Abstract. pulmonary alveolar proteinosis (pap) is a rare disease characterized by the accumulation of lipoproteinaceous material within alveolar spaces. Whole-lung lavage (Wll) has been the most common therapeutic intervention for this disorder. however, patients presenting with pap are usually hypoxemic or in poor clinical condition, and Wll may be impossible to perform. in such cases, multiple segmental lavage (MSL) may be advocated as a first-choice therapy prior to Wll. herein, we present two cases with idiopathic pap treated successfully with both lavage techniques consecutively. after the mSl procedure, Wll was performed, and both patients showed a marked clinical and physiologic improvement. therefore, for patients who are not good candidates for general anesthesia, we recommend mSl (or 'prewash') before Wll to produce an increase in the blood oxygen level for long-duration general anesthesia. in the surgical room, close monitoring and repositioning of the patient as well as maintenance and inspection of the correct tube position, and manual chest wall percussion are extremely important for the safety and success of the procedure. IntroductionPulmonary alveolar proteinosis (PAP) is a rare disorder first described in 1958 by rosen et al (1). alveolar spaces are progressively filled with a phospholipoproteinaceous material presumably caused by malfunction of the balance between surfactant production by type ii pneumocytes and surfactant removal. the latter is affected primarily by alveolar macrophages. A diagnosis of PAP can be confirmed by typical histopathological findings of lung biopsy specimens or the appearance of bronchoalveolar lavage. Whole-lung lavage (Wll) introduced by ramirez in the late 1960s, is still the gold standard therapy (2). therapy with granulocyte macrophage colony-stimulating factor (Gm-cSF) is another option, but its long-term safety has not yet been confirmed (3). The severity and natural history of alveolar proteinosis is variable, and severe hypoxemia may occur during the course of the disease. in patients with poor clinical condition and hypoxemia, Wll is difficult to perform due to possible complications involving general anesthesia. Wll often requires more than 4 hours per lung to perform (4). For surgery, the time is longer, and complication rates can be high. in these patients, multiple segmental lavage (MSL) with flexible bronchoscopy (FB) can be initially carried out to prepare the patient for the long-lasting general anesthesia required for Wll. Materials and methodsMultiple segmental lavage. In our technique, FB is wedged as accurately as possible in all of the segments without error during the procedure. Before and during MSL, 2% xylocaine and low-dose parenteral sedation with midazolam and phentanyl are administered. in general, the lavage is preferably carried out on the lung part or lobe noted to have the most extensive accumulation as determined by radiology. While the patient breaths oxygen through a nasal cannula, a FB is passed through the mouth and placed in ea...
Akciğer dokusunda immün yanıtÇevreyle kişinin direkt ilişkisini sağlayan ve çok geniş yüzeyler bulunduran akciğer dokusunun mikroorganizmalara karşı korunmasını sağlamakta adaptif immün yanıt hayati bir önem taşır. Adaptif immün yanı-tın en önemli organları lenf düğümleri ve içerdikleri T ve B lenfositleri olmakla birlikte, immün sistem, mikroorganizmalarla mücadele için akciğere özgü lenf düğü-münü andıran immün bölgeler de oluşturabilir (1). Akciğeri burada olmaması gereken protein ve benzeri molekülleri tespit etmek üzere sürekli tarayan makrofaj ve benzeri hücreler, yüzeylerinde bulunan ve mikroorganizmaları tanıyan reseptörler sayesinde bu organizmaları içleştirip parçaladıktan sonra oluşturdukları protein fragmanlarını (peptitleri) ve diğer molekülleri lenf düğümü ve benzeri dokularda özellikle T lenfositlerine sunarlar. Proteinlerin bütün yada parçalanmış hallerini B lenfositleri de tanır, ve bu şekilde her iki hücre türüde sayıca ve etkinlik bakımından artarak on gün gibi bir sürede, tanımış oldukları bu antijene özgü, etkin bir yanıt oluşturup hedef organizma/hücrenin ölümü ve dokudan temizlenmesini sağlarlar.Kansere karşı da adaptif immün yanıtların benzer tepkiler geliştirebildiğini biliyoruz. Kanser hücrelerinin AKCİĞER KANSERİNİN TEŞHİS, TEDAVİ VE TAKİBİNDE YENİ BİR PARAMETRE OLARAK ANTİ-TÜMÖR ANTİKORLARIN ÖNEMİ RELEVANCE OF ANTI-TUMOR ANTIBODIES AS NOVEL INDICATORS IN LUNG CANCER DIAGNOSIS, TREATMENT AND FOLLOW-UP Ekstraplevral 20 AbstractAlthough we know that the adaptive immune system mounts a response against cancer since the 1960ies, studies designed to comprehensively identify antibodies that reflect this response begun only about 15 years ago. Results from such studies utilizing state-of-art technologies are just becoming available. Several lines of evidence strongly suggest that the detection of autologous anti-tumor antibodies will be useful in the diagnosis of lung cancer, as well as predicting the prognosis of the disease and shaping its therapy; all which will likely happen once antibody detection panels for these purposes are generated within the next few years.
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