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At least 109 records · Page 6Linked to original sources
PubMed1996

Surveillance transbronchial biopsy in the diagnosis of acute lung rejection in heart and lung and lung transplant recipients.

From March 1991 to December 1993, 30 patients underwent transbronchial biopsy (TBB) after lung transplantation (16 with a heart lung transplant, 7 with a single lung transplant, and 7 with a double lung transplant). The now standard TBB technique was used. Initially, TBB was performed only when clinically indicated, i.e. when there were sound reasons to suspect the existence of acute rejection (AR) or pulmonary infection. From 1992, all the patients were entered into a prospective study, the protocol of which called for serial "surveillance" TBB to be performed, in addition to those for clinical indications, 15 days, 2, 3, 6, 9 and 12 months after the transplant, and then annually. One hundred and twenty nine transbronchial biopsies were performed in 2.5 yrs. Of the 121 successful TBBs, 54 (45%) were positive, i.e. showed signs of acute rejection. Sixty six of 129 (51%) of the TBBs were performed because of clinical indications, 45 of them (68%) within the first 3 months following the transplant. The other 63 were surveillance biopsies. About two thirds of the clinically indicated TBBs and more than a quarter of the surveillance TBBs, yielding adequate samples, were positive for AR > or = A2 (mild rejection). The sensitivity and specificity of the method in detecting AR were 91 and 100%, respectively. The overall incidence of complications was 10.8% (pneumothorax in 9% of cases). There were no deaths correlated to the procedure. Our results confirm the decisive role of TBB in the diagnosis of acute lung rejection. The high incidence of mild acute rejection, and the occasional finding of moderate acute rejection in stable asymptomatic patients, support the use of surveillance TBB in the first 6 months.

Bronchoscopy↗
PubMed2005

Micro-CT of the human lung: imaging of alveoli and virtual endoscopy of an alveolar duct in a normal lung and in a lung with centrilobular emphysema--initial observations.

The appearance of human lung parenchyma at the structural level of alveoli was investigated by the use of micro-computed tomography (CT). Approval for use of autopsy lungs was given by the head of the pathology institute of the university, in accordance with the requirements of the State Ministry of Science and Arts and without the need for institutional review board approval. Two human lungs (one normal lung and one lung with centrilobular emphysema of a mild to moderate degree) were inflated and fixed with hot formalin vapor. Lung specimens excised from the superior segment of the left lower lobe (B6) were stained with silver nitrate in a vacuum and investigated at a volume of interest of 4 mm for each side with a voxel size of 14 mum. Normal-size and enlarged alveoli became visible. A three-dimensional reconstruction of the terminal airspaces made virtual endoscopy of the alveolar ducts possible.

Aged↗
PubMed1989

Effects of lung surgery and one-lung ventilation on pulmonary arterial pressure, venous admixture and immediate postoperative lung function.

We studied 17 patients, with unilateral lesions in lung or thoracic wall, during thoracotomy performed in the full lateral position. Balanced anaesthesia was used with pethidine and 50% nitrous oxide, in oxygen. The procedure included a period of one-lung ventilation (OLV). Haemodynamic and gas exchange measurements were performed before and after pleurotomy, during OLV, after re-expansion of the lung and after closure of the thoracic wall. The function of each lung was assessed separately during the first and last stages. Mean venous admixture was 9-12% before and after OLV and 31% during OLV. There was a positive correlation between venous admixture and pulmonary arterial pressure during OLV. End-tidal PCO2, carbon dioxide elimination and compliance of the operated side were reduced significantly at the end of the procedure; this is consistent with reduced blood flow and increased water content in that lung.

Anesthesia, General↗
PubMed1992

Lack of bronchial hyperresponsiveness to methacholine and to isocapnic dry air hyperventilation in heart/lung and double-lung transplant recipients with normal lung histology. The Paris-Sud Lung Transplant Group.

To investigate whether survivors of heart/lung and double-lung transplantations have normal or increased nonspecific bronchial responsiveness, nine heart/lung and four double-lung transplant recipients with normal lung histology underwent methacholine challenge and voluntary isocapnic dry air hyperventilation (VIH) in a randomized order at a mean time of 14.8 +/- 12.1 months after surgery. Transplant recipients were compared with 10 normal subjects and 11 patients with mild asthma. Asthmatic patients had a mean provocative concentration of methacholine inducing a 20% fall (PC20) in FEV1 of 3.4 +/- 3.6 mg/ml (SD). Seventy seven percent of the transplant recipients and 70% of the normal subjects had PC20 superior to 32 mg/ml. The percentage fall from baseline FEV1 after VIH was 12.6 +/- 10.4% in asthmatic patients as compared with 1.9 +/- 2.9% in transplant recipients (p = 0.002) and 0.45 +/- 1.2% in normal subjects (p = 0.001). The decrease in FEV1 after VIH was similar in transplant recipients and normal subjects (p = 0.14). These results show that heart/lung or double-lung transplant recipients with normal lung histology have a normal response to nonspecific bronchial stimulation.

Adult↗
PubMed1996

Three hundred patients referred for lung transplantation. Experiences of the Dutch Lung Transplantation Program. Groningen Lung Transplantation Group.

In November 1990, a lung transplantation program began at the University Hospital in Groningen, the Netherlands. As of April 1994, 300 patients were referred for lung transplantation and we investigated the decisions that have been made concerning these referrals up to January 1, 1995. The patients were evaluated according to a stepwise procedure. In stage 1, written information about the referred patients was discussed during the weekly, multidisciplinary lung transplantation meeting. In this stage, 14% of the patients were rejected and 2% were postponed. If no major objections for transplantation were identified, the patient was invited for a visit to the outpatient clinic, stage 2. The newly acquired information from that visit was discussed again at the transplantation meeting. In this stage, 11% of the patients were rejected and 18% postponed. The remaining patients underwent an (partial or complete) inpatient evaluation, stage 3. From all patients about whom a decision was made in this stage, only 5% were rejected, respectively 35% after partial evaluation and only 1.5% after complete evaluation. A total of 110 patients (37% of all referred patients) were listed for lung transplantation, stage 4. Of the listed patients, 20% died while awaiting an appropriate donor. The group of patients with COPD/emphysema had by far the lowest death rate on the waiting list. Patients with short stature (< or = 1.65 m) had a much higher risk to die on the waiting list compared with patients with longer stature, 42% vs 13%. As of January 1, 1995, 55 patients have undergone transplantation, which is 50% of all patients on the waiting list and 18% of all referred patients. The stepwise selection procedure identifies patients with potential contraindications at an early stage. In this way, unrealistic expectations and unnecessary examinations, expense, and/or hospital admissions may be prevented. Donor shortage, and thus waiting list problems, still remains a significant drawback in the further development of lung transplantation.

Algorithms↗
PubMed1989

[The effect of airway deposition on the assessment of lung injury by 99mTc-DTPA clearance--lung injury in interstitial lung diseases assessed by using the duplicated 99mTc-DTPA aerosol inhalation method].

The 99mTc-DTPA aerosol inhalation method permits detection of pulmonary epithelial damage. We investigated one of several problems, airway deposition of inhaled aerosol, on the assessment of pulmonary epithelial permeability in healthy nonsmokers and patients with interstitial lung diseases. We used the rate constant of pulmonary 99mTc-DTPA clearance curve, k, as a parameter of the epithelial permeability. The alveolar-peripheral airway deposition of aerosol was estimated by the duplicated inhalation method, which we newly developed. The mean k in patients with interstitial lung diseases (2.52 +/- 0.72%/min, n = 8; p less than 0.01) was significantly greater than that in healthy nonsmokers (0.92 +/- 0.20%/min, n = 4). The alveolar-peripheral airway deposition was similar in both healthy nonsmokers and interstitial lung diseases (73.5 +/- 7.8% and 75.5 +/- 9.2%, respectively). The mean k corrected for alveolar-peripheral airway deposition (corrected k; kc) was higher in patients with interstitial lung diseases (4.08 +/- 1.63%/min; p less than 0.01) as compared with healthy nonsmokers (1.36 +/- 0.47%/min). The mean k was significantly greater than the mean kc in both groups (p less than 0.01, p less than 0.01). However, there was a significant correlation between the k and kc obtained among the subjects (r = 0.951; p less than 0.01). We, therefore, conclude that correction for alveolar-peripheral airway deposition was not necessary to distinguish the patients with interstitial lung diseases from the healthy nonsmokers using 99mTc-DTPA aerosol inhalation method although the correction was significant in the individual subjects.

Adult↗
PubMed1988

[Correlation between selenium levels in the human body and lung cancer. II. Multi-statistical analysis of the correlation between selenium levels in the blood, hair, lung and lung cancer].

18 factors, including possible lung cancer-causing factors and body selenium (Se) levels, were analyzed by computer-based multiple stepwise regression and main component analysis. 1. The results indicated that Se levels in blood, hair and lung had correlation with lung cancer to some extent. 2. The correlation of blood and lung Se was the most significant one, the significance of which was only second to age and smoking habits. The standardized regression and factor load coefficients showed a negative correlation with blood Se level and a positive one with lung Se level, which corresponded with the results obtained by the single factor analysis.

Factor Analysis, Statistical↗
PubMed1997

Prognostic value of pulmonary hypertension in patients with chronic interstitial lung disease referred for lung or heart-lung transplantation.

BACKGROUND: The purpose of this study was to identify precise and reliable prognostic parameters in patients affected by serious chronic interstitial lung disease, who were undergoing screening for lung or heart-lung transplantation. METHODS: Hemodynamic and respiratory function parameters of 67 patients (43 with idiopathic pulmonary fibrosis, 18 with histiocytosis X, and 6 with lymphangioleiomyomatosis) undergoing clinical screening for lung transplantation. RESULTS: Statistical analysis showed that hemodynamic and respiratory function parameters in patients affected by histiocytosis X and idiopathic pulmonary fibrosis were not related to survival time. Moreover, the degree of pulmonary hypertension showed no correlation between respiratory function parameters in all the groups of diseases examined. Patients affected with histiocytosis X, even with higher degrees of pulmonary hypertension, had a better survival rate (p < 0.0005) compared with patients with idiopathic pulmonary fibrosis. CONCLUSIONS: Hemodynamic and respiratory parameters obtained during the clinical screening for lung transplantation do not predict survival and cannot be used as prognostic indicators.

Adult↗
PubMed2001

Small dose of exogenous surfactant combined with partial liquid ventilation in experimental acute lung injury: effects on gas exchange, haemodynamics, lung mechanics, and lung pathology.

A combination of exogenous surfactant and partial liquid ventilation (PLV) with perfluorocarbons should enhance gas exchange, improve respiratory mechanics and reduce tissue damage of the lung in acute lung injury (ALI). We used a small dose of exogenous surfactant with and without PLV in an experimental model of ALI and studied the effects on gas exchange, haemodynamics, lung mechanics, and lung pathology. ALI was induced by repeated lavages (PaO2/FIO2 less than 13 kPa) in 24 anaesthesized, tracheotomized and mechanically ventilated (FIO2 1.0) juvenile pigs. They were treated randomly with either a single intratracheal dose of surfactant (50 mg kg(-1), Curosurf, Serono AG, München, Germany) (SURF-group, n=8), a single intratracheal dose of surfactant (50 mg kg(-1), Curosurf) followed by PLV with 30 ml kg(-1) of perfluorocarbon (PF 5080, 3M, Germany) (SURF-PLV-group, n=8) or no further intervention (controls, n=8). Pulmonary gas exchange, respiratory mechanics, and haemodynamics were measured hourly for a 6 h period. In the SURF-group, the intrapulmonary right-to-left shunt (QS/QT) decreased significantly from mean 51 (SEM 5)% after lavage to 12 (2)%, and PaO2 increased significantly from 8.1 (0.7) to 61.2 (4.7) kPa compared with controls and compared with the SURF-PLV-group (P<0.05). In the SURF-PLV-group, QS/QT decreased significantly from 54 (3)% after induction of ALI to 26 (3)% and PaO2 increased significantly from 7.2 (0.5) to 30.8 (5.0) kPa compared with controls (P<0.05). Static compliance of the respiratory system (C(RS)), significantly improved in the SURF-PLV-group compared with controls (P<0.05). Upon histological examination, the SURF-group revealed the lowest total injury score compared with controls and the SURF-PLV-group (P<0.05). We conclude that in this experimental model of ALI, treatment with a small dose of exogenous surfactant improves pulmonary gas exchange and reduces the lung injury more effectively than the combined treatment of a small dose of exogenous surfactant and PLV.

Animals↗
PubMed2005

Massive brain injury enhances lung damage in an isolated lung model of ventilator-induced lung injury.

OBJECTIVE: To assess the influence of massive brain injury on pulmonary susceptibility to injury attending subsequent mechanical or ischemia/reperfusion stress. DESIGN: Prospective experimental study. SETTING: Animal research laboratory. SUBJECTS: Twenty-four anesthetized New Zealand White rabbits randomized to control (n = 12) or induced brain injury (n = 12) group. INTERVENTIONS: After randomization, brain injury was induced by inflation of an intracranial balloon-tipped catheter, and animals were ventilated with a tidal volume of 10 mL/kg and zero end-expiratory pressure for 120 mins. Following heart-lung block extraction, isolated and perfused lungs were subjected to injurious ventilation with peak airway pressure 30 cm H2O and positive end-expiratory pressure 5 cm H2O for 30 mins. MEASUREMENTS AND MAIN RESULTS: No difference was observed between groups in gas exchange, lung mechanics, or hemodynamics during the 2-hr in vivo period following induction of brain injury. However, after 30 mins of ex vivo injurious mechanical ventilation, lungs from the brain injury group showed greater change in ultrafiltration coefficient, weight gain, and alveolar hemorrhage (all p < .05). CONCLUSIONS: Massive brain injury might increase lung vulnerability to subsequent injurious mechanical or ischemia-reperfusion insults, thereby increasing the risk of clinical posttransplant graft failure.

Animals↗
PubMed1990

[Differentiation of infiltrates between lung cancer and noncancerous lung disease by 123I-IMP lung imaging].

Lung imaging with N-isopropyl-p-123I-iodoamphetamine (123I-IMP) was performed to estimate the pulmonary lesion imaging findings in 3 patients with bronchogenic carcinoma (2: bronchioloalveolar carcinoma and 1: adenocarcinoma) and 18 with noncancerous lung diseases (10: bacterial pneumonia, 1: viral pneumonia, 1: aspiration pneumonia, 1: radiation pneumonitis, 4: pulmonary tuberculosis and 1: obstructive pneumonitis due to an endobronchial lipoma) at 30 min and 4 hr after i.v. injection of 111 MBq of 123I-IMP. These patients all exhibited infiltrates only in the chest radiograms. Decreased uptake of 123I-IMP was observed in the cancerous infiltrating lesions in 3 patients with bronchogenic carcinoma at 30 min and 4 hr, while the uptake of 123I-IMP was normal or increased at 30 min and intense at 4 hr in all 18 noncancerous infiltrating lesions. Therefore 123I-IMP lung imaging can be used to differentiate bronchogenic carcinoma from noncancerous lung disease in patients who exhibit infiltrates only in the chest radiograms.

Adult↗
PubMed1995

[Efficacy of video thoracoscopic lung biopsy in diffuse lung diseases: comparison with open lung biopsy].

The efficacy and safety of video thoracoscopic lung biopsy (VTLB) and of open lung biopsy (OLB) were compared in patients with diffuse lung diseases. Thirty-three patients who had undergone VTLB were retrospectively studied and compared with 67 patients who had undergone OLB. There were no significant differences in age (52.8 +/- 10.9 vs 53.4 +/- 10.3), in the number of biopsies per patient (2.6 +/- 0.6 vs 2.7 +/- 0.6), or in the rate of diagnosis (94% vs 93%) between the two groups. However, the rate of diagnosis was low when the number of VTLB or OLB performed per patient was low. The patients undergoing VTLB had significantly shorter operative times (VTLB, 100.2 +/- 27.2 min. vs OLB, 119.8 +/- 42.6 min; p < 0.01) and less blood loss (VTLB, 4.7 +/- 14.6 ml vs OLB, 65.7 +/- 77.0 ml; p < 0.001). Complications occurred in 3 of the 33 who underwent VTLB, and in 18 of the 67 who underwent OLB. These results indicate that VTLB is an effective and safe alternative in the diagnosis of diffuse lung diseases.

Adult↗
PubMed1997

Postoperative adjuvant chemotherapy for non-small-cell lung cancer. West Japan Study Group for Lung Cancer Surgery. The Japan Lung Cancer Research Group on Postsurgical Adjuvant Chemotherapy.

Given that no therapeutic methods of postoperative adjuvant chemotherapy for non-small-cell lung cancer have been established, we selected UFT (tegafur and uracil) for investigation because UFT is less injurious to the host than intensive chemotherapies. The second study of the West Japan Study Group for Lung Cancer Surgery showed that the 5-year survival rates were 64.1% in the UFT group (UFT 400 mg/day for 1 year after surgery) and 49.1% in the control group (surgery alone). Thus, the survival rate for all patients was improved significantly in the UFT group as compared with the control group (log rank test, P = .033; generalized Wilcoxon test, P = .019). To establish the usefulness of long-term oral administration of UFT as an adjuvant therapy for completely resected non-small-cell lung cancer, the nationwide Japan Lung Cancer Research Group on Postsurgical Adjuvant Chemotherapy is now conducting a comparative study of surgery alone versus surgery and UFT in patients with pathologic stage I adenocarcinoma.

Antineoplastic Agents↗
PubMed2000

Lobectomy for cavitating lung abscess with haemoptysis: strategy for protecting the contralateral lung and also the non-involved lobe of the ipsilateral lung.

We describe the anaesthetic management of a patient undergoing lobectomy for cavitating lung abscess complicated by haemoptysis. Surgery for lung abscess is one of the absolute indications for the use of a double-lumen tube (DLT). Because pus or blood could impede fibreoptic-assisted DLT placement, a traditional, blind placement of the DLT was performed. To protect the uninvolved parts of the operated lung, ventilation of the lung with the abscess was not performed until the resection of the involved lobe had been completed.

Adult↗
PubMed1996

Acute lung injury following lung resection: is one lung anaesthesia to blame?

Further examination of the parameters of oxidative stress, perioperative changes in the vasoregulatory mechanisms of the pulmonary circulation, and characterisation of the endothelial insult that probably occurs in all patients undergoing lung resection is necessary if the operative conditions under which lung surgery is carried out are to be optimised. Perhaps, then, more insight might be gained into how to improve preservation of lungs for transplantation and how to protect the lung from significant injury following resection.

Anesthesia, General↗
PubMed1993

[Heart-lung transplantation, single lung and both lungs].

Following the improvement in surgical techniques and immunosuppression regimens as well as a better selection of recipients, an increasing number of heart-lung, single lung and double lung transplantations have been performed within the last decade. In the early stages, most candidates had advanced pulmonary hypertension. More recently, patients with end-stage lung disease have been successfully transplanted. Providing the allografts remain free of complications, long-term survivors may benefit of well preserved pulmonary function. However, acute rejection, obliterative bronchiolitis and infections are still a major cause of morbidity and mortality.

Bronchiolitis Obliterans↗
PubMed1984

Establishment of epithelial cell strains from normal adult mouse lung resembling a urethane-induced lung adenoma cell strain and a metastasizing mouse lung carcinoma cell line.

Epithelial cell strains, designated NAL, have been established from normal lungs of adult female Balb/c mice. The ultrastructural characteristics, effect of dexamethasone on cellular morphology and proliferation rate, and the cytoskeletal protein pattern of NAL suggests that these cell strains may be related to a urethane-induced mouse lung adenoma cell strain NUL and to a metastasizing mouse lung tumour cell line CMT. NAL exhibited no anchorage-independent growth under normal conditions, however extensive passaging in the presence of 5 X 10(-6)M dexamethasone resulted in a colony forming efficiency in soft agar of 8.4% at passage number 30.

Adenoma↗
PubMed2006

CT appearance of radiation injury of the lung and clinical symptoms after stereotactic body radiation therapy (SBRT) for lung cancers: are patients with pulmonary emphysema also candidates for SBRT for lung cancers?

PURPOSE: The purpose of this study was to analyze the computed tomographic (CT) appearance of radiation injury to the lung and clinical symptoms after stereotactic body radiation therapy (SBRT) and evaluate the difference by the presence of pulmonary emphysema (PE) for small lung cancers. METHODS AND MATERIALS: In this analysis, 45 patients with 52 primary or metastatic lung cancers were enrolled. We evaluated the CT appearance of acute radiation pneumonitis (within 6 months) and radiation fibrosis (after 6 months) after SBRT. Clinical symptoms were evaluated by Common Terminology Criteria for Adverse Events, version 3.0. We also evaluated the relationship between CT appearance, clinical symptoms, and PE. RESULTS: CT appearance of acute radiation pneumonitis was classified as follows: (1) diffuse consolidation, 38.5%; (2) patchy consolidation and ground-glass opacities (GGO), 15.4%; (3) diffuse GGO, 11.5%; (4) patchy GGO, 2.0%; (5) no evidence of increasing density, 32.6%. CT appearance of radiation fibrosis was classified as follows: (1) modified conventional pattern, 61.5%; (2) mass-like pattern, 17.3%; (3) scar-like pattern, 21.2%. Patients who were diagnosed with more than Grade 2 pneumonitis showed significantly less no evidence of increased density pattern and scar-like pattern than any other pattern (p=0.0314, 0.0297, respectively). Significantly, most of these patients with no evidence of increased density pattern and scar-like pattern had PE (p=0.00038, 0.00044, respectively). CONCLUSION: Computed tomographic appearance after SBRT was classified into five patterns of acute radiation pneumonitis and three patterns of radiation fibrosis. Our results suggest that SBRT can be also safely performed even in patients with PE.

Aged↗