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

A numerical single path model of respiratory gas exchange with distributed alveolar gas sources was used to estimate the anatomical changes in small peripheral airways such as occur in chronic obstructive pulmonary diseases (COPD). A previous sensitivity analysis of the single path model showed that decreasing total acinar airway cross-sectional area by an area reduction factor, R, results in computed gas expirograms with Phase III steepening similar to that observed in COPD patients. From experimental steady state CO2 washout data recorded from six healthy subjects and six COPD patients, optimized area reduction factors for the single path model were found that characterize peripheral airway anatomy for each subject. Area reduction factors were then combined with measured functional residual capacity data to calculate the normalized peripheral airspace diameters in a given subject, relative to the airspace diameters in the generations of an idealized standard lung. Mean area reduction factors for the patient subgroup were 63% of those for the healthy subgroup, which is related to the gas transport limitation observed in disease. Mean airspace sizes for the patient subgroup were 235% of the healthy subgroup, which characterizes the increase in size and reduction in number of peripheral airspaces due to tissue erosion in emphysema. From these results, the air-phase diffusive conductance in COPD patients was calculated to be 32% of the mean value in the healthy subjects. These findings correlated well with standard pulmonary function test data for the patients and yield the recovery of acinar airway information from gas washout by combining the single path model with experimental measurements.
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PMID:Noninvasive recovery of acinar anatomic information from CO2 expirograms. 797 50

A review of anaesthesia for gynaecologic laparoscopic surgery is given. Special criteria are needed for selection of patients, choice of anaesthesia and intraoperative monitoring. The cardiovascular and respiratory system are affected by tension from the pneumoperitoneum, absorption of CO2 and Trendelenburg position. Gas insufflation can provoke venous gas embolism, pneumothorax, pneumomediastinum, pneumopericardium and subcutaneous emphysema. The introduction of laparoscopic instruments may result in unintentional injuries to intra-abdominal organs. The possibility that the procedure may have to be converted to open laparotomy needs to be considered. Bowel burns may result in perforation, peritonitis and sepsis. Laparoscopy is contraindicated in patients with serious cardiac disease, extensive bowel adhesions or intestinal obstruction. General anaesthesia with muscle paralysis, tracheal intubation and controlled ventilation is the preferred technique in these cases. Short acting anaesthetics are preferred in day case laparoscopy. Central neural blockade or infiltration anaesthesia supplemented with sedation and analgetics can be used for short laparoscopic procedures. The electrocardiogram, noninvasive arterial pressure monitor, airway pressure monitor, intra-abdominal pressure monitor, pulse oximeter and CO2 monitor are used routinely. Antiemetics and analgetics may be needed postoperatively.
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PMID:[Anesthesiological aspects of laparoscopy in gynecological surgery]. 799 2

We report on two patients with subcutaneous carbon dioxide (CO2) emphysema that developed during laparoscopic surgery with CO2 pneumoperitoneum (PP), in whom pulmonary elimination of CO2 (ECO2, Servo ventilator with integrated CO2 analyzer 930, Siemens) was continuously monitored. Patient 1 was a 61-year-old man with laparoscopic herniotomy. ECO2 immediately before PP was 120 ml/min x m2 and increased rapidly after 45 min PP to a maximum value of 340 ml/min x m2. At that time, minute ventilation had been increased from 7 to 11 l/min and PaCO2 had risen from 35 to 57 mm Hg. At the end of the procedure the patient showed excessive subcutaneous emphysema. Patient 2 was a 71-year-old woman in whom diagnostic laparoscopy was performed for staging of a pancreatic tumor. ECO2 immediately before PP was 140 ml/min x m2, increasing dramatically after 45 min PP to a maximum value of 529 ml/min x m2 (Fig. 1). At that time minute ventilation had been increased from 6.2 to 12.5 l/min and PaCO2 had risen from 40 to 77 mm Hg. PP was terminated and the patient was found to have extreme subcutaneous emphysema. She was mechanically ventilated for a further 40 min to normalize PaCO2 and ECO2. It seems reasonable to suppose that an increase in ECO2 by more than 100% of control during CO2-PP is an early sign of CO2 emphysema. In this situation hypercapnia is potentially life-threatening. Evidently, reabsorption of CO2 from loose connective tissue is far more rapid and effective than CO2 resorption from the peritoneal cavity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[CO2--emphysema in laparoscopic surgery. Changes in pulmonary CO2-elimination]. 809 57

Within one year 3 newborns with meconium-aspiration and 4 infants with bronchopulmonary dysplasia (BPD) were treated with HFP, synchronous with conventional ventilation (CMV). The entrance criteria were insufficient oxygenation (PO2/FiO2 < 50 mmHg) and/or CO2-elimination (> 60 mmHg), respectively peak inspiratory pressure Pi > 40 mmHg and mean airway pressure MAP > 20 mbar during CMV. All three cases of meconium-aspiration have shown a striking improvement in oxygenation and ventilation, in one case starting from a disastrous situation with PCO2 > 90 mmHg, PO2 30 mmHg (FiO2 100%). After a HFO period of 9 to 10 hours Pi, MAP and CMV-frequency could be reduced. The patients could be extubated after 1-2 weeks. In severe BPD only in one case continuous improvement and extubation in the 4. week of life were possible. Here the pulmonary artery pressure in doppler-echocardiography slightly was elevated (30-35 mmHg). In a further case extubation was possible after several trials with HFO. Indeed chronic respiratory insufficiency, progredient pulmonary emphysema on x-ray and clearly elevated pulmonary artery pressure (> 40 mmHg) persisted. In 2 further cases there was no longstanding improvement of ventilation. One child died after 8 months, one after 6 months. In both cases there was a right-to-left shunt over foramen ovale and pulmonary artery pressures at systemic level. HFO led to an improvement in oxygenation and ventilation in all three cases of meconium-aspiration and probably prevented a fatal outcome in one case. The effect seems to depend on improved secretolysis and gas exchange.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[High frequency oscillation in meconium aspiration and bronchopulmonary dysplasia]. 819 11

Ten patients underwent a laparoscopic surgical technique for thoracic and cervical dissection of the oesophagus during oesophagogastrectomy. Thoracotomy was avoided with potential benefits to the patient. To facilitate surgical access the right lung was collapsed using a double-lumen bronchial tube and carbon dioxide was insufflated into the right pleural cavity to compress the lung. Changes in haemodynamic and respiratory variables occurred. In the majority of the patients airway pressure and end-tidal CO2 increased, despite alterations in ventilation. In five patients systolic blood pressure decreased suddenly by between 15 and 35 mmHg, and in four patients SpO2 decreased to 91% or less, despite an FIO2 of 1.0. If carbon dioxide was insufflated too fast, or the lung failed to deflate adequately, the clinical picture was that of a tension pneumothorax. One patient developed surgical emphysema and a contralateral pneumothorax. Postoperatively two patients had recurrent laryngeal nerve damage. Suggestions are made to minimise the changes in haemodynamic and respiratory variables during carbon dioxide insufflation into the thorax.
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PMID:Capnothorax: implications for the anaesthetist. 821 53

We measured PT, TT, KPTT, Fg, vWF, AT-IIIAg, AT-IIIA, alpha 2M, TXB2, 6-keto-PGF1 alpha, PLg, tPAAg, tPAA and PAI of patients with acute onset of chronic bronchitis, pulmonary emphysema, and cor pulmonale. The results were that many above parameter had a worsening tendency along with deterioration of COPD, and Fg, vWF, TXB2, 6-keto-PGF1 alpha, tPAA and PAI were more sensitive than others. The analysis of multiple liner regression of 22 blood items in patients with cor pulmonale showed that pH, PaO2, PaCO2 had correlation with many items of prethrombotic state. We consider that in the progress of COPD, prethrombotic state gradually appeared and aggravated. The causes may be related with repeatedly infections, low O2, high CO2 and imbalance of acid-base equilibrium.
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PMID:[The study on prethrombotic state in patients with chronic obstructive pulmonary disease and cor pulmonale]. 822 62

Tobacco is one of the major toxic agents in our civilization. The extent and severity of the current smoking epidemics are due to the use of industrial cigarettes: their smoke, less irritant than that of cigars and pipe, can be inhaled intensively with rapid absorption of all toxic compounds. Tobacco smoke is composed of a gas phase (CO2, CO, CNH, etc.) and a particle phase (a very fine aerosol) in which more than 4000 substances have been identified. The main toxic compounds in tobacco are Co, nicotine and tars. CO binds to haemoglobin to form COHb, a major factor of hypoxia and vascular accidents. Within a few seconds, nicotine reaches the brain where it binds to specific receptors, which explains its psycho-active effects (psychological dependence) and the induction of physical dependence. This dual dependence is responsible for the failures and relapses observed in attempted withdrawals. Furthermore, nicotine stimulates the sympathetic system with hypersecretion of catecholamines resulting in vascular complications. Tars contain carcinogenic substances, such as aromatic hydrocarbons, which exert local effects on the respiratory tract and systemic effects since they are absorbed by the lungs; this explains the remote neoplasias such as cancer of the bladder. Tars also contain irritant agents (acrolein, formaldehyde, etc.) and oxidative substances responsible for chronic bronchitis and emphysema. Thus, all organs and tissues can be damaged by the toxic compounds that are present in tobacco and, in particular, in tobacco smoke.
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PMID:[Toxicology of tobacco]. 823 55

The effects and the mechanism of single and long-term administration of theophylline on ventilatory regulation were investigated in patients with chronic obstructive pulmonary disease (COPD). The ventilatory and mouth occlusion pressure (P0.1) responses during CO2 rebreathing were measured before and 4 hours after oral, single administration of theophylline in 15 patients with pulmonary emphysema, 15 patients with asthma and 10 healthy subjects. Ventilatory response to CO2 (VE/PCO2) was increased in patients with asthma and P0.1 response to CO2 (P0.1/PaCO2) was increased in patients with pulmonary emphysema after single theophylline administration. In patients with pulmonary emphysema, the increase in P0.1 was more marked than that in maximum inspiratory pressure static (MIPS). The effect of long-term administration of theophylline was studied in 8 patients with COPD and 8 patients with restrictive lung disease. In patients with COPD, P0.1/PaCO2 was significantly increased and the increase was maintained until three months later. These findings suggest that theophylline is effective in improving ventilatory and occlusion pressure responses to CO2 in patients with asthma probably by its bronchodilating effect, and in patients with pulmonary emphysema by its direct effect on the ventilatory control system.
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PMID:[Effects of theophylline on ventilatory regulation in patients with chronic obstructive pulmonary disease]. 827 16

The CO2 laser is a precision surgical laser because of its high degree of absorption in soft tissue with limited lateral damage. The tissue, which absorbs the CO2 laser energy, and has a high water content, will be converted to vapor with a small residue of ash and a by-product of heat. The laser can only be effective if these by-products, i.e. vapors, heat, and carbon ash residue, are not injurious and are well tolerated by the joint. These by-products must be either reabsorbed by the synovium or remain as a nonviable substance in the joint. From April 1989 through April 1990, 40 patients underwent 43 operative arthroscopies of the knee using the Pfizer CO2 laser. All procedures were chondroplasties, synovectomies, and/or meniscectomies. All accessible CO2 carbon ash residue was removed from the joint after the procedures using an intraarticular shaver and hand rasp. Postoperatively there were no cases of hemorrhagic effusions, subcutaneous emphysema, or synovitis. Histologic examinations performed on 10 patients undergoing subsequent surgery showed no evidence of carbon ash residue or synovitis seen grossly or microscopically. The carbon ash residue is not noxious to the joint and is completely removed from the joint, presumably by the synovial response.
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PMID:The synovial response after CO2 laser arthroscopy of the knee. 828 Mar 30

Maternal corticosteroid treatments augment lung function in the human preterm infant. However, not all fetuses respond, the response requires > or = 48 h of exposure, and multiple maternal doses expose the mother to potential risks. To evaluate the potential of direct fetal therapy, we used ultrasound to direct fetal intramuscular or intravascular injections of corticosteroids or saline in sheep and subsequently delivered the preterm lambs at 128 days gestational age to assess postnatal lung function. Relative to saline-injected controls, 0.5 or 2 mg/kg betamethasone given as a single intramuscular dose 48 h before delivery increased compliance and the efficiency of ventilation (as measured by an indicator that included ventilatory pressures and CO2 values) nearly twofold (P < 0.05). Lung volumes, measured from deflation pressure-volume curves, also increased (P < 0.05). However, the 2 mg/kg dose caused severe pulmonary interstitial emphysema in 5 of 13 lambs, suggesting adverse effects. An intravascular fetal dose of 12.5 mg/kg hydrocortisone or an intramuscular dose of 0.1 mg/kg betamethasone had no effect on postnatal lung function. In separate studies, the 2 mg/kg dose improved all indicators of lung function almost twofold after only 24 h of fetal exposure and delivery at 128 days gestational age (P < 0.01). There was a dose-dependent suppression of the postnatal cortisol surge in treated animals, although fetal treatment did not alter cord cortisol levels. Single-dose fetal hormone treatments can cause large and rapid improvements in postnatal lung function in preterm lambs.
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PMID:Lung responses to ultrasound-guided fetal treatments with corticosteroids in preterm lambs. 830 65


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