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Emphysema
Kinds of Emphysema Selected AbstractsCause of Death in Older Patients with Anatomo-Pathological Evidence of Chronic Bronchitis or Emphysema: A Case-Control Study Based on Autopsy FindingsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2001Jean Paul Janssens MD OBJECTIVES: To determine the most frequent causes of death of hospitalized older patients based on anatomo-pathological evidence and to compare the relative frequency of fatal events between patients with and without evidence of either chronic bronchitis (CB) or emphysema (E). DESIGN: Retrospective, case-control study based on a computerized database including anatomo-pathological data of patients deceased and autopsied over a 25-year period. SETTING: Two geriatric hospitals in Geneva. PARTICIPANTS: Not applicable. MEASUREMENTS: Autopsy records for cause(s) of death in patients with CB or E. RESULTS: 3,685 patients deceased in our institution (1,540 men; 2,145 women) were autopsied between 1972 and 1996; mean age at death was 81.5 ± 8.0 years. Anatomo-pathological evidence of CB or E was found in 983 patients (26.6% of total); 262 (7.2%) had predominantly CB, and 456 (12.3%) predominantly E. Pneumonia was the most frequent cause of death in all patients (21.8%). Myocardial infarction (MI) (17.6% vs 14%), and respiratory failure (5.1% vs 1.5%) occurred more frequently in subjects with CB and/or E than in controls. Fatal pulmonary embolism (PE) was more frequent in patients with E (18.4%) than in patients with CB (10.7%; odds ratio (OR) = 1.89, P = .008), or in controls (12.7%; OR = 1.56, P = .0008). CONCLUSION: Anatomo-pathological evidence of CB or E is highly prevalent in older patients, suggesting that CB and E are clinically underdiagnosed in this age group. Fatal MI occurred significantly more frequently in older patients with E or CB than in controls. Furthermore, patients with E were at significantly higher risk of fatal PE than patients with CB or controls. [source] Congenital lobar emphysema: Differential diagnosis and therapeutic approachPEDIATRICS INTERNATIONAL, Issue 5 2008Refik Ulku Abstract Background: Congenital lobar emphysema (CLE) is a rare anomaly of lung development that usually presents in the neonatal period with respirator distress and pulmonary lobar hyperinflation. It is commonly confused with pneumothorax. The aim of the present paper was to review the authors' experience in order to emphasize the importance of differential diagnosis with pneumothorax. Methods: Children with CLE treatment at Department of Thoracic Surgery, Dicle University School of Medicine, Turkey, between January 1993 and June 2004, were reviewed. Results: Ten children consisting of six boys and four girls (age range, 6 h,12 months) had CLE. Major presenting symptoms were tachypnea(n = 100%) and respiratory distress in (n = 80%). On chest radiograph, emphysema was seen in all patients, and shift-herniation to the opposite lung, atelectasis were observed. Computed tomography was performed in all patients, which indicated emphysema in the affected lobes in all cases. Pulmonary perfusion scan was performed in two patients, showing loss of perfusion in the affected lobe. The most common affected lobe was the left upper lobe (50%). In the present series, three patients were mistakenly diagnosed as pneumothorax and intercostal drains were inserted in the emergency department. Eight patients underwent lobectomy, and postoperative course was uneventful. Two patients were followed conservatively. Emphysema was detected in all pathological specimens. One patient was lost to follow up. Mean follow-up duration of all patients was 26.8 ± 29.24 months (range, 1,89 months). Conclusions: CLE is established on combined clinical, radiological and scintigraphic imaging. Surgical excision of the affected lobe is the appropriate treatment. Particularly, differential diagnosis should be made between CLE and pneumothorax. [source] Increased surfactant protein-D and foamy macrophages in smoking-induced mouse emphysemaRESPIROLOGY, Issue 2 2007Noriyuki HIRAMA Background and objective: The molecular mechanisms underlying COPD remain undetermined. The lungs of surfactant protein-D (SP-D) deficient mice show emphysema and an excessive number of foamy macrophages. This study aims to elucidate roles of SP-D and foamy macrophages in smoking-induced mouse emphysema. Methods: Twenty B6C3F1 mice were exposed to cigarette smoke (2 cigarettes/day/mouse for 6 months). The mice were killed, and formalin-fixed, paraffin-embedded lung sections were carried out on seven mice, BAL was carried out on six mice, and seven mice were used to make lung homogenates. In in vitro studies, A549 cells were transduced with the SP-D expression plasmid and treated with cigarette smoke extract to evaluate cell viability. Results: Emphysema was induced in the mice by chronic cigarette smoke exposure. Increased expression of matrix metalloproteinase-9 and -12 was observed, and foamy alveolar macrophages accumulated in the smoke-exposed lungs. Immunostaining of BAL cells revealed the major source of matrix metalloproteinase-12 to be foamy alveolar macrophages. Furthermore, SP-D was elevated in emphysema lungs. Expression of transcription factors, Fra-1, junB and C/EBP, (which induce SP-D) were significantly elevated in emphysema lungs. The in vitro expression of SP-D gene in A549 cells prolonged cell survival following exposure to cigarette smoke condensate. Conclusions: The accumulation of foamy alveolar macrophages may play a key role in the development of smoking-induced emphysema. Increased SP-D may play a protective role in the development of smoking-induced emphysema, in part by preventing alveolar cell death. [source] Penetrating injury at the thoracic inlet in a Paint-Arab mareEQUINE VETERINARY EDUCATION, Issue 12 2009Y. R. Rojman Summary A 12-year-old Paint-Arab mare was admitted for evaluation of a penetrating chest laceration at the thoracic inlet. The left brachiocephalic muscle was transected and the recurrent laryngeal nerve was traumatised. Subsequent to the injury, the horse developed Horner's syndrome on the left side of the neck and face, Grade IV left laryngeal hemiplegia, dysphagia, cough and subcutaneous emphysema. The defect was closed in multiple layers. Antimicrobial and antiinflammatory therapy was instituted along with local wound care. The mare remained bright and responsive and the wound healed normally. The mare showed no signs of respiratory distress. Dysphagia and ptosis persisted at 30 days post trauma. [source] Lung volume reduction surgery: The Thoracic Society of Australia and New ZealandINTERNAL MEDICINE JOURNAL, Issue 2 2001G. I. Snell Abstract Lung volume reduction surgery involves the removal of emphysematous lung tissue with the aim of palliating symptoms in selected patients with severe emphysema. This form of surgery is being practised in Australia with favourable short-term outcomes, similar to those reported in the literature. Large multicentre trials are currently underway in North America and the United Kingdom to clarify issues of safety and long-term efficacy. As a result, it is too early to apply an evidence-based approach to this procedure. In the meantime, local audits of practice need to be undertaken to define patient subgroups at higher risk of morbidity and mortality. (Intern Med J 2001; 31: 112,115) [source] Lung volume reduction surgery (LVRS) for emphysema,early Australian experienceINTERNAL MEDICINE JOURNAL, Issue 2 2000R. J. PIERCE No abstract is available for this article. [source] Dietary zinc, copper and selenium, and risk of lung cancerINTERNATIONAL JOURNAL OF CANCER, Issue 5 2007Somdat Mahabir Abstract Zinc, copper and selenium are important cofactors for several enzymes that play a role in maintaining DNA integrity. However, limited epidemiologic research on these dietary trace metals and lung cancer risk is available. In an ongoing study of 1,676 incident lung cancer cases and 1,676 matched healthy controls, we studied the associations between dietary zinc, copper and selenium and lung cancer risk. Using multiple logistic regression analysis, the odds ratios (OR) and 95% confidence intervals (CI) of lung cancer for all subjects by increasing quartiles of dietary zinc intake were 1.0, 0.80 (0.65,0.99), 0.64 (0.51,0.81), 0.57 (0.42,0.75), respectively (p trend = 0.0004); similar results were found for men. For dietary copper, the ORs and 95% CI for all subjects were 1.0, 0.59 (0.49,0.73), 0.51 (0.41,0.64), 0.34 (0.26,0.45), respectively (p trend < 0.0001); similar reductions in risk and trend were observed by gender. Dietary selenium intake was not associated with risk, except for a significant inverse trend (p = 0.04) in men. Protective trends (p < 0.05) against lung cancer with increased dietary zinc intake were also found for all ages, BMI > 25, current smokers, pack-years ,30, light drinkers and participants without emphysema. Increased dietary copper intake was associated with protective trends (p < 0.05) across all ages, BMI, smoking and vitamin/mineral supplement categories, pack-years ,30 and 30.1,51.75 and participants without emphysema. Our results suggest that dietary zinc and copper intakes are associated with reduced risk of lung cancer. Given the known limitations of case,control studies, these findings must be interpreted with caution and warrant further investigation. © 2006 Wiley-Liss, Inc. [source] ,1-Antitrypsin deficiency presenting with panniculitis and incidental discovery of chronic obstructive pulmonary diseaseINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2007Gretchen Korver MD A 60-year-old man presented to the Emergency Department (ED) with large, painful, indurated plaques on the right thigh, left abdomen, left chest, and right chest, which began without any preceding trauma on the right thigh 3 weeks prior to presentation in the ED. He was initially treated with cefazolin 1 g three times daily as home infusions. When the lesions continued to progress, he was admitted to the hospital and placed on amoxicillin/clavulanate and vancomycin. He had a single episode of fever of 102°F, but his white blood cell count and differential remained normal. An initial biopsy showed a dermal inflammatory infiltrate composed primarily of neutrophils and eosinophils with rare flame figures in the dermis. There was minimal fat seen in this biopsy. A differential diagnosis of Wells or Sweet's syndrome was entertained, and he was placed on 60 mg/day prednisone with no resolution of his symptoms. The patient's past medical history included hypertension, hyperlipidemia, peripheral neuropathy, and hiatal hernia. His family history was significant for emphysema in both parents and coronary artery disease in his father. Both of his parents smoked cigarettes. His grandfather, who was a coal miner, also had emphysema. Whilst on antibiotics and prednisone, the plaques on the patient's right thigh, right abdomen, and left chest expanded and ulcerated, draining an oily liquid (Figs 1 and 2). An incisional biopsy was obtained from his thigh. Histopathology showed a septal and lobular panniculitis with fat necrosis, neutrophils, and histiocytes (Fig. 3). Special stains for organisms were negative. Tissue sent for bacterial and fungal culture had no growth. Amylase and lipase levels were normal. Rheumatoid factor, antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA), cryoglobulins, and antiphospholipid antibodies were all normal. The ,1-antitrypsin level was low at 25 mg/dL (ref. 75,135). The ,1-antitrypsin phenotype was PiZZ. Figure 1. Indurated plaques on right chest and thigh and left chest Figure 2. Ulcerated plaques on left chest Figure 3. Septal and lobular panniculitis with fat necrosis. Hematoxylin and eosin ×10 The patient had a normal glucose-6-phosphate dehydrogenase level and was placed on dapsone 200 mg/day. The inflammation resolved and, over the course of several months, the involved areas healed with scarring. The patient denied any pulmonary complaints but, during his hospitalization, was found incidentally to have an oxygen saturation of 88% on room air. He was sent for evaluation by a pulmonologist, and pulmonary function tests revealed a mixed restrictive and obstructive pattern with a forced expiratory volume in 1 to forced vital capacity (FEV1/FVC) ratio of 63% of predicted. He had never smoked. He was placed on supplemental oxygen but, as his pulmonary disease has been stable, he has not been treated with intravenous antitrypsin inhibitor. [source] Alpha-1-antitrypsin deficiency associated with panniculitis treated with plasma exchange therapyINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2004Priscila De Oliveira MD Background, Alpha-1-antitrypsin is the principal serum protease inhibitor. In addition to the well-recognized association with early-onset emphysema and cirrhosis, alpha-1-antitrypsin deficiency may be associated with panniculitis. The treatment of this type of panniculitis presents a significant challenge. Previous attempts using immunosuppressive, anti-inflammatory, and cytotoxic drugs have shown variable results. Aim, To report a case of alpha-1-antitrypsin deficiency-associated panniculitis treated with plasma exchange therapy. Methods, A 23-year-old patient developed painful red nodules on her thighs and buttocks with spontaneous ulceration and discharge of oily fluid. A skin biopsy specimen showed septal and lobular panniculitis. The serum alpha-1-antitrypsin level was 22 mg/dL. She was treated with plasma exchange therapy. Results, Treatment of this patient with plasma exchange therapy led to the control of the cutaneous lesions. Conclusions, Plasma exchange therapy represents an alternative treatment which restores serum and tissue alpha-1-antitrypsin levels. This method is proposed because of its clinical benefits and greater availability. [source] Subcutaneous emphysema during restorative dentistryINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2007ROBERT J. STEELMAN Background., Subcutaneous emphysema is a rare occurrence in the dental setting. When it does occur, the entity may be mistaken for an anaphylactic reaction to a local anaesthetic agent or other medications used in dental surgery. Case Report., During restorative treatment of a left second primary molar air was introduced under an operculum. Communication with submandibular and sublingual spaces to the mediastinum was established. Conclusion., Therapy for subcutaneous emphysema involves, correct diagnosis and antibiotic coverage. Subcutaneous air will resolve over time so observation is indicated. [source] Arterial blood gases in extraperitoneal laparoscopic urethrocystopexyINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2002Hasan Kocoglu Abstract Background: The aim of this study was to investigate the effects of extraperitoneal laparoscopy and carbon dioxide insufflation on hemodynamic parameters, arterial blood gases and complications in urethrocystopexy operations. Methods: Twenty-five female patients who underwent extraperitoneal laparoscopic mesh urethrocystopexy operation for the correction of urinary incontinence were allocated to the study. Hemodynamic parameters were noted and blood gas analyzes were performed before the induction of anesthesia, 10 min after induction, 5 and 10 min after the beginning of carbon dioxide insufflation, at the end of carbon dioxide insufflation and 30 min after exsufflation. Results: There was no significant change in mean arterial pressure, peripheral oxygen saturation, arterial carbon dioxide pressure, and arterial oxygen saturation compared to preinsufflation and preinduction values. End-tidal carbon dioxide pressure did not increase above 45 mm/Hg during carbon dioxide insufflation. Arterial oxygen saturation and partial oxygen pressure did not decrease. Subcutaneous emphysema, pneumothorax, pneumomediastinum and pleural effusion were not noted in any patient. Conclusion: We conclude that, extraperitoneal laparoscopic urethrocystopexy is not associated with hemodynamic and respiratory impairment. [source] Serpin polymerization and its role in disease,The molecular basis of ,1 -antitrypsin deficiencyIUBMB LIFE, Issue 1 2009Anja S. Knaupp Abstract Protein aggregation is the cause of several human diseases. Understanding the molecular mechanisms involved in protein aggregation requires knowledge of the kinetics and structures populated during the reaction. Arguably, the best structurally characterized misfolding reaction is that of ,1 -antitrypsin. ,1 -Antitrypsin misfolding leads to both liver disease and emphysema and affect approximately 1 in 2000 of the population. This review will focus on the mechanism of ,1 -antitrypsin misfolding and the development of potential therapeutic strategies. © 2008 IUBMB IUBMB Life, 61(1): 1,5, 2009 [source] Cause of Death in Older Patients with Anatomo-Pathological Evidence of Chronic Bronchitis or Emphysema: A Case-Control Study Based on Autopsy FindingsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2001Jean Paul Janssens MD OBJECTIVES: To determine the most frequent causes of death of hospitalized older patients based on anatomo-pathological evidence and to compare the relative frequency of fatal events between patients with and without evidence of either chronic bronchitis (CB) or emphysema (E). DESIGN: Retrospective, case-control study based on a computerized database including anatomo-pathological data of patients deceased and autopsied over a 25-year period. SETTING: Two geriatric hospitals in Geneva. PARTICIPANTS: Not applicable. MEASUREMENTS: Autopsy records for cause(s) of death in patients with CB or E. RESULTS: 3,685 patients deceased in our institution (1,540 men; 2,145 women) were autopsied between 1972 and 1996; mean age at death was 81.5 ± 8.0 years. Anatomo-pathological evidence of CB or E was found in 983 patients (26.6% of total); 262 (7.2%) had predominantly CB, and 456 (12.3%) predominantly E. Pneumonia was the most frequent cause of death in all patients (21.8%). Myocardial infarction (MI) (17.6% vs 14%), and respiratory failure (5.1% vs 1.5%) occurred more frequently in subjects with CB and/or E than in controls. Fatal pulmonary embolism (PE) was more frequent in patients with E (18.4%) than in patients with CB (10.7%; odds ratio (OR) = 1.89, P = .008), or in controls (12.7%; OR = 1.56, P = .0008). CONCLUSION: Anatomo-pathological evidence of CB or E is highly prevalent in older patients, suggesting that CB and E are clinically underdiagnosed in this age group. Fatal MI occurred significantly more frequently in older patients with E or CB than in controls. Furthermore, patients with E were at significantly higher risk of fatal PE than patients with CB or controls. [source] Combined pulmonary toxicity of cadmium chloride and sodium diethyldithiocarbamateJOURNAL OF APPLIED TOXICOLOGY, Issue 2 2001Erzsébet Tátrai Abstract The pulmonary toxicity of sodium diethyldithiocarbamate and cadmium chloride, each separately and in combination, was compared in Sprague-Dawley rats after single intratracheal instillation in sequential experiments by chemical, immunological and morphological methods. With combined exposure, the cadmium content of the lungs increased permanently relative to that of the lungs of just cadmium-treated animals. Immunoglobulin levels of the whole blood did not change, whereas in bronchoalveolar lavage the IgA and IgG levels increased significantly. Morphological changes were characteristic of the effects of cadmium but were more extensive and more serious than in the case of cadmium administration alone: by the end of the first month, interstitial fibrosis, emphysema and injury of membranes of type I pneumocytes developed and hypertrophy and loss of microvilli in type II pneumocytes were detectable. These results showed that although dithiocarbamates as chelating agents are suitable for the removal of cadmium from organisms, they alter the redistribution of cadmium within the organism, thereby increasing the cadmium content in the lungs, and structural changes are more serious than observed upon cadmium exposure alone. Copyright © 2001 John Wiley & Sons, Ltd. [source] Application of ECMO in Multitrauma Patients With ARDS as Rescue TherapyJOURNAL OF CARDIAC SURGERY, Issue 3 2007Navid Madershahian M.D. The final rescue therapy for patients with severe hypoxia refractory to conventional therapy modalities is the extracorporeal gas exchange. Methods: We report the management of three polytraumatized patients with life-threatening injuries, severe blunt thoracic trauma, and consecutive ARDS treating by extracorporeal membrane oxygenation (ECMO). Two patients suffered a car accident with severe lung contusion and parenychmal bleeding. Bronchial rupture and mediastinal emphysema was found in one of them. Another patient developed ARDS after attempted suicide with multiple fractures together with blunt abdominal and thoracic trauma. Results: All patients were placed on ECMO and could be rapidly stabilized. They were weaned from ECMO after a mean of 114 ± 27 hours of support without complications, respectively. Mean duration of ICU stay was 37 ± 23 days. Conclusions: Quick encouragement of ECMO for the temporary management of gas exchange may increase survival rates in trauma patients with ARDS. [source] Morphometric Investigation of Death by AsphyxiaJOURNAL OF FORENSIC SCIENCES, Issue 3 2009Raffaele Giorgetti M.D. Abstract:, The aim of this study was to investigate the possibility of distinguishing deaths by asphyxia from those due to natural causes by comparing morphometric measurements in lungs. The study population comprised 27 subjects: 14 cases of death by asphyxia (hanging or drowning) and 13 cases of sudden natural death. Eighty parenchyma sections were used for each subject. Data were collected by computerized image analysis. Measurements aimed at quantifying, as percentages, pulmonary parenchyma (mean values of positive-fraction areas [PFA] and their standard deviations). Subjects who died of natural causes and of drowning showed a relative internal homogeneity compared to those who hanged. Results show significant discrimination between drowned subjects and those dying of natural causes (mean of PFA p = 0.01) and between hanged and drowned subjects (SD of PFA p = 0.04). Attention must be paid to the possible role played by senile emphysema. The method is proposed as a complementary tool in forensic cases. [source] Hyperpolarized 3He apparent diffusion coefficient MRI of the lung: Reproducibility and volume dependency in healthy volunteers and patients with emphysemaJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2008Sandra Diaz MD Abstract Purpose To measure the apparent diffusion coefficient (ADC) of hyperpolarized (HP) 3He gas using diffusion weighted MRI in healthy volunteers and patients with emphysema and examine the reproducibility and volume dependency. Materials and Methods A total of eight healthy volunteers and 16 patients with emphysema were examined after inhalation of HP 3He gas mixed with nitrogen (N2) during breathhold starting from functional residual capacity (FRC) in supine position. Coronal diffusion-sensitized MR images were acquired. Each subject was imaged on three separate days over a seven-day period and received two different volumes (6% and 15% of total lung capacity [TLC]) of HP 3He each day. ADC maps and histograms were calculated. The mean and standard deviation (SD) of the ADC at different days and volumes were compared. Results The reproducibility of the mean ADC and SD over several days was good in both healthy volunteers and patients (SD range of 0.003,0.013 cm2/second and 0.001,0.009 cm2/second at 6% and 15% of TLC for healthy volunteers, and a SD range of 0.001,0.041 cm2/second and 0.001,0.011 cm2/second, respectively, for patients). A minor but significant increase in mean ADC with increased inhaled gas volume was observed in both groups. Conclusion Mean ADC and SD of HP 3He MRI is reproducible and discriminates well between healthy controls and patients with emphysema at the higher gas volume. This method is robust and may be useful to gain new insights into the pathophysiology and course of emphysema. J. Magn. Reson. Imaging 2008. © 2008 Wiley-Liss, Inc. [source] Cervical surgical emphysema: Rare presentation of a sigmoid colon retroperitoneal perforation with abscess rupture through the lumbar triangle of PetitJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 2007L Zentner SUMMARY A retroperitoneal sigmoid colon perforation presenting with cervical surgical emphysema secondary to abscess rupture through the lumbar triangle of Petit into the posterior paraspinal muscle compartment has not been previously described. We report a case where previously ingested barium clearly demonstrates this unusual pathway. [source] Anterior infradiaphragmatic free gas following bronchial rupture: Case report and literature reviewJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2004Eamon SC Koh SUMMARY Bronchial rupture is an uncommon injury that presents clinically and radiologically with tension or non-tension pneumothorax, pneumomediastinum and subcutaneous emphysema caused by air leak and migration of free gas. Infradiaphragmatic gas has previously been demonstrated in mechanically ventilated patients with pneumomediastinum and is secondary to passage of air via anterior and posterior trans-diaphragmatic pathways. We present a case of bronchial rupture complicated by extensive infradiaphragmatic gas following mechanical ventilation that illustrates these pathways and some of the major radiographic signs associated with this injury. [source] Tracheal perforation secondary to suture irritation in a dog following a ventral slot procedureJOURNAL OF SMALL ANIMAL PRACTICE, Issue 7 2003D. N. Clements An eight-year-old springer spaniel was presented with acute-onset subcutaneous emphysema of five days' duration. The dog had undergone ventral slot decompression of the C5-C6 intervertebral disc space eight weeks before presentation. Cervical tracheoscopy demonstrated perforation of the dorsal tracheal membrane of the distal cervical trachea. Perforation of the dorsal tracheal membrane secondary to suture knot irritation was confirmed by exploratory surgery. Repair of the perforation was performed by plication of the dorsal tracheal membrane. The dog was represented nine days after the initial surgery with acute recurrence of subcutaneous emphysema. Air leakage at the plicated dorsal tracheal membrane was observed at exploratory surgery, and a bipedicle sternothyroideus muscle flap was used to support the plicated membrane. Recovery was uneventful and 10 months postoperatively there had been no recurrence of clinical signs. [source] Pneumothorax in cats with a clinical diagnosis of feline asthma: 5 cases (1990,2000)JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2003Edward S. Cooper VMD Abstract Objective: This paper characterizes the clinical findings in 5 cats with feline asthma complicated by concurrent pneumothorax. Design: Retrospective study. Medical records of cats with concurrent diagnoses of asthma and pneumothorax that were presented to the Veterinary Hospital of the University of Pennsylvania from 1990 to 2000 were reviewed. Results: Of 421 cases of feline asthma, 5 cats fulfilled the inclusion criteria (1.2%). All 5 had respiratory distress at presentation. One cat was panting, and the other 4 cats had respiratory rates of 28, 52, 58 and 120 breaths per minute (bpm), respectively (mean RR 65±39 bpm). Historical findings included untreated chronic cough (n=3), previously treated asthma (n=1), and no previous illness (n=1). Thoracocentesis was performed in 4/5 cats, and 3 of those cats required thoracostomy tubes. Four cats required immediate oxygen supplementation, and 1 of those cats required ventilation. All 5 cats had evidence of pneumothorax on initial radiographs. Follow-up radiographs revealed partial or complete resolution of pneumothorax in 4 cats which were discharged alive with total hospitalization of 2,7 days, but were then lost to follow-up. One cat was euthanized because it could not be weaned off mechanical ventilation, and necropsy confirmed end-stage feline asthma and emphysema. Conclusion: Small airway obstruction can predispose asthma patients to increased alveolar pressure, emphysema, and spontaneous pneumothorax, which can lead to dyspnea in affected cats. The short-term outcome in these cats was good despite the severity of dyspnea at presentation. [source] Noninvasive detection of pulmonary tissue destruction in a mouse model of emphysema using hyperpolarized 129Xe MRS under spontaneous respirationMAGNETIC RESONANCE IN MEDICINE, Issue 4 2010Hirohiko Imai Abstract In the present study, a chemical shift saturation recovery method in hyperpolarized 129Xe MR spectroscopy measurements was applied to two groups of spontaneously breathing mice, an elastase-induced emphysema model and a control group. Parameters detected were those related to lung structures and functions, such as alveolar septal thickness, h, the ratio of the alveolar septal volume relative to gas space volume, Vs/Va, and the transit time of blood through the gas exchange region, ,. To investigate the potential of these parameters as biomarkers, an attempt was made to detect physiologic changes in the lungs of elastase-treated mice. Our results showed that Vs/Va was significantly reduced in elastase-treated mice, reflecting emphysema-like destruction of the alveolar wall. Compared with histologic results, this degree of reduction was shown to reflect the severity of wall destruction. On the other hand, significant changes in other parameters, h and ,, were not shown. This study is the first application of hyperpolarized 129Xe MR spectroscopy to a mouse model of emphysema and shows that the Vs/Va volume ratio is an effective biomarker for emphysema that could become useful in drug research and development through noninvasive detection of pathologic changes in small rodents. Magn Reson Med, 2010. © 2010 Wiley-Liss, Inc. [source] Single-scan acquisition of registered hyperpolarized 3He ventilation and ADC images using a hybrid 2D gradient-echo sequenceMAGNETIC RESONANCE IN MEDICINE, Issue 6 2007Jim M. Wild Abstract The pulse sequences for hyperpolarized 3He lung MRI that have made the most clinical impact to date are 1) those that supply regional apparent diffusion coefficient (ADC) measurements, which provide insight into early emphysematous destruction of the alveoli in the lungs, and 2) high-resolution ventilation images that provide regional indicators of airway obstruction in obstructive airway disease, such as asthma, cystic fibrosis, and chronic obstructive pulmonary disease (COPD). In this work a hybrid 2D ADC-ventilation sequence was used with low flip angles to acquire both sets of data in the same breath-hold. The performance of the sequence was investigated in vivo in a healthy subject and a subject with mild emphysema, and compared with conventional 2D gradient-echo (GRE) 3He ventilation and ADC imaging sequences. Acquisition of the ADC and ventilation images in one breath-hold provides ventilation images with equal or better SNR (,20) and the same spatial resolution (3.75 mm × 3.3 mm in plane) with simultaneous accurate, high-resolution ADC images. The hybrid sequence offers a means of conserving gas by using two-thirds of the 3He gas needed for separate ADC and ventilation exams, and saves the subject from having to perform an extra breath-hold. The data are inherently spatially and temporally registered, allowing quantitative cross-correlation between high-spatial-resolution ADC and ventilation data. Magn Reson Med 57:1185,1189, 2007. © 2007 Wiley-Liss, Inc. [source] Dynamic oxygen-enhanced MRI reflects diffusing capacity of the lungMAGNETIC RESONANCE IN MEDICINE, Issue 6 2002Yoshiharu Ohno Abstract The purpose of this study was to demonstrate the feasibility of dynamic oxygen-enhanced MRI in a clinical setting. We hypothesized that dynamic oxygen enhancement can reflect the regional diffusing capacity of the lung. Ten patients with pulmonary emphysema and seven healthy volunteers were examined with a respiratory-synchronized inversion recovery single-shot turbo spin-echo sequence (TR = 3200,5000 ms, TE = 16 ms, TI = 720 ms, ETS = 4 ms) following 100% oxygen inhalation, using a 1.5 T whole-body scanner. Maximum mean relative enhancement ratios calculated by averaging six defined regions of interest (ROIs) in both lungs were statistically compared between healthy volunteers and patients, and were correlated with diffusing lung capacity (%DLCO). In patients with pulmonary emphysema, maximum mean relative enhancement ratios were significantly decreased compared to those in healthy volunteers (P = 0.0008). Maximum mean relative enhancement ratio had excellent correlation with % DLC0 (r2 = 0.83). Dynamic oxygen-enhanced MRI may reflect the diffusing capacity of the lung; therefore, imaging of oxygen enhancement with MRI may provide maps of the diffusing capacity. Magn Reson Med 47:1139,1144, 2002. © 2002 Wiley-Liss, Inc. [source] Transient Exit Block of a DDD Pacemaker with Unipolar Leads in Subcutaneous Emphysema Following PneumothoraxPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2001CHRÍSTOPHE MELZER MELZER, C., et al.: Transient Exit Block of a DDD Pacemaker with Unipolar Leads in Subcutaneous Emphysema Following Pneumothorax. This case report describes a transient pacemaker exit block due to subcutaneous emphysema following pneumothorax. Pneumothorax after pacemaker implantation is rare, but development of subcutaneous emphysema under such circumstances is even more uncommon. Exit block develops only with the use of unipolar leads; with implantation of bipolar leads, this complication cannot occur. [source] Posttracheostomy subcutaneous emphysema: a management planPEDIATRIC ANESTHESIA, Issue 3 2007Nirvik Pal MD No abstract is available for this article. [source] Combination of inhalational, intravenous, and local anesthesia for intubation in neonates with congenital lobar emphysemaPEDIATRIC ANESTHESIA, Issue 9 2006Mahesh Kumar Arora No abstract is available for this article. [source] Hypercapnia: what is the limit in paediatric patients?PEDIATRIC ANESTHESIA, Issue 7 2004A case of near-fatal asthma successfully treated by multipharmacological approach Summary We describe a case of prolonged severe hypercapnia with respiratory acidosis occurring during an episode of near-fatal asthma in an 8-year-old boy, followed by complete recovery. After admission to the intensive care unit, despite treatment with maximal conventional bronchodilatative therapy, the clinical picture deteriorated with evident signs of respiratory muscle fatigue. The child was sedated, intubated and mechanically ventilated. Magnesium sulphate, ketamine and sevoflurane were gradually introduced together with deep sedation, curarization and continuous bronchodilatative therapy. Ten hours after admission, arterial pCO2 reached 39 kPa (293 mmHg), pH was 6.77 and pO2 8.6 kPa (65 mmHg). Chest radiograph showed severe neck subcutaneous emphysema, with signs of mediastinal emphysema. No episode of haemodynamic instability was seen despite severe prolonged hypercapnia lasting more than 14 h. Oxygenation was maintained and successful recovery followed without neurological or cardiovascular sequelae. This case shows the cardiovascular and neurological tolerance of a prolonged period of supercarbia in a paediatric patient. The most important lesson to be learned is the extreme importance of maintaining adequate tissue perfusion and oxygenation during an asthma attack. The second lesson is that when conventional bronchodilators fail, the intensivist may resort to the use of drugs such as ketamine, magnesium sulphate and inhalation anaesthesia. In this context deep sedation and curarization are important not only to improve oxygenation, but also to reduce cerebral metabolic requirements. [source] Life threatening subcutaneous emphysema following surgical repair of tracheocutaneous fistulaPEDIATRIC ANESTHESIA, Issue 4 2003Virender Kumar Mohan MD Summary A 9-year-old male child posted for closure of tracheocutaneous fistula developed extensive subcutaneous emphysema resulting in acute respiratory distress immediately after transfer to recovery room. The clinical management, precautions and other complications of closure of tracheocutaneous fistula are discussed. [source] Surfactant protein C gene (SFTPC) mutation-associated lung disease: High-resolution computed tomography (HRCT) findings and its relation to histological analysis,,PEDIATRIC PULMONOLOGY, Issue 10 2010M. Mechri MD Abstract Aim of the Study Determine high-resolution tomography (HRCT) scan characteristics in children with SFTPC mutation and correlate them to histological findings. Patients and Methods This retrospective multicenter study included 15 children (7 females and 8 males) with SFTPC mutations. HRCT scans have been performed in all the children and lung biopsies in 8 children. Results From all signs assessed on initial HRCT scans, ground-glass opacities (n,=,14, 93%) and lung cysts (n,=,6, 40%) were predominant. Interlobular septal thickening (n,=,1, 7%), air space consolidation (n,=,1, 7%), paraseptal emphysema (n,=,2, 13%), and pulmonary nodules (n,=,1, 7%) were also found. Histological analysis revealed accumulation of macrophages in the alveolar lumen, type II pneumocyte hyperplasia, and alveolar septal thickening. Dilatation of the respiratory bronchiole and alveolar duct associated with muscular hyperplasia were also described. Interestingly, lung cysts on HRCT scans were associated with dilatation of terminal bronchioli and alveolar duct in lung biopsies. Conclusion In children with SFTPC mutations, HRCT scan finding was highly correlated to the histological findings and, as such, represent a useful tool to identify patients that may require SFTPC gene sequencing. Pediatr Pulmonol. 2010; 45:1021,1029. © 2010 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||||||||