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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Lung transplantation began to expand in 1983, after the advent of cyclosporin and the publication of the Toronto lung transplant group study. Single lung transplantation was first performed in patients with interstitial pneumopathy to be extended later to pulmonary emphysema, then to primary or secondary pulmonary arterial hypertension. Double lung transplantation provides patients suffering from chronic lung infection (e.g. cystic fibrosis) with a useful alternative to their ordinary treatment. The experience acquired throughout these years has resulted in wider criteria for patients' inclusion. More than acute rejection, bacterial infections directly condition the immediate prognosis. The frequency and severity of cytomegalovirus lung diseases lead to a discussion on the possibility of prophylactic and curative antiviral therapy. The occurrence of obliterative broncholitis, which reflects chronic lung rejection, jeopardizes the long-term results of transplantation. The functional results of the various types of lung grafting are analysed, and the position of lung transplantation in thoracic surgery is reassessed.
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PMID:[Lung transplantation]. 179 34

At the end of December 1990 11 patients had survived lung transplantation at the 2nd Department of Surgery, University of Vienna. In these patients 7 single lung (SLTX) and four bilateral lung transplantations (DLTX) were performed. The indication for operation in 6 cases was emphysema, in 2 cases mucoviscidosis, in 2 cases pulmonary fibrosis, and in 1 case secondary pulmonary hypertension, following operation of a ductus Botalli. By means of fitness tests, blood-gas analysis, pulmonary function tests and ventilation respectively perfusion scan a marked improvement of the clinical status of the patients following lung transplantation could be shown.
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PMID:[Uni- and bilateral lung transplantation: functional results. Vienna Lung Transplant Group]. 179

This study was aimed at evaluating CT sensitivity in identifying the signs of pulmonary cystic fibrosis (CF). The chests of 39 patients (16 males and 23 females, mean age 19.1 years) were examined by CT: all patients had been given a clinical score according to Schwachman and Kulckzycki criteria. Thickened bronchial walls were observed in all cases, which are typical of peribronchitis. Bronchiectases were present in 87% of cases; their extent, pattern and localization were exactly shown on CT scans. Bronchoceles were seen on CT scans in 64% of patients; less frequent was the finding of atelectases and subpleural bullous emphysema. In a great number of patients (64% and 82%, respectively) pleural thickening and hilar adenopathy were demonstrated on CT scans. In conclusion, our results confirm CT as a more sensitive method than conventional radiography to identify and locate the signs of pulmonary CF. The early identification of the lesions is of high prognostic value, since the early detection and treatment of bronchoceles may prevent permanent bronchiectasis.
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PMID:[Computerized tomography in pulmonary cystic fibrosis]. 189 85

We recently described a technique for bilateral sequential lung transplantation that replaces the en bloc double-lung operation, a procedure that was accompanied by frequent problems with airway healing. Twenty-seven patients have undergone 28 bilateral sequential lung transplantations over the past 14 months. Eighteen patients had transplantation because of end-stage emphysema; 6, cystic fibrosis; and 1 each, obliterative bronchiolitis, usual interstitial pneumonitis with pulmonary fibrosis, and bronchiectasis. Cardiopulmonary bypass was used electively in the first 5 patients until it was recognized that the procedure could be done safely without it, and in only 3 additional recipients has it been employed. Mean ischemic time for the first lung was 276 +/- 43 minutes and for the second lung, 410 +/- 64 minutes. There have been five deaths, three in the postoperative period (11% operative mortality) and two late. The other patients are alive and well and do not require oxygen 2 to 15 months after transplantation. Mean forced expiratory volume in 1 second rose from 16% +/- 8% of predicted to 84% +/- 17% at 12 weeks. Six-minute walk values increased from a mean of 251 +/- 91 m to 666 +/- 42 m at 24 weeks. The excellent exposure afforded to both hemithoraces by the thoracosternotomy incision and the rare need of cardiopulmonary bypass have allowed us to offer the option of transplantation to patients who formerly would have been turned down because of previous pulmonary resection or pleurectomy. On four occasions, ventilator-dependent patients underwent successful transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bilateral sequential lung transplantation: the procedure of choice for double-lung replacement. 189 30

Chronic upper lobe cavitary lung disease may be caused by infections, emphysema, cystic fibrosis, lung cancer, sarcoidosis and rheumatologic syndromes. The diagnostic evaluation includes a complete history, a physical examination, a chest radiograph, and sputum examination and culture. In some cases, computed tomographic scanning and biopsy are required.
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PMID:Chronic upper lobe cavitary lung disease. 198 87

The modern era of lung transplantation followed the introduction of cyclosporin and the development of en bloc heart-lung transplantation in 1980. This was followed in 1983 by the first long-term successful unilateral lung transplant by the Toronto group. The same group carried out the first successful double lung transplantation in 1986. Heart-lung transplantation remains the most common operation for patients with end-stage lung disease but is being gradually replaced by single lung transplantation for end-stage pulmonary hypertension, pulmonary fibrosis and emphysema. The major indication for double lung transplantation is cystic fibrosis or emphysema in subjects less than 45 years of age. The probability of survival after lung transplantation is approximately 65% after one year and 60 and 50% after two and three years respectively. This compares favorably to the early results obtained with heart transplantation. These survival figures represent a marked improvement in the prognosis of patients with end-stage lung disease who are candidates for lung transplantation since such subjects should have an expected survival of less than two years without this intervention. The major problems encountered with lung transplantation are technical difficulties during the operation, serious infections and acute episodes of rejection, both of which are most common in the first six months following the operation, and bronchiolitis obliterans, which is a late complication most probably related to chronic rejection. Organ availability remains a major limiting factor to the availability of lung transplantation and, as a consequence, numerous patients die while awaiting a donor organ.
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PMID:[Lung transplantation: the current state of knowledge]. 204 38

Chronic irreversible obstructive airways disease (COAD) is the end result of a number of disorders: airway damage from tobacco smoke, atmospheric pollution and occupational dust and fume, bronchiectasis, cystic fibrosis, bronchial asthma and a number of congenital disorders of defective airway defence. The clinical features include sputum, wheeze, breathlessness and infective and noninfective airway inflammation. The pathological consequences are airways obstruction, emphysema and respiratory failure. Except in bronchiectasis, the volume of daily sputum and bronchial infection is less than 20-30 years ago. At autopsy, bronchial gland hypertrophy is now an inconstant feature. Bronchial infection probably contributes little to airways obstruction, but the load of activated neutrophils in bronchiectasis is an important feature. Wheeze comes late to many patients with COAD. It is associated with less reversibility to bronchodilator drugs and more fixed airways obstruction compared to the conventional asthmatic and is probably of different aetiology. Breathlessness is of variable severity when the forced expiratory volume (FEV1) falls below 1.0 liters resulting in disability ranging from manageable to severe. The FEV1 declines an average by 70-80 ml/year (normal approx. 25 ml/year) until the value falls below 1.0 liters, then the rate of decline slows to a plateau which can persist for several years. During this period, hyperinflation, breathlessness and respiratory failure continue to worsen. Significant respiratory failure may be a terminal event or be present for many years. Arterial oxygen tension (PaO2) slowly declines in most patients--"pink puffers" generally have a minimal rate of fall until weeks or months before death, "blue bloaters," by contrast, several times as great.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Natural history of obstructive airways disease and hypoxia: implications for therapy. 211 87

Autonomic nervous system function has been studied both in vitro and in vivo using a variety of methodologies. In asthmatic patients, beta-adrenergic hyporesponsiveness and alpha-adrenergic and cholinergic hyperresponsiveness can be frequently demonstrated. These observations have provided support for the beta blockade theory of asthma, advanced in the late 1960s by Andor Szentivanyi's experiments involving sensitized rodents. However, in addition to asthma, aberrations in autonomic nervous system function have been noted in other individuals including cystic fibrosis patients and their parents, patients with emphysema and bronchitis, and in patients (allergic rhinitis and atopic dermatitis) who have demonstrable IgE antibody responses to a variety of antigens. Thus, although these defects are not specific for asthma, it is noteworthy that these conditions share many clinical features; the ultimate phenotypic expression of these abnormalities may depend on both genetic and environmental factors that have yet to be defined.
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PMID:Autonomic nervous system abnormalities and asthma. 215 65

Over the past ten years there has been fundamental progress in molecular biology, i.e. concerning the structure and function of genes. The understanding and diagnosis of several diseases, in particular those of the respiratory system, have been profoundly affected and changed. For example alpha-1-antitrypsin deficiency and the emphysema which results have now been dissected down to a molecular level and characterised by anomalies of certain critical portions of the gene coding for this protein. The same thing is found in cystic fibrosis where, thanks to recent technical progress, it is now possible to make a positive diagnosis in most unaffected carriers. The importance of molecular biology in lung cancer is equally established, and in small cell lung cancer one can already isolate a sub group of cancers presenting with an abnormal amplification of the c-myc oncogene. Finally, the role of inflammatory cells, in particular macrophages, in pulmonary fibrosis is best understood by studying the expression by macrophages of the genes coding for mediators which alter the replication of fibroblasts.
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PMID:[Application of molecular biology techniques to pneumology]. 217 33

Unilateral lung transplantation has become a successful method for the treatment of end-stage pulmonary disease, whereas double-lung transplantation has provided benefit to patients with nonfibrotic lung disease such as emphysema and cystic fibrosis. In the past 5 years, 16 single-lung and 13 double-lung transplantations have been performed by the Toronto Lung Transplant Group in patients with end-stage lung disease. Seven perioperative and two late deaths have been recorded so far. Since the introduction of heart-lung transplantation at Stanford in 1981 and at Pittsburgh in 1982 for the treatment of Eisenmenger's syndrome and terminal pulmonary vascular disease, more than 350 combined heart-lung transplantations have been carried out throughout the world. Presently, the 2-year actuarial survival is about 62%. The long-term results have not yet reached the same level of success as those of cardiac transplantation alone. Although several factors have played a role in this difference, a prominent cause has been the lack of a reliable and simple method for pulmonary protection against prolonged ischemia. Most of the techniques proposed against ischemia can be classified as normothermic or static hypothermic cardiopulmonary preservation. The use of the normothermic method has not always been successful. For this reason, interest has now been directed toward the potential for hypothermic preservation of the heart-lung bloc and the use of free-radical scavenger therapy in the reduction of reperfusion injury.
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PMID:Lung and heart-lung transplantation. 218 26


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