Pulmonary hyaline membrane: Sites of formation in adult lungs after assisted respiration and inhalation of oxygen

Abstract

PULMONARY hyaline membranes are found most commonly in premature infants that show progressively severe respiratory distress and die soon after birth. Accordingly the lesions have so far been studied mainly in infants; but the exact composition of the abnormal material, its mode of formation, and its cause are still unknown.Recent studies (Barter, 1959; Barter and Maddison, 1960) have shown that the membranes are confined predominantly to respiratory bronchioles, but are likely to be related to a more widespread injury to the linings of all the functioning respiratory tissues (Barter, Byrne and Carter, 1966).It is now well known that the membranes also occur in adult lungs and are associated with a variety of diseases (Spencer, 1962; Cederberg, Hellsten and Miorner, 1965; Anderson, 1966). Among the most common of these are uraemia and pulmonary infection; hyaline membranes may also occur after irradiation of the lung. Microscopic examination suggests that the membranes form only a short while before death (Barter et al.). There is a fairly close correlation between the occurrence of these membranes and the clinical picture of severe and progressive respiratory failure.Capers (1961) reported 37 cases of hyaline membranes in adults, and stated that the membranes are brightly eosinophilic strands of delicate laminated material, sometimes closely applied to the alveolar walls. Thirteen of his cases had been treated with oxygen.Recently Nash, Blennerhassett and Pontoppidan (1967) described hyaline membranes in 17 of a study group of 70 cases examinedpost mortem after prolonged mechanical ventilation. They found good correlation between inspiration of high concentrations of oxygen and the presence of the membranes. ., 35, 460. Amer. J. Dis. Child., 99, 216. Amer. J. Med., 31, 701. Actn path. microbiol. scnnd., 64,450. The human lung, New York, pp. 168 The lung, 2nd ed., Springfield, Ill., New Engl. J. Med., 276, 368. Amer. J. Patti., 34, 1033. Pathology of the lung, Oxford, and 171. p. 50. p. 545. Ibid

Pulmonary hyaline membrane: Light and electron microscopic study of the early stage

“…The distinction between respiratory bronchioles and alveoli is not easy to make even in adult lungs (Barter, Finlay-Jones and Walters, 1968) and is even more difficult in the foetus, especially in the early period of alveolar development.…”

Pulmonary structural changes in neonatal hyaline membrane disease treated with high pressure artificial respiration

“…in such a way that the reparative process is accentuated. The possible influence of this treatment may further be indicated by the work of Nash, Blennerhassett, and Pontoppiddan (1967), Regele (1967), and Barter, Finlay-Jones, and Walters (1968), who studied the lungs of adult patients treated with artificial respiration and high oxygen concentrations for various conditions. In their patients, hyaline membrane-like structures with interstitial fibrosis and metaplasia of alveolar epithelium appeared.…”