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At least 91 records · Page 5Linked to original sources
PubMed2003

Efficacy of thoracoscopic lung biopsy in interstitial lung diseases: comparison with open lung biopsy.

OBJECTIVE: To determine the efficacy of video-assisted thoracoscopic surgery (VATS) compared to open lung biopsy. DESIGN: Descriptive, observational case series. PLACE AND DURATION OF STUDY: The Cardio-thoracic Centre, Liverpool, UK, from January 1995 to December 1999. PATIENTS AND METHODS: One hundred consecutive patients, undergoing lung biopsy for interstitial lung disease during this period, were included in the study. Thirty patients underwent open lung biopsy, while 70 patients had VATS lung biopsy. Patient characteristics, site, size, number and laterality of biopsy, complications, morbidity, mortality and diagnostic yield was compared. P-value was determined to assess significance of findings. Statistical analysis was performed on SAS for windows version 8. RESULTS: Seventy-five percent had diagnostic yield in VATS group, while 37% in open group (p=0.04). Mean FEV1 was 3.2 litre in VATS group and 1.92 litre in open group (p=0.05). Right side was selected in 58.6% in VATS group and 36.7% in open group (p =0.04). Right lower lobe was the main site for biopsy in the VATS group compared to open group (18.6% versus 3.3%, p=0.04). Mean volume of biopsy was 15.6 cm3 in VATS group and 12.5 cm3 in open group (p=0.04). Two or more biopsies were carried out in 37.1% of the VATS group compared to 16.7% of the open group (p=0.04). Chest drain duration was in 1 day in VATS group compared to 2 days in open group (p=0.01). Length of stay was 3 days in VATS group and 4 days in open group (p=0.003). CONCLUSION: Patients undergoing thoracoscopic lung biopsy had a significantly reduced chest drain duration and post-operative length of stay. Thoracoscopic lung biopsy is beneficial in determining a diagnostic yield with an advantage of greater volume and selection of biopsy sites.

Adult↗
PubMed1983

LTA: a human lung tumor-associated antigen common to primary lung tumors and cultured lung tumor cell lines.

A human lung tumor-associated antigen (LTA) previously purified from a primary lung tumor has been identified in the sera of lung cancer patients. Frequencies of LTA elevations in lung cancer were: adenocarcinoma, 60%; squamous cell carcinoma, 42%; large cell carcinoma, 17%; and small cell carcinoma, 19%; normals, 2%; benign lung disease, 0%; and non-lung malignancies, 13%. The antigen was also shown to be produced by seven of the eight human lung tumor cell lines that were examined. A preliminary small-scale purification was attempted on an extract from one of these lines, ChaGo, which yielded a smaller and more basic form of LTA but which possessed similar, if not identical, antigenic activities as primary tumor LTA.

Antigens, Neoplasm↗
PubMed1996

Neutrophil recruitment into the lungs is associated with increased lung elastase burden, decreased lung elastin, and emphysema in alpha 1 proteinase inhibitor-deficient mice.

The possibility that polymorphonuclear leukocytes (PMN) recruited into the lung have the capability to damage alveolar septa was investigated in several strains of mice with different serum alpha 1 proteinase inhibitor levels and PMN lysosomal functions. After an intratracheal instillation of FMLP (200 micrograms), all strains of mice showed a similar PMN influx in alveolar spaces with an increase (approximately 4- to 5-fold) in bronchoalveolar lavage total cell count, which peaked at 24 to 48 hours. At this time, differential cell count in all strains revealed an approximately 40-fold increase in neutrophils. In C57BL/6J and pallid mice but not in NMRI mice, PMN influx was followed by a decrease in lung elastin content (-17% and -37%, respectively) and by the development of significant emphysema (mean linear intercept, +28% and +56%, respectively). The onset of the pulmonary lesion was preceded by a marked increase of neutrophil elastase burden in alveolar interstitium. Compared with NMRI mice, C57BL/6J and pallid mice have lower serum elastase inhibitory capacity levels. The degree of lung destruction was inversely correlated with elastase inhibitory capacity levels. Lung elastin degradation and emphysema may be induced by eliciting PMN into the lungs only in animals with a deficient anti-elastase screen. Compared with C57BL/6J mice, pallid mice showed a significantly greater lung elastin loss and a higher degree of emphysema after FMLP treatment. These differences may be accounted for by the higher baseline levels of interstitial elastase burden. It may be assumed that an enzymatically active elastase was already working on the lung interstitium before FMLP instillation in pallid mice.

Animals↗
PubMed1994

Reactivity of lung tumors with lung-derived and non-lung-derived monoclonal antibodies.

The reactivity of 74 lung-derived monoclonal antibodies (MAbs) provided by the Third International Workshop on Lung Tumor Antigens and of 41 non-lung-derived commercially available MAbs against sections of 15 lung tumors of various histologic types was investigated by immunohistochemistry. Three MAbs with specificity for human neural-cell adhesion molecule (H-NCAM) and 3 MAbs with specificity for small-cell lung carcinoma (SCLC) were able to distinguish between neuro-endocrine (NE) and non-NE tumors. Fifteen MAbs stained non-small-cell carcinomas (NSCLC) but not SCLC. Neuron-specific enolase (NSE) stained all NE tumors but also some of the non-NE tumors. Two MAbs showed specificity for mesotheliomas. Carcino-embryonic MAb strongly stained all SCLC and NSCLC. Among MAbs with lymphoid-cell specificities, Leu 7 (CD57) stained SCLC, but not NSCLC. LN2 (CD45R), LN3 (HLA-DR), Leu 22 (CD43) and BLA 36 reacted with NSCLC and were non-reactive with SCLC. Some of the lung-derived MAbs showed immune staining of lymphoma and melanoma.

Antibodies, Monoclonal↗
PubMed1998

Aerosol bolus dispersion in patients with bronchiolitis obliterans after heart-lung and double-lung transplantation. The Munich Lung Transplantation Group.

Bronchiolitis obliterans (BO) is one of the main late complications in patients after lung transplantation. Because BO is located in small airways, conventional lung function tests are supposed to be rather insensitive to detect early stages of this disease. In this study, the capability of the aerosol bolus dispersion test to detect BO was tested in 12 subjects with heart-lung and double-lung transplantation. Four of these patients had histological evidence of BO. The broadening (dispersion) of inhaled boluses consisting of monodispersed inert test particles during respiration was repeatedly measured in each subject. Additional measurements of spirometric and bodyplethysmographic measurements were performed. Patients with evidence of BO showed significantly increased aerosol bolus dispersion and significantly reduced maximal airflow parameters. Calculation of receiver operating characteristics (ROCs) revealed that from all lung function parameters under consideration, aerosol bolus dispersion divided by the maximum expiratory flow rate at 50% of vital capacity (MEF50) and MEI50 had the highest sensitivity and specificity for the detection of BO. Both parameters showed a sensitivity and specificity of 100%. Therefore, it may be speculated that even in early stages of disease, the combination of MEF50 measurement with aerosol bolus dispersion measurements may be a powerful tool for the detection of BO in patients with lung transplantation.

Adolescent↗
PubMed1991

Aerosol-derived lung morphometry: comparisons with a lung model and lung function indexes.

This study evaluated the ability of aerosol-derived lung morphometry to noninvasively probe airway and acinar dimensions. Effective air-space diameters (EAD) were calculated from the time-dependent gravitational losses of 1-microns particles from inhaled aerosol boluses during breath holding. In 17 males [33 +/- 7 (SD) yr] the relationship between EAD and volumetric penetration of the bolus into the lungs (Vp) could be expressed by the linear power-law function, log (EAD) alpha beta log (Vp). Our EAD values were consistent with Weibel's symmetric lung model A for small airways and more distal air spaces. As lung volume increased from 57 to 87% of total lung capacity (TLC), EAD at Vp of 160 and 550 cm3 increased 70 and 41%, respectively. At 57% TLC, log (EAD) at 160 cm3 was significantly correlated with airway resistance (r = -0.57, P less than 0.0204) but not with forced expired flow between 25 and 75% of vital capacity. Log (EAD) at 400 cm3 was correlated with deposition of 1-micron particles (r = -0.73, P less than 0.0009). We conclude that aerosol-derived lung morphometry is a responsive noninvasive probe of peripheral air-space diameters.

Adult↗
PubMed1985

Aromatic L-amino acid decarboxylase activities in human lung tissues: comparison between normal lung and lung carcinomas.

We measured the activity of aromatic L-amino acid decarboxylase with L-dihydroxyphenylalanine as a substrate (DOPA decarboxylase) in normal lung tissues and lung tumors obtained fresh at surgery. The activity in control human lung tissues was low and variable: 3.50 +/- 0.42 pmole/min/mg protein (n = 56, mean +/- SE, range 0.01-15), indicating the wide individual variations. Most of small cell carcinoma specimens showed very high activity, as compared with both control lung tissues and with other types of non-SCC lung cancers. Similar results were also obtained in the athymic mice heterotransplants of SCC. High activity was also observed using 5-L-hydroxytryptophan as a substrate (5-HTP decarboxylase) in nine SCC samples. Serotonin was not detected in any control lung tissues, but was detected in all the nine SCC samples, but dopamine was detected only in three out of nine SCC samples.

Animals↗
PubMed1989

Influence of high frequency ventilation at different end-expiratory lung volumes on the development of lung damage during lung lavage in rabbits.

The effects of high frequency ventilation in combination with sustained inflations was studied in the surfactant-deficient lungs of 18 New Zealand White rabbits (weight 1.9-2.1 kg) during anaesthesia with urethane and neuromuscular block with pancuronium. Lung damage was induced by repeated lung lavage. In nine rabbits (group I) baseline ventilator settings were maintained constant throughout the study and airway pressure was readjusted to achieve a constant tidal volume. In the other nine rabbits (group II), ventilation was reinstituted after lung lavage with one period of four sustained inflations followed immediately by high frequency ventilation. In group I there was a significant decrease in gas exchange for oxygen and deterioration in pulmonary mechanics, whereas in group II there was little change in baseline blood-gas values or pulmonary mechanics. These data suggest that, with adequate ventilatory management during the period of lung lavage, the lung damage produced by this manoeuvre may be obviated.

Anesthesia, Intravenous↗
PubMedDate not supplied

Unilateral absence of lung perfusion on pulmonary scintigraphy secondary to lung cancer with extensive pleural metastases from lung cancer.

A man with a 20-year history of smoking who underwent Tc-99m MAA Pulmonary perfusion imaging, which showed virtually absent perfusion of the right lung and fairly normal perfusion of the left lung. Eighteen days after the study, the patient died; at autopsy poorly differentiated carcinoma of the right lung was confirmed, which included extensive thickened pleura and plaques deposits and compression of the right lung; 200 ml of bloody pleural effusion was also found on the right side. The unilateral absence of lung perfusion on Tc-99m MAA pulmonary scintigraphy might reflect the autopsy findings of the right lung and pleura.

Aged↗
PubMed2000

Genome-wide allelotyping of lung cancer identifies new regions of allelic loss, differences between small cell lung cancer and non-small cell lung cancer, and loci clustering.

To identify the major tumor suppressor gene (TSG) loci involved in the pathogenesis of lung cancer, we have conducted a high-resolution (10 cM), genome-wide search of loss of heterozygosity (LOH). Thirty-six lung cancer cell lines [14 small cell lung cancers (SCLCs) and 22 non-SCLCs (NSCLCs)] and their matched control DNAs were analyzed using 399 fluorescent microsatellite markers from the ABI Prism linkage mapping set v.2 on an ABI 377 sequencer/genotyper. Overall, 22 different regions with more than 60% LOH were identified: (a) 13 regions with a preference for SCLC; (b) 7 regions with a preference for NSCLC; and (c) 2 regions affecting both SCLC and NSCLC. The chromosomal arms with the most frequent LOH were 1p, 3p, 4p, 4q, 5q, 8p, 9p (p16), 9q, 10p, 10q, 13q (Rb), 15q, 17p (p53), 18q, 19p, Xp, Xq. In addition, new homozygous deletions were found at 2p23, 8q24, 18q11, and Xq22. On average, 34% (SCLC) to 36% (NSCLC) of markers showed allele loss in individual tumors, with an average size of subchromosomal region of loss of five to six markers (50-60 cM). Whereas SCLC and NSCLC had different regions of frequent LOH (hot spots), and NSCLC had more of these regions (n = 22) than SCLC (n = 17), in all other parameters (fractional allelic loss, number of breakpoints, and number of microsatellite alterations), SCLC and NSCLC were not significantly different. Clustering analysis revealed correlations between LOH on different chromosomes that suggest previously unknown genetic interactions for lung cancer development. We conclude that (a) in lung cancer cell lines, at least 17-22 chromosomal regions with frequent allele loss are involved, suggesting that the same number of putative TSGs are inactivated; (b) SCLC and NSCLC frequently undergo different specific genetic alterations; and (c) clusters of TSGs are likely to be inactivated together. Overall, these data provide global estimates of the extent of genetic changes leading to lung cancer and will be useful for the positional cloning of new TSGs and for the identification of multiple new biomarkers for translational research.

Alleles↗
PubMed1994

Donor and recipient predicted lung volume and lung size after heart-lung transplantation.

Lung volumes after heart-lung transplantation (HLT) were recorded and compared with measurements at the time of assessment for surgery and the predicted values for recipients. The influence of donor lung size and recipients' underlying lung disease was evaluated. All patients underwent HLT between April 1984 and April 1991, and only those 82 who survived for at least 6 mo were studied. Mean total lung capacity (TLC) at preoperative assessment was 112% (SD = 28%) of the value predicted for recipients. One month after HLT, mean TLC was 83% (SD = 15%) of the predicted value but increased to 100% (SD = 15%) after 9 mo. No further change in average TLC occurred for 5 yr subsequently. The mean TLC of patients with emphysema before surgery was 164% (SD = 26%) of the predicted value and fell to the predicted value within 1 mo of HLT. The TLC in patients with primary pulmonary hypertension before surgery was close to the predicted value, but postoperative predicted TLC was achieved later than in emphysema patients. A donor-versus-recipient difference in TLC of more than 1L at the time of assessment did not influence the adaptation to the predicted value. FEV1 and vital capacity (VC) rose from means of 70% (SD = 25%) and 63% (SD = 20%) at 1 mo to 96% (SD = 27%) and 91% (SD = 18%), respectively, at 9 mo after HLT. After HLT, TLC returns to the predicted value for the recipient, and not to the preoperative TLC.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Lung computed tomography during a lung recruitment maneuver in patients with acute lung injury.

OBJECTIVE: To assess the acute effect of a lung recruitment maneuver (LRM) on lung morphology in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). PATIENTS: Ten patients with ALI/ARDS on mechanical ventilation. DESIGN: Prospective clinical study. SETTING: Computed tomography (CT) scan facility in a teaching hospital. INTERVENTIONS: An LRM performed by stepwise increases in positive end-expiratory pressure (PEEP) of up to 30-40 cm H(2)O. Lung basal CT sections were taken at end-expiration (patients 1 to 5), and at end-expiration and end-inspiration (patients 6 to 10). Arterial blood gases and static compliance (C(st)) were measured before, during and after the LRM. MEASUREMENTS AND MAIN RESULTS: Poorly aerated and non-aerated tissue at PEEP 10 cm H(2)O accounted for 60.0+/-29.1% of lung parenchyma, while only 1.1+/-1.8% was hyperinflated. Increasing PEEP to 20 and 30 cm H(2)O, compared to PEEP 10 cm H(2)O, decreased poorly aerated and non-aerated tissue by 16.2+/-28.0% and 33.4+/-13.8%, respectively ( p<0.05). This was associated with an increase in PaO(2) and a decrease in total static compliance. Inspiration increased alveolar recruitment at all PEEP levels. Hyperinflated tissue increased up to 2.9+/-4.0% with PEEP 30 cm H(2)O, and to a lesser degree with inspiration. No barotrauma or severe hypotension occurred. CONCLUSIONS: Lung recruitment maneuvers improve oxygenation by expanding collapsed alveoli without inducing too much hyperinflation in ALI/ARDS patients. An LRM during the CT scan gives morphologic and functional information that could be useful in setting ventilatory parameters.

Adult↗
PubMed1978

The weight of human lungs as a diagnostic criterium (distinction of normal lungs from shock lungs by histologic, morphometric and biochemical investigations).

Lung weight, extravascular water content, hemoglobin content as an index of blood congestion, and DNA content as an index of cellular content, were determined for 57 patients dying from multiple, extrathoracic trauma. This report, which confirms previous publications, concerns itself in particular with the problems of determination of the "normal" lung weight. Studies of the influence of survival time on the lung showed that lung weight may significantly increase to twice its value after very short times up to one hour after trauma as a result of blood congestion, and following longer survival may be elevated several times as a result of developing interstitial edema. Early appearing interstitial edema is morphometrically detectable already 10 minutes after the beginning of shock. Normal weights were obtained from 10 cases after immediate death following severe cranial trauma or decapitation by being run over. Our results show that normal lungs have an average weight of 234 g (s +/- 39). Literature values for "normal" lung weight are approximately twice as high.

DNA↗
PubMed2004

The Functional Assessment of Cancer Therapy-Lung and Lung Cancer Subscale assess quality of life and meaningful symptom improvement in lung cancer.

Treatment options for patients with advanced lung cancer who have received prior chemotherapy are largely palliative, with little hope for cure. Current therapies may provide only modest survival benefits to patients while potentially adding treatment-related toxicities to lung cancer-related symptoms. However, new treatments have been developed that may improve disease-related symptoms and quality of life with only mild toxicities. The Functional Assessment of Cancer Therapy-Lung, a validated, disease-specific quality-of-life instrument, effectively correlates quality-of-life changes with clinical outcomes in patients with non-small-cell lung cancer. In a large randomized trial from the Eastern Cooperative Oncology Group study 5592, a change of two to three points in the Lung Cancer Subscale of the Functional Assessment of Cancer Therapy-Lung was found to be clinically meaningful and correlated well with patient symptom differences at baseline, changes in symptoms after treatment, tumor response, and time to disease progression. Results from trials that include symptom improvement and quality of life as end points, in addition to the more standard outcomes of tumor response and survival, will provide meaningful information in evaluating the clinical benefits of new cancer treatments.

Clinical Trials as Topic↗
PubMed2006

Residential radon and lung cancer--detailed results of a collaborative analysis of individual data on 7148 persons with lung cancer and 14,208 persons without lung cancer from 13 epidemiologic studies in Europe.

OBJECTIVES: Studies seeking direct estimates of the lung cancer risk associated with residential radon exposure lasting several decades have been conducted in many European countries. Individually these studies have not been large enough to assess moderate risks reliably. Therefore data from all 13 European studies of residential radon and lung cancer satisfying certain prespecified criteria have been brought together and analyzed. METHODS: Data were available for 7148 persons with lung cancer and 14,208 controls, all with individual smoking histories and residential radon histories determined by long-term radon gas measurements. RESULTS: The excess relative risk of lung cancer per 100 Bq/m3 increase in the observed radon concentration was 0.08 [95% confidence interval (95% CI) 0.03-0.16; P=0.0007] after control for confounding. The dose-response relationship was linear with no evidence of a threshold, and it remained significant when only persons with observed radon concentrations of <200 Bq/m3 were included. There was no evidence that the excess relative risk varied with age, sex, or smoking history. Removing the bias induced by random uncertainties related to radon exposure assessment increased the excess relative risk of lung cancer to 0.16 (95% CI 0.05-0.31) per 100 Bq/m3. With this correction, estimated risks at 0, 100, and 400 Bq/m3, relative to lifelong nonsmokers with no radon exposure, were 1.0, 1.2, and 1.6 for lifelong nonsmokers and 25.8, 29.9, and 42.3 for continuing smokers of 15-24 cigarettes/day. CONCLUSIONS: These data provide firm evidence that residential radon acts as a cause of lung cancer in the general population. They provide a solid basis for the formulation of policies with which to manage risk from radon and reduce deaths from the most common fatal cancer in Europe.

Case-Control Studies↗
PubMed2005

Lung graft dysfunction in the early postoperative period after lung and heart lung transplantation.

BACKGROUND: We present a retrospective study of 9 years of experience in the management of graft dysfunction in the early postoperative period after lung transplantation (LT) and heart lung transplantation (HLT). MATERIAL AND METHODS: There were 190 LT and HLT (22.63% single LT, 71.05% bilateral sequential LT, and 7.36% HLT) performed from 1993 to 2002. Hemodynamic and respiratory parameters were monitored during the operative technique and critical care for the first 24 hours. We analyzed ischemic time, bypass need, and type of transplant. RESULTS: Lung graft dysfunction occurred in 37.2% of patients, but only in 12.2% was it severe. Nearly all patients were ventilated on a 50% fraction of inspired oxygen during the first 24-48 hours; 61.56% of patients were extubated before the first 5 postoperative day and 38.43% thereafter. The mean ischemia time for the first lung was 220 +/- 28 minutes: for the second lung, it was 378 +/- 31 minutes. The anesthetic time was 500-600 minutes. The variables associated with a significantly increased graft dysfunction were as follows: bilateral LT, and cardiopulmonary bypass requirement. The residence in the intensive care unit (ICU) was longer for patients with graft dysfunction than for those without that problem. Mortality directly related to graft dysfunction was only 4.07%. CONCLUSIONS: A correlation among graft ischemia and early postoperative morbidity and duration of ICU stay did not have a significant impact on mortality.

Heart-Lung Transplantation↗
PubMedDate not supplied

The diagnosis of obliterative bronchiolitis after heart-lung and lung transplantation: low yield of transbronchial lung biopsy.

Obliterative bronchiolitis is the most significant long-term complication of lung and heart-lung transplantation characterized by the rapid development of obstructive airway disease. It is thought to be a manifestation of chronic rejection and has been treated, with limited success, with augmentation of immunosuppression. Early detection of obliterative bronchiolitis and prompt initiation of therapy may result in an improved outcome. The role of transbronchial biopsy has been reported in the diagnosis of acute rejection and infection but not for obliterative bronchiolitis. To study this problem we retrospectively reviewed the transbronchial biopsy results of patients with advanced clinical obliterative bronchiolitis, as defined physiologically. Between January 1, 1988, and December 31, 1991, 46 "sets" of adequate transbronchial biopsy specimens were obtained from 16 patients (15 heart-lung recipients and one double lung recipient). Seven sets of transbronchial biopsy specimens (15.2%) showed obliterative bronchiolitis by pathologic study. In four patients with severe clinical obliterative bronchiolitis, only one transbronchial biopsy specimen of seven (14.3%) showed obliterative bronchiolitis. The pathologic diagnosis of obliterative bronchiolitis was confirmed in three of these patients at the time of autopsy or retransplantation. Twelve patients were still alive at the end of the study period, and all experienced further deterioration of lung function typical for obliterative bronchiolitis. We conclude that the sensitivity of transbronchial biopsy for obliterative bronchiolitis is poor. Possible explanations for these results are explored.

Adolescent↗