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)

In order to obtain normal values and 95% confidence limits of various CT indices, healthy adult subjects with no history of smoking (n = 36) underwent CT scanning under a variety of conditions. By then applying the normal limits thus obtained to CT images of COPD patients (n = 45), we examined the sensitivity for detecting abnormal emphysematous changes in the lung fields. To measure emphysematous alterations, we used the average value of lung CT densities (ROI), the maximally appearing value in a CT histogram (Hist. Peak), the relative area with low CT densities below -910 HU (%LDA) and the total cross-sectional area (Area) in each lung section. Regardless of the section thickness (10 mm or 1 mm), the lung volume level at which the breath was held or the site from which CT images were taken (upper, middle or lower lung field), no significant correlation was observed between the CT indices associated with emphysematous changes and the subjects' age. This allowed us to define, independently of the subjects' age, normal values and 95% confidence limits for the CT indices. Among the CT indices surveyed, %LDA was found to be the most sensitive indicator for detecting emphysematous abnormalities. In so far as the extent of emphysema may be determined by lung CT density, classical CT images of 10-mm section thickness appear to have a sufficiently high sensitivity for the detection of emphysematous abnormalities, such that high-resolution CT may be unnecessary.
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PMID:[Normal predicted values of CT indices reflect emphysematous alterations in the lung]. 946 16

In appropriately selected patients with COPD and alpha1-antitrypsin deficiency emphysema, lung transplantation prolongs life, improves functional capacity, and enhances quality of life. However, rejection remains an obstacle to better medium-term results, and lung transplantation is a treatment, not a cure and not a panacea.
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PMID:Lung Transplantation for COPD. 955 17

Emphysema and other forms of COPD are not only common, but also have a poor prognosis. Mortality with severe COPD may be as high as 60% at 5 years and is associated with a significant degree of disability and cost to the health-care system. Building on Dr. Otto Brantigan's experience in the 1950s, when multiple-wedge resections of emphysematous lung were performed to decrease lung volume, thereby improving airflow and reducing hyperinflation, recent investigators, utilizing improved surgical and anesthetic technique, have redeveloped a surgical approach to the treatment of emphysema. The operations used to treat emphysema include excision of large bullae (bullectomy) and resection of diffusely emphysematous lung and are variously known as lung volume reduction surgery (LVRS), pneumectomy, and reduction pneumoplasty. These operations aim for a 20 to 30% reduction in lung volume and may be performed by stapler or laser resection, or both. The mechanisms of benefit have been attributed to enhanced elastic recoil, correction of ventilation perfusion mismatch, improved efficiency of respiratory musculature, and improved right ventricular filling. Questions that remain to be answered include duration of benefits, safety, and cost of LVRS. The National Heart, Lung, and Blood Institute and the Health Care Financing Administration have responded to the demand for more access to and information about LVRS by organizing both a national registry and controlled clinical trial of these procedures over a 7-year period. This multicenter trial intends to enroll patients with end-stage emphysema to compare methods of bilateral LVRS to maximal medical therapy.
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PMID:Lung volume reduction surgery: answering the crucial questions. 955 18

A 66-year-old man with a history of COPD and Aspergillus fumigatus infection developed massive hemoptysis. Pulmonary artery angiography revealed an aneurysm which was successfully treated with coil embolization. This is the first known report of a pulmonary artery aneurysm causing massive hemoptysis in a patient with bullous emphysema.
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PMID:Massive hemoptysis from a pulmonary artery aneurysm associated with an emphysematous bulla. 955 60

Respiratory function test, arterial blood gas analysis, and ejection fraction were used to compare three protocols of breathing exercises during immersion in 38 degrees C water. Therapy was given for 2 mo to patients with stable chronic obstructive pulmonary disease. Protocol A consisted of a total exercise period of 20 min/wk (10 min/day, 2 days/wk) and was performed by 7 patients (5 cases of asthma and 2 cases of emphysema). Protocol B consisted of a total exercise period of 120 min/wk (20 min x 2 per day at 10:00 am and 3:00 pm, 3 days/wk) and was performed by 9 patients (6 asthmas and 3 emphysemas). Protocol C consisted of a total exercise period of 120 min/wk (20 min/day, 6 days/wk) and was performed by 8 patients (4 asthmas and 4 emphysemas). The ratio of forced expired volume in one second to forced vital capacity (FEV1.0%) was significantly increased in protocols B and C (P < 0.01). The ratio of forced vital capacity to the predicted normal value (%FVC) was not changed in any of the three protocols. A significant increase in peak flow was observed in protocols B and C (P < 0.05). The maximal expiratory flow at 25% (V25) was not changed in any of the three protocols. PaO2 was significantly increased and PacO2 was significantly decreased in protocol B (P < 0.01 and P < 0.05, respectively), whereas only PaCO2 was significantly decreased in protocol C (P < 0.05). Ejection fraction was increased in protocols B and C. These results suggest that exercise for a total period of 120 min/wk is preferable to that of 20 min/wk in COPD.
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PMID:Comparison of three protocols for breathing exercises during immersion in 38 degrees C water for chronic obstructive pulmonary disease. 955 16

Connection between histological type of lung cancer and existence of clinical and spirometric symptoms of COPD was analysed in 110 lung cancer patients (64 small cell, 23 adenocarcinoma, and 23 squamous). It was shown that adenocarcinoma was significantly more frequent among subjects with values of FEV1%VC over 70 than among subjects with small cell and squamous lung cancer. Also subjects with values of FEV1% VC over 70 had significantly higher oxygen blood pressure, and clinical and radiological symptoms of COPD were less intensive than in subjects with values of this index below 70. There was no correlation between histological type of lung cancer and bronchoscopic symptoms of bronchitis and radiological symptoms of emphysema.
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PMID:[Coexistence of obstructive lung diseases and lung cancer]. 965 83

1. The number of heart transplant operations performed in the United States has decreased by 16 procedures between 1995 (2,360) and 1996 (2,344). Following a period of rapid growth from 1990 (203) through 1995 (871), there was a decrease of 71 lung transplant procedures between 1995 (871) and 1996 (800). 2. The most frequently reported indication for heart transplantation in the US was coronary artery disease (44.88%). For other thoracic transplants, the most frequently reported indications included cystic fibrosis (31.85%) for double lung, emphysema/COPD (55.88%) for single lung and congenital heart disease (48.72%) for heart-lung transplants. The most frequently reported diagnoses for thoracic transplantation outside the US included cardiomyopathy (47.4%) for heart, cystic fibrosis (33.0%) for double lung, idiopathic pulmonary fibrosis (29.1%) for single lung and primary pulmonary hypertension (23.4%) for heart-lung transplants. 3. US heart transplant recipients were predominantly male (77.6%), older than age 50 (55.4%) and white (82.3%). In contrast, US lung transplant recipients were predominantly female (52.1%), aged 35-64 (73.5%) and white (89.5%). No significant variance from the US recipient demographic profile was noted for non-US recipients in this analysis. 4. The mean donor age for heart and lung transplants has risen slightly with an increase in mean age of 3.12 years for heart donors and 4.72 years for lung donors from 1987-1997. 5. The one-year survival rate for thoracic transplants performed in the US was 84.8% for heart, 70.1% for lung and 73.4% for heart-lung in 1996. Five-year survival for US thoracic transplants was 66.5% for heart and 43.2% for lung transplants performed in 1992. 6. There was little change in heart transplant survival based on transplant era (1987-89, 1990-92 and 1993-95). Lung recipients transplanted in the 1993-95 era showed a 16% increase in survival compared with those transplanted in the 1987-89 era at the 48-month time point. 7. The most important risk factor for US heart recipients at one month, one year, and conditionally at 5 years after transplantation was receipt of a previous heart transplant. Other substantial long-term risk factors included donor age and non-white, non-black recipient. 8. The most important risk factors for mortality in US lung recipients were the order of the transplant (primary or repeat) and the patient's medical condition at time of transplant. Diagnosis, recipient age and recipient race were highly influential risk factors for conditional 5-year mortality. 9. For heart and lung recipients, the major cause of hospitalization during the first 2 years after transplantation was infection.
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PMID:Worldwide thoracic organ transplantation: a report from the UNOS/ISHLT International Registry for thoracic organ transplantation. 991 89

Bronchial rupture is a rare but severe complication of intubation with a double-lumen tube. Cardinal symptoms are mediastinal and subcutaneous emphysema as well as pneumothorax. Larger injuries result in an air leak and the endtidal carbon dioxide decreases. The gas exchange may worsen drastically when mucosal prolapse or bronchial haemorrhagia lead to bronchial occlusion. Mediastinitis or sepsis can be the sequel of the opened mediastinum. If bronchial injury is suspected probably fibreoptic bronchoscopy is indicated. We report on a case of bronchial rupture due to overinflation of the endobronchial cuff or movement of the inflated cuff when repositioning the patient. The conservative therapy was successful in spite of the fact that surgical intervention is recommended in the literature following bronchial rupture. To avoid tracheobronchial injuries an adequate tubus size must be selected. The more flexible polyvinylchloride (PVC) tubes without a carinal hook should be preferred to the Carlens tube. An atraumatic intubation is promoted by leaving the stylet inside after the tip of the tube has passed the vocal cords. To identify the minimum occlusive pressure of the endobronchial cuff for lung isolation different methods are described and should be used. The cuff has to be deflated when the patient is repositioned and when one-lung-ventilation is not required. Tumours of the tracheobronchial tree and weakness of the bronchial wall caused by steroid hormone therapy or COPD may increase the risk of tracheobronchial laceration.
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PMID:[Diagnosis, procedures and conservative therapy of a bronchial rupture after intubation with double-lumen tube]. 1007 58

COPD is a disorder characterized by chronic exspiratory airflow limitation in patients with chronic bronchitis and/or emphysema. The obstruction is generally progressive, but may be partially reversible and may be accompanied by airway hyperreactivity. In this review we discuss the epidemiology, Pathophysiology, clinical features, diagnostic approaches and therapeutic management in patients with COPD. Cigarette smoking is the main risk factor for the development and progression of COPD; environmental or occupational exposure to dust or fumes and genetic factors are further contributing factors. Therefore, smoking cessation is the most important therapeutic approach. Better knowledge of neutrophilic inflammation led to the development of new drugs for the treatment of COPD. The new long-acting inhaled beta 2-agonists fundamentally improved antiobstructive therapy. They are useful to control night-time or early morning symptoms. The role of steroids and theophylline is still unclear. Their value and efficient use are discussed.
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PMID:[Etiology, diagnosis and therapy of COPD]. 1021 33

Lung cancer (LC) and chronic obstructive pulmonary lung diseases (COPDs; including emphysema and chronic bronchitis) share a common etiology. Despite the known associations of alpha1-antitrypsin deficiency (alpha1AD) with COPD and COPD with LC, few studies examined the association of alpha1AD alleles and LC. We hypothesize that heterozygous individuals who carry a deficient allele of the alpha1AD gene Pi (protease inhibitor locus) are at an increased risk of developing LC. The Pi locus is highly polymorphic with >70 variants reported. There are at least 10 alleles associated with deficiency in alpha1-antitrypsin. Using an exact binomial test, we compared the alpha1AD carrier rate in 260 newly diagnosed Mayo Clinic LC patients to the reported carrier rate in Caucasians in the United States (7%). alpha1AD carrier status, determined by isoelectric focusing assay, was examined with respect to the history of cigarette smoking, COPD, and histological types. Thirty-two of the 260 patients (12.3%; 95% confidence interval, 8.6-16.9%) carried an alpha1AD allele, which was significantly higher than expected (P = 0.002). Twenty-four of the 32 carriers had allele S, 6 had allele Z, and 2 had allele I. Patients who never smoked cigarettes were three times more likely to carry a deficient allele (20.6%; P = 0.008), although smokers had a higher carrier rate (11.1%; P = 0.025) when compared with the 7% rate. Patients with squamous cell or bronchoalveolar carcinoma had a significantly higher carrier rate than expected (15.9% and 23.8%, P < or = 0.01, respectively). Our preliminary findings suggest that individuals who carry an alpha1AD allele may have an increased risk for developing LC, specifically squamous cell or bronchoalveolar carcinoma.
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PMID:Alpha1-antitrypsin deficiency allele carriers among lung cancer patients. 1035 Apr 43


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