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PubMedDate not supplied

[The role of oxidative stress in the pathogenesis of pulmonary emphysema].

OXIDATIVE PULMONARY DAMAGE: The pathogenesis of pulmonary emphysema is incompletely understood. Nearly 90% of all patients with chronic obstructive pulmonary diseases are smokers. Cigarette smoke is a rich source of oxidants. Oxidative stress increases oxidant generation, which cannot be neutralized with antioxidant defense mechanisms. Lipids, proteins and deoxyribonucleic acid are components of the cell that are most sensitive to oxidative damage. Oxygen radicals can modify amino acid side chains, form protein aggregates, cleave peptide bonds, and make proteins more susceptible to proteolytic degradation. It has been shown that neutrophils have a principal effector role in pulmonary tissue damage. Neutrophil elastase can damage air spaces by degrading elastin, and a variety of extracellular membrane proteins, proteoglycans, and glycoproteins. Neutrophil elastase can also stimulate inflammation by increasing interleukin-8 synthesis. Additionally, neutrophil elastase can activate or inactivate inhibitors of neutrophil collagenase, and secretory leukoprotease proteinase inhibitor. Apart from neutrophils, oxidative stress causes activation of other phagocytes and severe inflammatory response ensues. LIPID PEROXILATION AND PULMONARY EMPHYSEMA: Except protein oxidation and lipid peroxidation, oxidants may disturb signal transmission in the cells, as well as normal cell membrane function and function of organelles. Modified structure of deoxyribonucleic acid may cause mutations, which in absence of repairation enzyme activity lead to cell injury. IRON AND OXIDATIVE STRESS: Iron metabolism is also important in the development of pulmonary emphysema due to its role in production of some oxidants.

Humans↗
PubMed1999

Lung volume reduction surgery results in pulmonary emphysema. Changes in pulmonary function.

From December 1993 to August 1998, we conducted 57 lung volume reduction surgeries on patients with severe pulmonary emphysema but without giant bullae. Of these, 26 underwent unilateral lung volume reduction surgery and 31 bilateral surgery. We analyzed the results of thoracoscopic lung volume reduction surgery (unilateral: 25; bilateral: 16) and volume reduction surgery by median sternotomy (unilateral: 1; bilateral: 15). Bilateral surgery via thoracoscope and median sternotomy significantly improved symptoms and pulmonary functions; mean improvement in forced expiratory volume in 1 second was 42.4% for bilateral thoracoscopic volume reduction surgery and 60.0% for median sternotomy. Unilateral volume reduction surgery produced a mean improvement in forced expiratory volume in 1 second of 28.9%. No significant complications were seen with either procedure. Reevaluation at 1 and 2 years after lung volume reduction surgery showed improvement to be well maintained.

Aged↗
PubMed1989

Respiratory muscle strength and gas exchange in neuromuscular diseases: comparison with chronic pulmonary emphysema and idiopathic pulmonary fibrosis.

To examine whether or not the respiratory muscle weakness is correlated with decrease in arterial oxygen tension (PaO2), respiratory muscle and pulmonary functions in 14 patients with neuromuscular diseases (NMD) were studied and compared with those of 12 patients with chronic pulmonary emphysema (CPE) and 15 patients with idiopathic pulmonary fibrosis (IPF). Respiratory muscle strength was assessed by maximal static inspiratory and expiratory mouth pressure at three lung volumes (RV, FRC and TLC). Although mean pulmonary functions in NMD showed virtually normal function, respiratory muscle strength was significantly less than the corresponding values in CPE and IPF. In NMD, maximal inspiratory mouth pressure at RV level (PImax) correlated positively with %TLC and %VC (r = 0.652 and r = 0.536, respectively). Moreover, PImax was significantly correlated with PaO2 (r = 0.561), but not with PaCO2. Maximal expiratory mouth pressure at TLC (PEmax) correlated positively with %TLC and %VC. In CPE and IPF, respiratory muscle strength had no correlation with PaO2 and PaCO2. These findings suggest that inspiratory muscle dysfunction in NMD may be one of the factors responsible for determination of the level of hypoxemia and lung volume.

Adult↗
PubMed2006

[Perioperative management of abdominal operation in three patients with pulmonary emphysema associated with pulmonary hypertension].

Anesthesia for abdominal operation in patients with emphysema is accompanied with a high risk of respiratory insufficiency requiring postoperative artificial ventilation. Furthermore, in patients whose pulmonary emphysema progresses and leads to pulmonary hypertension, there is the risk of developing right heart failure with postoperative respiratory insufficiency. Because perioperative circulatory drifting is massive in abdominal operation, they develop right heart failure easily during the postoperative refilling phase. Therefore, it is important to avoid right heart failure during the postoperative period in these patients. We estimate pulmonary artery pressure using echocardiography at bedside and give dopamine for diuresis during the postoperative period. We succeeded in perioperative management of abdominal operation in three patients with pulmonary emphysema associated with pulmonary hypertension.

Aged↗
PubMed2001

A case of localized persistent interstitial pulmonary emphysema.

Interstitial pulmonary emphysema is a well-documented complication of assisted mechanical ventilation in premature infants with respiratory distress syndrome. Localized persistent interstitial pulmonary emphysema (LPIPE) confined to a single lobe was incidentally presented in a 4-day-old female infant. This patient was a normal full-term baby with no respiratory distress symptom and no experience of assisted mechanical ventilation. Chest radiograph showed radiolucent area in right lower lobe zone, which needed differential diagnosis from other congenital lesions such as congenital cystic adenomatoid malformation and congenital lobar emphysema. CT scan showed irregular-shaped air cystic spaces and pathologically, cystic walls primarily consisted of compressed lung parenchyma and loose connective tissue intermittently lined by multinucleated foreign body giant cells.

Diagnosis, Differential↗
PubMed2004

Increased levels of cell death and proliferation in alveolar wall cells in patients with pulmonary emphysema.

BACKGROUND: Pulmonary emphysema, a major component of COPD, is pathologically characterized by destructive alterations in pulmonary architectures as a result of persistent inflammation. However, alterations in the turnover of pulmonary cells are less well understood. This study was designed to examine whether the turnover of alveolar wall cells is altered in patients with emphysema. PATIENTS AND MEASUREMENTS: We obtained lung tissue specimens from patients with emphysema who had undergone lung volume reduction surgery (13 patients) as well as asymptomatic smokers (7 patients) and nonsmokers (9 patients) undergoing lung resections for solitary lung cancers. Paraffin-embedded lung tissue sections were evaluated for apoptosis and proliferation using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL) or immunohistochemistry for Bax, proliferation cell nuclear antigen (PCNA), and topoisomerase IIalpha. Tissue sections were also immunostained for epithelial membrane antigen, surfactant protein A, and CD31. RESULTS: The percentages of alveolar wall cells undergoing apoptosis and proliferation of the total number of alveolar wall cells were significantly higher in patients with emphysema than in asymptomatic smokers and nonsmokers (p < 0.05). The percentage of TUNEL-positive alveolar wall cells was positively correlated with the percentage of PCNA-positive alveolar wall cells. Most of the TUNEL-positive and PCNA-positive cells were alveolar epithelial cells. CONCLUSIONS: These results suggest that the turnover of alveolar wall cells is enhanced in emphysematous lungs, compared to healthy lungs. Emphysema may be a dynamic disease process in which alveolar wall cell death and proliferation are repeated.

Aged↗
PubMed1999

[Lung volume reduction surgery for pulmonary emphysema].

Surgical treatment for pulmonary emphysema has received renewed attention, because many studies have demonstrated improvements in dyspnea and pulmonary function. After lung volume reduction surgery (LVRS) for carefully selected advanced pulmonary emphysema, pulmonary functional impairments, such as expiratory flow limitation, increase in lung volume, decrease in lung elastic recoil, impaired gas exchange are improved. Improvements of dynamic hyperinflation, respiratory muscle function and exercise tolerance were also demonstrated after LVRS for pulmonary emphysema. Finally these functional effects may improve symptom and prognosis of pulmonary emphysema with better quality of life. Although the basic mechanism responsible for the improvements are not well known yet, physiological mechanisms which brought improvement after surgical treatment for pulmonary emphysema should be further investigated.

Exercise Tolerance↗
PubMed1989

[Pulmonary circulatory disturbance on magnified peripheral pulmonary wedge angiography in chronic pulmonary emphysema].

Magnified peripheral pulmonary wedge angiography was performed in chronic pulmonary diseases. We classified the wedge angiography into five types based on the changes of capillary background (CBG) findings. Type I (normal), Type II (CBG is scattered and pulmonary arterial branches are tortuous), Type IIIa (CBG is decreased and pulmonary arterial branches are normal), Type IIIb (CBG and pulmonary arterial branches are also decreased or disappeared), Type IV (totally convergent). Using this classification, wedge angiography was performed in 42 patients out of 66 patients with chronic pulmonary emphysema diagnosed by selective alveolo-bronchography (SAB). Each type was compared in terms of hemodynamic data, blood gases and pulmonary function. Pulmonary emphysema was classified into types II, IIIa, and IIIb. There was no relation between SAB findings and wedge angiography classification. Severe hemodynamic data cases were found in types II and IIIb. The PaO2 of type II and IIIb were significantly lower than that of type IIIa. In pulmonary function tests, the mixed impairment type of ventilation was more frequently seen in type IIIb than IIIa. There was no relationship between SAB findings (66 cases) and hemodynamic data. These results suggest that classifying wedge angiography into five types (I, II, IIIa, IIIb, IV) may be useful for evaluating severity and determining prognosis and therapeutic measures in chronic pulmonary emphysema.

Adult↗
PubMed1977

[Pulmonary emphysema. Changes in the pulmonary function of experimentally induced emphysema].

By intratracheal injection of the protease papain to experimental animals parenchymal changes in the lung can be induced, that resemble human emphysema. Papain (dosage 26 to 112 mg, 1 to 4 injections) was given intratracheally to 8 bastard dogs (weighing from 12.5 to 20 kg) during light general anesthesia. Pulmonary function was assessed in weekly intervals and related to morphologic changes in the lung. Static compliance of the lung and FRC measured during respiratory arrest were increased after papain, bronchial resistance, measured while artifically ventilated at constant pressure was also increased. Changes of static lung compliance and FRC were seen after the first administration of papain, but further increased with time of observation and after multiple doses of papain. Increase of resistance was not found before 5 weeks. At quiet breathing resistance was not increased at all. No significant changes were found of arterial pO2 and pCO2, pH, standard and actual bicarbonate, diffusion capacity for O2, tidal volume, minute ventilation and ventilatory rate. Morphological findings confirmed the changes described by others. Pulmonary function appears to be pathological at a time when morphology still seems to be normal. The question is discussed to what extent the model of experimental emphysema induced by proteolytic enzymes can contribute to the understanding of human pulmonary emphysema. Lung function in the course of experimental emphysema is compared with function in different clinical types of emphysema.

Acid-Base Equilibrium↗