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

Single lung transplantation was performed in several steps: laparotomy to prepare an omentopexy, followed by pneumonectomy and implantation of a pulmonary graft, both by postero-lateral thoracotomy. The patients suffered from lymphangiomyomatosis (1), panacinar emphysema (2) and idiopathic pulmonary fibrosis (1). Immunosuppressive treatment was started before surgery. Anaesthesia was induced and maintained with alfentanil, midazolam and vecuronium. The patients were intubated with a Carlens endotracheal tube. Ventilation was carried out using an oxygen-air mixture, without any nitrous oxide or halogenated anaesthetic agent. Besides the usual parameters, expired CO2 concentrations, and oxygen saturation in the pulmonary artery were monitored. Partial femoro-femoral cardiopulmonary bypass was not required. Three major problems were encountered: hypoxia, hypercapnia, and pulmonary arterial hypertension. Hypoxia first occurred during the period of one-lung ventilation, during pneumonectomy, and again after unclamping of the graft vessels before the bronchus had been anastomosed. It was treated either by increasing the FiO2, inflating the lungs with pure oxygen, or partial clamping of the homolateral pulmonary artery. Hypercapnia occurred in three of the four patients until the graft was ventilated again. Except in one patient with preoperative pulmonary hypertension, the increase in pulmonary vascular resistances remained moderate after clamping of the pulmonary artery. Sufficient oxygen delivery, with more than 50% venous oxygen saturation, was maintained at this time by the infusion of dopamine and dobutamine. Two other specific problems were encountered in the emphysematous patients: severe hypotension following the start of artificial ventilation and after placing the patient in lateral position; thoracic asymetry with overdistension of the emphysematous lung, and mediastinal shift.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Anesthesia in unilateral pulmonary transplantation]. 185 49

Six full-term newborn infants are described who suffered from severe adult respiratory distress syndrome (ARDS). The triggering event was intrauterine/perinatal asphyxia in five, and group B streptococcal (GBS) septicemia in three. All had severe respiratory distress/failure and were ventilated mechanically with high concentrations of inspired oxygen and positive end-expiratory pressure. Radiography of the chest showed dense bilateral consolidation with air bronchograms and reduced lung volume. Persistent pulmonary hypertension (PPH) was documented in all cases. The coincidence of ARDS and PPH rendered respiratory management extremely difficult. For this reason high-frequency ventilation was instituted in all patients in order to improve CO2 elimination and induce respiratory alkalosis. Acute complications of respiratory therapy were encountered in five patients (pneumothorax, pulmonary interstitial emphysema, pneumopericardium). Three infants died (irreversible septic shock, progressive severe hypoxemia, and sudden cardiac arrest) after 17, 80, and 175 h of life. Histologic examination of the lungs was possible in all fatal cases and revealed typical changes of acute to subacute stages of ARDS. Three infants survived, the mean time of mechanical respiratory support being 703 h. Two patients were still dependent on oxygen after 1 month of life, and all survivors had increased interstitial markings and increased lung volumes on their chest roentgenograms at this time.
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PMID:The paradox of adult respiratory distress syndrome in neonates. 200 41

Infants presenting with pneumothorax within the first 24 hours of life were studied in an attempt to produce a reliable index of the severity of the disease. Of these 54 patients, 46 infants required intubation and ventilator support; 18 (39%) survived and 28 (61%) died. Overall mortality in this series was 52%. We have been able to define clearly the two groups (survivors and nonsurvivors) based on their response to ventilatory parameters. The nonsurvivor group displayed CO2 retention associated with pneumopericardium and pulmonary interstitial emphysema. This group was unresponsive to high fraction of inspired oxygen and high positive end expiratory pressure. The survivor group responded well to a fraction of inspired oxygen of less than 70% and a positive end expiratory pressure of 6 cm or less. Arterial CO2, pneumopericardium, pulmonary interstitial emphysema, pneumomediastinum, and birthweight are useful in predicting the severity of the respiratory distress in these infants and in evaluating the nonsurvivors from the survivors.
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PMID:Arterial blood gas and expiratory pressure monitoring in infants with pneumothorax: prognostic predictability. 210 36

The authors review the literature about the pathogenesis -still unknown- of Zenker's diverticulum as well as their experience of endoscopic treatment of this disease. From 1964 till 1988, they have treated endoscopically 507 patients, 323 by electrocoagulation, 184 by CO2-laser. The endoscopic procedure is described, consisting in precise division of the tissue bridge between the oesophagus and the diverticulum by micro-endoscopic surgery under general anesthesia. In recent years, the CO2-laser was found preferable, since it may cause less tissue necrosis and consequently less fibrous scar tissue. The results were very favourable, with more than 99% of the patients satisfied. Although many patients were old and in poor condition, only one patient died two days after operation because of cardiac failure. Complications such as bleeding, emphysema, mediastinitis and stenosis were seen in 5% of the patients, but in most cases there complications were mild and conservative therapy was sufficient. Stenosis occurred in 8 patients treated by electrocoagulation and in none of the patients treated by laser. Microendoscopic surgery is a safe and efficient method of therapy for the hypopharyngeal diverticulum.
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PMID:Pathogenesis and endoscopic treatment of the hypopharyngeal (Zenker's) diverticulum. 212 49

CO uptake (VCO) normalized by CO2 output (VCO2) and by alveolar ventilation (VA) does not depend on lung exchanger activity or on mixing. It reflects circulatory amputation in patients with kyphoscoliosis. Measurements were therefore performed in patients with chronic respiratory failure (CRF) stabilized after intensive care to evaluate the deterioration of blood perfusion. The VCO/VCO2 ratio (specific VCO, VCO Sp) was measured, together with gasometry, at the patient's bedside in 41 cases of CRF (group P). In some cases, measurements were repeated either after modification of FIO2 or of the respiratory rate (bradypnoea), or during the patient's stay in hospital. The results were compared with those obtained in a group of patients with stable emphysema (group E). The VCO Sp and VCO/VA deficit values were extremely variable but always severe, and were higher in the E group. They were little modified when SaO2 was corrected by FIO2 without excess, when forced bradypnoea increased VA and PaO2, or during the months of clinical stabilization which followed the measurements. The authors discuss the significance of the deficit compared with the alterations of spirometry and CO ductance and with bradypnoea-induced improvement of DuCO and PaO2. The results obtained indicate the degree of vascular bed destruction in CRF. They justify a systematic application of the test to determine its value and significance compared with other methods used to explore pulmonary circulation.
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PMID:[Alterations of pulmonary blood perfusion in chronic respiratory insufficiency. Evaluation by normalized carbon monoxide uptake measured at the patient's bedside after intensive care]. 212 64

Although many factors have been shown to relate to survival in patients with COPD, the patient's age and baseline postbronchodilator FEV1 are the best predictors of mortality. The presence of mild obstructive airway disease is not indicative of a progressive downhill course and shortened survival. Mortality in patients with a baseline postbronchodilator FEV1 greater than or equal to 50% of predicted was only slightly greater than that of a group of healthy smokers. Investigators attempting to compare survival in patients with COPD should attempt to exclude patients with asthma or asthmatic bronchitis, because these individuals have a much better prognosis than those with typical COPD (emphysema and chronic bronchitis). Patients should be matched closely for age and severity of impairment, because younger individuals and those with milder impairment are likely to live longer. Other factors besides age and baseline FEV1 have been shown to affect survival. Patients who stop smoking are likely to survive longer than those who continue to smoke. The presence of malnutrition has clearly been shown to worsen survival. Further studies will be necessary to determine if corticosteroid therapy can slow down progression of disease in patients with typical COPD. Oxygen therapy improves survival in COPD patients with significant hypoxemia, many of whom also have CO2 retention, polycythemia, and cor pulmonale. There are now multiple studies in the literature suggesting that the type of comprehensive respiratory care provided by pulmonary rehabilitation programs can not only improve the quality of life but also survival in patients with chronic obstructive pulmonary disease.
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PMID:Prognosis in chronic obstructive pulmonary disease. 220 43

We have analyzed the heart and lung findings in 31 patients in the National Institutes of Health (NIH) Nocturnal Oxygen Therapy Trial (NOTT) with particular emphasis on cor pulmonale. Increased right ventricular weight was related to decreased bronchiolar diameter, decreased ratio of bronchiolar diameter to external arterial diameter, and an increased proportion of airways less than 400 microns in diameter. No relationship was found between the severity of emphysema, mucous gland enlargement, peripheral airway mucous plugging, or other measurement of central and peripheral airways. Patients with right ventricles weighing more than 100 g had higher pulmonary artery pressures at rest and higher arterial CO2 levels than those weighing 100 g or less. When the patients were divided into Types A, B, and X according to Burrows' criteria, those with Type X had a higher volume proportion of mucous glands; type B were intermediate; and Type A had the smallest. The amount of bronchial muscle was less in Type B patients than in Type A, and right ventricles weighted less in Type A patients than in Type B. Hypoxic ventilatory drive was lower in Type B patients than in Type A. Absolute right ventricular weight appeared to be a better measurement of right ventricular enlargement than relative right ventricular weight in the NIH NOTT patients. We conclude that right ventricular weight in patients with hypoxic chronic airflow obstruction (CAO) is related to airway narrowing, and that the Type B syndrome is associated with decreased ventilatory drive.
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PMID:Cor pulmonale: correlation with central airway lesions, peripheral airway lesions, emphysema, and control of breathing. 233 40

The response of breathing patterns to increased expiratory resistance is not only of physiologic interest, with respect to the control of breathing, but also of clinical interest because of its clinical relevance to obstructive diseases such as asthma and emphysema. To elucidate the response of breathing patterns to increased expiratory resistance during anesthesia, the respiratory effects of expiratory flow-resistive loading on breathing patterns were studied in 15 conscious and 10 lightly anesthetized subjects. Inspiratory time, expiratory time, respiratory frequency, inspiratory duty cycle, tidal volume, minute ventilation, and mean inspiratory flow rate were determined from a respiratory inductive plethysmograph. End-tidal CO2 was continuously recorded. In awake subjects, respiratory frequency was reduced without change in tidal volume or mean inspiratory flow rate, and minute ventilation was significantly decreased; the synchrony between rib cage and abdomen wall motion was well maintained during the loads. In contrast, in anesthetized subjects, respiratory frequency was reduced with remarkable increases in tidal volume, mean inspiratory flow rate, and minute ventilation, whereas coordination between rib cage and abdomen compartments was disturbed. End-tidal CO2 did not change in conscious subjects, but it increased in anesthetized subjects during the loads. These results indicate that there are differences between conscious and anesthetized subjects in breathing patterns during expiratory loading, and suggest that the ability to coordinate rib cage-abdomen wall motion is easily disturbed during anesthesia in patients with expiratory flow limitation.
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PMID:Respiratory effects of expiratory flow-resistive loading in conscious and anesthetized humans. 234 54

Chest negative pressure ventilation (CNPV) and intermittent positive pressure ventilation (IPPV) through a nose mask were used for ventilatory support of 4 patients with chronic respiratory failure due to old tuberculosis (2 patients), chronic pulmonary emphysema, and kyphoscoliosis (VC, 0.91 +/- 0.16 L; %VC 31.2 +/- 3.2; FEV1.0, 0.62 +/- 0.19 L). These ventilatory supports were used for relief of chronic arterial CO2 retention, weaning from the mechanical ventilation, therapy for the acute exacerbation on the chronic respiratory failure, and the relief of the respiratory muscle fatigue. After CNPV and IPPV through a nose mask, PaCO2 showed a significant fall from 75.7 +/- 14.8 Torr to 60.2 +/- 12.3 Torr (p less than 0.01). All patients showed improvement of clinical symptoms. Two patients have continued CNPV at home on a regular basis. We conclude that CNPV and IPPV through a nose mask significantly improve hypoventilation and quality of life in some patients with chronic respiratory failure.
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PMID:[Noninvasive ventilatory support on chronic respiratory failure with hypoventilation]. 262 Jan 35

We have used the CT transthoracic scan to measure regional lung density in vivo, as our previous studies have shown that this correlates with the increase in size of distal air spaces, which is a defining characteristic of emphysema. We have studied 32 patients with chronic airflow limitation (FEV1, 15 to 68% predicted) caused by chronic bronchitis and emphysema (synonym, COPD), with a wide range of arterial PO2 (38 to 90 mm Hg) and PCO2 (32 to 63 mm Hg) while breathing air at rest. We could find no significant relationships between the extent of emphysema (as assessed in vivo by the EMI number defining the lowest fifth percentile of the CT density histogram of the lung fields) and either arterial blood gas tensions, mean pulmonary arterial pressure, cardiac output, or calculated total pulmonary vascular resistance while at rest (n = 32) or during supine leg exercise (n = 29). We conclude that the extent of emphysema does not correlate with the clinical or pathologic features of the "pink and puffing" (i.e., mild hypoxemia, no CO2 retention, no pulmonary hypertension, etc.) or "blue and bloated" (i.e., hypoxemia, CO2 retention, pulmonary hypertension) pattern of patients with COPD nor to the spectrum of hemodynamic and gas exchange abnormalities that commonly occur in patients between these two extreme examples. Thus, "pink puffers" should not be equated with "the emphysematous" pattern of this disease. Although these clinicophysiologic patterns remain valid as descriptions, they do not relate to the extent of underlying emphysema in COPD.
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PMID:Pulmonary hemodynamics, gas exchange, and the severity of emphysema as assessed by quantitative CT scan in chronic bronchitis and emphysema. 272 56


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