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

One infant, age 19 days, with congenital lobar emphysema whose main symptoms included dyspnea, cyanosis and severe infant Respiratory Distress Syndrome, was presented in this paper. The most reliable diagnostic tool was chest x-ray films with anteroposterior and lateral views. As additional diagnostic method, thorax computerized tomography was also used. The affected lobe was the left upper lobe. Resection of the affected lobe was performed with good results.
J Cardiovasc Surg (Torino) 1994 Aug
PMID:Congenital lobar emphysema. A case report. 792 54

The purpose of this study was to develop objective preoperative selection methods for predicting outcome in patients undergoing thoracoscopic laser ablation of emphysematous pulmonary bullae. Initial radiographic presentation was correlated with physiologic function both before and after the operation in 24 patients entered into a prospective clinical protocol for evaluation of carbon dioxide laser treatment of emphysematous pulmonary bullae. Nineteen surviving patients underwent follow-up evaluation 1 to 3 months after the operation. Pulmonary function test results showed improvements in spirometry (forced vital capacity increased 0.82 +/- 0.125 L, forced expiratory volume in 1 second increased 0.36 +/- 0.07 L, and maximum voluntary ventilation increased 11.69 +/- 2.6 L/m; p < 0.002); airway resistance decreased by 0.9 +/- 0.35 cm of water/L per second, and specific conductance increased 0.019 +/- 0.006 L/cm H2O per second (p < 0.02). Lung volumes improved (residual volume decreased 1.25 +/- 0.23 L, p < 0.001) without significant change in resting gas exchange. Quantitative radiographic grading of extent of preoperative pulmonary bullae correlated well with response to laser treatment in patients with preoperative and postoperative studies. Patients with large bullae accompanied by crowding of adjacent lung structures, upper lobe predominance, and minimal underlying emphysema had greatest improvement in pulmonary function results with laser bullae ablation (p < 0.05). However, some patients with multiple smaller bullae and diffuse emphysema also demonstrated objective improvement after operation. Quantitative radiographic analysis of the extent of bullous disease and the degree of associated emphysema can be used to determine short-term postoperative pulmonary response and may be useful in selecting future thoracoscopic laser bullae ablation candidates. Additional follow-up will be necessary to further improve selection criteria and help define the long-term role of thoracoscopic laser treatment of bullous emphysema.
J Thorac Cardiovasc Surg 1994 Mar
PMID:Thoracoscopic laser ablation of pulmonary bullae. Radiographic selection and treatment response. 812 18

In recent times minimally invasive surgery has secured a firm place among the therapeutic options in thoracic surgery. The experience and results gained from video-assisted surgery on 109 patients between January 1, 1992 and July 31, 1993 are critically discussed. The procedure could be completed thoracoscopically on 94 of them. A change of method was necessary nine times for technical reasons and six times for oncological reasons (two times due to metastasis, four times due to bronchial carcinoma). A total of 154 individual operations were conducted. Sixty-three patients with recurrent spontaneous pneumothorax were successfully treated. The relapse rate was 1.5%. With the exception of three rethoracotomies (one due to postoperative hemorrhaging and two to persistent fistula) no significant complications occurred. Further indications included capsulated pleural empyema (n = 1), persistent hematothorax (n = 2), pleurectomy for malignant pleural effusion (n = 2), pleural tumors (n = 3), pulmonary parenchyma (n = 2), interstitial lung diseases (n = 3), bullous emphysema (n = 2), peripheral lung nodules (n = 18), mediastinal tumors (n = 8), and sympathectomy (n = 2). The advantages of video-assisted thoracoscopic surgery for patients include cosmetic considerations, low pain, earlier postoperative mobilization, and for some indications, a shorter operation period. The significant disadvantages for the surgeon are the loss of binocular vision as well as the impossibility of intraoperative palpation.
Thorac Cardiovasc Surg 1993 Dec
PMID:Video-assisted thoracoscopic surgery--indications, results, complications, and contraindications. 812 59

Descending necrotizing mediastinitis can occur as a complication of oropharyngeal and cervical infections that spread to the mediastinum via the cervical spaces. Delayed diagnosis and inadequate mediastinal drainage through a cervical or minor thoracic approach are the primary causes of a high published mortality rate (near 40%). Between 1985 and 1992, six men (mean age, 49 years) with descending necrotizing mediastinitis were surgically treated at our institution. The primary oropharyngeal infection was peritonsillar abscess (three cases) and odontogenic abscess (three cases). In all cases, occurrence of respiratory insufficiency associated with serious cervical infection suggested the mediastinitis diagnosis. Computed tomographic scans confirmed the mediastinitis, showing mediastinal abscess and mediastinal emphysema. All patients underwent surgical drainage of the deep neck infection combined with mediastinal drainage through a thoracic approach. The outcome was favorable in five patients who had mediastinal drainage through a thoracotomy; the patient who had mediastinal drainage through a minor thoracic approach (anterior mediastinotomy) died of tracheal fistula on postoperative day 18. In our experience, aggressive mediastinal drainage by a thoracotomy approach regardless of the level of mediastinal involvement led to improvement in survival of these patients, with a 17% mortality rate.
J Thorac Cardiovasc Surg 1994 Jan
PMID:Descending necrotizing mediastinitis. Advantage of mediastinal drainage with thoracotomy. 828 19

During the last two years video-assisted operative thoracoscopy has introduced new impetus into thoracic surgery. Today it is viewed as a sparing and safe alternative to thoracotomy for a wide spectrum of indications. The prerequisites, instruments, and operative techniques are discussed. In oncological thoracic surgery it still remains to be verified whether the criteria of radicality are fulfilled by this new technique. Using video-assisted operative thoracoscopy, we have successfully operated on 209 patients with the following indications: recurrent pneumothorax (n = 94), interstitial lung disease (n = 25), coin lesion (n = 20), pleural effusion (n = 17), hyperhidrosis (n = 14), mediastinal tumor or lymphoma (n = 10), thoracic empyema (n = 9), bullous emphysema (n = 8), pleural tumor (n = 5), hematothorax (n = 3), malignant pericardial effusion (n = 3), and chylothorax (n = 1). The advantages of this minimally traumatizing operating technique lie in a better view of the operative site, the objectively measurable reduction in postoperative restriction, less pain, earlier postoperative mobilization, and shorter hospital stay. This operating technique, in addition to being sparing, requires markedly less time than a thoracotomy. The disadvantages are the two-dimensional monitor picture and, especially, the loss of palpation.
Thorac Cardiovasc Surg 1993 Jun
PMID:Prerequisites, indications, and techniques of video-assisted thoracoscopic surgery. 836 65

The aim of the present study was to determine levels of endothelin-1 in bronchoalveolar lavage fluid and in plasma in patients with lung and heart-lung allografts. The aim was based on the hypothesis that levels of endothelin-1 are elevated in the bronchoalveolar lavage fluid of patients with lung allografts. Patients (n = 23) undergoing heart-lung (n = 8), single-lung (n = 10), or bilateral lung (n = 5) transplantation were included in the study. In patients with single-lung allografts, endothelin-1 levels were analyzed in bronchoalveolar lavage fluid from both the transplanted and the nontransplanted, native lung. The level of endothelin-1 was also analyzed in bronchoalveolar lavage fluid from 12 patients who did not undergo transplantation. Transbronchial biopsies and bronchoalveolar lavage were done routinely or when clinically indicated on 64 different occasions, between 2 and 104 weeks after transplantation. The level of endothelin-1 was measured in bronchoalveolar lavage fluid and plasma by radioimmunoassay. Immunoreactive endothelin-1 was detectable in bronchoalveolar lavage fluid from all patients. The concentration of endothelin-1 in bronchoalveolar lavage fluid from transplanted lungs (2.94 +/- 0.30 pg/ml, n = 64) was significantly higher compared with that in bronchoalveolar lavage fluid from patients without allografts (0.86 +/- 0.20 pg/ml, n = 12, p < 0.01). In patients who received single-lung transplantation because of emphysema, the level of endothelin-1 in bronchoalveolar lavage fluid from the transplanted lung was significantly greater than that from the native lung (5.61 +/- 1.9 versus 0.39 +/- 0.05 pg/ml, p < 0.05). Concentrations of endothelin-1 in bronchoalveolar lavage fluid did not correlate with grade of rejection, infection, or time after transplant. Plasma levels of endothelin-1 were unchanged with pulmonary rejection. These results indicate that endothelin-1 is released into bronchi of transplanted human lungs. The release is not associated with rejection or infection. Because of its potent mitogenic properties, endothelin-1 may have a potential impact in the development of posttransplant complications such as bronchiolitis obliterans.
J Thorac Cardiovasc Surg 1996 Jan
PMID:Increased levels of endothelin-1 in bronchoalveolar lavage fluid of patients with lung allografts. 855 73

We evaluated the use of a lateral thoracoscopic approach for lung reduction surgery in patients with diffuse emphysema. Sixty-seven patients with a mean age of 61.9 years underwent operation. Operative side was determined by preoperative imaging. The procedures were laser ablation in 10 patients and stapler resection in 57 patients. Ten patients, including six of the 10 patients in the laser-only group had poor outcome (death or hospitalization longer than 30 days), leading us to abandon the laser technique. Of the remaining 57 patients undergoing primary stapled resection, duration of chest tube placement averaged 13 days (range 3 to 53 days) with a mean hospital stay of 17 days (range 6 to 99 days). Seven patients required ventilation for longer than 72 hours, six patients underwent conversion of the procedure to open thoracotomy, four patients acquired arrhythmias, and three patients were treated for empyema. There was one early death (1.7%), from cardiopulmonary failure. Forty patients returned for 3-month evaluation. Significant (p < 0.0001) improvements were seen in forced vital capacity (2.69 L after vs 2.26 L before) and forced expiration volume in 1 second (1.04 L after vs 0.82 L before), with 25 of 40 patients (63%) showing an improvement of more than 20%. Lung volume measures, in particular residual volume, fell significantly. Arterial blood gas analysis revealed that carbon dioxide tension fell significantly in patients with preoperative hypercapnia (carbon dioxide tension > 45 mm Hg, p = 0.018). Six-minute walk test results improved (894 feet after vs 784 feet before, p = 0.002), and symptomatic benefit was confirmed by significant improvement in the dyspnea index. The combination of both hypercapnia and reduced single-breath diffusing capacity for carbon monoxide was significantly more frequent (p = 0.0026) and was 86% specific (5 of 6 patients) in predicting serious postoperative risk. We conclude that the lateral thoracoscopic surgical approach to diffuse emphysema offers significant improvement in pulmonary mechanics and functional impairment. Patients with a combination of hypercapnia and reduced single-breath diffusing capacity for carbon monoxide should not be considered for this procedure because of significant perioperative risk.
J Thorac Cardiovasc Surg 1996 Feb
PMID:Unilateral thoracoscopic surgical approach for diffuse emphysema. 858 1

Two procedures (laser bullectomy and lung reduction surgery with staples) are currently available for the surgical treatment of patients with diffuse emphysema. We compared the efficacy of these two surgical approaches in 72 patients, aged 67 +/- 7 years (mean +/- standard deviation), who had diffuse emphysema scored as severe on computed tomography and severe fixed expiratory airflow obstruction. The patients were prospectively randomized to undergo either neodymium:yttrium aluminum garnet contact laser surgery (n = 33) or stapled lung reduction surgery (n = 39) by unilateral thoracoscopy. The operative mortalities were 0% and 2.5%, respectively. No significant differences were noted between the groups (p < 0.05) with respect to operating time, hospital days, or air leakage for more than 7 days. However, a delayed pneumothorax developed in six patients (18%) who had laser treatment (p = 0.005). The operations eliminated dependency on supplemental oxygen in 52% of the laser group and 87.5% of the stapled lung reduction group (p = 0.02). The mean postoperative improvement in the forced expiratory volume in 1 second at 6 months was significantly greater for the patients undergoing the staple technique (32.9% vs 13.4%, p = 0.01) than for the laser treatment group.
J Thorac Cardiovasc Surg 1996 Feb
PMID:A randomized, prospective trial of stapled lung reduction versus laser bullectomy for diffuse emphysema. 858 1

Unilateral pulmonary agenesis is a rare congenital anomaly whose aetiology is not completely known. Vitamin A deficiency, viral agents, or genetic factors are discussed. The incidence was estimated at 1 in 10,000-15,000 autopsies by several authors. Associated malformations, mainly affecting the cardiovascular, gastrointestinal, and musculoskeletal system influence the prognosis of patients as does the location of the missing lung. We report the implantation of a tissue-expander in a three-months-old infant suffering from a right-sided lung agenesis associated with sinus-venosus defect. Other malformations were excluded by sonographic methods. Mediastinal shift with dextropositio cordis in compensatory emphysema of the left lung and frequent infections were the cardinal symptoms. These led to cardiopulmonary decompensation twice. The implantation of the tissue-expander was performed following an aortopexy, which was only temporarily successful. This method allows the filler to be adapted with age to the pleural volume by instillation of sterile saline solution via a microport. Whether or not thorax deformities and scoliosis will be prevented cannot be predicted exactly at this time.
Thorac Cardiovasc Surg 1995 Oct
PMID:Pulmonary agenesis in a newborn: implantation of tissue expander to prevent a mediastinal shift. 861 Feb 90

Throughout the 20th century, several operations have been advocated as methods of treatment for patients with emphysema and, often, they were promoted as offering potential cures. Unfortunately, most of these procedures attempted to treat the wrong physiological or anatomic deficit so that mid- or long-term results were unpredictable or frankly disastrous. Procedures such as costochondrectomy were designed to permit further enlargement of the lungs, whereas thoracoplasty was designed to reduce lung volume. Operations were performed to restore the curvature of the diaphragm or devised to increase blood supply to the lung. Almost every thoracic structure including chest wall, diaphragm, pleura, nerves, airways, lung, or esophagus became "at risk" for surgical intervention. Short of bullectomy for emphysematous bullous lung disease and perhaps volume reduction for diffuse emphysema, none of these procedures has stood the test of time.
Semin Thorac Cardiovasc Surg 1996 Jan
PMID:History of surgery for emphysema. 867 50


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