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PubMed2000

Paradoxical motion of the hemidiaphragm in patients with emphysema.

The authors evaluate paradoxical diaphragmatic motion using magnetic resonance (MR) imaging in patients with emphysema. The subjects were 12 healthy volunteers and 10 male patients with moderate to severe air flow obstruction. With subjects in the supine position, 30 sequential sagittal images of the bilateral lungs were obtained during quiet and forced breathing using a 1.5T MR unit with a body coil. The sequence was single shot fast spin echo (SSFSE) with half Fourier transformation. Subtraction images were made from the original images (by subtracting a given image from the preceding image), which visualized the chest wall motion as white or black bands on the edge of the lung fields. The authors evaluated both the original and subtraction images. MR imaging showed abnormal hemidiaphragmatic motion during forced breathing: the ventral portion of the hemidiaphragm moved downward while the dorsal part moved upward like a seesaw in 6 patients. MR images also revealed abnormal ribcage motion; the ventral ribcage moved anteriorly when the hemidiaphragm moved upward in 7 patients. No abnormal motion was observed in healthy volunteers. MR is a noninvasive and useful tool for evaluating the asynchronous respiratory motion in patients with emphysema.

Adult↗
PubMed1997

Orbital emphysema as a complication of bungee jumping.

Bungee jumping is a dangerous sport with increasing popularity in the western world. We report the case of a 28-yr-old man who sustained an orbital emphysema as a result of bungee jumping. He jumped head first from a 160-ft high bridge over a river. At the end of the jump he dived into the water with his head in a reclined position. The sudden dive into the water caused an increase of the air pressure in the nose and paranasal sinuses, which led to an emphysema of the right orbit resulting from a skull fracture not detectable by x-ray. The patient was treated with oral antibiotics. Five days later, he had no clinical complaints and the ophthalmologic examination was normal. This variation of bungee jumping may bear severe risk factors for health in addition to those known from the classic jumps.

Adult↗
PubMed1979

Congenital lobar emphysema.

Congenital lobar emphysema is a rare disorder thay may present outside the newborn period. It is generally best treated surgically by excision of the affected lobe. We describe a 6 1/2-week-old infant in whom the initial auscultatory and roentgenographic findings were confusing and of no help in making the diagnosis. The etiology of congenital lobar emphysema remains unclear.

Diseases in Twins↗
PubMed2004

Lung-volume reduction surgery for severe emphysema: appraisal of its current status.

PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States, as well as a major cause of disability. In its end stages, its inexorable progression results in profound suffering for those afflicted. Medical therapy has proven largely ineffective in improving dyspnea and functional status, and does not alter pulmonary function. Over the past decade, lung-volume reduction surgery (LVRS) has been proposed as a palliative treatment for certain subgroups of COPD patients with emphysema, but initial enthusiasm over its application had been confounded by uncertainty about the potential cost and morbidities associated with LVRS, as well as durability of its beneficial effects. Longer-term follow-up data of initial uncontrolled trials along with several landmark controlled trials have recently been published, offering insight as to the "proper" place of LVRS in the treatment of these unfortunate patients. This review will summarize and offer perspective on these recent findings, as well as offer thoughts on recent refinements in preoperative imaging assessment, and pioneering efforts in less invasive bronchoscopic lung-volume reduction that should further aid the clinician in defining who should benefit from this treatment approach. RECENT FINDINGS: Lung-volume reduction surgery can result in demonstrable benefit in selected subgroups of COPD patients with upper-lobe disease and poor exercise capacity before surgery with improvements in six-minute walk distances, forced expiratory volume in the first second (FEV1), dyspnea scores and quality-of-life scores, and decreases in residual volume (RV) as well as the need for supplemental oxygen. Patients with FEV1 less than 20% of predicted and either homogeneous emphysema or diffusing capacities (DLCO) less than 20% of predicted do not benefit from LVRS and have unacceptable peri-operative mortalities. Costs to society are high, with a cost of $98,000 per quality-adjusted-life year gained over a 2-year period if only those with upper-lobe disease are offered the procedure. SUMMARY: Lung-volume reduction surgery can improve both objective and subjective measures of lung performance in properly selected COPD patients. Durable effects of up to 5 years have now been demonstrated. As costs (both fiscal and emotional) of such an approach are high, refinement in patient selection remains a current goal in the surgical approach to COPD.

Exercise Tolerance↗
PubMed2003

The use of pulmonary interstitial emphysema as an indicator of live birth.

Making the determination of live birth versus stillbirth in a discarded newborn infant based on gross and microscopic autopsy findings can be a challenging task for the forensic pathologist. The traditional criteria for live birth determination are frequently challenged in court, and indisputable evidence of live birth remains elusive. The histologic finding of pulmonary interstitial emphysema has not been considered as a useful determinant of live birth. The authors report two cases of discarded newborn infants in which the finding of pulmonary interstitial emphysema was used as an indicator of live birth.

Adult↗
PubMed2005

Congenital lobar emphysema: tube thoracostomy not the treatment.

A 23-month-old boy was transferred to our facility after being diagnosed with a right-sided pneumothorax in an outlying hospital emergency department. The patient's primary complaint was a nonproductive cough and runny nose. Vital signs were stable with 98% oxygen saturation by pulse oximetry. Physical examination was unremarkable except for diminished breath sounds on the right. Chest x-ray revealed a large lucency over the right lung field, yet an intact vascular pattern. Computed tomography scan of the chest revealed congenital lobar emphysema of the right upper lobe. The pathophysiology, clinical presentation, diagnostic evaluation, and management of congenital lobar emphysema are reviewed.

Chest Tubes↗
PubMed2004

Comparison of the sensitivities of 5 different computed tomography scanners for the assessment of the progression of pulmonary emphysema: a phantom study.

RATIONALE AND OBJECTIVES: To compare the sensitivities of 5 different computed tomography scanners (4 multislice CT [MSCT] and 1 single-slice CT) in the assessment of the progression of pulmonary emphysema. METHODS: A Perspex cylinder phantom was constructed containing small pieces of polythene foam with densities representative of lung. Changing the cylinder's volume simulated subtle lung density changes. The sensitivity to density changes was defined by the variation in the residual errors from the linear regression line between time and density. RESULTS: The single-slice CT scanner was significantly less sensitive to density changes than MSCT scanners. Also, among MSCT scanners, small but significant differences were found when the standardized acquisition protocol was used. CONCLUSIONS: Considering the large sensitivity differences between single- and multislice CT scanners, we would recommended using MSCT scanners in clinical multicenter trials in emphysema. The protocol standardization of MSCT scanners can still be further improved.

Humans↗
PubMed2006

MDCT-based 3-D texture classification of emphysema and early smoking related lung pathologies.

Our goal is to enhance the ability to differentiate normal lung from subtle pathologies via multidetector row CT (MDCT) by extending a two-dimensional (2-D) texturebased tissue classification [adaptive multiple feature method (AMFM)] to use three-dimensional (3-D) texture features. We performed MDCT on 34 humans and classified volumes of interest (VOIs) in the MDCT images into five categories: EC, emphysema in severe chronic obstructive pulmonary disease (COPD); MC, mild emphysema in mild COPD; NC, normal appearing lung in mild COPD; NN, normal appearing lung in normal nonsmokers; and NS, normal appearing lung in normal smokers. COPD severity was based upon pulmonary function tests (PFTs). Airways and vessels were excluded from VOIs; 24 3-D texture features were calculated; and a Bayesian classifier was used for discrimination. A leave-one-out method was employed for validation. Sensitivity of the four-class classification in the form of 3-D/2-D was: EC: 85%/71%, MC: 90%/82%; NC: 88%/50%; NN: 100%/60%. Sensitivity and specificity for NN using a two-class classification of NN and NS in the form of 3-D/2-D were: 99%/72% and 100%/75%, respectively. We conclude that 3-D AMFM analysis of lung parenchyma improves discrimination compared to 2-D AMFM of the same VOIs. Furthermore, our results suggest that the 3-D AMFM may provide a means of discriminating subtle differences between smokers and nonsmokers both with normal PFTs.

Algorithms↗
PubMed2006

Light cigarette smoke-induced emphysema and NFkappaB activation in mouse lung.

Light cigarette (LC) exposure is supposed to be less hazardous with a decreased incidence of cancer and tobacco-associated diseases. C57BL/6 mouse groups were subjected to smoke from 3, 6 or 12 LC for 60 days and compared with mice exposed to ambient air (EAA) in order to study lung injury by morphometrical and biochemical methods. Bronchoalveolar lavage (BAL) analysis and histology and stereology were performed. Tissue from the right lung was used for measuring thiobarbituric acid reactive substances (TBARS) and Western blot analysis. One way anova was performed followed by the Student-Newman Keuls post-test (P < 0.05). The cellular content of BAL was 95% alveolar macrophages in all groups except in mice exposed to 3 LC, where 23% neutrophils were observed. Emphysema was not observed in three and 6 LC, but it was found in 12 LC parallel to increased volume density (Vv) of airspaces from 61.0 +/- 0.6 (EAA) to 80.9 +/- 1.0 (12 LC) and decreased Vv of elastic fibres from 17.8 +/- 0.9 (EAA) to 11.8 +/- 0.6 (12 LC). All exposed groups to LC showed low TBARS levels compared with mice EAA. Lung tissue from animals exposed to 12 LC showed decreased tissue inhibitor of metalloprotease-2 and increased matrix metalloprotease-12 detection, which suggests an imbalance in extracellular matrix (ECM). Increased tumour necrosis factor-alpha and nuclear factor-kappaB detection were observed in exposed groups to LC when compared with mice EAA. The data suggest that LC is so dangerous to lungs as full-flavour cigarettes inducing ECM imbalance and emphysema.

Animals↗
PubMed1998

Effects of isoflurane on oxygenation during one-lung ventilation in pulmonary emphysema patients.

BACKGROUND: Hypoxic pulmonary vasoconstriction has an important role in human one-lung ventilation (OLV) in the lateral decubitus position under general anesthesia. During OLV, inhalational anesthesia may inhibit hypoxic pulmonary vasoconstriction and the decrease in arterial oxygenation. We studied the effect of isoflurane administration on arterial oxygen tension in chronic obstructive pulmonary disease patients. METHODS: Ten patients who had thoracoscopic laser ablation of bullous emphysema were studied. Patients received 2% isoflurane in oxygen from induction until the first 20 min of OLV in the lateral decubitus position, then were switched to 1% isoflurane lasting 20 min and next were switched to 0.5% isoflurane lasting 20 min. After each 20-min inhalation, pulmonary and hemodynamic parameters were measured. The given concentrations for isoflurane were merely vapor meter concentrations. RESULTS: PaO2/FIO2, Qs/Qt respiratory rate peak inspiratory pressure and PaCO2 showed no significant changes at each point of isoflurane. Expiratory tidal volume significantly decreased (P < 0.05) with 0.5% isoflurane compared to that with 2% isoflurane. Cardiac output, mean arterial pressure, mean pulmonary arterial pressure, systemic vascular resistance and pulmonary vascular resistance showed no significant changes at each point of isoflurane. CONCLUSIONS: In patients with pulmonary emphysema, arterial oxygenation is not affected by low isoflurane concentration during OLV in the lateral decubitus position.

Aged↗
PubMed1996

Classification of lung sounds in patients with asthma, emphysema, fibrosing alveolitis and healthy lungs by using self-organizing maps.

The performance of the self-organizing map (SOM), an artificial neural network, was evaluated in the classification of lung sounds. Patients with asthma (n = 8), emphysema (n = 8) and fibrosing alveolitis (n = 8), and patients with healthy lungs (n = 8) were selected for the study. Fast Fourier transform (FFT) spectra from midinspiratory breath sounds recorded at the right lower lobe area were used to construct feature vectors in the learning and classification process of SOM. The sound segments did not contain wheezing sounds. The lung sounds of 25/32 (78%) patients were classified correctly, with an overall kappa (kappa) value of 0.71. The agreement between the clinical and proposed diagnoses based on classification of lung sounds was good among patients with emphysema (kappa = 0.92) and those with healthy lungs (kappa = 0.83), but only moderate among patients with asthma (kappa = 0.52) and fibrosing alveolitis (kappa = 0.54). This is due to the limitations in distinguishing breath sounds of asthmatics without wheezing sounds from those with crackles in fibrosing alveolitis by the spectral pattern alone. The results indicate that SOM based on FFT spectra is potentially useful in the classification of lung sounds, e.g. in health screening or in differential diagnosis of pulmonary disorders. To enhance the performance of SOM, other features of lung sounds should be combined with FFT spectra.

Adult↗
PubMed2006

Pulmonary interstitial emphysema in live birth determination: radiographic and gross pathologic features.

Pulmonary interstitial emphysema (PIE) has previously been reported as a useful finding in the determination of live birth in cases where the birth and death were not attended. Herein, we present the radiographic and gross pathologic features of PIE in such a case. In this instance, in addition to parenchymal interstitial emphysema, there were subpleural air collections and a pneumothorax.

Adult↗
PubMed2002

Surgical treatment of congenital lobar emphysema in a puppy.

Congenital lobar emphysema was found in a three-month-old male springer spaniel. Clinical signs included coughing, progressive dyspnoea and abnormal lung auscultation. Radiographic examination revealed overinflation and hyperlucency of the right middle lung lobe. Following lung lobectomy, clinical signs resolved and the animal had normal exercise tolerance. Previous case reports are reviewed and discussed in relation to human congenital lobar emphysema.

Animals↗
PubMed1982

Lung fibrosis and emphysema: divergent responses to a common injury?

Cadmium chloride, administered intratracheally to golden Syrian hamsters, causes an acute lung injury which evolves into a lesion with functional and morphological features of diffuse fibrosis. With simultaneous feeding of a lathyrogen, beta-aminoproprionitrile, this same injury evolves into functional and morphological changes of bullous emphysema. These results suggest that the same lung injury might result in either fibrosis or emphysema, connective tissue synthesis during the healing phase being the critical determinant.

Aminopropionitrile↗