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PubMed1978

Surgical treatment of infantile lobar emphysema in cardiovascular disease with left-to-right shunts.

Serious symptoms associated with the lobar emphysema in congenital heart diseases with left-to-right shunt disappeared after radical operation for cardiac lesion. The study of seven autopsied cases revealed that the lobar emphysema resulted from check valve mechanism created by compression of the bronchi by distended pulmonary artery. Eight cases of our experience of lobar emphysema disappeared shortly after the operation for congenital heart disease with left-to-right shunt seems to indicate infantile lobar emphysema in congenital heart diseases with left-to-right shunt should not be treated by resection but rather by radical operation for cardiac lesion as soon as possible even in infancy.

Bronchi↗
PubMed2002

Effects of shenmai and aminophylline on apoptosis of small airway smooth muscle cells and the expression of relevant genes in rats with emphysema.

The effects of Shenmai injection (SMI) and aminophylline on apoptosis of small airway smooth muscle cells (SASMC) and the Fas/FasL expression in rats with papain-induced emphysema were investigated. Rat emphysema model was established by a single intratracheal instillation of papain. Apoptosis and Fas/FasL expression of SASMC were detected by immunohistochemistry SABC and TUNEL assay at day 1, 3, 5, 7, 15, 30 after modeling, and the effect of SMI and aminophylline on them were observed. The results indicated that the Fas/FasL expression positive rate in SASMC was 2.31 +/- 0.55/1.28 +/- 0.47 respectively. After a single intratracheal instillation of papain, the expression of Fas/FasL positive rate in the placebo group was increased in a time-dependent manner. SMI could inhibit the expression of Fas/FasL, but aminophylline couldn't. The positive rate of apoptosis in the control group was 0.87 +/- 0.32. After a single intratracheal instillation of papain, the SASMC apoptosis positive rate in the placebo group was increased in a time-dependent manner. The SASMC apoptosis rate in all groups was declined after treatment with SMI, but the effect of aminophylline was not obvious. It was demonstrated that in the pathogenesis of emphysema Fas/FasL played an important role in the regulation of SASMC apoptosis. SMI influenced the expression of Fas/FasL and declined SASMC apoptosis by inhibiting the releasing of inflammatory media and played an important role in the therapy of emphysema.

Aminophylline↗
PubMed2000

Relationship between regional severity of emphysema and coronary heart disease.

We analyzed the relationship between regional severity of emphysema, which was evaluated by three-dimensional fractal analysis (3D-FA) of Technegas SPECT images, and coronary heart disease (CHD). For 22 patients with emphysema who underwent Technegas SPECT, we followed up CHD events. The follow-up period was 5.4+/-0.5 (mean +/- SD) years. We defined the upper-lung fractal dimension (U-FD) and lower-lung fractal dimension (L-FD) obtained with 3D-FA of Technegas SPECT images as the regional severity of emphysema. FD became greater with the progression of emphysematous change. During the follow-up period, CHD events occurred in 6 (27%) of the 22 patients. The ratio of U-FD to L-FD for patients with CHD events (0.87+/-0.22) was significantly smaller than for patients without CHD events (1.52+/-0.38) (p = 0.0015). These findings suggest that severer emphysema in the lower lung indicates a higher risk of CHD than that in the upper lung.

Aged↗
PubMed1995

Laparoscopic extraperitoneal inguinal hernia repair complicated by subcutaneous emphysema.

The case of a healthy 59-yr-old man who underwent elective laparoscopic extraperitoneal inguinal hernia repair and general anaesthesia is presented. After one hour of surgery, a sudden increase in the FETCO2 from 5.0% to 9.4% in relation to a massive subcutaneous emphysema, but without any haemodynamic instability, was noticed. The acute rise of FETCO2 was the first sign of an abnormal event. Nevertheless, subcutaneous emphysema was diagnosed with chest wall examination and palpation. Subcutaneous emphysema and hypercarbia are potential complications of laparoscopic surgery, but are more likely to occur in extraperitoneal surgery, since insufflated CO2 can diffuse easily into the surrounding tissues. High insufflation pressures will increase chances of this occurring and was the most likely cause of this complication. This case encouraged us to make recommendations for the management of laparoscopic extraperitoneal surgery which included: monitoring of CO2 insufflation pressure, routine examination and palpation of chest wall, use of N2O with caution, adjusting ventilation to physiological FETCO2 and excluding other causes of subcutaneous emphysema and hypercarbia.

Hernia, Inguinal↗
PubMed1999

Subjective symptoms and prognosis after lung volume reduction surgery in patients with severe pulmonary emphysema.

Lung volume reduction surgery improves symptoms in patients with severe pulmonary emphysema, but patients are not always satisfied surgical results. Our purpose was to determine the profiles and prognosis of unsatisfactory cases of lung volume reduction surgery. A total of 58 patients with advanced symptomatic emphysema underwent thoracoscopic volume reduction of emphysematous lung tissue. Patients subjectively evaluated their condition 3 months after surgery as "better," "same," or "worse" than before surgery. Of these, 30 evaluated themselves as "better" (58%), 17 as the "same" (33%), and 4 (8%) as "Worse." Most patients with vital capacity (VC) exceeding 2,000 mL (percentage of vital capacity for the predicted value (%VC) of > 60%) with upper-lobe-predominant and centrilobular emphysema were satisfied with surgical results. All patients with lower-lobe-predominant or whole-lung panacinar emphysema evaluated their results as "worse." Six late deaths occurred due to pulmonary infection (3), respiratory failure (2), and an unknown sudden cause (1), with most of these patients having preoperative low VC and high postoperative partial carbon dioxide pressure in the arterial blood (PaCO2).

Aged↗
PubMed1994

[CO2--emphysema in laparoscopic surgery. Changes in pulmonary CO2-elimination].

We report on two patients with subcutaneous carbon dioxide (CO2) emphysema that developed during laparoscopic surgery with CO2 pneumoperitoneum (PP), in whom pulmonary elimination of CO2 (ECO2, Servo ventilator with integrated CO2 analyzer 930, Siemens) was continuously monitored. Patient 1 was a 61-year-old man with laparoscopic herniotomy. ECO2 immediately before PP was 120 ml/min x m2 and increased rapidly after 45 min PP to a maximum value of 340 ml/min x m2. At that time, minute ventilation had been increased from 7 to 11 l/min and PaCO2 had risen from 35 to 57 mm Hg. At the end of the procedure the patient showed excessive subcutaneous emphysema. Patient 2 was a 71-year-old woman in whom diagnostic laparoscopy was performed for staging of a pancreatic tumor. ECO2 immediately before PP was 140 ml/min x m2, increasing dramatically after 45 min PP to a maximum value of 529 ml/min x m2 (Fig. 1). At that time minute ventilation had been increased from 6.2 to 12.5 l/min and PaCO2 had risen from 40 to 77 mm Hg. PP was terminated and the patient was found to have extreme subcutaneous emphysema. She was mechanically ventilated for a further 40 min to normalize PaCO2 and ECO2. It seems reasonable to suppose that an increase in ECO2 by more than 100% of control during CO2-PP is an early sign of CO2 emphysema. In this situation hypercapnia is potentially life-threatening. Evidently, reabsorption of CO2 from loose connective tissue is far more rapid and effective than CO2 resorption from the peritoneal cavity.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Subcutaneous emphysema: a rare manifestation of a perforated diverticulitis in a patent inguinal canal.

Patients with complicated diverticulitis rarely present with extraperitoneal manifestations but the manifestation of subcutaneous emphysema appears even more seldom. We present the case of a patient with a history of diabetes and immunosuppression, who was admitted with sepsis in association with cellulitis and subcutaneous emphysema of the left groin. The absence of peritonism due to corticosteroid treatment, a history of a recent fall with an ilio- and ischio-pubic fracture and subcutaneous emphysema led to a delay in the diagnosis. The final diagnosis was a perforated diverticulitis in a patent inguinal canal, which was only revealed after surgery. The various complications of diverticulitis, including extraperitoneal manifestations, and associated microorganisms implicated in cellulitis and subcutaneous emphysema are briefly reviewed.

Aged, 80 and over↗
PubMed2006

Sliding thin slab, minimum intensity projection imaging for objective analysis of emphysema.

PURPOSE: The aim of this study was to determine whether sliding thin slab, minimum intensity projection (STS-MinIP) imaging is more advantageous than thin-section computed tomography (CT) for detecting and assessing emphysema. MATERIALS AND METHODS: Objective quantification of emphysema by STS-MinIP and thin-section CT was defined as the percentage of area lower than the threshold in the lung section at the level of the aortic arch, tracheal carina, and 5 cm below the carina. Quantitative analysis in 100 subjects was performed and compared with pulmonary function test results. RESULTS: The ratio of the low attenuation area in the lung measured by STS-MinIP was significantly higher than that found by thin-section CT (P < 0.01). The difference between STS-MinIP and thin-section CT was statistically evident even for mild emphysema and increased depending on whether the low attenuation in the lung increased. Moreover, STS-MinIP showed a stronger regression relation with pulmonary function results than did thin-section CT (P < 0.01). CONCLUSION: STS-MinIP can be recommended as a new morphometric method for detecting and assessing the severity of emphysema.

Aged↗
PubMed1982

Management of the patient with emphysema, coronary artery disease, and lung cancer.

Coronary artery disease, emphysema, and lung cancer often occur together and have cigarette smoking as a common etiologic contributor. The management of the patient with lung cancer, coronary artery disease, and emphysema is complex. The patient with significant coronary artery disease should undergo coronary artery bypass before or concurrently with pulmonary resection. Only proven carcinomas should be resected at the time of coronary artery bypass grafting because immunosuppression secondary to cardiopulmonary bypass can result in the life-threatening spread of fungal or other infections if biopsy is performed at the time of cardiopulmonary bypass. The risk of pulmonary resection is increased in the patient with emphysema because of decreased efficiency of the lungs and chest wall. Likewise, emphysema results in greater risk in the patient with coronary artery disease because of increased demands on the heart.

Coronary Disease↗
PubMed1984

Experimental pulmonary emphysema induced in the rat by intratracheally administered elastase: morphogenesis.

Emphysema was produced experimentally in rats by administration of porcine pancreatic elastase at dose levels of 75, 100, 125, and 150 units elastase activity/100 g body wt. All doses studied were equally effective in producing emphysema. Dose levels of over 75 units activity/100 g offered no advantage in terms of degree or severity of emphysema produced; however, such doses exacerbated hemorrhage and edema, resulting in relatively high post-instillation mortality. Lesion morphogenesis at all doses tested paralleled those described in this and in other species by other investigators. The 75-unit activity produced a quantifiable degree of emphysema which was relatively constant among animals. Results suggest that because of group differences in susceptibility to elastase (or variations in batches of elastase), dose-range studies should be performed on each new group of animals.

Animals↗
PubMed1983

Morphological and biochemical features of elastase-induced emphysema in strain A/J mice.

Elastase-induced animal models of pulmonary emphysema are potentially useful to study the physiological, anatomical, and biochemical injuries associated with emphysema. After the endotracheal instillation of porcine pancreatic elastase (0.15 or 0.30 mg elastase per 100 g body weight) into strain A/J mice, selected biochemical and morphometric indices od lung damage were examined. Elastase produced extensive air space enlargement without appreciable mortality. Lesions involving the lung parenchyma distal to the terminal bronchioles were observed within 2 weeks and possessed features resembling panlobular and centrilobular emphysema. Morphometric analyses of emphysema indicated that after the acute phase of tissue damage and repair, the lesions stabilize without further deterioration of alveolar structure. Increased lung elastin synthesis was noted following endotracheal elastase, resulting in lung elastin levels 30% higher than controls 8 weeks after treatment. Minimal alterations to lung DNA and protein levels indicated that elastase produced specific lung lesions exclusive of inflammation and edema.

Animals↗
PubMed1989

Morphogenesis of abnormal elastic fibers in lungs of patients with panacinar and centriacinar emphysema.

Pulmonary elastic fibers in a patient with panacinar emphysema due to alpha-1-antitrypsin deficiency and three patients with centriacinar emphysema related to anthracosis were studied by electron microscopy and by light and electron microscopic immunohistochemistry for elastin. Four types of abnormal elastic fibers were found: (1) finely disrupted fibers, (2) fibers with vacuolar changes and deposits of electron-dense granular material, (3) accumulations of small, rounded amorphous components of elastic fibers near bundles of microfibrils, and (4) large, confluent masses consisting mainly of aggregates of irregularly and compactly arranged, small-sized amorphous components. The amorphous components in these four types of abnormal elastic fibers tended to stain evenly with antielastin antibody. This is attributed to greater penetration of antielastin antibody into fibers that were incompletely polymerized because of immaturity or hydrolytic damage. Finely disrupted fibers were frequently found in the patient with panacinar emphysema and were presumed to have been damaged by elastase. The other three types of elastic fibers were frequently found in the patients with centriacinar emphysema. The vacuoles and electron-dense deposits in elastic fibers probably represented the consequence of damage to elastic fibers. The small round amorphous components in elastic fibers might be formed from abnormal elastogenesis. The large, confluent elastic masses were thought to be formed by the aggregation of elastic fibers in areas of coalescence of alveolar walls undergoing structural remodeling.

Adult↗
PubMed2006

Botulinum toxin as treatment for a unique case of subcutaneous emphysema.

A developmentally delayed 11-year-old male developed extensive spontaneous subcutaneous emphysema 6 weeks after a laryngotracheal separation. Computed tomography demonstrated a small amount of air at the distal end of the laryngeal stump and significant esophageal air. Aerophagia was diagnosed with air presumed diverted through the laryngeal stump due to cricopharyngeal hypertension. Cricopharyngeal botulinum toxin injection was coordinated with a minimal neck dissection to drain the subcutaneous emphysema. The subcutaneous emphysema gradually improved and the patient was discharged home. His subcutaneous emphysema has not returned after four total botulinum toxin injections every 3 months.

Aerophagy↗
PubMed2004

Determinants of health-related quality of life in patients with pulmonary emphysema.

QUESTION OF THE STUDY: The aim of our study was to examine the relationship between health-related quality of life (HRQL), lung function parameters and intensity of dyspnea in order to determinate what variables influence the HRQL in patients with pulmonary emphysema. PATIENTS AND METHODS: Forty (mean aged 66+/-9) consecutive male patients with pulmonary emphysema were evaluated. All patients underwent spirometry, measurement of lung volumes, inspiratory and expiratory respiratory pressure (MIP and MEP), measurement of corrected carbon monoxide diffusing capacity (KCO), and 6-min walking test (6MWT). The scale of dyspnea by the baseline dyspnea index (BDI) and British Medical Council Research (MCR), and the quality of life by Chronic Respiratory Question Disease (CRQD) were also assessed. RESULTS: FEV1, FVC, 6MWT, KCO, MEP, MIP, BDI and MCR were correlated with dimensions of CRQD. Factor analysis reduced these variables to four factors, which accounted for 86.2% of the total variance: (1) airway obstruction, (2) dyspnea, (3) capacity of effort, (4) maximum static respiratory pressure. In the multiple regression model BDI and MEP explained the 64% of the total variance of CRQD. CONCLUSIONS: Quality of life measured by CRQD in patients with emphysema is predominantly determined by dyspnea, and in minor degree by expiratory muscle strength. Our results underscore the usefulness of dyspnea scales and MEP in the evaluation of HRQL in patients with emphysema.

Aged↗
PubMed2005

Concomitant upper-lobe bullous emphysema, lower-lobe interstitial fibrosis and pulmonary hypertension in heavy smokers: report of eight cases and review of the literature.

INTRODUCTION: Smoking can cause a variety of pulmonary interstitial diseases. Pulmonary fibrosis has traditionally been considered a non-smoking-related disease. Recently, however, evidence of smoking-induced fibrosis has emerged. SUBJECTS AND METHODS: A group of eight patients from the pulmonary clinic in Rabin Medical Center with a combine presentation of fibrosis and emphysema was identified retrospectively. All patients underwent chest computed tomography and pulmonary function tests. One patient underwent lung-heart transplantation and a complete review of his lung pathology was obtained. Transbronchial biopsy was performed in 3 additional patients and echocardiography was performed to evaluate the pulmonary vasculature. RESULTS: Upper-lobe emphysema with bulluos changes was found in all patients. In addition, a basal interstitial process was recognized, ranging from ground glass opacities to severe pulmonary fibrosis, with honeycombing. The radiological findings matched the pathological results of combined emphysema and usual interstitial pneumonia. Pulmonary function tests were also in accord, showing severe hypoxemia with mild obstruction, normal-to-mildly reduced lung volumes and a severe decrease in diffusion capacity. Most of the patients had moderate-to-severe pulmonary hypertension as well as diffuse coronary artery disease. CONCLUSION: Our findings are in line with emerging evidence that the spectrum of interstitial damage caused by smoke includes not only Langerhans cell hystiocytosis, respiratory bronchiolitis or desquamative interstitial pneumonia but also advanced usual interstitial pneumonitis as well. We believe that in some patients smoking plays a destructive role by a variety of mechanisms and can cause emphysema, lung fibrosis as well as pulmonary vasculopathy and hypertension. Future studies are needed to define the genetics and pathophysiology of this uncommonly reported clinical syndrome.

Aged↗
PubMed2003

Neutrophil elastase contributes to cigarette smoke-induced emphysema in mice.

To address the role of neutrophil elastase in pulmonary emphysema, neutrophil elastase-deficient mice and wild-type littermate controls were exposed to long-term cigarette smoke. Compared to wild-type littermates, mice that were deficient in neutrophil elastase were significantly protected (59%) from the development of emphysema. Previously, we demonstrated complete protection from emphysema in the absence of macrophage elastase. Further analysis revealed several interactions between these two elastases. Each elastase inactivated the endogenous inhibitor of the other, with neutrophil elastase degrading tissue inhibitor of metalloproteinase-1, and macrophage elastase degrading alpha-1-antitrypsin. Cigarette smoke-induced recruitment of both neutrophils and monocytes was impaired in the absence of neutrophil elastase. Moreover, there was less macrophage elastase activity secondary to decreased macrophage accumulation in neutrophil elastase-deficient mice. This study demonstrates a direct role for neutrophil elastase in emphysema and highlights the interdependence of the proteinases and inflammatory cells that mediate lung destruction in response to cigarette smoke.

Animals↗
PubMed2001

Lung volume reduction surgery in emphysema: a systematic review.

The aim of this study was to systematically review the literature regarding the safety and efficacy of lung volume reduction surgery (LVRS) in patients with emphysema. Studies on LVRS to August 2000 were identified using MEDLINE, Embase, Current Contents, and the Cochrane Library. Human studies of patients with upper, lower or diffuse distributions of emphysema were included. All types of bullous emphysema were excluded. A surgeon and researcher independently assessed the retrieved articles for their inclusion in the review. When LVRS was compared with medical management, at 2 years LVRS was associated with a higher FEV1 and at least equivalent survival. The use of staple excision of selected areas of lung appeared to be more efficacious than laser ablation. There is insufficient evidence to show preference for median sternotomy or videoscopically assisted thoracotomy, as the more safe and efficacious procedure. In highly selected patients with emphysema LVRS is deemed an acceptable treatment. To fully evaluate the safety and efficacy of LVRS, outcomes beyond 2 years must be included. The results of prospective randomized trials between medical management and LVRS, now in progress, are essential before a final assessment can be made.

Hospital Mortality↗
PubMed2002

Thirteen-year experience in lung transplantation for emphysema.

BACKGROUND: Emphysema is the most common indication for lung transplantation. Recipients include younger patients with genetically determined alpha-1 antitrypsin deficiency (AAD) and, more commonly, patients with chronic obstructive pulmonary disease (COPD). We analyzed the results of our single-institution series of lung transplants for emphysema to identify outcome differences and factors predicting mortality and morbidity in these two groups. METHODS: A retrospective analysis was undertaken of the 306 consecutive lung transplants for emphysema performed at our institution between 1988 and 2000 (220 COPD, 86 AAD). Follow-up was complete and averaged 3.7 years. RESULTS: The mean age of AAD recipients (49 +/- 6 years) was less than those with COPD (55 +/- 6 years; p < 0.001). Hospital mortality was 6.2%, with no difference between COPD and AAD, or between single-lung transplants and bilateral-lung transplants. Hospital mortality during the most recent 6 years was significantly lower (3.9% vs 9.5%, p = 0.044). Five-year survival was 58.6% +/- 3.5%, with no difference between COPD (56.8% +/- 4.4%) and AAD (60.5% +/- 5.8%). Five-year survival was better with bilateral-lung transplants (66.7% +/- 4.0%) than with single-lung transplants (44.9% +/- 6.0%, p < 0.005). Independent predictors of mortality by Cox analysis were single lung transplantation (relative hazard = 1.98, p < 0.001), and need for cardiopulmonary bypass during the transplant (relative hazard = 1.84, p = 0.038). CONCLUSIONS: AAD recipients, despite a younger age, do not achieve significantly superior survival results than those with COPD. Bilateral lung transplantation for emphysema results in better long-term survival. Accumulated experience and modifications in perioperative care over our 13-year series may explain recently improved early and long-term survival.

Adult↗