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

We conclude that inclusion of the hilar region adds little morbidity, while failure to treat is associated with a finite risk of hilar recurrence. It therefore would seem advisable to include the lung roots in "mantle" field techniques in patients with good pulmonary reserve. Our experience with this group of patients, and with others not included here, suggests that the risk of hilar involvement may be particularly pronounced in patients who present with intradiaphragmatic disease. On the other hand, the relapse rate in the hila is sufficiently small that straight-edged mediastinal fields can be used with relative safety in patients with emphysema or other pre-existing dysfunction for whom inclusion of the additional volume might lead to pulmonary insufficiency.
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PMID:Hilar irradiation in early stage Hodgkin's disease. 60 66

The alpha-1-antitrypsin gene is localized to chromosome 14. Numerous genetic variations may occur and some of these result in severely reduced concentration in the serum. The commonest cause of severe deficiency of alpha-1-antitrypsin is the gene-variant Z in the homozygotic form which occurs in one out of 2,000 Danes. Severe deficiency in alpha-1-antitrypsin results in liver symptoms in approximately 10% of the children. Some of these will develop cirrhosis of the liver. In adults at the ages of about 30 to 40 years, gradual development of emphysema occurs and this is earliest and most pronounced in smokers. Adults have also increased frequency of cirrhosis but this is much less pronounced than the development of emphysema. In addition to a number of theoretical therapeutic possibilities, liver transplantation is now possible and this is employed particularly in children with cirrhosis. In young persons with terminal pulmonary insufficiency with anticipated survival for less than one year, heart/lung transplantation or possibly isolated lung transplantation may be considered. An alpha-1-antitrypsin concentrate has been produced. Intravenous dosage once monthly can provide a concentration in the serum for three to four weeks which, as a rule, suffices to prevent emphysema. It is not yet known whether this treatment has any prophylactic effect in cases of developed emphysema. It is to be anticipated that treatment instituted prior to development of emphysema will prevent development of pulmonary disease but the treatment is rather expensive and must, probably, continue throughout life. No controlled investigation of the effect of treatment is available and the range of indications is not defined.
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PMID:[New therapeutic possibilities in alpha 1-antitrypsin deficiency]. 218 56

Based on 48 patients suffering from larger bullous pulmonary emphysema, the problem of operability was investigated. In spite of a considerable preoperative cardiopulmonary insufficiency in several cases the patients were treated surgically. The good postoperative results show that the border lines recognized up to now can be partially ignored without endangering the success of the operation. In patients who have been well adapted to chronic pulmonary insufficiency for years, postoperative respirator treatment should be used sparingly. The decision in favour of an operation must be made individually.
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PMID:[Operability in cardiopulmonary insufficiency]. 232 78

Neonatal pulmonary diseases may require mechanical ventilation and supplemental oxygen therapy. These supportive measures can damage the immature lung or distort the normal maturation processes of the developing lung. The formation of hyaline membranes occurs acutely, often complicated by left-to-right cardiac shunts. Pulmonary edema occurs next, followed by interstitial fibrosis and finally by parenchymal emphysema. This process is termed bronchopulmonary dysplasia. Significant morbidity and mortality are associated with this developmental pulmonary dysplasia, particularly during the first two years of life. A delay in normal growth and development is often present, acute episodes of pulmonary insufficiency are seen, and multiple episodes of pulmonary infection occur. Subsequently, the radiographic appearance and the clinical symptoms improve. Therapy is mainly supportive throughout the course of the disease and the bronchopulmonary dysplasia tends to resolve slowly. Residual pulmonary dysfunction is usually mild or absent.
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PMID:Bronchopulmonary dysplasia. 361 5

Significant changes in the radiographic features of bronchopulmonary dysplasia (BPD) have accompanied recent advances in treatment of neonatal respiratory distress syndrome. Retrospective study of 709 newborns showed atypical radiographic findings in many patients with clinical BPD. While 12/20 infants with clinical BPD showed changes identical to Northway's stage 4 disease, the remaining 8 (40% of patients with significant respiratory dysfunction) had diffuse, fine infiltrates without emphysema. Radiographic progression from RDS through all Northway stages was observed in only 4 patients. Diagnosis of stage 2 BPD was complicated by the presence of PDA in 9/17 cases. Stage 3 BPD was identified with certainty in only 5 infants, but may have coexisted with PIE in as many as 22 cases. Nevertheless, there was close agreement between the radiographic findings and clinical severity of chronic lung disease. Mild (type 1) infiltrates following RDS may be distinguished from chronic pulmonary insufficiency of prematurity (CPIP) or "immature lung." In patients who require only short-term supplemental O2, type 1 changes may reflect delayed resolution of RDS in an underdeveloped lung. These same findings in infants with prolonged O2 dependence usually indicate a mild form of BPD. Coarse infiltrates and emphysema (type 2) are almost always associated with severe respiratory impairment.
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PMID:Persistent pulmonary abnormalities in newborns: the changing picture of bronchopulmonary dysplasia. 370 91

We report here our first experience with the use of a total artificial heart in a human being. The heart was developed at the University of Utah, and the patient was a 61-year-old man with chronic congestive heart failure due to primary cardiomyopathy, who also had chronic obstructive pulmonary disease. Except for dysfunction of the prosthetic mitral valve, which required replacement of the left-heart prosthesis on the 13th postoperative day, the artificial heart functioned well for the entire postoperative course of 112 days. The mean blood pressure was 84 +/- 8 mm Hg, and cardiac output was generally maintained at 6.7 +/- 0.8 liters per minute for the right heart and 7.5 +/- 0.8 for the left, resulting in postoperative diuresis and relief of congestive failure. The postoperative course was complicated by recurrent pulmonary insufficiency, several episodes of acute renal failure, episodes of fever of unidentified cause (necessitating multiple courses of antibiotics), hemorrhagic complications of anticoagulation, and one generalized seizure of uncertain cause. On the 92nd postoperative day, the patient had diarrhea and vomiting, leading to aspiration pneumonia and sepsis. Death occurred on the 112th day, preceded by progressive renal failure and refractory hypotension, despite maintenance of cardiac output. Autopsy revealed extensive pseudomembranous colitis, acute tubular necrosis, peritoneal and pleural effusion, centrilobular emphysema, and chronic bronchitis with fibrosis and bronchiectasis. The artificial heart system was intact and uninvolved by thrombosis or infectious processes. This experience should encourage further clinical trials with the artificial heart, but we emphasize that the procedure is still highly experimental. Further experience, development, and discussion will be required before more general application of the device can be recommended.
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PMID:Clinical use of the total artificial heart. 1476 80

We previously reported the clinical role of plasma immunoreactive atrial natriuretic polypeptide (ANP) and cyclic GMP in patients with respiratory diseases, bronchial asthma (BA), chronic pulmonary emphysema (CPE) and pulmonary insufficiency induced by pulmonary tuberculosis (TBC). In this study, moreover, we divided patients with respiratory failure induced by tuberculosis sequelae into two groups, patients with oxygen therapy group [O2 (+) group] or ordinary practical treatment group [O2 (-) group], and we evaluated the difference of the roles of ANP in two groups and the correlation of ANP and c-GMP with clinical findings, blood gas analysis, electrocardiogram, chest roentogen photography and spirogram in two groups. In conclusion, the respiratory failure in patients with tuberculosis sequelae is compensated by increased cardiac output, and that causes the rising of right atrial pressure. These results show, addition to the basic effects of ANP, the concentration of plasma ANP is released with relating the degree of respiratory failure.
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PMID:[Clinical evaluation of plasma atrial natriuretic polypeptide in patients with respiratory failure in pulmonary tuberculosis]. 826 22

Aortobronchic fistula is a very unusual complication of thoracic aneurysm. We report the case of a 71-year old man with rupture of a thoracic aortic aneurysm in the left main bronchus. The patient had suffered a car crash fifteen years ago, without any evidence of aortic rupture at the time. Thereafter, he developed an aortic isthmic dilation (36 mm in diameter). The patient suffered from long standing pulmonary insufficiency and emphysema and was admitted several times on an urgent basis for acute dyspnea. During an hospitalization for respiratory distress, he presented haemoptysis and left lung hyperinflation secondary to partial fistulization and extrinsic compression of the main left bronchus. Isthmic aortic resection and prosthetic grafting was performed and the left main bronchus was closed by an autologous pericardial patch. Ten days later, following an air-leak from the bronchial closure, a transposed latissimus dorsi flap was used by the plastic surgeon to repair the defect. Nevertheless, the patient died from multisystemic failure six weeks later.
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PMID:Rupture of a thoracic aneurysm in the left bronchus. 1092 18

Lung volume reduction has become an accepted option for surgical treatment of pulmonary emphysema. Lately this method was introduced in Lithuania.The first 14 of 19 patients, who underwent lung volume reduction surgery, where admitted due to spontaneous pneumothorax, that is a common complication of pulmonary emphysema. Lung volume reduction using wedge resection or plication was performed in 13 and 6 patients respectively. Rethoracotomy was required for postoperative bleeding (2 cases) and prolonged air leakage (1 case). Two patients died. Pulmonary insufficiency decreased significantly in 2/3 of operated on patients. There were no recurrent spontaneous pneumothorax.
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PMID:[Surgical treatment of pulmonary emphysema]. 1256 Jun 11

Nonsmall cell lung cancer often occurs in patients with severe emphysema. Lobectomy in these patients is often contraindicated due to extensive parenchymal destruction and subsequent pulmonary insufficiency. Video-assisted thoracoscopic lobectomy has been described as a less morbid procedure in high-risk patients. Lung volume reduction surgery has been shown to improve pulmonary function in selected patients with emphysema. We describe the successful combination of lobectomy and lung volume reduction surgery (LVRS) with a video-assisted thoracoscopic (VATS) approach in a high-risk patient with Stage I nonsmall cell lung cancer.
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PMID:Combined video-assisted thoracoscopic lung volume reduction surgery and lobectomy in a high-risk patient. 1466 49


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