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PubMed1997

Lung volume reduction surgery for emphysema.

OBJECTIVE: To report the results of lung volume reduction surgery (LVRS) for severe emphysema in Australia. SETTING: A tertiary teaching hospital. DESIGN: A prospective study of a consecutive case series. PARTICIPANTS: 20 patients (mean age, 56 years) with severe emphysema--mean forced expiratory volume in one second (FEV1), 0.72 L (28% of predicted) and severe gas trapping (mean residual volume, 286% of predicted). INTERVENTION: Bilateral apical LVRS was performed via a median sternotomy with a linear stapler; bovine pericardial strips were used to reinforce the staple line. RESULTS: There was a 95% survival, and a mean (range) inpatient stay of 17 (8-45) days. No complications occurred in nine patients; a further six patients had only minor complications. Five patients had major complications (sputum retention requiring reintubation, persistent air leak requiring reoperation, duodenal perforation, and epidural haemorrhage); one patient died from multiorgan failure at 28 days. Intercostal drainage was left in situ for a mean of eight days. The results of FEV1, Medical Research Council (MRC) Dyspnoea Score and six-minute walk test improved in more than 90% of patients. FEV1 improved an average of 0.35 L (54% over baseline) (P < 0.001). Mean MRC Dyspnoea Score decreased from 3.4 to 2.1 (P < 0.001). Mean distance for the six-minute walk test increased from 306 to 431 metres (P < 0.001). CONCLUSION: Our experience confirms that LVRS produces worthwhile early outcomes for a subgroup of patients with severe emphysema. The clinical, economic and ethical questions raised by this new therapy will need to be assessed.

Adult↗
PubMed1998

[Experimental pulmonary emphysema in rats. Inflammatory phenomena and progression of lung damage].

BACKGROUND: Although the hamster model of elastase induced emphysema is well characterized, the rat model has received less attention. AIM: To evaluate the effect of a single intratracheal elastase dose on lung pathological changes of Sprague-Dawley rats. MATERIAL AND METHODS: Rats were injected with a single intratracheal elastase dose of 28 U/100 g body weight or saline and studied 7, 15, 30 and 365 days after injection. RESULTS: Forty percent of rats died in the first 48 hours after injection, six were sacrificed at 7 days, 6 at 15 days, 7 at 30 days and 12 at 365 days. Progressive centroacinar emphysema was found from day 7 after elastase, with a persistent inflammatory reaction in the vicinity of emphysematous areas. CONCLUSIONS: Present findings differ from the panacinar emphysema described in the hamster using a similar elastase dose.

Animals↗
PubMed1999

The use of subcutaneous drains to manage subcutaneous emphysema.

Subcutaneous emphysema is a frequent complication of thoracic and cardiac surgical procedures, and emergency tracheostomy is often advocated as the treatment for this complication. However, we report the case of a patient in whom massive subcutaneous emphysema, which had developed after emergent replacement of the aortic root, was relieved using subcutaneous drains and suction, instead of a tracheostomy. We found that the subcutaneous drains provided effective decompression of the head and neck areas, and markedly reduced airway pressure and subcutaneous air. We recommend subcutaneous drains for safe, effective, and inexpensive management of massive subcutaneous emphysema.

Aged↗
PubMed2000

Active management of a patient with endstage pulmonary emphysema using lung volume reduction surgery and intensive rehabilitation.

INTRODUCTION: Lung volume reduction surgery (LVRS) and pulmonary rehabilitation are newer options available in the treatment of advanced emphysema. We describe the progress of our first local patient to have undergone these 2 new treatment modalities. CLINICAL PICTURE: A 65-year-old man with advanced emphysema, limited by crippling dyspnoea despite maximal medical therapy with inhaled bronchodilator therapy, methylxanthines and supplementary oxygen. TREATMENT: Physical reconditioning with a 4-week inpatient pulmonary rehabilitation programme, followed by LVRS and a further 6-week outpatient pulmonary rehabilitation. OUTCOME: Dramatic improvements in spirometric indices, arterial blood gases, exercise capacity and overall functional status. Improvements maintained at one-year follow up period. CONCLUSIONS: LVRS with pulmonary rehabilitation is an exciting new treatment option in a select group of patients with advanced emphysema. Their role in improving overall performance status and quality of life should be considered in patients otherwise considered to have reached the limits of medical therapy.

Aged↗
PubMedDate not supplied

[Interstitial gastric emphysema in children].

UNLABELLED: Gastric pneumatosis is an unusual clinical finding in infants and children and it appears in the three following similar conditions: pneumatosis cystoides; emphysematous gastritis, and gastric emphysema. MATERIALS METHODS AND RESULTS: The clinical pictures and radiographic appearance of this association are described in four patients in whom the clinical course made suspect interstitial gastric emphysema. Two patients had hypertrophic pyloric stenosis and two, unspecific erosive gastritis. In the first two patients, a Fredet-Ramstedt procedure was performed. All patients survived. Differential diagnostic considerations, the importance of correct radiological diagnosis, and the results of proper therapy are discussed. CONCLUSIONS: Pyloric and duodenal obstruction in infants is the main etiologic factor in gastric emphysema.

Emphysema↗
PubMed2001

[Comparison of 133Xe gas dynamic SPECT and thin-section CT in patients with pulmonary emphysema].

PURPOSE: We assessed 133Xe gas dynamic single photon emission computed tomography (SPECT) by comparing washout axial images with thin-section CT (TSCT) in patients with pulmonary emphysema. METHODS: Twenty-three patients were studied. All patients were diagnosed as having pulmonary emphysema on the basis of TSCT. We compared TSCT of upper, middle and lower lung fields with 133Xe gas dynamic SPECT axial images at the corresponding levels during the 3 to 4 minutes of washout phase. If the degree of 133Xe gas retention or TSCT finding of ventral and dorsal parts was not the same, the images were divided into two parts. RESULTS: A total of 174 lesions in 23 cases were examined, but 3 lesions having no retention of 133Xe gas at equilibrium phase were excluded. The results showed that: there were 37 lesions (21.6%) with equivalent severity on both images; there were 42 lesions (24.5%) with more severity on 133Xe gas dynamic SPECT than on TSCT; and there were 92 lesions (53.8%) with more severity on TSCT than on 133Xe gas dynamic SPECT. The severity on 133Xe gas dynamic SPECT and TSCT was not always compatible. One of the reasons for the variable 133Xe gas retention even when the lesion had the same severity on TSCT, may be bronchial stricture which cannot be seen on TSCT. CONCLUSION: By comparison of axial images of 133Xe gas dynamic SPECT with CT images, we could recognize the areas of 133Xe gas retention in detail. Results suggest that 133Xe gas dynamic SPECT can be useful to identify ventilation impairment in pulmonary emphysema.

Aged↗
PubMed2000

[History of surgical treatment for emphysema].

Great efforts have been paid to the effective surgical managements of diffused emphysema in the past century, which can be grossly divided into three stages, namely, the early exploration, lung transplantation and lung volume reduction surgery. Lung transplantation, developed in the 80's, and especially lung volume reduction surgery, which was developed in the 90's, was recognized as the most effective therapy for terminal stage of emphysema, which offers a new approach for the victims of emphysema.

Emphysema↗
PubMed1975

Ruminal and plasma concentrations of 3-methylindole associated with tryptophan-induced pulmonary edema and emphysema in cattle.

Five Hereford cows were given an intraruminal dose of L-tryptophan (0.35 g/kg of body weight), and 2 cows were used as controls. Of the 5 treated cows, 3 developed clinical signs of interstitial pul monary edema, and emphysema and severe pulmonary lesions were seen at necropsy after 96 hours. Another cow developed moderate clinical signs and pulmonary lesions, and the remaining cow had few clinical signs and mild pulmonary lesions. The severity of clinical signs in each cow was related to the severity of pulmonary lesions at necropsy. The 3-methylindole (3MI) was present in ruminal fluid and plasma within 6 hours after administration of tryptophan, and the concentrations increased to 3.0 and 9.0 mug/ml within 12 to 24 hours. Severity of pulmonary lesions was related to maximal concentration and duration of 3MI in the plasma. At necropsy, gross lesions were characterized by diffuse, pulmonary edema and interstital emphysema; and the lungs were dark red, firm, and heavier than normal. Predominant microscopic changes included accumulation of proteinaceous residue, hypertrophy and hyperplasia of alveolar lining epithelium, thickening of alveolar septums, and emphysematous thickening of interstitial tissues. These changes were similar to previously reported 3MI-induced pulmonary lesions. The presence of 3MI in ruminal fluid and plasma after administration of tryptophan and the relationship between concentration of 3MI and severity of clinical signs indicate that 3MI is the principal metabolite of ruminal fermentation which leads to the development of acute pulmonary edema and emphysema in cattle given tryptophan.

Animals↗
PubMed1998

[Thoracoscopic lung reduction surgery for emphysema].

OBJECTIVE: To study the surgical treatment of emphysema. METHOD: Five patients with severe diffused pulmonary emphysema underwent surgical bilateral lung volume reduction by video-assisted thoracoscopy. All patients were male and their age ranged from 60 to 71 years (mean 64.3 years). Before surgery, 5 patients required supplement oxygen with exertion and one oxygen supplement at rest. Preoperative and postoperative assessments included standard pulmonary function studies, chest CT scan and quantitative nuclear lung perfusion and ventilation scan. Wedge resection was performed were in 3 patients, simple plication in 1, and combined wedge resection and plication in 1. There were no early or late mortality and no requirement for immediate postoperative ventilatory assistance. RESULT: Follow-up ranged from 10 to 12 months. After surgery the mean forced expiratory volume in 1 second (FEV(1)) was significantly increased from 0.46 L to 1.13 L (P < 0.001) and the mean forced vital capacity (FVC) was markedly improved from 1.74 L to 2.93 L (P < 0.001). Pulmonary compliance was significantly improved and resistance of airway decreased (P < 0.001). The mean distance during 6-min walk test increased from 10 m to 400 m in 4 patients. CONCLUSION: Thoracoscopic bilateral lung volume reduction is an effective and safe technique for patients with severe emphysema. It can relieve dyspnea and improve in excise tolerance and quality of life.

Aged↗
PubMed1999

[Severe emphysema treated by lung volume reduction surgery].

OBJECTIVE: To investigate criteria of screening surgical candidates and clinical effects of lung volume reduction surgery (LVRS) for severe emphysema. METHODS: 20 patients with severe emphysema under went resection of the targeted overinflated, destructive and dysfunction pulmonary tissue by linear stapler or Endo-GIA and sternotomy approach or video-assistant thoracoscopy. 20% - 30% of the volume of each lung was resected. RESULTS: After operation, dyspnea evidently alleviated or disappeared. Pulmonary function: FEV(1) increased by 41.4%, RV, TLC decreased by 27.5% and 22.7% respectively. PaO(2) increased by 12.6 mm Hg. Six-minute walk test increased by 55.8%. There was significant difference above indexes between preoperation and postoperation (P < 0.01). Eight patients were complicated by a prolonged air leakage (> 7 days), and one by irritable digestive ulcer and bleeding. No death occurred during perioperation. CONCLUSIONS: LVRS is an effective for severe emphysema.

Aged↗
PubMed2002

[Late-stage emphysema treated with lung volume reduction: report of 22 cases].

OBJECTIVE: To Summarize the clinical experience in the treatment of late-stage emphysema by lung volume reduction (LVR) in 5 years. METHODS: We retrospectively studied the indications, contraindications, operation procedures and complications of LVR in 22 patients. RESULTS: Before operation, the average FEV(1) was 24.5%, RV 196.8%, and TLC 130.5%; after operation they were 27.8%, 148.8% and 112.5%, respectively. 16 patients needed inhaling oxygen before operation, and 5 after operation. 16 patients finished 6-minute walking test with an average of 198 m, all patients walked much longer with an average of 256 m after operation. 3-degree lung function was observed in 14 patients, and 4-degree before operation in 8 patients; but 2-degree lung function in 5 patients, 3-degree in 13, and 4-degree in 4 after operation. CONCLUSIONS: Heterogeneous type emphysema with clear target area, especially bullous emphysema is the best indication for LVR. Lung function and life quality could be much improved postoperatively. Homogeneous type could also be treated with LVR in highly selected cases. TLCO < 20% is not an absolute contraindication, others standards need further investigation. Video-assistant thoracoscopic surgery (VATS) with subaxillary small incision for LVR is safe, reliable and effective. Application of stapler buttressing with bovine pericardia could decrease air leakage postoperatively.

Aged↗
PubMed2002

[Traumatic cervical subcutaneous emphysema in children].

Neck emphysema is an unusual pathology in childhood depending on several conditions. We report the case of a subcutaneous emphysema of the neck after an oropharyngeal injury in a child and take the advantage of the event in order to review the etiology and pathogeny of neck emphysema, because the otolaryngologist must know the differential diagnosis, face to the presence of air inside the neck, since the definitive treatment depends on is etiology.

Child, Preschool↗
PubMed1975

[The spontaneous mediastinal and skin emphysema].

A report is given on four patients with spontaneous mediastinal and skin emphysema. In three cases younger patients from 14 to 21 years were concerned, in the fourth case a 63-year-old patient was concerned. Two of the younger patients revealed a long lasting malnutrition. As favouring or triggering factor, respectively, for the pathogenesis of the mediastinal emphysema in accordance with Macklin an increase of the intrathoracic pressure by retching, pressing or vomiting is regarded. Apart from this a vasoconstriction of the alveolar vessels (due to decrease of the plasma volume) and nutritional disease might be of importance. In all patients the mediastinal and skin emphysema receded under symptomatic therapeutic measures within some days.

Adolescent↗
PubMed2002

Surgical emphysema following intraoral drainage of buccal space abscess.

The authors present a case of surgical emphysema following intraoral drainage of a buccal space abscess, a complication not previously reported. Surgical emphysema was remedied after removing a penrose drain and conservative treatment, suggesting retention of the drain caused the emphysema.

Abscess↗
PubMed2003

[Single-lung transplantation for end-stage emphysema].

OBJECTIVE: To evaluate operative technique, patient selection and perioperative management of single-lung transplantation for a patients with end-stage emphysema. METHODS: A 56-year-old patient with end-stage emphysema underwent left-lung transplantation on September 28, 2002. The surgical technique used was similar to that mentioned in the literature. The donor lung was perfused by LPD solution with a cold ischemic time of 260 minutes. Cardiopulmonary bypass was not performed. RESULTS: The patient weaned from a ventilator at the 93th hour after operation. Immunosuppressants included cyclosporine, mycophenolate mofetil and corticosteroid. Acute rejection occurred on the ninth day after operation and was cured by bolus methylprednisolone given intravenously. Lung function was improved significantly and the patient was discharged from the hospital on the 47th day after operation. CONCLUSION: Single-lung transplantation for patients with end-stage emphysema is effective for long-term improvement of pulmonary function.

Adult↗
PubMed2000

[Preventive and therapeutic effect of Chinese herbs naofeikang on experimental emphysema and pulmonary artery hypertension in hamsters].

OBJECTIVE: To observe preventive and therapeutic effect of Chinese herbs Naofeikang on hypoxic pulmonary artery hypertension of elastase-induced emphysema hamsters and investigate its mechanism. METHODS: Hamsters for 30 days after intratracheally-instilled elastase, were kept in hypoxia environment under normal atmospheric pressure for 15 days, 50 hamsters were divided into prevention group (Prv), treatment group (T), emphysema + hypoxia (EH), and control group(N). Mean pulmonary artery pressure (MPAP) was measured before hamsters were killed. And then right ventricle hypertrophy index (RVHI) was measured, as well as circulating endothelial cells (CEC) and cells recoveries from bronchoalveolar lavage fluid (BALF) were counted. Meanwhile, pulmonary tissue changes were studied under light microscope with morphometric analysis. RESULTS: Compared with EH group, MPAP, CEC, and cells recoveries of BALF of Prv and T groups were significantly decreased (P < 0.05 or P < 0.01); Mean linear intercept and percentage of arterial media area of Prv and T groups had totally a significant difference (P < 0.01) in comparison with EH group. CONCLUSIONS: Chinese herbs Naofeikang could lower pulmonary hypertension, preserve vessel endothelial cells and lessen the inflammatory reaction in pulmonary tissue. Thereby, it could hinder the further development of emphysema and inhibit the remodeling of pulmonary small artery.

Animals↗
PubMedDate not supplied

MRI lung perfusion 2D dynamic breath-hold technique in patients with severe emphysema.

BACKGROUND: Our aim was to prospectively evaluate a semi-quantitative pulmonary perfusion MR technique using a breath-hold 2D dynamic sequence in patients with severe pulmonary emphysema. MATERIALS AND METHODS: Thirty patients with severe emphysema were studied with pulmonary perfusion MRI. Results were compared with those obtained through lung scintigraphy, considered as the gold standard technique. We used Fast Field Echo (FFE) pulse sequences in the coronal and sagittal planes, with paramagnetic contrast agent administration. Ten healthy volunteers were studied as the control group. Three thoracic radiologists independently reviewed all the subjects, evaluating the site and entity of perfusional defects. Peak intensity and apparent mean transit time were calculated. RESULTS: MRI showed high sensitivity (86.7%) and good specifity (80.0%) in detecting perfusional defects. We observed lower peak signal intensities in emphysematous regions. CONCLUSION: Lung perfusion MR is a potential alternative to Nuclear Medicine in the evaluation of severe pulmonary emphysema.

Adult↗
PubMed1992

[Evaluation of physical fitness and exercise performance in patients with chronic pulmonary emphysema].

Physical fitness was studied in patients with chronic pulmonary emphysema using Kraus-Weber methods in addition to pulmonary function and exercise tolerance. In Kraus-Weber tests, explosive strength of abdominal muscles in these patients were within the normal range, but both abdominal and back muscle endurance were significantly diminished compared to age-matched controls. On the other hand, flexibility was not different between the patients and the controls, although large variation was present. Exercise performance as assessed by 6 minutes' walk distance in patients was significantly correlated with FEV1.0, DLco and maximal inspiratory mouth pressure, as well as explosive strength of abdominal muscles and abdominal and back muscle endurance capacity. Treadmill walking training for 20 minutes with a load greater than 80% VO2max, twice a week for 2 months was performed in 11 patients with mild to moderate pulmonary emphysema. Six minutes' walk distance (6MD) was significantly prolonged with improvement of back muscle endurance and flexibility. Another walking training consisting of five repetitions of two minutes' near maximal walking and a two minute interval of rest was performed in 6 patients with severe pulmonary emphysema. 6MD tended to increase with improvement of both back and abdominal muscle endurance. However, pulmonary function tests and VO2max showed no significant changes after both types of training. Improved walked distance after the training was significantly correlated with improved VO2 at AT. Furthermore VO2, VE, HR and lactate production during exercise at the same load were significantly decreased compared to pre-training. Dyspnea sensation measured by modified Borg scale during exercise was improved after the training. It is concluded that a physical training program adapted to the condition of the individual patients could improve exercise performance, and should be prescribed in addition to medication.

Aged↗