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

Lung volume reduction surgery is designed to alleviate symptoms of breathlessness and improve the quality of life for selected patients with severe emphysema. By resecting hyperinflated, nonfunctional areas of the lung, thoracic volume is reduced, chest wall and diaphragmatic mechanics are improved, and ventilation to the remaining portions of lung is improved. The operative procedure is designed to obtain maximum improvement with the least possible risk. Early mortality (less than 90 days) has been 3%, all from respiratory complications. Late mortality (more than 90 days) has been an additional 2%. Refinements in operative technique, including use of continuous staple line excision buttressed by bovine pericardium, creation of apical pleural tents, and avoidance of suction the chest tubes, have led to a steady decline in hospital stay, with the current average of 11 days and a median of 7 days. Ninety-nine of the 100 patients have been extubated at the end of the procedure, thus avoiding the need for postoperative ventilatory assistance.
Semin Thorac Cardiovasc Surg 1996 Jan
PMID:Lung volume reduction surgery for severe emphysema. 867 51

Lung volume reduction surgery (LVRS), which involves the bilateral wedge resection of 20% to 30% of the most diseased lung through a median sternotomy, is emerging as a promising treatment option for select patients with severe, debilitating emphysema. This article details our observations and preliminary investigations related to the imaging evaluation of patients including selection criteria, postoperative findings, and structural changes in the thorax after surgery. Routine preoperative evaluation includes inspiratory and expiratory chest radiographs, computed tomography (CT) examination, and nuclear medicine lung scan. Investigational studies include quantitative CT to assess disease severity and dynamic magnetic resonance imaging to study respiratory movements. Postoperative improvement in FEV1, oxygenation, and exercise tolerance correlate with the degree of heterogeneity, hyperinflation, lung compression, upper lobe severity, and percentage of retained mildly diseased lung shown on preoperative imaging studies. Postoperative radiographic monitoring is important for detection of complications. Postoperative follow-up examinations show reduced thoracic distention, improved coordination of respiratory movement, and increased diaphragm curvature and excursion, supporting the hypothesis of improved respiratory mechanics as a major contributing factor to the success of LVRS.
Semin Thorac Cardiovasc Surg 1996 Jan
PMID:Radiology of pulmonary emphysema and lung volume reduction surgery. 867 52

Lung volume reduction surgery (LVRS) is performed to alleviate the dyspnea of patients with emphysema and improve performance in the activities of daily living. Removing diseased and functionless lung may improve the function of remaining, less diseased lung by (1) increasing elastic recoil pressure, thereby increasing expiratory airflow rates, (2) decreasing the degree of hyperinflation resulting in improved diaphragm and chest wall mechanics, and (3) decreasing inhomogeneity resulting in decreased work of breathing and improved alveolar gas exchange. The guidelines used for patient assessment were (1) airflow limitation with a forced expiratory volume in 1 second (FEV1) less than 35%, (2) hyperinflation and air trapping with total lung capacity more than 125% and respiratory volume more than 250% predicted, and (3) regional heterogeneity of the emphysematous process providing target areas for resection. We sought to exclude patients with the following: (1) obliteration of the pleural space by previous disease or surgery, (2) severe structural abnormalities of the thoracic cage, (3) PaCo2 greater than 55 mm Hg. (4) mean pulmonary artery pressure greater than 35 mm Hg. (5) predominant airway disease such as asthma, bronchiectasis, or chronic bronchitis with persistent excessive purulent secretions, (6) significant coexisting disease, and (7) maintenance corticosteroid therapy in excess of 10 mg prednisone per day. The assessment process continues to be evaluated by analysis of patient outcome.
Semin Thorac Cardiovasc Surg 1996 Jan
PMID:Evaluation of patients with emphysema for lung volume reduction surgery. Washington University Emphysema Surgery Group. 867 53

Bilateral volume reduction surgery has been designed to reduce total thoracic volume and improve chest wall mechanics in patients with severe emphysema who, up to now, had very limited viable surgical options. This procedure has been performed in more than 120 such patients at our institution. We present the anesthetic considerations and our experience from their management.
Semin Thorac Cardiovasc Surg 1996 Jan
PMID:Anesthetic management for bilateral volume reduction surgery. 867 54

Between January 1993 and April 1995, 84 patients with emphysema underwent bilateral lung volume reduction surgery at Barnes Hospital, Fifty-three patients had completed 3 months; 37 patients, 6 months; and 19 patients, 1 year of follow-up. Significant improvement was observed in spirometric parameters, oxygenation, 6-minute walking distance, dyspnea indices, and quality-of-life scores. The average increases in FEV1 were 52%, 51%, and 61%, at 3,6, and 12 months, respectively, after surgery. The most common postoperative complication, prolonged ( > 7 days) chest tube drainage, was present in 63% of the cases, and the mean duration of hospitalization in the survivors was 15 days (range 5 to 49 days). This has been reduced to 11 days (median 7.5 days) for the subsequent 40 patients. Five postoperative deaths occurred, 2 in the first, 2 in the third, and 1 in the fifth postoperative month, respectively. The overall mortality in the 84 patients was 6%, and the actuarial survival at 1 year was 93%. Volume reduction surgery is a promising therapeutic option for patients with an appropriate pattern of emphysema. Improvement has been sustained for more than 1 year, and long-term follow-up is planned to ascertain the duration of the benefits.
Semin Thorac Cardiovasc Surg 1996 Jan
PMID:Results of lung volume reduction surgery in patients with emphysema. The Washington University Emphysema Surgery Group. 867 55

Between January 1993 and February 1996, we performed 150 bilateral lung volume reduction procedures for patients with severe emphysema. Patients were selected on the basis of severe dyspnea, increased lung capacity, and a pattern of emphysema that included regions of severe destruction, hyperinflation, and poor perfusion. Twenty percent to 30% of the volume of each lung was excised with the use of a linear stapler and bovine pericardial strips attached to buttress the staple line. Patients were between 36 and 77 years old, with an average 1-second forced expiratory volume of 25% of predicted, total lung capacity of 142% of predicted, and residual volume of 283% of predicted. Ninety-three percent of patients required supplemental oxygen, continuously or with exertion. All patients but one were extubated at the end of the procedure. The 90-day mortality was 4%. Hospital stay progressively decreased with experience, and for the last 50 patients the median hospital stay was 7 days. Prolonged air leakage was the major complication. Results at 6 months show a 51% increase in the 1-second forced expiratory volume and a 28% reduction in the residual volume. The Pao2 increased by an average of 8 mm Hg, and 70% of the patients who had previously required continuous supplemental oxygen no longer had this requirement. The improvements in measured pulmonary function were paralleled by a significant reduction in dyspnea and an improvement in the quality of life. Reevaluation at 1 year and 2 years after operation showed the benefit to be well maintained. We conclude that lung volume reduction offers benefits not achievable by any means other than lung transplantation for highly selected patients with severe emphysema.
J Thorac Cardiovasc Surg 1996 Nov
PMID:Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema. 920 98

Both unilateral and bilateral lung volume reduction procedures are being advocated for treatment of severe, generalized emphysema. We analyzed the results of 166 consecutive patients who underwent unilateral (n = 87) or bilateral (n = 79) thoracoscopic stapled lung volume reductions to help define the role for these procedures. There was no statistically significant difference in the operative mortality (3.5% vs 2.5%), mean length of stay (11.4 +/- 1 vs 10.9 +/- 1 days), or morbidity for the unilateral and bilateral groups, respectively (p not significant for all variables). Oxygen dependence was eliminated in 18 (36%) of 50 patients who had unilateral procedures and 30 (68%) of 44 of those who had bilateral procedures (p < 0.01). Prednisone was eliminated for 38 (54%) of 51 unilateral-procedure patients, compared with 30 (85%) of 35 bilateral-procedure patients (p = 0.02). Overall, bilateral procedures produced a mean improvement in the forced expiratory volume in 1 second (FEV1) of 57%, compared with 31% for unilateral reduction procedures (p < 0.01). Our bilateral staple procedure produced a 72.8% mean increase in the FEV1 for patients who had upper lobe emphysema. Especially compromised patients (age > or = 75, with preoperative room air Po2 < or = 50 mm Hg or FEV1 < or = 500 ml) had the same morbidity and operative mortality with unilateral or bilateral procedures, but they had a higher 1-year mortality (17% vs 5%), primarily because of respiratory failure after the unilateral operation (p < .001). Although unilateral staple lung volume reduction may produce an excellent result in a given patient, the bilateral procedure appears to be the procedure of choice, because it provides better overall results at no increased morbidity or mortality compared with the unilateral procedure. The results of bilateral staple lung volume reduction by thoracoscopy appear to be comparable to those of median sternotomy.
J Thorac Cardiovasc Surg 1996 Nov
PMID:Should lung volume reduction for emphysema be unilateral or bilateral? 891 31

A 49-year-old man was involved in a motor vehicle crash and was admitted to a local hospital. The following day, he was transferred to our hospital because of worsening dyspnea. Initial examination revealed no subcutaneous emphysema, and chest computed tomography (CT) demonstrated no mediastinal air. A left thoracentesis tube was placed for pneumothorax, which reduced the patient's respiratory distress. He had a persistent, productive cough, which worsened when he drank water. A repeat chest CT on the fifth hospital day revealed a tracheo-esophageal fistula. Bronchoscopy and esophagoscopy confirmed the diagnosis. He underwent repair of the trachea and esophagus. The ruptured membraneous portion of the trachea was closed with interrupted sutures and covered with pedicled pericardial flap. The perforated anterior esophageal wall was sutured in layers and reinforced with a fifth intercostal muscle flap. A gastrostomy tuve was placed for feeding access. Within 6 weeks, the patient recovered completely.
Jpn J Thorac Cardiovasc Surg 1998 Feb
PMID:[Combined rupture of trachea and esophagus following blunt trauma--a case report]. 955 70

During November 95 to April 97, 45 percutaneous dilatational tracheostomies were performed in a nonselected patient series of 2788 open cardiac surgery cases. Tracheostomy was performed as early as the 2nd postoperative day (median: 6th day), when extubation was not foreseen within the next few days. Duration of intubation was 13 days (mean). We observed 6 complications in 5 patients (13.3%), namely bleeding, misplacement of the tube, subcutaneous emphysema, and superficial infection of the tracheostoma. Mediastinitis and wound infection of the sternal wound did not occur in any single case. There was no death due to tracheostomy. Clinically evident tracheal stenosis and inadequate granulation of the stoma were not observed after extubation. In our opinion, percutaneous dilatational tracheostomy is justifiable, shows good results, and entails minimal risk if done early after cardiac surgery, and it is also superior to standard surgical tracheostomy. Increased incidence of mediastinitis was not seen.
Thorac Cardiovasc Surg 1998 Apr
PMID:Percutaneous dilatational tracheostomy done early after cardiac surgery--outcome and incidence of mediastinitis. 961 10

Lung volume reduction surgery is emerging as a promising treatment option for selected patients with severe, debilitating end-stage emphysema refractory to medical management. Lung volume reduction surgery involves the removal of space occupying severely diseased, slowly ventilating and hyperexpanded lung, thus allowing the better conserved adjoining lung parenchyma to expand into the vacated space and function effectively. The operation can be accomplished by unilateral or bilateral thoracoscopy, thoracotomy or median sternotomy. The most emphysematous areas are excised using stapling or laser techniques or both. This review summarises the results of lung volume reduction surgery performed by various operative techniques. Results indicate that in the majority of patients improvement occurs in subjective dyspnoea and objective pulmonary function while oxygen and steroid dependence are reduced or eliminated at the cost of acceptable mortality and morbidity. Even though bilateral procedures produced much greater improvement, it is emphasized that it is the lung resection and not the operative approach that is critical to the success of the operation. Regardless of the technique used, the surgical treatment of emphysema is palliative in nature.
J Cardiovasc Surg (Torino) 1998 Apr
PMID:Lung volume reduction surgery for emphysema. A review. 963 13


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>