UMLS:C0034067 - FACTA Search

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

The benefits of mechanical ventilation with positive end-expiratory pressure (PEEP) are well documented, especially for patients with acute respiratory failure. PEEP increases functional residual capacity (FRC) and reduces closing volume (CV) and ventilation-perfusion mismatching. Little is known about the effects of PEEP in patients with chronic obstructive pulmonary disease, where closing volume and ventilation-perfusion mismatching are increased. We investigated the effects of PEEP in a canine model of panlobular emphysema (PLE). METHODS. After completion of control-period measurements, PLE was induced in eight dogs by intratracheal application of 20 ml aerosolized 16% papain solution. Three weeks later the effects of continuous positive-pressure ventilation (CPPV, PEEP 10 cmH2O) on gas exchange, FRC, and CV were investigated. Conventional intermittent positive-pressure ventilation (IPPV) served as reference. Measurements of CV were done using both the foreign gas bolus method and the single-breath oxygen test. FRC was determined by the nitrogen dilution technique. RESULTS. The papain-induced emphysema produced a deteriation in oxygenation, enlargement of FRC and CV, and an increase in quasi-static lung compliance. CPPV led to a further increase of FRC, but gas exchange was not improved nor was CV reduced. In the PLE period, mean pulmonary arterial pressures (MPAP) were higher during both modes of ventilation. CPPV tended to increase MPAP and pulmonary capillary wedge pressure when compared with IPPV. Systemic hemodynamic conditions were stable throughout the experiment. CONCLUSIONS. The application of PEEP to emphysematous lungs seemed to enlarge FRC, predominantly in the nondependent rather than in the dependent lung regions, which are prone to airway closure. In patients with emphysema, ventilation with PEEP may further deteriorate the impaired distribution of ventilation and thus counteract any improvement of gas exchange.
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PMID:[The effect of PEEP-ventilation on gas exchange and airway closure in experimental pulmonary emphysema]. 203 21

SO2-bronchitis, papaine-emphysema and paraquat fibrosis were induced in Wistar rats. Blood pressure, cardiac index, total peripheral resistance, arterial blood gas values, parameters of acid-base balance were determined. Effects of 0.1 and 0.3 microgram.-1.min-1 isoproterenol iv. infusion were examined. Morphologic alterations of the lungs were verified by histopathological examinations. All the parameters investigated were found to be normal in the control rats. The treated groups differed from the normal ones: an increased blood pressure was observed in emphysema and fibrosis. A decreased cardiac index was characteristic of chronic bronchitis, high cardiac index of emphysema, high TPR of bronchitis and arterial hypoxaemy of fibrosis. The groups reacted differently to beta adrenergic stimulation: in bronchitic and fibrotic rats the cardiac index was augmented, whereas in emphysematous ones the increase proved to be smaller. The effects of isoproterenol infusion can be related to the altered beta-receptor function in the various experimental pulmonary diseases.
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PMID:Acid-base balance and cardiac index in SO2-bronchitic, papaine-emphysematous and paraquat-fibrotic rats after isoproterenol treatment. 233 7

We evaluated the hemodynamic effects of nitrendipine, a dihydropyridine Ca2+ channel blocker, and hypoxia in intact dogs with emphysema produced by treatments with aerosolized papain. We also determined the effects of emphysema, chronic Ca2+ channel blocker treatment, and acute hypoxia on the distribution of vascular resistance in isolated left lower lobes. Pulmonary vascular resistance was increased (4 +/- 1 mm Hg/L/min) in the animals studied 6 months after receiving 4 weekly treatments with papain compared with control animals (2.6 +/- 0.6 mm Hg/L/min, p less than 0.05), and this effect of emphysema was blunted with chronic nitrendipine, 3 mg/kg twice a day (3.1 +/- 0.9 mm Hg/L/min). Both at baseline and at 6 months, hypoxia-induced increases in pulmonary vascular resistance were abolished by nitrendipine. The total pulmonary pressure gradient (delta Pt) was partitioned into pressure gradients across arterial (delta Pa), middle (delta Pm), and venous (delta Pv) vessels by occlusions performed during normoxia (PIO2 = 200 mm Hg) and hypoxia (PIO2 = 30 mm Hg). Papain-treated animals had elevated delta Pt compared with that in control animals because of an increased delta Pv (9.7 +/- 1.1 mm Hg versus 5.2 +/- 0.4 mm Hg in control animals, p less than 0.05). In contrast, only delta Pm was increased with papain + nitrendipine (2.6 +/- 1.0 mm Hg versus 0.2 +/- 0.3 mm Hg in control animals, p less than 0.05). An increase in the downstream pressure gradient was also observed when lobes from animals with emphysema were studied under conditions of reverse perfusion. Hypoxic responses were similar in the control and papain groups, with increases in delta Pa and delta Pm.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of nitrendipine and hypoxia on pulmonary vascular resistance in experimental emphysema. 238 15

To examine the relationship between morphologic changes and the alteration of pulmonary function, papain solution was administered to 11 dogs by inhalation and to 5 dogs by a single intratracheal injection. Pulmonary function tests, including determination of lung volume subdivision, diffusion capacity (DLCO), pressure-volume relationship of the lung and arterial blood gas were performed before and after papain treatment. The dogs were then killed and the lungs processed for pathologic studies. The severity of emphysema was graded as percent of emphysema according to Dunill's method and we compared this to the antemortem pulmonary function data. Exponential constant K was determined by fitting lung pressure-volume data to the equation V = Vo (1-e-KP). After papain administration, DLCO decreased, K of the pressure-volume curve increased, and arterial blood oxygen pressure reduced significantly. The changes of residual volume, the ratio of residual volume to total lung capacity, DLCO per unit lung volume, and the values of the exponential functions of pressure-volume data were correlated with the severity of emphysema with statistical significance, but none of them showed excellent order correlation. Multiple regression equation using 2 to 4 of the parameters indicated that the severity of emphysema can be predicted more accurately. We conclude that recognition of the severity of emphysema requires a multivariate approach including the determination of lung volume, DLCO, and pressure volume relationship of the lung, because the relationship between the severity of emphysema and the values obtained with these measurements are nonlinear.
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PMID:[Correlation between the function and structure in papain-induced emphysema in dogs]. 260 76

The protease-antiprotease imbalance concept has gained wide acceptance in reference to experimental animal models of human pulmonary emphysema. The destructive process may be induced by proteolytic enzymes such as porcine pancreas elastase (E) or papain (P), or by oxidants such as chloramine T (CT) which cause inactivation of alpha-1-antiprotease. The susceptibility to development of severe emphysema has been found to differ among animal species. We investigated the inhibition of elastase and papain by serum of seven species (rat, dog, human, rabbit, sheep, hamster, mini pig) and the effect of CT on serum inhibition. The relative inhibitor concentration of serum was expressed in terms of its inhibitor capacity for elastase and papain (EIC and PIC) defined as number of inhibited units (U) of enzyme catalysed hydrolysis of chromogenic peptide substrate (SAPNA and BAPNA) per unit of serum. The effect of CT on enzyme inhibition was quantified in terms of fractional loss of inhibition relative to control. The serum concentration of inhibitor was highest in the rat (EIC 8642 +/- 989 microU/microliter, PIC 214.2 +/- 110.3 microU/microliter; means +/- SD). Next in order of decreasing EICs were dog, human, rabbit, sheep, hamster, and mini pig exhibiting the lowest EIC (2523 +/- 184 microU/microliter) while sheep had lowest PIC (39.6 +/- 3.5 microU/microliter). The EIC/PIC ratio varied from 20 (mini pig) to about 100. The reduction of elastase inhibition after CT exposure of serum was high (80-100%) in rat, dog, human, and hamster, moderate (40%) in mini pig and rabbit, and low (10%) in sheep. Because papain was directly affected by CT the effect of CT on papain inhibition could not be analysed. The data suggest that the intrinsic antiprotease and antioxidant screen varies among experimental animals. For the purpose of animal models of emphysema, hamster appears to be most susceptible to the progressive destruction of lung parenchyma elicited by experimental burden of proteases or oxidants.
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PMID:Elastase and papain inhibition by serum of mammals. 274 Aug 28

Single breath nitrogen washout tests were analyzed in dogs (n = 8) with healthy lungs and after development of emphysema. The animals were in the supine position and studied during anaesthesia and mechanical ventilation (FiO2 = 0.4, FiN2 = 0.6). During controlled expiration with constant flow (VE = 0.15 l/s) onset of phase IV of the alveolar plateau was related to airway closure of dependent lung regions (closing volume CV). In the control state, CV accounted for 6.2 +/- 1.5% VC, and closing capacity (CC) was lower than functional residual capacity (FRC). Likewise, gas exchange was normal in all animals (PaO2 = 24.7 +/- 3.32 kPa, PaCO2 = 5.18 +/- 0.53 kPa, PA-aO2 = 2.6 +/- 0.3 kPa). Panlobular emphysema (PLE) was induced by inhalation of papain (100 mg/kg). After three weeks development of PLE was documented by measurements of lung volumes (functional residual capacity (FRC), expired vital capacity (EVC), total lung capacity (TLC), residual volume (RV], pulmonary mechanics (dynamic and static compliance (Cdyn, Cstat), mean airway resistance (Raw], gas exchange (PaO2, PaCO2, PA-aO2), and by radiomorphological analysis. In the PLE-group, FRC and RV (p less than or equal to 0.05), and Cstat (p less than or equal to 0.01) were significantly elevated. CV increased to 16.2 +/- 2.7% VC (p less than or equal to 0.01) and CC exceeded FRC by 80 ml, indicating that tidal volume breathing took place within the range of closing volume. Oxygenation was significantly impaired (PaO2 = 18.6 +/- 3.72 kPa, PA-aO2 = 6.5 +/- 1.1 kPa, p less than or equal to 0.05), but not CO2-elimination. Pathological analysis by radiomorphological means showed dissiminate parenchymal lesions compatible with emphysema of grade II severity located predominantly in subpleural areas. In dogs with papain-induced PLE, premature closure of dependent airways is enhanced, which is due to structural changes and a loss of elastic recoil in the lungs.
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PMID:Single breath N2 washout in papain-induced pulmonary emphysema. 276 46

The efficacy of constant-flow ventilation (CFV) was investigated in eight mongrel dogs before (control-phase) and after development of papain-induced panlobular emphysema (PLE-phase). For CFV, heated, humidified and oxygen-enriched air was continuously delivered via two catheters positioned within each mainstem bronchus at flow rates (V) of 0.33, 0.5 and 0.66 l/s. Data obtained during intermittent positive pressure ventilation (IPPV) served as reference. In the control-phase, Pao2 was lower (P less than or equal to 0.05) and alveolo-arterial O2 difference (P(A-a)O2) was higher (P less than or equal to 0.01) during CFV at all flow rates when compared with IPPV. This may be due to inhomogeneities of intrapulmonary gas distribution and increased ventilation-perfusion (VA/Q) mismatching. Paco2 and V showed a hyperbolic relationship; constant normocapnia (5.3 kPa) was achieved at 0.48 +/- 0.21 l/s (V53). Development of PLE resulted in an increase of functional residual capacity (FRC), residual volume (RV) and static compliance (Cstat) (P less than or equal to 0.05). PaO2 had decreased and P(A-a)O2 had increased (P less than or equal to 0.05), indicating moderate pulmonary dysfunction. Oxygenation during CFV was not significantly different in the PLE-phase when compared with the control-phase. Paco2 and V showed a hyperbolic relationship and V5.3 was even lower than in the control-group (0.42 +/- 0.13 l/s). In dogs with emphysematous lungs CFV maintains sufficient gas exchange. This may be due to preferential ventilation of basal lung units, thereby counterbalancing the effects of impaired lung morphometry and increased airtrapping. Conventional mechanical ventilation is more effective in terms of oxygenation and CO2-elimination.
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PMID:Constant-flow ventilation in canine experimental pulmonary emphysema. 280 Sep 79

We evaluated the pulmonary circulatory effects of emphysema produced by papain in 6 dogs that received 4 weekly treatments of papain administered by aerosolization. A control group of 6 dogs received saline treatments. Hemodynamic measurements were performed during normoxic and hypoxic (10% oxygen) ventilation approximately 3 and 6 months after treatment. Baseline hemodynamic parameters were comparable in both groups and were unchanged at 6 months in the control group. In the papain-treated group at 6 months, there were significant reductions in PaO2 (95 +/- 4 to 79 +/- 3 mm Hg, p less than 0.005) and increases in mean pulmonary artery pressure (12 +/- 1 to 18 +/- 3 mm Hg, p less than 0.05) and pulmonary vascular resistance (2.0 +/- 0.3 to 6.2 +/- 2.1 units, p less than 0.01). Morphometric evaluation demonstrated increased medial thickness in muscular pulmonary arteries less than 50 mu in size. Morphologic evaluation confirmed the presence of panlobular emphysema with papain administration. We conclude that chronic emphysema produced in dogs by aerosol administration of papain results in elevated pulmonary artery pressure, which is characterized pathologically by medial hypertrophy of small pulmonary arteries. This model appears suitable for further study of the pathogenesis of pulmonary vascular disease associated with chronic lung disease.
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PMID:Pulmonary vascular structural and functional changes in papain-induced emphysema in dogs. 363 41

In a chronic canine model of pulmonary emphysema, we studied the interaction between left ventricular (LV) mechanics and pulmonary disease during severe hypoxemia. The hypoxemia was similar to that which may occur during a severe exacerbation of chronic obstructive lung disease. In six dogs with papain-induced emphysema and in seven dogs without emphysema, LV mechanics were examined when a hypoxic gas mixture was inspired to reduce PO2 to about 35 mmHg (hypoxic study) and during nonhypoxic conditions (room air study). In both groups, LV diastolic compliance was reduced during the hypoxic study by a similar amount. This finding could not be explained in terms of ventricular interdependence. Our analysis suggested that hypoxia decreased diastolic compliance (i.e., increased LV diastolic stiffness) by impairing LV relaxation. The primary effect of hypoxia was to decrease the extent to which LV relaxation occurred for a given end-diastolic pressure, while the rate of LV relaxation was decreased just slightly. This study indicates that severe hypoxemia because of respiratory failure may impair myocardial relaxation leading to a decrease in LV filling.
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PMID:Increased left ventricular stiffness impairs filling in dogs with pulmonary emphysema in respiratory failure. 372 77

An ultrastructural study of the myocardium in control dogs and in dogs with papain-induced emphysema of 6 months duration without signs of right ventricular hypertrophy was undertaken to determine the number, size, and relative volume of the mitochondria. In the right ventricle of the emphysematous dogs, the number of mitochondrial profiles was greater per unit area of tissue (46.18 +/- 1.28/100 micron 2 versus 41.20 +/- 1.60/100 micron 2, p less than 0.05), but the mitochondria were smaller in size (mean mitochondrial profile area: 0.39 +/- 0.01 micron 2 versus 0.46 +/- 0.02 micron 2, p less than 0.05; mean mitochondrial "diameter": 0.65 +/- 0.01 micron versus 0.71 +/- 0.02 micron, p less than 0.05) than in control dogs. A highly significant negative correlation was found in the right ventricle of control and emphysematous dogs between the number per unit area and the size (area) of the mitochondrial profiles (r = -0.92; p less than 0.001). The increase in number but decrease in size of the mitochondrial profiles resulted in an unchanged relative volume of mitochondria in the right ventricle of the emphysematous dogs. In the subendocardium and in the subepicardium of the left ventricle of the papain-treated dogs, these changes were smaller and did not reach significance. These ultrastructural changes in the myocardium of the emphysematous animals are considered to be a response to a situation of prolonged increase in work of the right ventricle and may represent an early stage of a developing right ventricular hypertrophy.
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PMID:Increase in number and decrease in size of mitochondrial profiles in myocytes of the right ventricle of dogs with experimental emphysema. 375 13

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