with brain abscess were treated by craniotomy and continuous closed system antibiotic irrigation. By the use of this technique, repetitive abscess aspirations were not necessary.