Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 31-year-old woman sustained multiple injuries, including severe contusion of the right lung with massive subcutaneous emphysema. Four weeks later she was transferred to our institution with post-traumatic adult respiratory distress syndrome and carbon dioxide retention, resulting from a postlaceration stenosis of the left main-stem bronchus. Bronchoplasty was contraindicated because of the serious condition of the patient. Repeated bronchial dilatations produced initial improvement in oxygenation and minute ventilation requirements. However, because of the nature of the stenosis and the lack of recovery of right lung function, the patient's encouraging clinical course reached a plateau and attempts at weaning from the respirator were unsuccessful. Bronchoplasty was performed on postadmission day 50 and resulted in gradual recovery of pulmonary function. Six months following discharge, the patient continues a steady improvement. Management of the patient's injuries represented a unique challenge previously unencountered.
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PMID:Post-traumatic bronchial stenosis and acute respiratory insufficiency. 737 4

Recent in vitro studies and animal investigation indicate that plasma leucocyte elastase (PLE) can dissolve pulmonary structural proteins, such as elastin, and produce lesions in the lung similar to that seen in adult respiratory distress syndrome (ARDS) and emphysema. In contrast, heparin strongly inhibits PLE and protects elastin from elastolysis. On the basis of these findings, PLE levels were monitored in 24 patients with non-small cell lung carcinoma (NSCLC) undergoing lobectomy. Ten patients from Killingbeck Hospital (Group 1) received 5000 IU subcutaneous (s.c.) heparin commenced 2 h prior to surgery and continued at 8 h intervals until the patient was fully ambulatory. Fourteen patients from Bradford Royal Infirmary (Group 2) received no heparin as standard policy. There was no significant difference in pre-operative PLE levels between groups. The post operative PLE levels in both groups increased significantly (P < 0.02) on the first post operation day (POD). However, PLE levels of Group 2 were 2.5 to 5.3 times higher than those of Group 1 at each postoperative interval (first, third, and seventh POD) respectively (0.002 < P < 0.02). There was no difference in blood loss between groups (P = 0.17). These results indicate that post operative PLE activity is elevated in NSCLC patients following lobectomy and s.c. heparin administration as thromboprophylaxis may inhibit PLE activity post operatively without increasing blood loss. Therefore, heparin may have a role to play in protecting lung tissue against the pulmonary lesions caused by proteolytic activity of PLE, and theoretically reduce post-operative complications, such as ARDS or emphysema.
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PMID:Influence of heparin thromboprophylaxis on plasma leucocyte elastase levels following lobectomy for lung carcinoma. 873 46

Neutrophil elastase (NE) is the most important protease of the human lung; if not inhibited NE is able to attack nearly all structural proteins and components of the immune system of the lung. In the normal human lung this is prevented by an excess of protease inhibitors. Based on quantitative and kinetic analyses alpha 1-antitrypsin (AAT) is the most important protease inhibitor of the human lung followed by the Secretory Leukoprotease Inhibitor (SLPI). As protease inhibitors may be inactivated by proteases and reactive oxygen metabolites released from polymorphonuclear cells, it is not surprising that some lung diseases--in particular lung emphysema caused by AAT deficiency, cystic fibrosis and ARDS--are characterized by an imbalance between proteases and protease inhibitors. Because uninhibited NE seems to play an important role in the pathogenesis of these diseases, it is obvious to use protease inhibitors as drugs. Up to now in most studies in men AAT purified from human plasma has been used: worldwide a substantial number of patients with lung emphysema caused by AAT deficiency is treated continuously; in addition AAT was aerosolized to patients with cystic fibrosis in a short term study with results suggesting that this therapy is efficient at least on a biochemical basis. We performed in vitro and in vivo animal studies with the recombinant form of SLPI (rSLPI). In these experiments we found that aerosolized rSLPI a) is not altered in its form or function in the first 13 h following aerosol; b) has a half-tie of 12 h in the lung; c) reaches the interstitium of the lung in intact form.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Therapy of lung diseases with antiproteases]. 791 Apr 1

Spontaneous pneumothorax (PNO) is usually due to rupture of a small subpleural bleb into the pleural cavity and affects mainly young men. After simple drainage, recurrence occurs in about 50% of cases. The risk of recurrence increases after each new PNO. Secondary PNO complicates an underlying pulmonary disease, especially chronic obstructive pulmonary disease with emphysema. A new form of secondary PNO has emerged in the recent years in AIDS patients with pneumocystis carinii pneumonia. We have shifted to a thoracoscopic therapy of PNO since May 1991. 25 PNO in 24 patients (1 bilateral) have been treated since that time up to April 1993. 19 PNO were primary, whereas 6 were secondary, included 3 iatrogenic PNO. Resection of the leaking parenchymal area was performed in 20 patients, and parietal partial pleurectomy was done in 20 cases. In the remaining cases, fibrin glue was applied on the lesion and in 3 cases, chemical pleurodesis was attempted using silver nitrate or talc. 1 AIDS patient died of ARDS. 3 patients had recurrent PNO and had thoracotomy without complication. 21 patients did well. Partial PNO recurred in one of them 4 months later, and was treated by simple needle aspiration. Thoracoscopy is a useful method to treat recurrent or persistent spontaneous PNO. After only 25 cases, our success rate in primary PNO is 90%. There should be a learning curve. On the basis of our experience, we believe that recognition of the lesion and its resection as well as apical parietal pleurectomy are necessary to obtain good results and a low recurrence rate.
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PMID:[Thoracoscopic treatment of recurrent pneumothorax]. 803 19

Polymorphonuclear leukocytes (PMN) enter the circulation from the bone marrow and remain within the vascular space unless they become activated and migrate out of the vessels as part of an inflammatory response. This article reviews their behavior in the pulmonary circulation of both healthy and diseased individuals. First, the flow of PMN is compared with that of erythrocytes (RBC) to explain how differences in the traffic of these two cell types result in a concentration of PMN with respect to RBC in pulmonary capillary blood. Second, some recent concepts are presented concerning the role of PMN in the pathogenesis of emphysema, and the hypothesis is discussed that the inhalation of cigarette smoke contributes to the pathogenesis of emphysematous lung destruction by delaying and activating PMN while they travel through lung capillaries. Finally, the example of streptococcal (i.e., pneumococcal) pneumonia is used to illustrate new information as to how PMN adhere to the endothelium and migrate into an inflammatory site in the lung. The effect of this localized inflammatory response on PMN traffic in the surrounding lung also is discussed in relation to the pathogenesis of the generalized lung injury (acute respiratory disease syndrome [ARDS]) that can complicate severe pneumococcal lung infections.
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PMID:Felix Fleischner Lecture. The traffic of polymorphonuclear leukocytes through pulmonary microvessels in health and disease. 809 9

In the patients suffering from adult respiratory distress syndrome (ARDS), pulmonary barotrauma is a frequent and fearful complication, whose timely and accurate diagnosis is therefore needed. To this purpose, bedside chest films often exhibit some diagnostic drawbacks. Computed tomography (CT) of the chest is rarely used because of the problems concerning the transfer and the control of these critically ill patients outside the Intensive Care Unit. The chest CT findings of 84 ARDS patients were retrospectively reviewed, investigating: a) the presence of barotrauma (pulmonary bullae, pneumothorax, pneumomediastinum, subcutaneous emphysema); b) the positioning of thoracostomy tubes; c) the chest films performed on the same day as CT. CT showed the presence of barotrauma in 41 patients. Pulmonary bullae were seen in 26 cases (31%), pneumothorax (mainly in anteromedial location) in 27 cases (32%) and pneumomediastinum in 11 cases (13%). In 22 patients with thoracostomy tubes CT demonstrated the exact site of the drainages: in 7 cases only the tubes were correctly positioned, or were working properly. The presence of pulmonary bullae (regarded as the evidence of interstitial pulmonary emphysema) proved to be associated with a higher mortality rate than that of the entire sample (58% vs 38%); in 30 of 41 patients with barotrauma (73%) CT proved to be superior to chest films, especially to demonstrate pulmonary bullae (26 cases detected by CT vs 7 cases diagnosed by chest films). In 14 of 41 patients with barotrauma the information yielded by CT directed the choice of treatment: thoracostomy tubes were positioned in the cases of pneumothorax undetected by chest films and in the cases of only partially drained multilocular pneumothorax, or replaced in the event of tube mispositioning. In conclusions, in ARDS patients the use of chest CT is recommended in selected cases only, when complications (especially barotrauma) are suspected and unrevealed by bedside chest films.
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PMID:[Computed tomography in the diagnosis of pulmonary barotrauma associated with the adult respiratory distress syndrome]. 812 32

Oxidants play a major role in mediating a variety of human disorders. The sources of oxidants may vary. They can be released by activated inflammatory cells or derive from the environment (such as pollution or tobacco smoke). In addition to acute, usually reversible reactions, numerous pulmonary diseases are associated with long lasting oxidant stress (adult respiratory distress syndrome, drug induced lung lesions, chronic obstructive pulmonary diseases, asthma, emphysema, interstitial fibrosis). Therapeutic action aimed at increasing anti-oxidant defense mechanisms is still a clinical challenge. Administration of N-acetylcysteine by the oral route is a simple and efficacious means of correcting oxidant-antioxidant imbalance.
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PMID:[Respiratory diseases and oxidants]. 812 94

Two infants with severe respiratory syncytial virus infection which resulted eventually in classical adult respiratory distress syndrome (ARDS) are presented. Both infants had severe apneic spells, necessitating intubation and mechanical ventilation (MV). Chest radiographs changed after a few days after institution of MV from initial bronchopneumonia like pattern to severe ARDS. Assessment of respiratory system mechanics (single breath occlusion technique) revealed severe restrictive disease in both cases. The first patient recovered with residual restrictive changes determined during a follow-up 2.5 months later, whereas the second infant died because of ARDS, pulmonary interstitial emphysema and hypoxemic hypoxia.
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PMID:Respiratory syncytial virus triggered adult respiratory distress syndrome in infants: a report of two cases. 816 64

Single lung transplantation (SLT) is now successfully used in patients with severe emphysema. Mechanical imbalance between the native emphysematous and the healthy transplanted lung can be easily managed, unless severe graft failure occurs, leading to acute respiratory failure. Emergency retransplantation has been used in this setting, since the conventional approach to adult respiratory distress syndrome (ARDS) (mechanical ventilation and positive end-expiratory pressure [PEEP]) fails, due to the mechanical discrepancy between the two lungs. We describe two cases of severe graft failure following SLT in emphysema patients that were successfully treated with prolonged independent respiratory treatment. Mechanical ventilation and PEEP were applied to the failing transplanted lung while the native emphysematous lung was maintained on spontaneous breathing to avoid hyperexpansion and barotrauma. The independent lung respiratory treatment lasted 35 and 25 days, respectively: to our knowledge, these are among the longest-lasting independent respiratory treatments reported. The management was simplified by the early use of a double-lumen tracheostomy cannula as an alternative to orotracheal double lumen tube.
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PMID:Prolonged independent lung respiratory treatment after single lung transplantation in pulmonary emphysema. 841 44

The authors reviewed the radiographic and computed tomographic (CT) appearances of abnormal air-filled spaces in the lung that develop in response to lung diseases. The major types of these lung diseases include infection, vessel-related or vascular-embolic disorders, bronchiectasis, emphysema, pulmonary fibrosis, adult respiratory distress syndrome and air-block diseases, and unusual disorders of the lung (such as Langerhans cell histiocytosis, Klippel-Trenaunay syndrome, and tracheolaryngeal papillomatosis). After studying the CT scans, conventional radiographs, and medical records of 150 patients with various abnormal air-filled spaces in their lungs and 300 lung specimens and the corresponding high-resolution CT scans, the authors concluded that mechanisms of air-space formation fall into five basic categories: (a) vascular occlusion or ischemic necrosis, (b) dilatation of the bronchi, (c) disruption of the elastic fiber network of the lung, (d) remodeling of the lung architecture and retractile fibrosis, and (e) multifactorial or unknown mechanisms.
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PMID:Abnormal air-filled spaces in the lung. 839 71


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