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PubMedDate not supplied

[Spontaneous cervical and mediastinal emphysema].

Cervical emphysema may have its origin in multiple causes. The continuity of the fascial planes connecting the soft tissues of the neck to the mediatinum and retroperitoneum enables the "aberrant air" localized in one of these three areas to spread to the other ones. The otolaryngologist must know the differential diagnosis of the presence of air in the neck, since the ultimate treatment to be given will depend on the etiology involved. We present two clinical cases of cervical emphysema secondary to spontaneous pneumomediastinum. One of the cases is idiopathic while the other one is associated with diabetic ketoacidosis. We analyze this and other causes that can give rise to cervical emphysema.

Adult↗
PubMed1996

Subcutaneous emphysema in a neonatal foal.

A 16-hour-old foal was examined because of subcutaneous emphysema, which began developing 3 hours after a routine delivery. Physical examination did not reveal soft-tissue or musculoskeletal trauma, and there were no skin injuries to explain the subcutaneous accumulation of air. Results of CBC and serum biochemical analysis were within reference limits, and findings on endoscopy of the pharyngeal area, trachea, and esophagus were within normal limits other than observation of dorsal pharyngeal compression. A pulmonary bulla, pneumomediastinum, and pneumothorax were detected on thoracic radiography. Because of the apparent association of the subcutaneous emphysema and thoracic abnormalities, a diagnosis of primary subcutaneous emphysema was made. A tracheostomy tube was placed to facilitate ventilation and to provide an exit point for the trapped air. Supportive care was provided. The foal's condition resolved over the subsequent 8 days.

Airway Obstruction↗
PubMed2003

Association of emphysema, gout, and inflammatory markers with long-term incidence of age-related maculopathy.

OBJECTIVE: To examine the relationship of 2 diseases associated with systemic inflammatory response, emphysema and gout, and selected markers of systemic inflammation with the 10-year incidence of age-related maculopathy. DESIGN: Population-based cohort study. PARTICIPANTS: We included persons aged 43 to 86 years at baseline examination from 1988 to 1990 living in Beaver Dam, Wis, of whom 3684 subjects participated in a 5-year follow-up examination and 2764 participated in a 10-year follow-up. METHODS: Standardized protocols for physical examination, blood collection, administration of a questionnaire, and stereoscopic color fundus photography to determine the presence of age-related maculopathy. Standard univariate and multivariate analyses were performed. MAIN OUTCOME MEASURES: Incidence and progression of age-related maculopathy. RESULTS: While controlling for age, sex, and other factors (history of heavy drinking or smoking, systolic blood pressure, and vitamin use), a higher white blood cell count at baseline was associated with the 10-year incidence of drusen 125 microm or greater in diameter (risk ratio [RR] per 10(6)/ microL = 1.10; 95% confidence interval [CI], 1.03-1.17), retinal pigment epithelial depigmentation (RR = 2.08; 95% CI, 1.01-1.16), and progression of age-related maculopathy (RR = 1.09; 95% CI, 1.03-1.15). A lower serum albumin level was associated with the incidence of exudative macular degeneration (RR per grams per deciliter = 0.31; 95% CI, 0.13-0.76). A history of emphysema at baseline was associated with the incidence of retinal pigment epithelial depigmentation (RR = 2.84; 95% CI, 1.40-5.78), increased retinal pigment (RR = 2.20; 95% CI, 1.11-4.35), and exudative macular degeneration (RR = 5.12; 95% CI, 1.63-16.06); a history of gout was associated with the incidence of pure geographic atrophy (RR = 3.48; 95% CI, 1.27-9.53). CONCLUSIONS: These findings indicate modest relationships between both increased white blood cell count and emphysema and the increased 10-year incidence of lesions defining early and late age-related maculopathy. Further investigation of these relationships in other studies is needed.

Adult↗
PubMed1999

Pulmonary dysfunction in silica-exposed workers: a relationship to radiographic signs of silicosis and emphysema.

BACKGROUND: It has been established that occupational exposure to silica dust may cause significant impairment of pulmonary function. To compare the contribution of silicosis and emphysema to pulmonary dysfunction, radiographic signs of silicosis and emphysema in silica exposed workers were analyzed. METHODS: Two hundred and twenty workers exposed to silica working in a Chinese refractory plant were selected as study subjects. Their findings of silicosis and emphysematous changes on radiograph were classified and evaluated. A questionnaire on respiratory symptoms, smoking, and occupational history was administered. All the workers performed measurements of spirometry and CO single-breath diffusing capacity. RESULTS: Radiographic hyperinflation was detected in 9% of the workers without silicosis and in 33% of the workers with silicosis. Silicosis was significantly associated with hyperinflation after adjusting for exposure duration, age, and smoking. Respiratory symptoms were more frequent in the more severe cases of silicosis. Regression analysis showed that silicosis was significantly associated with decreases in the parameters of pulmonary function, but the significance disappeared when the hyperinflation term was added to the models. Radiographic hyperinflation was strongly associated with decreases in FEV1 and FEV1/FVC while relevant factors were controlled. Comparison between workers with and without hyperinflation showed that the former had significantly lower pulmonary function values. CONCLUSIONS: The results suggest that emphysema associated with silicosis is likely to be responsible for pulmonary obstruction and decreased diffusing capacity occurring in silica-exposed workers.

Adult↗
PubMed1999

Impaired respiratory mechanics in pulmonary emphysema: evaluation with dynamic breathing MRI.

To evaluate impaired respiratory mechanics in pulmonary emphysema, dynamic breathing magnetic resonance imaging (BMRI) was acquired with fast-gradient echo pulse sequences at fixed thoracic planes over two to three slow, deep respiratory cycles in 6 controls and 28 patients with pulmonary emphysema including 9 patients undergoing lung volume reduction surgery (LVRS). Respiratory motions of the diaphragm and chest wall (D/CW) were assessed by a cine-loop view, a fusion display of maximal inspiratory and expiratory images, and the time-distance curves. By contrast with normal subjects with regular synchronous D/CW motions, the patients frequently showed reduced, irregular, or asynchronous motions, with significant decreases in the maximal amplitude of D/CW motions (MAD and MACW), and the length of apposition of the diaphragm (LAD) (P < 0.0001, P < 0.001, P < 0. 01, respectively). After LVRS, nine patients showed improvements in D/CW configuration and mobility, with significantly increased MAD, MACW, and LAD (P < 0.01, P < 0.0001, and P < 0.05, respectively). In 40 studies of 28 patients including the post-LVRS examinations, the normalized MAD and MACW significantly correlated with %FEV(1) (r = 0. 881 and r = 0.906; P < 0.0001, respectively). BMRI seems useful for noninvasively and directly assessing the impaired respiratory mechanics associated with abnormal ventilation in pulmonary emphysema, and also for monitoring the effects of LVRS. J. Magn. Reson. Imaging 1999;10:510-520.

Aged↗
PubMed2005

Severe bilateral panlobular emphysema and pulmonary arterial hypoplasia: unusual manifestations of Menkes disease.

Menkes disease is an X-linked recessive disorder of copper transport characterized by neurological deterioration, connective tissue, and vascular defects, abnormal hair, and death in early childhood. We report on a patient with Menkes disease in whom severe diffuse emphysema caused respiratory failure and death at 14 months of age. He had severe growth and developmental delays and other typical clinical manifestations of Menkes disease. He developed respiratory problems requiring continuous supplemental oxygen and a progressively enlarging soft tissue mass appeared on the neck. Imaging studies revealed cystic spaces in multiple lobes of the lung consistent with bullous emphysema. The neck mass was determined to be an internal jugular venous aneurysm. At autopsy, extensive emphysematous change was evident. Post-mortem barium injections of the pulmonary arterial system revealed marked dilatation and tortuosity of the preacinar pulmonary arteries and reduced numbers of intra-acinar arteries. Severe emphysema, presumably caused by abnormal elastin due to deficiency of the copper-dependent enzyme lysyl oxidase, may represent an underestimated clinical complication of Menkes disease and should be considered in the differential diagnosis of chronic respiratory disease in these patients.

Adenosine Triphosphatases↗
PubMed1976

The cross sectional area of diaphragmatic muscle fibres in emphysema, measured by an automated image analysis system.

The cross-sectional area of diaphragmatic muscle fibres was measured using a Quantimet 720 image analysis system in 18 patients with emphysema and six control non-emphysematous patients. The technique proved to be an accurate method of measuring muscle fibre area and much more rapid than the previously described methods. The mean cross-sectional area of the muscle fibres in the emphysematous group was 1069-5 mum2 and this was significantly greater than the mean of the control group which was 851-0 mum2. In the emphysematous group nine patients who died from chronic airways obstruction had a larger mean muscle fibre area than the nine patients with non-fatal respiratory disease. The emphysematous patients showed a marked increase in the number of very large muscle fibres (2000-2200 mum2) in the diaphrahm and also an increased variation in size from fibre to fibre. The increase in muscle fibre size showed a positive correlation with ventricular weight but not with the amount of emphysema in the lungs. It would appear that although the excursion of the diaphragm is reduced in emphysema the muscle fibres do not atrophy but in fact undergo work hypertrophy. This is presumably due to the horizontal shortening of the muscle fibres, when the diaphragm is working at a poor mechanical advantage, because it cannot descend normally in emphysematous patients.

Adolescent↗
PubMed1994

Cardiac collagen changes during the development of right ventricular hypertrophy in tight-skin mice with emphysema.

The tight-skin (Tsk) mouse is a genetic model of pulmonary emphysema. In this mouse, right ventricular hypertrophy (RVH) starts to develop at approximately 8 months of age, probably as a consequence of the emphysema. The aim of the present study was to investigate cardiac collagen synthesis, content, and types both before and during the development of RVH. Collagen synthesis, assessed by the [3H]proline incorporation method, was significantly increased in the right ventricle of 3-month-old Tsk mice. This was accompanied by a marked increase in right ventricle collagen content. Collagen typing showed no difference from controls. At 8 months of age collagen synthesis had returned to control values, right ventricular collagen content was elevated but held lower values than at 3 months, and collagen typing showed a prevalence of the more compliant type III. By 16 months of age, right ventricular collagen content had returned to control values and there was a shift in collagen types due to a relative increase of the more rigid type I. At 24 months of age right ventricular collagen content was increased again and collagen type I continued to predominate. These results suggest a dynamic role for collagen both before and during the development of RVH secondary to emphysema.

Animals↗
PubMed1993

Potency of an oxidation-resistant mutant of secretory leukocyte proteinase inhibitor in lipopolysaccharide-induced emphysema in hamsters.

Secretory leukocyte inhibitor (SLPI) is a potent inhibitor of serine proteinases, but sensitive to oxidative inactivation due to a methionine residue in the active centre of the inhibitor. We compared the potency of an oxidation-resistant mutant of recombinant SLPI with native recombinant SLPI in lipopolysaccharide (LPS)-induced emphysema in the hamster. Application of this oxidation-resistant mutant reduced the induced emphysema by 70 and 85% in two separate series of experiments. In contrast, an equal amount of native rSLPI resulted in significantly lower inhibition, 30 and 23%, respectively (P = 0.002). To demonstrate the effect of oxygen radicals upon a single LPS instillation in the lungs, we measured anti-neutrophil elastase activity in lung lavage fluid at 10 and 24 h after the instillation of a mixture of LPS and native rSLPI. We found that residual native rSLPI was only 70 and 55% active, respectively. The rSLPI-mutant remained 93% active in a similar experiment. The native and mutant inhibitor showed equal potency against proteinases in a granule extract of hamster neutrophils. We conclude that the replacement of methionine by leucine in the inhibitory centre of rSLPI results in a decreased sensitivity to oxidative inactivation and that this alone is sufficient to explain the greater efficiency of the rSLPI-mutant in reducing the extent of LPS-induced emphysema.

Animals↗
PubMed1995

Mild emphysema: a novel method using formalin-fixed lungs for computed tomography and pathological analyses.

We evaluated a novel method of computed tomography (CT) analysis using formalin-fixed lungs of autopsy cases with mild emphysema. Eight formalin-inflated lungs (FILs) obtained at autopsy were examined using CT after draining off the formalin and air inflation with an air pump, and subjected to pathological study including pathological scoring of emphysema and microscopic image analysis (MIA). Satisfactory CT examination was carried out within 5 h of lung fixation. The mean alveolar area determined by MIA correlated highly with the lung volume (r = 0.845) and CT score (r = 0.722). This method is simple compared with conventional polyethylene glycol fixation for CT and enables CT examination of resected lungs without anxiety about biohazards, Mild emphysema can be detected by MIA.

Aged↗
PubMed1989

Single breath N2 washout in papain-induced pulmonary emphysema.

Single breath nitrogen washout tests were analyzed in dogs (n = 8) with healthy lungs and after development of emphysema. The animals were in the supine position and studied during anaesthesia and mechanical ventilation (FiO2 = 0.4, FiN2 = 0.6). During controlled expiration with constant flow (VE = 0.15 l/s) onset of phase IV of the alveolar plateau was related to airway closure of dependent lung regions (closing volume CV). In the control state, CV accounted for 6.2 +/- 1.5% VC, and closing capacity (CC) was lower than functional residual capacity (FRC). Likewise, gas exchange was normal in all animals (PaO2 = 24.7 +/- 3.32 kPa, PaCO2 = 5.18 +/- 0.53 kPa, PA-aO2 = 2.6 +/- 0.3 kPa). Panlobular emphysema (PLE) was induced by inhalation of papain (100 mg/kg). After three weeks development of PLE was documented by measurements of lung volumes (functional residual capacity (FRC), expired vital capacity (EVC), total lung capacity (TLC), residual volume (RV], pulmonary mechanics (dynamic and static compliance (Cdyn, Cstat), mean airway resistance (Raw], gas exchange (PaO2, PaCO2, PA-aO2), and by radiomorphological analysis. In the PLE-group, FRC and RV (p less than or equal to 0.05), and Cstat (p less than or equal to 0.01) were significantly elevated. CV increased to 16.2 +/- 2.7% VC (p less than or equal to 0.01) and CC exceeded FRC by 80 ml, indicating that tidal volume breathing took place within the range of closing volume. Oxygenation was significantly impaired (PaO2 = 18.6 +/- 3.72 kPa, PA-aO2 = 6.5 +/- 1.1 kPa, p less than or equal to 0.05), but not CO2-elimination. Pathological analysis by radiomorphological means showed dissiminate parenchymal lesions compatible with emphysema of grade II severity located predominantly in subpleural areas. In dogs with papain-induced PLE, premature closure of dependent airways is enhanced, which is due to structural changes and a loss of elastic recoil in the lungs.

Animals↗
PubMed1984

Mediastinal emphysema simulating acute pericarditis.

A case of extensive subcutaneous emphysema, retropneumoperitoneum and mediastinal emphysema is described. The mediastinal emphysema was associated with signs and symptoms of pericardial tamponade, and previously undocumented ECG changes, consistent with acute pericarditis, were noted.

Acute Disease↗
PubMed1983

Multidimensional analysis of the symptoms of chronic bronchitis and emphysema.

Subjective symptoms and experiences were explored within a group of 146 severe, chronic bronchitis and emphysema patients. Eighty-nine symptoms and experiences, derived from initial interviews with 29 patients, were rated according to the frequency of occurrence during breathing difficulties. Key cluster analyses were used to derive a Bronchitis-Emphysema Symptom Checklist (BESC) measuring 11 symptom categories: Helplessness-Hopelessness, Decathexis, Fatigue, Poor Memory, Peripheral-Sensory Complaints, Dyspnea, Congestion, Sleep Difficulties, Irritability, Anxiety, and Alienation. The BESC symptom categories are highly reliable and the relationships among categories are stable across two subgroups of patients. The BESC provides one way to describe how patients cope with and experience chronic bronchitis and emphysema.

Adaptation, Psychological↗
PubMed1980

The value of cardiac catheterization and cineangiography in infantile lobar emphysema.

Lobar emphysema is an uncommon cause of respiratory distress in infancy. Congenital heart disease is seen in about 20% of the patients with infantile (congenital) lobar emphysema. We described six infants with lobar emphysema. In three of them a congenital heart disease was demonstrated by cardiac catheterization and cineangiography; two had a tetralogy of Fallot with right aortic arch and the third infant a ventricular septal defect. The pulmonary angiography showed stretching of the arteries with very poor filling of the peripheral arteries and a characteristic smaller pulmonary vein in the affected lobe. In all the six patients the pulmonary artery pressure was normal. All the patients underwent lobectomy with good results. We feel that a preoperative cardiac catheterization and cineangiography is of value in this very sick group of infants.

Cardiac Catheterization↗
PubMed1984

Spontaneous occurrence of localized pulmonary interstitial and endolymphatic emphysema in infancy.

Two infants are described with persistent pulmonary interstitial and endolymphatic emphysema of the localized, bullous type, occurring apparently spontaneously. Roentgenographically, the process simulated congenital lobar emphysema in the first patient and bilateral post-infectious pneumatoceles in the second. The histologic features of the lesion were identical to those seen in localized pulmonary interstitial emphysema caused by positive pressure ventilation in newborns with hyaline membrane disease.

Female↗
PubMed1979

[Clinical-functional emphysema diagnostics and immunological correlations (author's transl)].

By application of the correlation flow resistance/intrathoracic gas volume the lung emphysema is differentiated in quality within the scope of chronic obstructive lung diseases. For these groups immunoglobulins, the alpha1-trypsin activity in serum and the activity of further protease inhibitors were determined. There are no substantial variables in the different groups with regard to immunoglobulins. In the emphysema group alpha1-antitrypsin was a little reduced. This group included 2 patients with an alpha1-antitrypsin deficit. The two-dimensional separation of the inter-alpha-trypsin big inhibitor shows 3 areas which decrease significantly in case of severe emphysemata. The irritation of the inter-alpha-trypsin big inhibitor, i.e. in its turnover, parallel to the increasing degree of emphysema formation, is discussed.

Adult↗
PubMed1990

Risk factors for fatal pulmonary interstitial emphysema in neonates.

Among 315 infants treated for respiratory distress syndrome (RDS) over a 2 year period, 32 prematures were studied retrospectively with the diagnosis of pulmonary interstitial emphysema (PIE). Eighteen died. In this group, birth weight below 1600 g, need for oxygen above 0.6 on the 1st day and appearance of bilateral pulmonary interstitial emphysema within the first 48 h of life were significant risk factors, with a mortality rate of 94%. In order to recognize one or more early criteria predictive of fatal PIE, we compared ventilation parameters on day 1 between neonates with fatal PIE and those with the same birth weight and initial severity of RDS but without PIE treated during the same period. High positive inspiratory pressure on day 1 was found to be the most significant parameter associated with further appearance of fatal pulmonary interstitial emphysema. A cut-off level of 26 cm H2O was found to be discriminant. These criteria may be useful in selecting those neonates who might best benefit from a new therapy such as high frequency ventilation, before irreversible lesions appear.

Birth Weight↗
PubMed1999

Correlation of unilateral thoracoscopic lung volume reduction with improvement in lung function and exercise performance in patients with severe pulmonary emphysema.

This study was conducted to investigate the correlation of thoracoscopic lung volume reduction to changes in pulmonary function and exercise performance in patients with pulmonary emphysema. Unilateral thoracoscopic lung volume reduction treatment was performed in 30 patients with severe pulmonary emphysema. If large bullae were present, they were excised using an endoscopic stapling device, and the emphysematous pleura was contracted by neodymium:yttrium-aluminium-garnet laser to reduce the volume of nonfunctional lung air space. Pulmonary function and incremental exercise tests were performed before and at least 3 months after treatment. Follow-up functional evaluation showed a highly significant improvement in the forced expiratory volume in 1s (FEV1), forced vital capacity, static compliance, and maximal oxygen uptake. The functional residual capacity as measured by the gas dilution method (FRCgas), was unchanged; however, it was found to be decreased significantly when measured by body plethysmograph (FRCbox). Positive correlations existed between the reduction in FRCbox and the increase in FEV1 (r = 0.586, P = 0.0042) and maximal oxygen uptake (r = 0.550, P = 0.018). Pulmonary ventilation and exercise ability in patients with pulmonary emphysema were improved in a volume-dependent manner by thoracoscopic lung volume reduction. These findings indicate that patients with a preoperative trapped gas volume level exceeding 11 would be ideal candidates for thoracoscopic lung volume reduction.

Aged↗