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PubMedDate not supplied

[Polyalveolosis: pathogenesis of congenital lobar emphysema?].

BACKGROUND: Congenital lobar emphysema is an unusual condition and its pathogenesis remains unknown. The variety of findings in pathology studies of the resected specimens led to increasing academic interest. About 50 per cent of the cases have no definitive diagnosis in pathology. The most recent theory proposes an increased number of alveoli within each acinus (polyalveolar lobe). PURPOSE: The aim of this paper is to report the morphometric measures of surgical specimens of 12 patients with congenital lobar emphysema, using the Emery and Mithal technique (radial alveolar count). METHODS: We made a case-control study, classifying the cases by age. Mann-Whitney's U test and linear regression techniques were used in data analysis: Mann-Whitney's U in comparing the cases and respective controls and linear regression to evaluate the influence of age in the measures found. RESULTS: The results revealed a significantly higher radial alveolar count than expected for the age group under 3 years; no difference was observed in the age group between 3 and 7 years and in children older than 7, the radial alveolar count was lower than expected. The normal development of the lung consists in an increasing number of alveoli increase from birth until adulthood, but this number remains constant, independent of age in congenital lobar emphysema. CONCLUSIONS: Such findings allow us to conclude that polyalveolar lobe can and must be diagnosed by a simple and practical method, such as the radial alveolar count, which decreases the incidence of the unknown etiology. The findings of an increased number of alveoli on patients younger than 3 is related to congenital lobar emphysema, since the number of alveoli does not increase in congenital lobar emphysema, just the opposite to what one would expect in the normal development of the lung.

Adolescent↗
PubMed1989

Carrageenan-induced pulmonary emphysema of rabbit.

A transbronchial injection of 0.75% carrageenan in physiologic saline induced pneumonia followed by emphysema in the insulted lobe. In the stages of pneumonia, scattered infiltration of polymorphonuclear leukocytes was seen throughout the affected lobe within a few days of treatment; later this was replaced by the accumulation of carrageenan-laden macrophages, which lasted for one to two months. Enlargement of alveoli and alveolar ducts appeared 2 weeks to 2 months after the treatment, and pulmonary emphysema was observed at 4 months. The lobes that were not treated with carrageenan were normal in appearance during both the pneumonia and the emphysema. Morphometric analysis of the lung at 4 months showed decrease of the alveoli and/or alveolar ducts and enlargement of their luminal spaces, also suggesting the development of emphysema. In contrast to various kinds of elastases that are known to produce emphysematous changes in animals, the elastolytic activity of carrageenan solution did not show any such effects, although in the homogenate of the lobes given carrageenan, a moderate but significant increase in the proteinase activities of alveolar macrophages are said to occur (Bowers et al. 1985). It was suggested that carrageenan-induced emphysema is a chronic disorder associated with both carrageenan toxicity and accumulated carrageenan-laden macrophages in the insulted lobes.

Animals↗
PubMed2007

Comparison of standard- and low-radiation-dose CT for quantification of emphysema.

OBJECTIVE: This study was performed to compare standard- and low-radiation-dose techniques in the CT quantification of emphysema. MATERIALS AND METHODS: The study population consisted of 36 men and 20 women who were current or former heavy smokers and underwent standard-dose (effective tube current, 100-250 mAs) chest CT at our institution within 6 months of having undergone low-dose (effective tube current, 30-60 mAs) chest CT. All CT scans were reconstructed at 5-mm slice thickness with a smooth filter. CT-measured lung volume, mean and median lung attenuation, and percentage of lung volume with attenuation lower than multiple thresholds (emphysema index values) were compared by Pearson correlation, two-tailed and paired Student's t tests, and regression analysis. RESULTS: There were no significant differences in mean attenuation (-848 vs -846 H, p > 0.35) for the low dose and the standard dose or in median lung attenuation (-879 vs -878 H, p > 0.66). Low- and standard-dose emphysema indexes were correlated at all attenuation thresholds (r = 0.86-0.97). Mean emphysema indexes were higher on the low-dose scans, but the mean difference at all thresholds was less than 3%. The differences were significant (p < 0.05) only at the lower index thresholds, correlated with differences in lung volume (r < or = 0.86), and increased with greater differences in dose. CONCLUSION: Low-dose technique has minimal effect on CT quantification of emphysema.

Aged↗
PubMedDate not supplied

Experimental emphysema following one intravenous infusion of trypsin.

This study was undertaken to investigate the effects of a deficit in protease inhibitor (AT) induced by intravenously administered trypsin on the development of elastase-induced emphysema. Rats receiving a perfusion of trypsin (4.5 mg/kg body wt) intravenously (TIV rats) or one instillation of elastase (92 IU/subject) into the trachea (ELAS rats) were compared with rats receiving both trypsin and elastase (TIVELAS rats). Compared with 8 sham-injected rats, the serum AT activity of 14 TIV rats decreased slightly (5.5%) 150 min after the beginning of the perfusion. In six other TIV rats sacrificed early after the perfusion, a granulocyte sequestration with edema and vascular thrombi demonstrated early lung injury. Anatomical studies of lung and determination of the mean linear intercept (MLI) were carried out 56 days after the administration of the enzymes. Emphysema was confirmed by a significant (P less than .001) MLI increase (about 150 microns) in 22/24 TIV, 20/21 ELAS, and 21/21 TIVELAS rats in comparison with 40 control rats (78 microns). These similar results of the treated rats show that trypsin did not worsen elastase-induced emphysema and also indicate that trypsin given intravenously alone induces emphysema as does elastase when introduced into the airways. The AT activity decrease consequent to proteolysis by trypsin and pulmonary leucostasis may contribute to this trypsin-triggered emphysema.

Animals↗
PubMed1999

The pulmonary matrix, glycosaminoglycans and pulmonary emphysema.

This paper reviews recent evidence of the effect of intratracheal hyaluronan (HA) to limit the induction of experimental emphysema in hamsters. Experimental emphysema was induced by both neutrophil and pancreatic elastase instilled intratracheally. Emphysema was quantified anatomically by measurement of alveolar mean linear intercept. Hyaluronidase, instilled intratracheally, enhanced the induction of experimental emphysema. Air-space size measured one week after intratracheal instillation of elastase showed that administration of 1 mg HA immediately following elastase administration resulted in a marked reduction in air-space enlargement (82 microM vs 122 microM, p < 0.01). Similarly, animals given either 1 or 2 mg HA 2 h before elastase or 2mg HA 1 h after elastase showed a significant decrease in air-space enlargement compared to controls (96 microM, 88 microM vs 120 microM and 66 microM vs 104 microM, respectively; p < 0.05. Experimental emphysema induced by neutrophil elastase was also limited by the administration of 1 or 4 mg of HA, administered 2 h prior to elastase (57 and 59 microM, respectively vs 64 for controls, p < 0.05). Characterization of administered HA showed a mean molecular weight of 104,800 Da, less than 5% protein and a uronic acid/hexosamine ratio of 1, which is characteristic of HA. Studies using fluorescein-labeled hyaluronan (HA) showed fluorescence associated with interstitial, pleural and vascular elastic fibers. The mechanism of attachment of the administered HA to elastin remains unknown. Fluorescein labeling of elastin was visible for at least 4 h post-instillation. These studies indicate a protective effect of hyaluronan against elastase degradation of pulmonary elastin in vivo by both pancreatic and neutrophil elastases. The anatomical studies further suggest a mechanism of protective coating of hyaluronan which may limit access to pulmonary elastin from neutrophils and alveolar macrophages. Results also suggest that a reduction in pulmonary hyaluronan content increases the susceptibility of elastin to degradation by elastases. These studies provide evidence for an antielastase effect of hyaluronan which is not dependent upon enzyme inhibition but on anatomical protection of pulmonary elastin by other mechanisms.

Animals↗
PubMed1981

Emphysema and occupational exposure to industrial pollutants.

In a case-referent study, the possible association between the development of emphysema and occupational exposure to industrial pollutants has been studied. Based on complete work histories from the participants, the number of years of employment in a polluted workplace was assessed for 36 patients with emphysema and 72 referents, matched for age (+/- 2 a) and smoking habits. Analyzed as matched triplets, the estimated risk ratio for the exposed (greater than or equal to 10 a in polluted workplaces) subjects developing emphysema in comparison to the nonexposed (less than 10 a in polluted workplaces) was 3.0, a value statistically significant. Estimated risk ratios according to the number of years employed in a polluted workplace did not show any significant trend towards a dose-response relationship. Only one of the emphysema patients had never smoked. In the further study of the relationship between emphysema and occupational exposure, the interaction between cigarette smoke and different occupational exposures seems to be of particular interest.

Aged↗
PubMed1992

Emphysema-like pulmonary disease associated with human immunodeficiency virus infection.

OBJECTIVE: To describe a possible association between prolonged infection with human immunodeficiency virus (HIV) and a pathophysiologic process suggestive of pulmonary emphysema. DESIGN: Case series. SETTING: The Ohio State University Hospital, Columbus, Ohio. MEASUREMENTS AND MAIN RESULTS: We describe four HIV-seropositive individuals ranging in age from 32 to 55 years who presented with dyspnea. Radiographic examination of the chest showed no infiltrates. All patients were presumed to have had prolonged HIV infection (mean CD4 count, 99.8 +/- 43 cells/mm3), but none had a previous history of pneumonia or opportunistic infections. Comprehensive examination of bronchoalveolar lavage fluid showed no pathogens or other complications of HIV infection. All patients had markedly abnormal pulmonary function tests that were suggestive of emphysema with air-trapping, hyperinflation, and a markedly decreased diffusing capacity. However, only minimal evidence of airflow obstruction was noted. Three patients subsequently had high-resolution computed tomographic scans of the chest that revealed emphysema-like bullous changes. Known causes of emphysema were not present in these patients. CONCLUSIONS: Our findings support an association between prolonged HIV infection and an emphysema-like process. This syndrome may occur in the absence of previous pulmonary infections or apparent pulmonary complications and is characterized by unusual pulmonary function test abnormalities.

Adult↗
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↗
PubMed1997

[Video-assisted thoracoscopic bullectomy for giant bullous emphysema].

Giant bullous emphysema often has serious dyspnea, and is difficult to manage. Bullectomy through thoracotomy for this disease carries a substantial morbidity and mortality. The aim of this report is to investigate the feasibility and key techniques of video-assisted thoracoscopic bullectomy for giant bullous emphysema. From December 1995 to October 1996, 6 patients with giant bullous emphysema underwent bullectomy by means of video-assisted thoracoscopy. Giant bullae occupied at least 50% of hemithorax, and 4 of which occupied more than 90%. According to Hugh-Jones dyspnea criteria: grade II in 3 cases, grade III in 2 and grade IV in 1, four bullectomies were done by video-assisted theracoscopy alone. One bullectomy and one left pneumonectomy were performed by combination of theracoscopy and a 8 cm thoracic incision. All procedures were accomplished successfully. The operating time ranged from 65 to 150 minutes. There was no blood transfusion and perioperative complications. Lung function was significantly improved in all patients after surgery (all better than grade II). Thoracoscopic bullectomy for giant bullous emphysema is a technically feasible and safety procedure, especially for group I and group II patients. However, there are still many problems to be resolved in thoracoscopy for group III and IV giant bullous emphysema.

Adult↗
PubMed2000

Quantitative analysis of technegas SPECT: evaluation of regional severity of emphysema.

UNLABELLED: The purpose of this study was to quantify the regional severity of emphysema by 3-dimensional fractal analysis of technegas (99mTc-carbon particle radioaerosol) SPECT images. METHODS: Technegas SPECT was performed on 22 patients with emphysema. The lungs were delineated using 4 cutoff levels (15%, 20%, 25%, and 30% of the maximal pixel radioactivity), and the total number of pixels was measured in the areas surrounded by the contours obtained with each cutoff level. We calculated fractal dimensions from the relationship between the total number of pixels and cutoff levels transformed into logarithms. Fractal dimension for total or regional lung was defined as the severity of emphysema. RESULTS: Total lung fractal dimension (T-FD), upper lung fractal dimension (U-FD), and lower lung fractal dimension (L-FD) for patients with emphysema were 1.84 +/- 0.46 (mean +/-SD), 2.22 +/- 0.61, and 1.77 +/- 0.49, respectively. U-FD was significantly greater than was L-FD. Patients with the ratio of U-FD to L-FD of <1.16 had a significantly greater percentage forced vital capacity (FVC) than did patients with the ratio of >1.16. Patients with an L-FD of <1.8 had a significantly greater forced expiratory volume in 1 s (FEV1)/FVC than did patients with that of >1.8. No significant difference was found between patient groups stratified by U-FD. CONCLUSION: The regional severity of emphysema was well shown by these fractal dimensions.

Female↗
PubMedDate not supplied

[Automatic evaluation of total lung capacity and of emphysema involvement with spiral computerized tomography (CT) in obstructive pneumonia].

OBJECTIVE: To evaluate, in patients with chronic obstructive lung disease or chronic bronchitis, inspiratory helical CT with 3D postprocessing, to measure lung volumes and the amount of emphysema and to compare these measurements with lung function tests. MATERIAL AND METHODS: Seventeen patients with chronic obstructive lung disease disease or chronic bronchitis underwent pulmonary function tests and helical CT after a full inspiration with 3D postprocessing (lower threshold -1024 HU, upper thresholds -200, -300 and -400 HU). Lung inspiratory volumes (TLC-CT) were determined for each model; the amount of emphysema was evaluated by means of an automatic score and a visual score with HRCT. RESULTS: There is a good correlation between automatic and visual scores (p < 0.001); the automatic score had a good correlation with lung function tests, above all with total lung capacity (r = -0.56; p = 0.01) but the visual score had a much closer correlation with DLCO (r = -0.70; p < 0.001). TLC-CT had a significant correlation with pletismographic TLC (TLC-P); the upper threshold -200 HU was more correct (TLC-P = 8011 cc.; TLC-CT 200 = 7138 cc.; r = 0.83; p < 0.001). The volume change of 3D model was about 230 cc. per 100 HU (p < 0.001) modifying upper thresholds, but no change was observed in the volume occupied by emphysema and the percentage of emphysema presented minimal, clinically non significant modifications. DISCUSSION AND CONCLUSIONS: In emphysematous patients, the helical CT with 3D model construction is a good technique to evaluate lung volumes and to quantify emphysema with automatic score; this one, however, probably underscores the extent of pathology; therefore, the addition of a visual score with HRCT is probably worthwhile.

Aged↗
PubMed1975

Pulmonary edema and emphysema in cattle after intraruminal and intravenous administration of 3-methylindole.

Intraruminal and intravenous administration of 3-methylindole (3MI; skatole) caused interstitial pulmonary edema and emphysema in cattle. In 3 adult heifers given the intraruminal dose of 0.2 g of 3 MI per kilogram of body weight, clinical signs of respiratory disease appeared between 6 and 12 hours after dosing, and death due to pulmonary edema and emphysema occurred at 33, 69, and 72 hours. The mean plasma concentration of 3MI became maximal (18.5 mug/ml) at 3 hours and then decreased to low concentrations by 48 hours. In 2 heifers given an intraruminal dose of 0.1 g of 3MI/kg, clinical signs developed, but they did not die during the 96-hour experiment. The mean plasma concentration of 3 MI became maximal (16.8 mug/ml) at 3 hours and decreased to 1.6 and 0.4 mug/ml at 12 and 36 hours, respectively. At necropsy of the heifers, the lung were large, firm, dark red, and heavier than normal. Diffuse pulmonary edema was the predominant change in cattle which died early, and interstitial emphysema was more severe at later stages of the disease. During the early stages, alveoli were overdistended, and a few more ruptured. Most alveolar spaces were filled with proteinaceous residue, but the alveolar septums were smooth and of normal thickness. At later stages, proliferation of alveolar cells was observed, and alveolar septums were thickened. In 3 cows given 0.06 g of 3MI/kg by jugular infusion, clinical signs appeared in all cows, and 1 cow died of pulmonary edema and emphysema 56 hours after the infusion was started. Severe pulmonary lesions seen in all of the cows given a 3MI infusion were similar to those in the cows given an intraruminal dose of 3MI. The mean plasma concentration of 3MI increased to 10.7 mug/ml at 9 hours after starting the infusion and decreased to 0.5 mug/ml at 18 hours. The results indicate that 3MI, a product of ruminal tryptophan fermentation, can cause pulmonary edema and interstitial emphysema in cattle and support the hypothesis that 3MI is the causative agent in tryptophan-induced pulmonary disease.

Administration, Oral↗
PubMed2001

[Longitudinal follow-up evaluation of pulmonary emphysema using high-resolution Computed Tomography (HRCT) study and pulmonary function tests].

PURPOSE: To evaluate the usefulness of HRCT in the identification of longitudinal progression of emphysema and to establish the sensitivity of HRCT compared with functional tests. MATERIAL AND METHODS: 15 ex-smokers with chronic obstructive lung disease were studied, using two consecutive HRCT examinations (t1 and t2); emphysema was evaluated by HRCT visual score and, at the same time, pulmonary function tests. RESULTS: As a whole, the extension of emphysema with HRCT presented a good correlation with Tiffeneau index (IT). At t1 a significant correlation between HRCT and IT was almost reached; it was achieved between HRCT and PaCO2, FEV1 and IT. At t2, there was a significant correlation between HRCT and IT, FEV1 and IT, FEV1 and PaO2, FEV1 and PaCO2, IT and PaO2. In the interval between t1 and t2 there was a significant worsening of HRCT visual score and IT, with no modification of FEV1, PaO2 and PaCO2. The change in HRCT visual score had a significant correlation with FEV1. DISCUSSION AND CONCLUSIONS: HRCT is able not only to identify and quantify anatomic emphysema, but also to evaluate progression of the disease. In the middle-short term anatomic emphysema worsens significantly and visual score HRCT is more sensitive than functional tests for longitudinal evaluation because emphysematous destruction is faster than decline in function. Furthermore emphysematous destruction in smokers progresses even after smoking cessation. The usefulness of combining HRCT with functional tests in the follow-up remains to be established. Longitudinal examination by HRCT could allow us to identify the smokers that tend to develop earlier and more seriously the symptoms of chronic obstructive lung disease.

Female↗
PubMed2002

[CT pulmonary functional imaging in emphysema: a correlative study of CT technique and pulmonary function test].

OBJECTIVE: To compare the effectiveness of high resolution CT, CT pulmonary functional imaging, and pulmonary function test (PFT) in the quantitative evaluation of emphysema and obstructive pulmonary disease. METHODS: The study included 37 patients with obstructive ventilatory defect and 20 normal controls. CT and pulmonary function test were performed in all subjects in one week. Correlation between and differences among HRCT visual scoring, parameters of CT pulmonary functional imaging and the result of pulmonary function test were compared. RESULTS: (1) Emphysema was detected by CT in 23 of the 37 patients with obstructive ventilatory defect. (2) HRCT visual scoring was correlated only with D(L)CO% (r = -0.731, P < 0.001) among other pulmonary function parameters. (3) HRCT visual scoring in patients with enrphysema was correlated with pixel indices (PI) at full inspiration and expiration. Visual scoring showed the best correlation with PI(-910in) (r = 0.506, P < 0.001) and PI(-910ex) (r = 0.610, P < 0.001). (4) The grading of pulmonary function based on PI(-910in) and PI(-910ex) showed no difference from the grading by pulmonary function tests (chi(2) = 0.527, P = 0.913; chi(2) = 3.645, P = 0.302). The grading of emphysema based on PI(-910in) accorded with the grading by pulmonary function tests (chi(2) = 2.59, P = 0.459). CONCLUSIONS: HRCT is more sensitive than conventional CT in diagnosing emphysema. However, in terms of slice thickness and radiation dose, it cannot be used in the evaluation of both lungs. CT functional imaging is easily performed, and the results are objective and correlated with the result of HRCT visual scoring and PFTs. It may be, therefore, more useful in diagnosing early emphysema and evaluating lung function.

Adult↗
PubMed2002

[Pulmonary emphysema in klotho mutant mice (deficient in klotho gene expression): klotho gene essential in postnatal pulmonary integrity].

The homozygous mutant klotho (KL-/-) mouse, which is deficient in klotho gene expression, exhibits multiple phenotypes resembling human aging that include a short life span, arteriosclerosis, osteoporosis, skin atrophy, and ectopic calcifications. Histologic examination of KL-/- mice at 4 weeks of age reveals pulmonary emphysema. The emphysematous changes are not caused by a developmental defect or hypoplasia of the lung. The lungs of heterozygous mutant klotho (KL+/-) mice show emphysematous changes and alveolar calcification which are almost identical to those in KL-/- mice. These observations indicate that the klotho gene expression is essential to maintaining normal alveolar architecture in postnatal life. Pulmonary function tests reveal prolonged expiration time in KL-/- mice. The expression of type IV collagen and surfactant protein-A mRNA is markedly upregulated in KL-/- mice, suggesting that a defect in matrix synthesis or in type II pneumocyte function, or both, may be involved in the pathogenesis of pulmonary emphysema in this mutant. Several animal strains have been reported to develop pulmonary emphysema, but the klotho mouse is unique because it simultaneously exhibits various aging phenotypes. Analysis of pulmonary emphysema in klotho mice will provide a unique insight into the relationship between pulmonary emphysema and aging.

Aging↗
PubMed2003

[Expression of matrix metalloproteinases in lung tissue and levels of some cytokines in bronchoalveolar lavage fluid in the obstructive emphysema rat models].

OBJECTIVE: To observe the changes of matrix metalloproteinase-2 (MMP-2), MMP-9 and interleukin-10 (IL-10), tumor necrosis factor-alpha (TNFalpha) in lung tissue of the obstructive emphysema rat models and to evaluate the relationship between these changes and emphysema formation. METHODS: The rat emphysema models were established by exposure to cigarette smoking. Pulmonary function tests were performed to evaluate the forced expiratory volume in 0.3 second (FEV(0.3)), FEV(0.3)/forced vital capacity (FVC) and functional residual capacity (FRC). The morphological indices of emphysema were measured by computer image analyzer. The protein expression and enzymatic activity of MMPs in lung tissue were observed. The contents of IL-10 and TNFalpha in bronchoalveolar lavage fluid (BALF) were measured. RESULTS: Pulmonary function test showed that in model group the FEV(0.3)/FVC was decreased, whereas the FRC was increased significantly than those in control group (P < 0.01, respectively). There was a significant decrease in the relative content of elastin in lung tissue in model group than that in control group. The expression and enzymatic activity of MMP-2 and MMP-9 in lung tissue, the counts of total leukocytes and neutrophils and the level of TNFalpha in BALF were significantly elevated, but the level of IL-10 in BALF was significantly reduced in model group compared with those in control group (P < 0.01, respectively). There were statistically significant positive correlations between the enzymatic activity of MMP-2, MMP-9 and the total leukocyte counts (P < 0.01, respectively), and significant negative correlations between the enzymatic activity of MMP-2, MMP-9 and the content of elastin (P < 0.05, respectively). CONCLUSIONS: MMP-2, MMP-9, IL-10 and TNFalpha may play an important role in the formation of obstructive emphysema in rat models caused by passive smoking.

Animals↗
PubMed2003

[Physiological effects of lung reduction surgery: the contribution of an animal model of emphysema].

INTRODUCTION: Lung volume reduction surgery (LVRS) is a technique largely used for palliation of symptoms in selected patients with emphysema. Despite some encouraging early results, it is often still regarded as an experimental technique due to the significant associated mortality and unpredictable results. STATE OF ART: The aim of this study was to explore the pathophysiological basis of benefit from LVRS when applied to a hamster model of emphysema induced by elastase and thus allow better selection criteria of patients being considered for this treatment. PERSPECTIVES: Despite a positive effect on pulmonary elastic recoil pressures, LVRS did not, unlike its effects in humans, improve airway obstruction in the emphysematous hamsters. Differences in chest wall mechanics may explain these contrasting findings. Adaptation of the intrinsic and cellular properties of the diaphragm that are seen in emphysema are preserved after LVRS. CONCLUSIONS: Despite differences with emphysema in humans, this hamster model supports the importance of the residual volume/total lung capacity ratio when selecting patients with emphysema for LVRS. The positive outcome of this intervention on the dynamics of the diaphragm is not compromised by modifications undergone by the diaphragmic myocytes.

Animals↗
PubMed2003

[Emergency treatment of post-traumatic orbital emphysema: a case report].

PURPOSE: Orbital emphysema is a common complication of orbital wall fractures (50% of blow-out fractures). It is generally a benign and self-limited condition. However, it may compromise retinal and optic nerve vascularization and therefore requires rapid management. PATIENT AND METHOD: We report a case of traumatic orbital emphysema resulting in ischemic optic neuritis. The orbital emphysema was drained using a 25-gauge needle mounted on a syringe filled with normal saline, with the plunger removed, and guided by air bubble eruption. RESULTS: Vision was promptly recovered following drainage of the orbital emphysema. CONCLUSION: The development of orbital emphysema after an orbital fracture is a consequence of a forceful expiratory effort raising intranasal pressure. It must be drained, as described, in cases of vascular compression.

Anti-Inflammatory Agents↗