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PubMed1982

[Mediastinal emphysema after thoracotomy (author's transl)].

A mediastinal emphysema was seen via x-ray film in 35 of 40 patients after opening of the mediastinum by longitudinal sternotomy. After about a week it was found in approximately every second patient; after 14 days it had been fully absorbed by all patients. Mediastinal emphysema could occur in conjunction with a cutaneous emphysema, and pneumothorax, respectively. Occasionally a pneumopericardium is seen even in the recumbent patient. Safe diagnosis of mediastinal emphysema is possible in the anterior lower mediastinum projected on to the cardiac silhouette if the x-ray film is taken obliquely.

Humans↗
PubMed1981

Pattern recognition in radiographs of excised air-inflated human lungs. IV Emphysema alone and with other common lesions.

To evaluate at autopsy the radiographic pattern of emphysema alone and with alveolar oedema, haemorrhage or pneumonia in excised air-inflated lungs the distribution of these findings in 89 lungs was determined histologically on 441 sections sampled systematically. Pathologic-radiologic correlations were studied on the basis of 58 sections from 30 lung selected to represent most clearly the features in question. In mild centrilobular emphysema (CLE) the number and calibre of small blood vessels was often reduced. Small translucencies could appear. In moderate CLE vascular changes were always visible and unevenly distributed translucencies in most cases. Some lungs looked slightly rounded. In severe CLE the number of blood vessels was greatly reduced, they were displayed between extensive tissue defects, and the lung looked always rounded. Only mild panlobular emphysema occurred in the material. This was difficult to distinguish radiologically but could show up as a coarse reticular background with a reduced number of blood vessels, and the lung could look rounded. Paracicatricial emphysema appeared as translucent areas around scars. Simultaneous alveolar processes often obscured the blood vessel changes of CLE and could accentuate or hide the tissue defect translucencies. The same alveolar processes were more unevenly distributed in emphysematous than in non-emphysematous lungs.

Adult↗
PubMed1981

[A contribution to bullous emphysema].

Bullous pulmonary emphysema is a disease predominantly occurring uni- or bilaterally in men. While smaller localized bullae in the apex of the upper lobes may be the cause of spontaneous pneumothorax in younger asthenic patients, it may be the cause of fatal situations in older patients by rupture of giant bullae. False diagnosis between partial spontaneous pneumothorax and bullous emphysema are common, even now. The therapy of choice in all patients with bullous emphysema and still sufficient pulmonary function is surgical treatment with taking away the bullae. Only in patients older than 70 years with cardiorespiratory failure a longer lasting drainage therapy seems to be indicated. The results of all cases with bullous emphysema (47) treated in the thoracicosurgical department of the Research Institute for Pulmonary Diseases and Tuberculosis within 27 years are reported.

Adult↗
PubMed1995

Pallid mice with genetic emphysema. Neutrophil elastase burden and elastin loss occur without alteration in the bronchoalveolar lavage cell population.

BACKGROUND: According to a current hypothesis, pulmonary emphysema results from damage to the elastic fiber network caused by an imbalance within the lower respiratory tract between elastase(s) and protease inhibitors. This hypothesis is based largely on studies of persons with genetic deficiency of serum alpha 1-proteinase inhibitor. We recently reported a spontaneously occurring emphysema in the pallid mouse with an inherited deficiency of serum alpha 1-proteinase inhibitor. This animal reproduces important features of the human condition. We describe here the changes in alveolar elastolytic burden and in the bronchoalveolar lavage (BAL) cell population, which precede and accompany the development of emphysema in pallid mice. EXPERIMENTAL DESIGN: A possible correlation between the levels of lung elastase burden and the loss of lung elastin content was investigated in the period of development of emphysema in pallid mice. Changes in alveolar cells were investigated for specimens from BAL fluids and lung tissue by cytologic, histologic, and immunogold-electron microscopic methods. RESULTS: An immunogold-positive reaction for elastase was observed on elastin within the alveolar walls of pallid mice from 2 months onward. The average of gold particle density progressively increased with age, reaching high values at 12 and 16 months of age, the age at which parenchymal destruction was previously reported to occur. Lung elastin content had normal values at 2, 4, and 8 months of age. However, it was significantly lower at 12 and 16 months of age. The immunogold values of elastase burden correlated inversely with the decrease in lung elastin content. Total and differential cell counts from BAL fluids of pallid mice did not differ significantly at any time in life and were similar to age-matched controls. However, in pallid mice from 8 months of life onward, pulmonary macrophages contained characteristic intracytoplasmic crystalloid inclusions, which were electrondense and bounded by a single membrane. Using electron microscopy and an immunogold-labeling technique with anti-mouse I-III collagen IgG, these inclusions were identified as collagen-derived products. CONCLUSIONS: The data reported in this paper suggest that emphysematous lesions in pallid mice are associated with a progressive increase of elastase in alveolar intestitium and with loss of lung elastin. Surprisingly, the number of neutrophils in BAL fluids does not increase with the increase of lung elastolytic burden. However, intracytoplasmic crystalloid inclusions related to collagen degradation were observed in pulmonary macrophages of pallid mice at the time of septal disruption. The presence of similar structures in alveolar macrophages from mice or other animal species may be indicative of connective tissue breakdown or remodeling of tissue collagen.

Animals↗
PubMed1995

Extensive subcutaneous emphysema and hypercapnia during laparoscopic cholecystectomy: two case reports.

We report two cases of marked hypercapnia of more than 60 mm Hg (PaCO2) and extensive subcutaneous emphysema noted during laparoscopic cholecystectomy. The first case, a 55-year-old man was diagnosed as having cholecystolithiasis and had hypercapnia up to 83.5 mm Hg (PaCO2) during laparoscopic cholecystectomy. The patient resumed spontaneous respiration under controlled ventilation accompanied by persistent bigeminal pulse. Soon after deflation, CO2 returned to normal range, and extensive subcutaneous emphysema was detected in the recovery room. The second patient, a 53-year-old woman, had cholecystolithiasis and also underwent laparoscopic cholecystectomy. Both hypercapnia rising to 61.1 mm Hg (PaCO2) and extensive subcutaneous emphysema appeared just before completion of resection of the gallbladder. Mild hypercapnia during pneumoperitoneum of about 50 mm Hg (PaCO2) has been reported previously. As compared with cases in the literature, the present cases suggest that hypercapnia is due to extensive subcutaneous emphysema. The large absorption surface area in the subcutaneous tissue and the large difference in the partial pressure cause the extensive gaseous interchange of CO2 between subcutaneous tissue and blood perfusing into it at the moment between peritoneal cavity and blood perfused the peritoneum.

Carbon Dioxide↗
PubMed1995

[Evaluation of selected factors induced by antioxidative activity in serum of cigarette smokers and in patients with early phase emphysema].

We investigated the concentration of ceruloplasmin (CP), transferrin (T) and metal ions (Cu, Zn) in serum of healthy smokers, emphysema patients and healty non-smoking subjects (control). We observed elevated Cu concentration in smokers and emphysema patients. Elevated CP concentration was observed only in those emphysema patients who smoked cigarettes, but not in healthy smokers. This observation excludes the possibility of compensative CP and Cu increase as the effect of chronic oxidant exposure. Changes in concentration of CP and Cu observed by us are probably due to chronic inflammation of respiratory tract not only of emphysema patients but also of chronic smokers without signs of the disease.

Adult↗
PubMed1994

Survival of paraquat intoxication complicated with mediastinal emphysema: a case report.

Paraquat intoxication is a common medical problem in this country. The mortality is high, particularly in the cases of high dose ingestion. Mediastinal emphysema observed in paraquat intoxication always means mortality, however, we experienced a survivor. A 29 y/o female ingested about 10-15 c.c. of 24% (2.4-3.6 gm) paraquat to attempt suicide. Nausea and protracted vomiting occurred shortly after. During hospitalization, mediastinal emphysema developed on the 7th day and subsided 10 days later. Serum paraquat level determination revealed 185 ng/ml in 20 hours after ingestion and 34 ng/ml on the 6th day. She received general supportive treatments with the augmentation of sodium thiosulfate. Hypokalemia had been observed for 11 days and was intractable until hypomagnesemia was identified and corrected. So far, she had returned back to her work for more than 1 year, although the chest x-ray revealed slight pulmonary fibrosis. The high ingested dose, oral ulcers, high serum level and mediastinal emphysema of this patient all implicate a poor prognosis of paraquat intoxication; however, these contradict the observed survival of our patient. In conclusion, mediastinal emphysema observed in paraquat intoxication is not related to the serum level of paraquat. It does not absolutely lead to death and may simply come from the esophageal rupture after vigorous vomiting in paraquat intoxication.

Adult↗
PubMed1994

Assessment of emphysema using high resolution CT, CT expiratory density mask, and plain chest films.

Pulmonary function tests (diffusing capacity for carbon monoxide of the lungs) and radiological imaging (plain chest film, high resolution computed tomography (CT) and CT expiratory density mask) were compared in the assessment of 29 patients with suspected airways obstruction. Conventional roentgenogram showed a good agreement with the diffusing capacity of the lungs and proved to be useful in predicting the presence of severe emphysema, but the extension of the disease was more precisely assessed by computed tomography. A good agreement was found between high resolution CT and density mask CT, although the "subjective" high resolution identified more patients with mild emphysema than the "automated" density mask. In conclusion, although the plain chest film is useful in the diagnosis of severe emphysema, CT (especially when high resolution is used) is helpful in identifying cases of mild disease and in diagnosing the type of emphysema.

Adult↗
PubMed1994

[A case of mediastinal emphysema due to blunt trauma that a continuous drainage to the extrapleural space took effect].

A 70-year-old male was admitted to our hospital with chest bruise, resulting in fracture of the right rib. Nine hours later, the patient came to use again with a chief complaint of dyspnea and chest oppression. He had extensive subcutaneous emphysema in the upper half of the body. Chest X-ray films revealed remarkable mediastinal emphysema and collapse in a part of right lung. Chest CT scan disclosed enlargement of extrapleural cavity. These findings suggested progression of mediastinal emphysema. Continuous drainage to the extrapleural cavity was performed and the clinical course was uneventful. Thus, a satisfactory result can be obtained by extrapleural drainage in a patient with severe mediastinal emphysema.

Aged↗
PubMed1996

Tobacco smoke and age as risk factors in emphysema. Morphometrical study on the rat.

During ageing, a progressive deterioration in the pulmonary function, which can be accelerated by exposure to tobacco smoke, takes place. The hypothesis that the initial age of exposure to tobacco smoke is a factor of utmost importance in the development of emphysema is proposed. Eighty-six rats, aged nineteen months at the time of sacrifice, were used and were ordered into three groups: the first group consisted of unmanipulated animals; the second, of animals which had been exposed to tobacco smoke from the age of twelve months to the age of nineteen months; and the third, of animals which had been exposed to tobacco smoke from the age of nine months to the age of twelve months. The lungs of the animals were histologically processed for light microscopy and were studied morphometrically by computer. Eleven quantitative variables were quantified and ordered into three groups: variables related with alveolar enlargement; variables related with tissue loss; and variables related with the elastic fibre. The number of animals in which alveolar enlargement and tissue destruction concurred was counted, thus enabling the attributable and relative risks of developing emphysema to be calculated in the two groups of manipulated animals. From the results it is clear that, when compared with the unmanipulated group, the two groups which had been exposed to tobacco smoke displayed an increase in the variables which quantified alveolar enlargement and a decrease in those which measured tissue loss; these results were more significant in the third group (p < 0.001) than in the second (p < 0.05); significant differences were also found between these two groups of animals. The relative risk and attributable risks of developing emphysema were 2.41 and 28.15 respectively in the second group and 3.48 and 34.48 in the third group. Our results lead us to propose that the risk of developing emphysema exists in inverse proportion to the initial age of exposure to tobacco smoke.

Aging↗
PubMed1996

Single lung transplantation followed by contralateral bullectomy for bullous emphysema.

BACKGROUND AND METHODS: Single lung transplantation for emphysema is now standard practice despite initial concerns, including the possibility that the compliant diseased lung would compress the transplanted lung as a result of hyperinflation. We describe a patient with severe bilateral bullous emphysema and alpha-1-antitrypsin deficiency who underwent single lung transplantation after which hyperinflation of the native lung led to significant compression of the pulmonary allograft. The patient subsequently underwent bullectomy of the contralateral lung with marked improvement in his functional status. RESULTS: After bullectomy, the patient's forced expiratory volume in 1 second increased from 1.77 to 2.82 L, his total lung capacity fell from 7.23 to 6.19 L, and his 6-minute walk increased from 724 to 1269 feet. However, 7 months after bullectomy, there was evidence that the bullous disease in the native lung was recurring. CONCLUSIONS: Significant hyperinflation of the native lung with compromise of the pulmonary allograft can occur after single lung transplantation for bullous emphysema. Bullectomy of the diseased lung after transplantation improved allograft function in our patient. Alternatively, bilateral lung transplantation for severe bilateral bullous emphysema may be considered.

Humans↗
PubMed1996

Retroperitoneal and abdominal wall emphysema after transanal excision of a rectal carcinoma.

The use of transanal excision to remove rectal carcinomas is a relatively new application of this surgical procedure, which may require full thickness excision. Retroperitoneal and abdominal wall emphysema are potential complications of surgical procedures that breach the wall of the colon and rectum. Computed tomographic scans provide the clearest diagnostic picture of developing emphysema, and prompt diagnosis through accurate interpretation of the scans is essential to minimize morbidity and mortality. When the diagnosis is made early and no active infection accompanies the emphysema, the preferred approach to initial treatment is nonsurgical. This article presents a case in which local transanal excision was performed on a 70-year-old male to remove a superficial adenocarcinoma from the lower rectal wall. He developed postoperative retroperitoneal and abdominal wall emphysema. Conservative treatment is discussed.

Abdominal Muscles↗
PubMed1996

Cigarette smoke-induced emphysema in guinea pigs is associated with diffusely decreased capillary density and capillary narrowing.

There is little information about whether alveolar capillaries are altered in emphysema. To examine this question, we used scanning electron microscopic morphometry of microvascular corrosion casts to evaluate capillary structure in a guinea pig model of cigarette smoke-induced emphysema. After 6 months, the mean airspace size in the smoke-exposed animals was 157 +/- 31 microns and 106 +/- 11 microns (p < 0.001) in the control (air-exposed) animals. Because previous results from our laboratory had shown differences in size and density between central and peripheral capillaries in normal guinea pigs, these two areas were sampled separately in the present study. Capillaries in the emphysematous animals were narrowed compared with those in the control animals in both the center (mean diameter, 7.51 +/- 1.95 versus 8.93 +/- 2.01 microns, p < 0.001) and periphery (mean diameter, 8.52 +/- 2.13 versus 10.15 +/- 2.16 microns, p < 0.001) of the lobule. Smoke-exposed animals had a decreased capillary density in both the center (0.73 +/- 0.06 versus 0.79 +/- 0.05, p < 0.001) and periphery (0.77 +/- 0.07 versus 0.84 +/- 0.04, p < 0.001) of the lobule. We conclude that cigarette smoke-induced emphysema is associated with a diffuse and relatively uniform narrowing of capillaries with loss of capillary density throughout the lung. These findings may reflect diffuse smoke-induced abnormalities in the alveolar wall matrix with stretching of capillaries over enlarged airspaces and may partially explain the alteration of ventilation perfusion distribution in cigarette smoke-induced emphysema.

Animals↗
PubMed1996

[Mediastinal emphysema].

18 patients have been treated in our department for mediastinal emphysema (ME) during last 15 years. Small degree ME was found in 5 cases medium degree ME in 6 cases and in 5 patients tension emphysema was noted. Small degree ME was caused by abdominal and thyroid gland surgery, middle degree ME was recognized after surgical treatment of the mediastinal tumors or after mediastinal traumas. Tension emphysema of the mediastinum was observed in patients artificially ventilated, after blunt chest injuries or in the course of pneumonia. Sometimes it was impossible to establish the cause of ME. Tension emphysema of the mediastinum was usually life-threatening and required decompression.

Adolescent↗
PubMed1996

[Evaluation of emphysema progression as measured by computed tomography in patients with chronic obstructive pulmonary disease].

It has been difficult to assess the progression of pulmonary emphysema since accurate quantification of the extent of this condition has only previously been possible on post mortem or resected lungs. Previously we have shown that measurements of CT lung density correlated with the degree of emphysema, measured morphometrically in resected lungs. We have therefore employed this technique to assess the progression of emphysema in 17 patients (12M, 5F) with wide range of chronic airflow limitation (FEV1 15-68% predicted). There was little change in the degree of airflow limitation, hyperinflation or arterial blood gas values over 30 +/- 4 months of follow up (p > 0.05). However during this period there was a significant decrease in the lowest 5th percentile of CT density, which fell from -920 +/- 32 to -940 +/- 36 Hounsfield units (p < 0.005) associated with significant fall in the diffusing capacity for carbon monoxide. We believe that these data show the ability of CT scanning to assess the progression of emphysema in patients with chronic obstructive pulmonary disease.

Aged↗
PubMedDate not supplied

Thoracoscopic lung volume reduction surgery for emphysema.

Resection of large bullae to decompress adjacent lung tissue with the goal of improving pulmonary function has been an accepted surgical approach for many years. However, the indication for lung volume reduction is not bullous disease but diffuse emphysema and the surgical approach is based on an entirely different concept. The resection of the most affected parts of the emphysematous parenchyma aims at a reduction of the over expansion of the chest with the goal of improving respiratory mechanics. This concept was introduced by Brantigan in 1959, but has failed to gain widespread acceptance until recently. Based on the extensive experience in lung transplantation for patients with end stage emphysema J. D. Cooper reevaluated the idea successfully. He reported remarkable improvements in FEV1 and a reduction in hyperinflation after performing bilateral lung volume reduction through a median sternotomy. During the last 2 years we performed bilateral lung volume reduction in more than 30 patients with diffuse emphysema using video assisted thoracoscopy (VAT) and studied the results prospectively. In the first 20 patients preoperative mean forced expiratory volume in 1 second (FEV1) was 765 ml/sec and improved by a mean of 42% (0-100%) three months postoperatively. This gain in FEV1 was already observed at the end of hospitalisation approximately two weeks after surgery. The 12 minute walking distance improved over 40%. In our highly selected study population we had no perioperative mortality. Lung volume reduction is a palliative treatment of severe pulmonary emphysema. Currently no data is available on the duration of the improvement. In this selected group of patients dyspnea is reduced and pulmonary mechanics are improved, with a resulting increase in quality of life.

Adult↗
PubMed1997

Assessment of the severity of pulmonary emphysema by computed tomography.

Pulmonary emphysema is defined as an abnormal enlargement of alveolar spaces distal to the terminal bronchioles, with alveolar wall disruption and without obvious fibrosis. Clinico-functional evaluation and chest radiographic diagnosis are not highly accurate in detecting emphysema and in establishing the extent of the process of alveolar destruction. Several computed tomography (CT) techniques are now available for detection and quantitative assessment of emphysema. The results appear to correlate significantly better than chest radiography with functional impairment and pathological score. Many options have been proposed by different authors regarding CT technique. The choice, however, is essentially between inspiratory high resolution CT (HRCT) with a visual scoring system, and automated quantitative evaluation by means of a "density mask" (DM) program. This paper presents the state of the art on CT quantification of pulmonary emphysema and briefly discusses the technical options and parameters to be used, together with the problems to be solved.

Humans↗
PubMed1997

[Six patients in whom exacerbation of asthma was complicated by mediastinal emphysema].

We encountered 6 patients with bronchial asthma complicated by mediastinal emphysema. Their average age was 21 years. All were atopic and had histories of asthma in childhood. In 5 of the 6, mediastinal emphysema developed when the patients had upper respiratory infections. In 3, the mediastinal emphysema worsened. After insertion of subcutaneous drains to decrease intramediastinal pressure, the conditions of those 3 patients improved remarkably. The conditions of the other 3 improved after medication only. During the period of this study, 1.24% of all patients treated at Hiroshima Asa Citizen's Hospital for exacerbations of asthma had mediastinal emphysema.

Adolescent↗