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PubMed2003

[A study on the role of vascular endothelial growth factor in emphysema of rat caused by smog exposure].

OBJECTIVE: To explore the role of vascular endothelial growth factor (VEGF) in emphysema of rat caused by smog exposure. METHODS: Thirty-six 12-week male rats were randomly divided into 2 groups: a smog exposure group (S group), and a normal control group (N group). S group rats were randomly subdivided into 3 groups: S(1) group, S(2) group, S(3) group, which were exposed to smog for 2 weeks, 4 weeks, 8 weeks, respectively; N group rats were randomly subdivided into 3 groups: N(1) group, N(2) group, N(3) group, which were raised in normal oxygen condition for 0 week, 4 weeks, 8 weeks, respectively. The expressions of VEGF mRNA and VEGF protein and kinase-insert domain containing receptor (KDR) protein were determined by reverse transcription-polymerase chain reaction (RT-PCR) and modified SABC immunohistochemistry assay separately. The pathological change in smog exposure rat lung was determined by HE staining. MLI and MAN were determined as an index of emphysema. Variance analysis, nonparametric analysis and correlate analysis were conducted in SPSS 10.0. RESULTS: (1) There were airway inflammation in S group rat lungs, and an early-emphysema-like change in S(3) group rat lungs: MAN in S(3) group was significantly decreased compared with N(3) group, MLI in S(3) group was significantly increased compared with N(3) group (P < 0.05). (2) VEGF189 mRNA in lung and VEGF protein in alveolar and bronchial epithelium of rats in S(1) group were significantly lower than those in N(1) group (P < 0.01); VEGF189 mRNA, VEGF165 mRNA and VEGF121 mRNA of lung tissue and VEGF protein in alveolar and bronchial epithelium of rats in S(2) group were significantly lower than those in N(2) group (P < 0.01), too; VEGF protein in alveolar and bronchial epithelium and KDR expression in pulmonary vascular endothelium of rats in S(3) group was lower than that in N(3) group (P < 0.01, P < 0.01, P < 0.05), but VEGF mRNA have no difference (P > 0.05). (3) VEGF protein expression in alveolar epithelium and bronchial epithelium had a positive correlation with MAN (r = 0.43, r = 0.37, P < 0.05) and an inverse correlation with MLI (r = -0.42, r = -0.37, P < 0.05). CONCLUSIONS: Smog exposure decrease the expression of VEGF and KDR in rat lung. VEGF might involve in the pathology of emphysema caused by smog exposure.

Animals↗
PubMed2004

How a test for elastic fiber breakdown products in sputum could speed development of a treatment for pulmonary emphysema.

Pulmonary emphysema is a devastating disease for which there is no effective treatment. The development of therapeutic agents for this disorder has been hampered by the lack of clinical or biochemical tests which can rapidly evaluate drug efficacy. Since emphysema is associated with degradation of elastic fibers, the authors propose measuring the content of the elastin-specific amino acids, desmosine and isodesmosine, in sputum as a more immediate means of monitoring therapeutic interventions. Sputum samples would be chemically degraded to separate the component amino acids of elastic fibers, then measured for the total quantity of desmosine and isodesmosine, using any one of a number of established methods for quantifying these compounds, including radioimmunoassay, chromatography, or mass spectrometry. Such techniques allow for detection of nanogram quantities of desmosine and isodesmosine, and the procurement of ample amounts of induced sputum from the lower respiratory tract should improve the chances of detecting these amino acids. If proven valid, such a test could serve as a convenient marker for assessing lung injury in pulmonary emphysema, thereby facilitating rapid evaluation of new forms of treatment for this disease. The test might also prove to be a useful screening procedure for persons who smoke or otherwise have a greater than normal risk of developing emphysema.

Desmosine↗
PubMed1992

[A case of spontaneous mediastinal emphysema developed by numbness of the left arm, dysphagia and chest pain].

A 20-year-old female developed dysphagia, chest pain and numbness of the left arm after dinner on August 22, 1990. She consulted a doctor, who diagnosed tachycardia and prescribed propranolol. On August 23, she hadn't improved. On the same day, she visited our hospital. Chest X-ray films revealed lucent band and distinct line running parallel to the border of the heart and we suspected mediastinal emphysema. Immediately we took chest CT scan, which demonstrated free air surrounding the trachea, thoracic aorta and heart. We diagnosed spontaneous mediastinal emphysema. She was treated with bed rest and mediastinal emphysema subsided within 8 days. The numbness in the patient's arm is an unusual symptom in mediastinal emphysema. We suggest that the numbness of the arm may be due to interference with the circulation to the arm by distention of the mediastinal tissue.

Adult↗
PubMed1992

Parenteral administration of trypsin triggers lung emphysema.

Eight weeks after a single intravenous injection of trypsin, more than half of 26 treated rats showed pulmonary emphysema, as demonstrated by a significant increase of the mean linear intercept (MLI = 107 microns) in comparison with 11 controls (69 +/- 15 microns) (mean +/- SD). As observed 56 days after the injection, the intraperitoneal administration of trypsin (24 rats) also leads to lung emphysema (MLI = 101-106 microns), as does endotracheal instillation of elastase (13 rats), (MLI = 108 microns). The intraperitoneal administration of trypsin in animals constitutes a model close to human pathology with which lung alterations in acute pancreatitis may be studied. Having no elastolytic properties, trypsin cannot directly induce emphysema. The observation of a pulmonary leucostasis in eight rats sacrificed early after the trypsin injection suggested that leucocyte trapping and activation are important for the genesis of this trypsin-triggered emphysema.

Acute Disease↗
PubMed2003

Surgical treatment of severe emphysema--analysis of own material.

UNLABELLED: The aim of the study was a retrospective analysis of effectiveness of surgical treatment of severe diffuse emphysema, including urgent cases with symptomatic pneumothorax. We analyzed 99 patients with severe diffuse emphysema who underwent surgical treatment in Department of Thoracic Surgery in Lublin between 1995 and 2001. The evaluated group consisted of 86 men and 13 women aged from 27 to 83 (mean age 56.6). Among them 54 were operated on due to sudden pneumothorax, which was a result of bursted emphysematous parenchyma. Those patients were not evaluated with spirometry and CT of the chest. All the other patients were carefully examined and qualified for surgical treatment according to precise criteria: presence of clinical and radiological symptoms of diffuse severe emphysema (DSE), FEV1<35%, pCO2>50mmHg. Those 43 patients eligible for Lung Volume Reduction Surgery iLVRS) also did not have any main contraindications for lung surgery. In the whole analyzed population 89 resections were unilateral, limited to 20-25% of the most destroyed tissue. In 10 cases operation was bilateral, among them four were simultaneous and the remaining six were not. In our study we evaluated the frequency and degree of complications, early results of treatment, influence of surgery on selected parameters: FEV1, pCO2, subjective dyspnea according to Medical Research Council Dyspnea Scale. We observed three perioperative deaths. The most common complications were air leak> five days, cardiopulmonary insufficiency, pneumonia. Early results showed subjective decrease of dyspnea and in most cases improvement of the analyzed parameters. CONCLUSIONS: The early results are optimistic and correspond to the observations of other authors. Further analysis of the collected data and long term results will allow establishing the role of LVRS in treatment of Diffuse Severe Emphysema.

Adult↗
PubMed2004

[Role of surgical lung volume reduction in the treatment of patients with severe emphysema].

OBJECTIVE: Based on literature data and own experience (unique in Hungary) we like to present the indications, contraindications, risks as well as medium and long term follow ups of the lung volume reduction surgery (LVRS) applicable in cases of therapeutic resistant end-stage emphysema (COPD). MATERIAL: In Szombathely between 1997 and 2003, 69 LVRS--by multiple wedge resections of most functionless parts of the lungs--were made on 56 patients (44 males and 12 females with a mean age of 52.5 years) via median sternotomy for both sides (12 pts), axillary thoracotomy on one (30 pts) or both sides in two sessions (13 pts) and VATS (one side, 1 pt). Selection criteria based on radiographic, spirometric and cardiac function tests. Indications were: diffuse homogenous emphysema: 17 pts, heterogenous emphysema 39 pts. Combined surgery for severe COPD and pulmonary malignancy was applied too (7/56 pts - 12.5%). RESULTS: Thirty-day operative mortality was 4.3% (3/69) similar to international results. We noticed high incidence of early complications: air leak (37.6%), serious arrhythmia (13%), respiratory insufficiency (8.7%), longer drainage time (5.7 days). Reoperations were 2/69 interventions (2.9%) because of air leak and bleeding. Late recurrent pneumothorax was observed in 1 case (1.3%). The mean follow up time was: 31.8 months. FEV1, RV, paO2, paCO2 and the quality of life improve as seen in follow-up, and patients regain apart of the former activity. There were no differences in the outcome in patients undergoing unilateral or bilateral LVRS. On the basis of literature and own data the long-term significant positive improvements last about 12-24 months. Thereafter one can observe a slow decrease of the cardiopulmonary functions, however, the quality of life remains adequate for longer. SUMMARY: The LVRS has a certain risk, but perioperative mortality is acceptable. LVRS is a realistic alternative of lung transplantation in case of severe COPD first of all in patients presenting with heterogenous emphysema (particularly upper lobe) and low exercise capacity. The expense of LVRS is maximum 10% of lung transplantation. Patients having undergone an LVRS and patients unacceptable for LVRS can be suitable for lung transplantation.

Adult↗
PubMed2005

[Sudden difficulty in ventilation due to massive subcutaneous emphysema during laparoscopic cholecystectomy].

A 56-year-old woman with cholecystolithiasis was scheduled for laparoscopic cholecystectomy. Anesthesia was induced with fentanyl and propofol IV, and the trachea was intubated using vecuronium IV. Anesthesia was maintained with 60% nitrous oxide and propofol intravenously, and vecuronium was used for muscle relaxation. Following induction of carbon dioxide pneumoperitoneum, PETCO2 slightly increased. During pneumoperitoneum PETCO2 as easily controlled by increasing minute volume of ventilation. Fifty minutes after the start of pneumoperitoneum, suddenly the peak airway pressure increased and PETCO2 reached 70 mmHg continuously. At this time, severe massive subcutaneous emphysema from the anterior thorax to the head and neck was noted, and the manual lung ventilation was very difficult. After discontinuation of pneumoperitoneum, PETCO2 gradually decreased with improvement of the neck subcutaneous emphysema. At the same time the lung ventilation improved. We speculate that major causes of difficulty in ventilation were the decreased compliance and the tracheal tube comppression, which were due to massive subcutaneous emphysema. Our findings show that we have to stop pneumoperitoneum immediately, when we find a sudden increase of the peak airway pressure or PETCO2 with subcutaneous emphysema during laparoscopic cholecystectomy.

Carbon Dioxide↗
PubMed1992

[Extravascular thermal volume in pulmonary emphysema].

The extravascular thermal volume of the lung (ETVL) was measured by the heat-sodium double indicator dilution technique in 10 patients with chronic pulmonary emphysema. ETVL was 4.99 +/- 1.23 ml/kg, and correlated significantly with TLC(r = 0.747), %VC(r = 0.664), PaO2(r = 0.779), AaDO2(r = -0.796), shunt ratio(r = -0.7), and total pulmonary vascular resistance(r = 0.698). ETVL tended to decrease with the progression of the severity of emphysema as assessed by computed tomography. These results suggest that 1) the extravascular thermal volume decreases in chronic pulmonary emphysema parallel with an increase in the severity of the complaint, and that 2) the decrease of extravascular thermal volume may reflect a decrease in the size of the pulmonary capillary bed. It is concluded that the measurement of extravascular thermal volume may be useful for the evaluation of the severity of pulmonary emphysema.

Aged↗
PubMed2005

[Analysis of alpha-1-antitrypsin phenotypes and genotypes in patients with early-onset pulmonary emphysema].

An increased risk for the development of emphysema occurs in all carriers of deficient variants of Alpha-1-Antitrypsin (A1AT). A DNA polymorphism in the 3' promoter region of A1AT gene (locus Pi), which is important for a modulation of gene expression in a response to inflammation, seems to be an additional genetic risk factor for emphysema. In the study, we present two relatively young patients with panlobular lung emphysema associated with a normal level of A1AT in serum. To contribute to our knowledge about a molecular basis of the pulmonary changes, the evaluation of A1AT phenotype with the use of an isoelectrofocusing of serum proteins and the analysis of DNA polymorphism in the 3' region of A1AT gene (Taq I RFLP) have been performed. The obtained results indicate on a necessity to include procedures of A1AT phenotyping and locus Pi genotyping in both the population screening of patients and the detailed clinical diagnostics of young patients with emphysema and/or COPD.

Adult↗
PubMed2006

[Mediastinal emphysema after a punch on the back; report of a case].

A 19-year-old man was punched on the back, and anterior chest pain appeared about 3 hours after injury. The patient was consulted a physician complaining of anterior chest pain. On chest X-ray, mediastinal emphysema was suspected, and transferred to our hospital. Chest computed tomography (CT) revealed mediastinal emphysema. On esophageal radiography and bronchofiberscopy, no abnormal findings were detected. Conservative therapy was conducted, and symptoms had gradually improved. On the 8th hospital day, mediastinal emphysema was improved on chest CT. The patient was discharged on the 10th hospital day. The most frequent cause of mediastinal emphysema after trauma is traffic or downfall accident, and no report on this condition after the punch on the back was found.

Adult↗
PubMed2006

[An experimental study on pulmonary vascular inflammation in a rat model of chronic bronchitis and emphysema].

OBJECTIVE: To study the characteristics of intra-acinar pulmonary artery inflammation in rats with chronic bronchitis (CB) and emphysema and to evaluate the protective and therapeutic effects of erythromycin (EM). METHODS: Eighteen male Wistar rats were divided into 3 groups randomly, 6 rats per group, a normal control group (group A), a CB and emphysema group (group B), and an EM-treatment group (group C). The rat model of CB and emphysema was established by intratracheal instillation of lipopolysaccharide (LPS) and daily exposure to cigarette smoke. After 8 weeks the pathological and morphometric changes in the lung were analyzed. RESULTS: (1) The inflammation in intra-acinar pulmonary arteries, described as total inflammatory cells per square millimeter of adventitia (cell/mm(2)), was different among the three groups, (33 +/- 6) cell/mm(2) in group A, (158 +/- 68) cell/mm(2) in group B, and (54 +/- 7) cell/mm(2) in group C; the difference being significant between group A and group B and between group B and group C (t = 9.6, 9.2, all P < 0.01). (2) The morphometric characteristics of intra-acinar pulmonary muscular arteries: the thickness of intra-acinar pulmonary muscular arteries, described as intimal area per total area, was significantly different among the groups (t = 9.7, 9.4, all P < 0.01), (21 +/- 4)% in group A, (37 +/- 3)% in group B, and (30 +/- 1)% in group C. CONCLUSIONS: There was inflammatory reaction largely of lymphocyte infiltration in the adventitia of intra-acinar pulmonary arteries in rats with CB and emphysema. Inflammatory reaction in intra-acinar pulmonary arteries plays an important role in vascular remodeling. EM may prevent the inflammation and remodeling of intra-acinar pulmonary arteries to some degree.

Animals↗
PubMed1991

[Subcutaneous emphysema as a complication of colonoscopy].

A 71-year-old man underwent colonoscopy and multiple poly-pectomy. A few hours after the procedure he developed massive subcutaneous emphysema of the abdomen, chest, mediastinum, scrotum and both legs. Treatment was by conservative measures only. The emphysema gradually disappeared and he was discharged within a few days without sequelae. Subcutaneous emphysema is a rare complication of colonoscopy which has also been described after other endoscopic and radiological investigations of the gastrointestinal tract. It is due to a tiny laceration of the mucosal wall of the colon incurred during aggressive instrumentation, through which pass large quantities of air. The laceration is located underneath the peritoneal sac and the air flows into the retroperitoneum (closed or extraperitoneal perforation). The appearance of subcutaneous emphysema a few hours later, usually after leaving the hospital, is characteristic. In contrast to intraperitoneal perforation (open perforation), surgical intervention is not indicated and treatment is usually conservative. It includes complete cessation of oral alimentation, insertion of a nasogastric tube, IV drip, and correction of hydro-electrolytic or acid-base imbalances. The overall prognosis following such measures is excellent.

Aged↗
PubMed1991

[An experimental pathological study of the effect of bronchiolitis on emphysema and cor pulmonale pathogenesis].

Nitric acid and elastase were injected into the tracheae of Wistar white rats and the effect of bronchiolitis on the pathogenesis of experimental emphysema and cor pulmonale was studied. The result showed that, although simple bronchiolitis and obstruction of the bronchioles produced no decisive effect on the development of emphysema, it aggravated the lesion and further induced pulmonary hypertension and cor pulmonale. Data also showed that when there was no bronchiolitis, blood gas, pulmonary artery pressure and right ventricular weight of the experimental rats would still be maintained within normal range even though emphysema was severe. The result indicates that although emphysema often goes together with chronic bronchitis clinically, cor pulmonale can be prevented if inflammation of the respiratory tract is effectively controlled.

Animals↗
PubMed1991

[The value of residual volume testing in determining degree of emphysema in patients with pneumoconiosis].

A comparative study of chest roentgenograms and the value of RV/TLC% in determining degree of emphysema of patients with pneumoconiosis and workers exposed to dust was made in 400 cases. Accordance rate of RV/TLC% with roentgenograms in determining emphysema in the same subjects was 61.1% and that in the patients group, 67.7%. Moreover, the accordance rate increased with grade of pneumoconiosis diagnosed. The results showed that RV/TLC% was valuable in determining emphysema of patients with pneumoconiosis. The classes of degree of emphysema were proposed according to the testing value of RV/TLC%.

Adult↗
PubMed1991

Response to corticosteroids in chronic airflow obstruction: relationship to emphysema and airways collapse.

We have studied the relationship between emphysema and airways collapse, and response to corticosteroids in patients with chronic airflow obstruction. One hundred and seven patients completed a placebo-controlled trial comparing 2 wks treatment with oral prednisolone 40 mg.day-1 to inhaled beclomethasone dipropionate 500 micrograms t.d.s. Response to corticosteroids was defined on the basis of changes in forced expiratory volume in one second (FEV1), and/or forced vital capacity (FVC), and/or mean peak expiratory flow (PEF) after treatment. Patients were categorized as those with physiologically defined emphysema (carbon monoxide transfer coefficient (KCO) less than 70% predicted and total lung capacity greater than 120% predicted), and those with pressure dependent airways collapse on the flow-volume loop (ratio of inspiratory to expiratory flow at 50% vital capacity [I:E50] greater than 10). The response to placebo showed a significant order effect, probably due to a carry-over effect of active treatment of at least 3 wks. Hence, the efficacy of active treatment over placebo in the subgroups defined was assessed by analysis of data generated from the first treatment phase of the trial. The presence or absence of physiologically defined emphysema did not affect the response to oral prednisolone. Inhaled beclomethasone dipropionate, however, was less effective in the emphysema group. Pressure dependent airways collapse did not affect the response to either prednisolone or beclomethasone. However, when data from all three treatment phases were analysed there was no significant difference in the response to either drug in any of the subgroups defined.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1991

Lack of type II cells and emphysema in human lungs.

Ten surgically removed human lungs or lobes were studied, to assess the relationship between the abundance of type II alveolar epithelial cells and the degree of emphysema. Type II cell abundance (total number as well as percentage of the total parenchymal cell population) was determined in sections of randomly selected tissue samples of these lungs or lobes by using a type II cell specific antibody specific anti-lavage serum (SALS-Hu), which recognizes surfactant-associated proteins. In these tissue samples we also determined the degree of emphysema with the aid of a number of morphometric parameters, destructive index (DI), mean linear intercept (Lm in mm), and the number of normal alveolar attachments on (pre)terminal bronchioles (normal AA.mm.1). We subsequently calculated the Spearman rank correlation coefficients (rs) between the abundance of type II cells and parameters for emphysema. We found a significant negative correlation between the percentage of type II cells and DI at tissue sample level (rs = 0.55; p = 0.02). We also calculated correlation coefficients between the abundance of type II cells and the degree of small airways disease in (pre)terminal and respiratory bronchioles (SADscore), lung function, age and smoking habits. The results suggest a role for type II cells in the pathogenesis of emphysema.

Adult↗
PubMed1991

Effect of human antileucoprotease on experimental emphysema.

Antileucoprotease (ALP), a potent inhibitor of human neutrophil elastase (HNE), may be a modulating factor in the pathogenesis of emphysema. Investigating the clearance of intratracheally-instilled ALP in hamsters, we observed a rapid clearance from the airway lumen within 60 min, whereafter the remaining 40% slowly decreased with a calculated half-life (T0.5) of 2.8 h. Lung tissue-associated ALP showed a peak at 40 min and slowly decreased (T0.5 approximately 3 h). In vivo efficacy of ALP on HNE-induced pulmonary lesions was studied by instillation of either 365 micrograms or 730 micrograms ALP, followed after 1 h by 420 micrograms HNE. Emphysema, haemorrhage and secretory cell metaplasia (SCM) were quantified 21 days after instillations. ALP was found to be able to inhibit emphysema and haemorrhage in a dose-related way, the decrease of haemorrhage being less pronounced. SCM was minimally affected. These results show that ALP inhibits efficiently the development of HNE-induced emphysema and, to a lesser extent, haemorrhage. We speculate that tissue-associated ALP might be responsible for this protection.

Animals↗
PubMed1991

[Qualitative assessment of centrilobular emphysema using computed tomography].

The ability of computed tomography (CT) in the qualitative assessment of centrilobular emphysema (CLE) was studied, with special reference to the morphological relationship between emphysematous change and relatively large bronchovascular bundle forming the margin of secondary pulmonary lobule. Three autopsied lobes with mild, moderate and severe CLE were fixed by the method of Heitzman. Then high resolution CT (HRCT) was applied to those inflation-fixed lobes, which allowed for direct one-to-one pathologic correlation. Furthermore, HRCT findings of these clinical cases with emphysema were analysed. Emphysematous change in CLE was observed as low-attenuation area (LAA) within the homogeneous background on Ct images. In mild and moderate cases, LAA's were round or oval in shape, however in severe case they were observed to be irregular in shape. The border between LAA and parenchyma was not clearly defined, however in severe case LAA was found to be bordered partially or rather subtotally by the bronchovascular bundle. In mild and moderate cases, LAA's were observed to be distant from relatively large bronchovascular bundle. On the other hand, in severe case, only a small amount of lung parenchyma was left between LAA and bronchovascular bundle. These findings correspond to morphologic characteristics of CLE, that is, the process of emphysematous change tends to take place in the center of the secondary lobule, and even if the lobe is severely destroyed, some portion of the peripheral acinus is still preserved at lobular margin. Thus, CT can help to identify the presence of CLE. Furthermore, CT scan analysis of severe grade emphysema may lead to the differentiation between CLE and panlobular emphysema.

Aged↗