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

Thirty consecutive patients undergoing lung resections were randomized into two groups: Group A (n = 15) received minitracheotomy postoperatively and group B (n = 15) were control patients. Postoperative respiratory course was monitored by serial clinical assessments, chest x-ray examination, arterial blood gases, sputa bacterial cultures, and the patient's requirement and response to chest physiotherpy. The two groups were similarly matched in age (mean 58.5 years), smoking habits, pulmonary functions, and surgical procedures. Postoperative pulmonary complications of collapse/consolidation developed in 11 patients (two in group A and nine in group B) (p less than 0.03). Four patients (all in group B) required nimitracheotomy in addition to antibiotics and chest physiotherapy to treat their pneumonia. Chest physiotherapy requirement was less in group A than in group B, with a mean number of sessions of seven in group A and eight in group B and a mean total time of 92 minutes in group A and 112 minutes in group B. The mean duration of minitracheotomy was 4.13 days. Minor temporary symptoms resulted from the minitracheotomy in eight patients (42%) and included discomfort, voice changes, subcutaneous emphysema, and stridor. There was one case of long-term morbidity (5%)-skin scarring from wound infection at the site of the minitracheotomy. No postoperative deaths resulted. We conclude that the prophylactic use of minitracheotomy is safe and effective in decreasing postoperative respiratory complications in patients undergoing lung resections.
J Thorac Cardiovasc Surg 1991 May
PMID:Prophylactic minitracheotomy in lung resections. A randomized controlled study. 202 47

Using cyclosporine A (CyA), long-term results after heart-lung transplantation became possible. Since 1981, 761 clinical heart lung transplantations have been registered at the International Society for Heart Transplantation. Candidates for this operation reveal signs of irreversible heart and lung diseases which are caused by cardiac lesions (e.g. valvular disease, Eisenmenger reaction due to congenital malformation) or pulmonary disorders (e.g. primary pulmonary hypertension, emphysema, fibrosis). The standard surgical procedure necessitates three anastomoses which combine donor and recipient tracheae, right atria and aortae. Immunosuppression consists of CyA (blood levels of 300-500 ng/ml), azathioprine (1-2 mg/kg/d) and rabbit antithymocyte globuline (RATG) (IgG: 2-4 mg/kg/d). After the first 2 postoperative weeks, RATG is replaced by low dose methylprednisolone (0.3-0.1 mg/kg/d). As an alternative, RATG may be omitted completely. Postoperatively, a variety of complications may evolve. Early problems (within the first month) comprise acute pulmonary rejection, bacterial pneumoniae, and multiorgan failure. Diagnosis of acute lung rejection proves difficult; it includes clinical signs, chest radiographic appearances and cytoimmunological monitoring of the peripheral blood. Transbronchial lung biopsies are for precise diagnosis of similar value to endomyocardial biopsies after heart transplantation. Late postoperative complications comprise viral, bacterial, fungal, and protozoal infections and chronic obliterative bronchiolitis. With increasing experience, the 30 day mortality fell to below 20% according to the International Society for Heart Transplantation. The one-year survival rate between 1986 und 1988 was reported to be 61%. The results of some individual groups are even better.
Thorac Cardiovasc Surg 1990 Oct
PMID:Heart-lung transplantation in 1990--indications, surgical technique, postoperative complications and outcome. 226 34

Congenital bronchopulmonary malformations are uncommon but potentially life-threatening anomalies of infants and children. Between 1970 and 1988, 45 patients from birth to 13 years of age (23 boys and 22 girls) underwent evaluation and treatment for bronchopulmonary malformations. Thirty-seven had solitary lesions: bronchogenic cyst (n = 13), cystic adenomatoid malformation (n = 9), congenital lobar emphysema (n = 6), pulmonary sequestration (n = 6), arteriovenous malformation (n = 2), and bronchial atresia (n = 1). Eight additional patients had two simultaneous abnormalities and three patients had congenital diaphragmatic hernias. Twenty-one patients had respiratory symptoms, which were severe in seven. Twelve had pulmonary infection and 10 patients were completely free of symptoms. Plain chest roentgenogram was the only diagnostic imaging performed in 11 patients. Thirteen patients underwent computed tomographic scan, but in only four was it essential for diagnosis. Prenatal ultrasonography in three patients demonstrated cystic adenomatoid malformation in two, with one false negative study. Postnatally, ultrasonography was also useful in establishing the diagnoses of cystic adenomatoid malformation and pulmonary sequestration. Thoracotomy with excision of the lesion by lobectomy or pneumonectomy resulted in survival of 42 patients (93%). Three deaths in neonates were due to pulmonary hypoplasia and hypertension. Two of them had concomitant diaphragmatic hernia; the other had a cystic adenomatoid malformation and died despite the use of postoperative extracorporeal membrane oxygenation. These data demonstrate that congenital bronchopulmonary malformations usually can be diagnosed by plain chest x-ray films. Ancillary studies such as ultrasonography or computed tomography may occasionally be necessary. Combinations of the different types of bronchopulmonary malformations occurred frequently. All lesions, including symptomatic lesions in neonates, can be managed surgically soon after diagnosis.
J Thorac Cardiovasc Surg 1990 Apr
PMID:Congenital bronchopulmonary malformations. Diagnostic and therapeutic considerations. 231 79

Patients with continuous expansion of either giant lung cysts or areas of localized bullous emphysema will eventually deteriorate into a state of extreme respiratory distress due to compression of the remaining healthy pulmonary tissue. Thirty-one patients with these 2 types of lung disease having very poor respiratory function underwent surgery for the release of compromised healthy lung by resection of the expanding processes. A rational investigation program including respiratory tests, ventilation and perfusion scintigraphy and pulmonary angiography was gradually developed and analyzed. Surgical mortality was 12.9% in unilateral operations, probably somewhat higher in later contralateral interventions. The operative risk was higher in the emphysema group than in the group with giant lung cysts. Follow-up has demonstrated encouraging results in both groups concerning increased pulmonary function as well as improved working capacity.
Thorac Cardiovasc Surg 1985 Dec
PMID:Surgical improvement of patients with pulmonary insufficiency due to localized bullous emphysema or giant cysts. 241 66

The great majority of cases of emphysema are generalized with diffuse involvement of all portions of the lung: Clearly, surgery has little to offer in such cases. In contrast, there is an uncommon variant involving primarily the upper lobes and the superior portions of the lingula and lower lobes, which spares the relatively normally functioning lower lobes. A number of diagnostic tests are available to identify compression of uninvolved lower lobe tissue, the most reliable of which identify pulmonary vasculature that is crowded together. We suggest that whole lung tomograms or pulmonary angiograms provide the most convincing evidence of compression of normal tissue. In properly selected patients with compression or displacement of normal lung, thoracotomy with simple excision of the bullae is tolerated by even the most ill patients if care is taken to carefully support the patient postoperatively with assisted ventilation and prolonged chest tube suction. There were no deaths in 19 patients and the results were rewarding, often spectacular, and surprisingly enduring. It is likely that some patients with operable bullous emphysema are not being studied or offered operation because of a lack of knowledge about the benefits possible with bullectomy.
J Thorac Cardiovasc Surg 1989 Mar
PMID:The current status of surgery for bullous emphysema. 291 33

At the Children's Hospital of Pittsburgh the extracorporeal membrane oxygenation program was started in 1980. The results of our experience from 1980 to 1985 were previously reported. In the past 2 years 39 additional newborn infants have been treated with this modality, with an overall survival rate of 79% (31/39). This survival rate is much better than that obtained in 33 neonates who had been treated in the previous 5 years (54%; p less than 0.05). A new aspect of our extracorporeal membrane oxygenation program is the use of total apneic lung rest for persisting pulmonary interstitial emphysema during support with the oxygenator. Six neonates were treated with this technique because of worsening pulmonary interstitial emphysema during extracorporeal circulation. Five of them survived. Another indication for extracorporeal membrane oxygenation in our pediatric population has been left ventricular or biventricular failure after cardiopulmonary bypass. Four of our seven patients treated for this indication are long-term survivors. At present, because of the impossibility of using other forms of left ventricular assist devices in the pediatric population, it seems that extracorporeal membrane oxygenation is the most effective treatment for left ventricular failure after cardiopulmonary bypass. From our experience, even in the absence of long-term follow-up of patients supported with extracorporeal membrane oxygenation, it appears that the benefits of this therapeutic modality far exceed the risks in the high-risk population for which it is being used.
J Thorac Cardiovasc Surg 1988 Oct
PMID:Extracorporeal membrane oxygenation in children. New trends. 317

We have previously demonstrated the technical feasibility of an en bloc double lung transplantation in acute canine experiments. We have now conducted survival experiments in cynomolgus monkeys. Profound hypothermia and circulatory arrest were used to avoid the need for cardiopulmonary bypass in these very small animals. Because of the complexities of this technique, few long-term survivals resulted, but these experiments did confirm excellent lung function and satisfactory tracheal healing. On the basis of these experiments, we have performed our first clinical double lung transplantation on a 42-year-old woman with end-stage emphysema caused by alpha 2-antitrypsin deficiency. The patient has returned to normal activities with excellent lung function.
J Thorac Cardiovasc Surg 1988 Jan
PMID:Experimental and clinical double lung transplantation. 327 39

The clinical presentation and surgical treatment of thoracic anomalies--developmental malformations of the respiratory tract, congenital chylothorax or mediastinal masses--in 15 infants are reported. The age range at operation was 2 weeks to 8 months. The diagnoses were lobar emphysema (3 cases), bronchogenic cyst (3), cystic adenomatoid malformation (1), enteric duplication (2), hyperplastic thymus (2), neuroblastoma (1), chylothorax (1), cystic lymphangiectasia (1) and tracheal stenosis (1). The most common symptom was respiratory embarrassment, with acute development in half of the cases. The diagnosis could be established or suspected from chest radiography in 14 of the 15 infants. All were submitted to thoracotomy. None died postoperatively, but three had major complications. At postoperative follow-up 13 of 14 patients were free from respiratory symptoms.
Scand J Thorac Cardiovasc Surg 1988
PMID:Surgical management of thoracic anomalies in infants. Respiratory-tract malformations, congenital chylothorax and mediastinal masses. 338 51

The validity of previous recommendation of early thoracoscopy and tetracycline pleurodesis in the management of spontaneous pneumothorax without thoracoscopically visualized true cyst was assessed under non-trial, normal hospital conditions. Among 46 patients treated during a year, seven underwent immediate thoracotomy following finding of large cysts. Of the remaining 39 patients, 11 had recurrence of pneumothorax after a median of 11 (range 2-64) weeks. Repeat thoracoscopy then showed large cyst or bullous emphysema in seven cases. Tetracycline pleurodesis was again performed in the others. In continued observation for at least 2 years there were no further recurrences. The importance of meticulous thoracoscopy is stressed. The demonstrated diagnostic errors do not detract from the value of tetracycline pleurodesis when spontaneous pneumothorax is caused by rupture of only tiny blebs on the surface of an otherwise healthy lung. The procedure is fast, simple and efficacious.
Scand J Thorac Cardiovasc Surg 1987
PMID:Pleurodesis in spontaneous pneumothorax by means of tetracycline. Follow-up evaluation of a method. 361 43

Anesthetic management during tracheobronchial reconstruction is a concern to the anesthetist, who must maintain satisfactory gas exchange while ensuring adequate exposure to the trachea. The technique for high-flow catheter ventilation was first described for bronchoscopy, and it involves positive-pressure breathing with a high flow (40 to 60 L/min) of oxygen. This flow is directed to a semirigid catheter inserted in the endotracheal tube and around which the tracheobronchial anastomosis can be done without interruption. The value of the technique was tested in 18 patients undergoing tracheobronchial reconstructions. Patients' ages ranged from 22 to 69 years and the average duration of catheter ventilation was 35 minutes. Regardless of the duration of high-flow catheter ventilation good arterial blood gas values were maintained in all patients. In six patients, the average oxygen tension (measured at 5 minute intervals) was 416 mm Hg and the average carbon dioxide tension was 34 mm Hg. One patient developed surgical emphysema during the procedure. The high-flow catheter ventilation provides specific advantages during tracheobronchial procedures: avoidance of endotracheal manipulations, unobstructed field during surgical reconstruction, and good oxygenation throughout the procedure.
J Thorac Cardiovasc Surg 1985 Apr
PMID:High-flow catheter ventilation during major tracheobronchial reconstruction. 388 8


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