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  • 1
    ISSN: 1432-1076
    Keywords: Respiratory distress syndrome ; Surfactant ; Follow up studies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The postnatal growth, respiratory status and neurodevelopmental outcome of surviving babies enrolled in the first European multicentre trial of porcine surfactant (Curosurf) replacement for severe neonatal respiratory distress syndrome, were assessed at corrected ages of 1 and 2 years. Follow up rates of survivors were 93% at 1 year and 89% at 2 years. Treated and control groups were similar at both 1 and 2 years in terms of physical growth, the prevalence of persistent respiratory symptoms and the occurrence of major and minor disability. Serum antibodies recognising Curosurf and surfactant-anti-surfactant immune complexes were detected in both treated and control babies, the titres showing no difference between groups. Examination of histological lung sections from non-survivors revealed a higher incidence of severe pulmonary interstitial emphysema in control babies than in those treated with surfactant. Surfactant treatment for severe respiratory distress syndrome reduces neonatal mortality and air leaks and is not associated with an increase in disability 2 years later.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1076
    Keywords: Surfactant ; Hydrophobic apoproteins ; Premature newborn rabbits ; Lung compliance ; Image analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Premature rabbit neonates (gestational age 27 days) were treated at birth with natural surfactant purified from chloroform extracts of porcine lung lipids either by acetone precipitation (Surfactant CK, n=10) or liquid gel chromatography (Curosurf, n=22). Another group of animals received artificial surfactant “reconstituted” from isolated low molecular weight (≤15 K) apoproteins and synthetic dipalmitoylphosphatidylcholine (DPPC) and dipalmitoylphosphatidylglycerol (DPPG) (Aposurf, n=10). The phospholipid concentrations of the preparations were adjusted to provide the same individual dose of DPPC for each group of treated animals (3 or 4 mg). In comparison with untreated controls from the same litters, there was a 4–7-fold enhancement of lungthorax compliance in all groups of surfactant-treated animals during a 3-h period of artificial ventilation. The average initial (20 min) compliance value was lower in the Aposurf-treated group than in animals receiving natural surfactant preparations, but the difference between the groups gradually diminished and was no longer statistically significant during the 2nd and 3rd h of artificial ventilation. Judged from the fall in tidal volume during ventilation with a short expiration phase (0.17 instead of 0.75s), the apoprotein-based artificial surfactant was also less effective in stabilizing the lungs. A similar conclusion could be drawn from data on alveolar expansion in histological sections, evaluated by automated image analysis. Alveolar volume density was improved only moderately in the Aposurf-treated group (0.24 vs. 0.14; P=0.05), whereas the expected, prominent increase in this parameter was observed in both groups of natural surfactant-treated animals (0.48–0.62 vs. 0.14; P〈0.001). We conclude that a physiologically active artificial surfactant can be prepared from the smaller (≤15 K) apoproteins, DPPC and DPPG; the in vivo effects of this preparation were clearly beneficial, yet inferior to those obtained with the same dose of natural surfactant.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1076
    Keywords: Surfactant ; Intracranial haemorrhage ; Respiratory distress syndrome ; Infants ; Neonates
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Within a randomized European multicentre trial the time of onset, severity and progression of intracerebral haemorrhages (ICH) were investigated prospectively by serial cranial ultrasonography in 343 ventilated infants with severe respiratory distress syndrome (RDS) following instillation of single or multiple doses of a natural porcine surfactant (Curosurf). In 148/343 infants (43%) ICH was diagnosed (grade I or II: 22%, grade III or IV: 21%). In 26 cases (8%) ICH was present on the ultrasound scan prior to surfactant instillation at a median age of 6h. Incidence and severity of ICH was similar after single- or multiple-dose surfactant treatment. Using a logistic regression model the following risk factors predictive of ICH were defined: low birth weight, allocation to certain hospitals, vaginal delivery, Apgar score≤6, rectal temperature on admission ≤36°C, primary anaemia, acidosis prior to treatment, RDS grade IV in pre-treatment chest films and poor response to surfactant treatment Our study provides supportive evidence that multiple doses of Curosurf do not increase the risk for ICH as compared to single-dose administration.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 0014-5793
    Keywords: Hydrophobic polypeptide ; N-terminal trimming ; Primary structure ; Species variation ; Surfactant
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology , Chemistry and Pharmacology , Physics
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 0034-5687
    Keywords: Alveolus ; Epithelium ; Immaturity ; Lung ; Newborn ; Protein ; Pulmonary epithelium ; Rabbit ; Surfactant
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Respiration Physiology 80 (1990), S. 181-192 
    ISSN: 0034-5687
    Keywords: Animal, rabbit ; Fetal lung liquid ; Neonatal lung, surfactant ; Surfactant
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Respiration Physiology 88 (1992), S. 233-246 
    ISSN: 0034-5687
    Keywords: Development ; Lung water ; Mammals ; Mechanics of breathing ; Surfactant ; amiloride ; compliance ; immature lung ; lung water resorption ; rabbit ; resorption ; surfactant ; surfactant
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1433-0474
    Keywords: Schlüsselwörter B-Streptokokken ; Elastase ; Neutrophile Granulozyten ; Pneumonie ; Surfactant ; Key words Group B streptococci ; Neutrophil elastase ; Pneumonia ; Surfactant
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Purpose: We analyzed the influence of surfactant on inflammatory response, bacterial proliferation and tissue levels of free elastase, a key neutrophil enzyme, in experimental neonatal group B-streptococcal pneumonia. Method: Near-term tracheotomized rabbit fetuses were infected intratracheally with streptococci and ventilated for 5 h. Following the infection the animals received either surfactant (Curosurf 200 mg/kg) or saline (2.5 ml/kg). Controls (n = 11) received only saline. One group of animals (n = 8) was investigated immediately following the injection of bacteria. Results: Surfactant-treated animals demonstrated mitigation of bacterial growth and less marked inflammatory changes on light microscopic examination when compared with infected littermate controls receiving saline. In addition, significantly lower tissue levels of elastase could be demonstrated in the surfactant-treated group (mean ± SEM: 4.22 ± 0.95 vs 8.02 ± 1.28 μg/g lung; p 〈 0.05). Animals treated with saline alone and animals investigated immediately following infection had significantly (p 〈 0.05) lower tissue levels of free elastase in lung homogenate (2.97 ± 0.57 and 2.01 ± 0.45 μg/g lung, respectively). Conclusions: Based on our results we speculate that surfactant plays an important role in the regulation of inflammatory response in neonatal infectious lung disease.
    Notes: Zusammenfassung Fragestellung: Mit Hilfe eines Tiermodells der neonatalen B-Streptokokken-Pneumonie sollte der Einfluß von Surfactant auf das pulmonale Entzündungsgeschehen und die Freisetzung von Elastase, einem proteolytischen Enzym neutrophiler Granulozyten, untersucht werden. Methode: Kaninchenfeten mit einer Tragzeit von 29,5 Tagen wurden intratracheal mit B-Streptokokken infiziert und über einen Zeitraum von 5 h beatmet. 15 min nach der Infektion wurden Surfactant (Curosurf 200 mg/kg) bzw. ein identisches Volumen (2,5 ml/kg) NaCl 0,9 % verabreicht. Im Lungenhomogenisat der linken Lunge wurden die Bakteriendichte bestimmt sowie die Aktivität der freien Elastase gemessen. Die rechte Lunge wurde lichtmikroskopisch im Hinblick auf entzündliche Veränderungen untersucht. Ergebnisse: Die mit Surfactant behandelten Tiere ( n = 11) wiesen ein signifikant niedrigeres Bakterienwachstum, geringer ausgeprägte entzündliche Veränderungen bei der histologischen Beurteilung sowie eine verminderte Aktivität der freien Elastase (Mittelwert ± SEM: 4,22 ± 0,95 vs. 8,02 ± 1,28 μg/g Lunge; p 〈 0,05) im Vergleich zu infizierten Tieren auf, die NaCl erhalten hatten (n = 12). Kontrolltiere, die nur NaCl erhalten hatten (n = 11) und eine weitere Gruppe von Tieren, die unmittelbar nach Infektionsbeginn untersucht wurden (n = 8), zeigten im Vergleich eine signifikant (p 〈 0,05) niedrigere Aktivität der freien Elastase im Lungenhomogenisat (2,97 ± 0,57 bzw. 2,01 ± 0,45 μg/g Lunge). Schlußfolgerungen: Nach Surfactantbehandlung wurden bei experimenteller B-Streptokokken-Pneumonie eine verminderte Bakterienproliferation sowie eine verminderte Freisetzung von Elastase beobachtet. Surfactant scheint somit bedeutsam in die Regulation entzündlicher Vorgänge in der Lunge einzugreifen.
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