Lung volume reduction surgery as salvage procedure after previous use of endobronchial valves

Open in a separate window OBJECTIVESLung volume reduction (LVR) is an efficient and approved treatment for selected emphysema patients. There is some evidence that repeated LVR surgery (LVRS) might be beneficial, but there are no current data on LVRS after unsuccessful bronchoscopic LVR (BLVR) with endobronchial valves (EBVs). We hypothesize good outcome of LVRS after BLVR with valves.METHODSIn this study, we retrospectively investigated all patients who underwent LVRS between 2015 and 2019 at 2 centres after previous unsuccessful EBV treatment. They were further divided into subgroups with patients who never achieved the intended improvement after BLVR (primary failure) and patients whose benefit was fading over time due to the natural development of emphysema (secondary failure). Patients with severe air leak after BLVR and immediate concomitant LVRS and fistula closure thereafter were analysed separately.RESULTSA total of 38 patients were included. Of these, 19 patients had primary failure, 15 secondary failure and 4 were treated as an emergency due to severe air leak. At 3 months after LVRS, forced expiratory volume in 1 s had improved significantly by 12.5% (P = 0.011) and there was no 90-day mortality. Considering subgroups, patients with primary failure after BLVR seem to profit more than those with secondary failure. Patients with severe air leak after BLVR did not profit from fistula closure with concomitant LVRS.CONCLUSIONSLVRS after previous BLVR with EBVs can provide significant clinical improvement with low morbidity, although results might not be as good as after primary LVRS.     

Accuracy of multidetector computed tomography with maximum intensity projection technique in the assessment of fissure integrity

BackgroundBronchoscopic lung volume reduction (BLVR) is a potential treatment for patients with severe emphysema, performed through the placement of unidirectional endobronchial valves (EBVs). Their benefits are only achieved in patients that significantly reduce lobar volume, and it is mandatory that the fissures are complete. Fissure evaluation is preferably done by computed tomography, but little is known if its evaluation corresponds to the anatomical findings. The aim of this study is to evaluate the accuracy of thoracic radiologists in the identification of complete fissures by multidetector computed tomography (MDCT) using maximum intensity projection (MIP) technique, compared with direct anatomical evaluation.MethodsProspective study, conducted in a single institution. Patients submitted to thoracic surgery had their fissures classified as complete or incomplete by thoracic surgeons and their preoperative chest scans evaluated by three radiologists, blinded for surgical evaluation. With the intraoperative categorization as a reference, the accuracy and concordance of the three thoracic radiologists’ evaluation were calculated. The most experienced radiologist evaluated the fissures at two different moments to estimate the intra-observer agreement.ResultsThere were included 67 patients, being 37 (55%) males, with a mean age of 64 years. The accuracy of radiological identification of complete fissures ranged from 76.8% for left posterior oblique fissure to 85.1% for left anterior oblique fissure, with the best performance achieved by the most experienced radiologist. The concordance of the radiological evaluation for fissure integrity compared to the surgical assessment (k) was 0.53–0.68. Intra-observer agreement ranged from 0.74 to 0.87.ConclusionsThe evaluation of the fissure integrity by MDCT analysis using MIP technique by thoracic radiologists had high accuracy among the thoracic radiologists.     

PPARγ——治疗COPD的新靶点

COPD是一种慢性气道疾病.目前主要的治疗药物有支气管舒张剂和糖皮质激素.最近的研究表明,过氧化物酶体增殖物激活受体γ(peroxisome proliferator-activated receptor γ,PPARγ)激动剂具有抗炎作用.本文对PPARγ对COPD的作用进行综述.     

Reduced area of the normal lung on high-resolution computed tomography predicts poor survival in patients with lung cancer and combined pulmonary fibrosis and emphysema

Background

This study aimed to determine the radiologic predictors and clarify the clinical features related to survival in patients with combined pulmonary fibrosis and emphysema (CPFE) and lung cancer.

终末期肺气肿肺减容术的各种影像学检查比较及进展

肺气肿是慢性阻塞性肺疾病的一种常见临床表现,特点是不可逆性的终末气道的扩张和肺泡壁损害.肺减容术主要应用于终末期肺气肿患者,主要原理是切除部分无功能的肺组织来提高肺组织的弹性回缩力、横膈的运动功能及改善循环通气血流比.虽然心肺功能可以通过1秒用力呼气容积等进行检查,但是肺气肿的分布、异质性、严重程度及肺功能变化需要影像学及放射性核素评价,比如计算机断层显像、肺通气/灌注显像等,这些检查各自具有优势,同时又相互补充,对术前患者的选择及术后疗效的评估具有重要价值.     

抑制β2肾上腺素受体过度激活对被动吸烟大鼠肺组织病理改变的影响

目的 使用β肾上腺素受体阻断剂抑制被动吸烟大鼠动物模型β2肾上腺素受体的过度激活,观察其肺功能、小气道病理发肺气肿改变.方法 雄性SD大鼠随机分为正常对照组(9只),吸烟组(8只)和吸烟+β肾上腺素受体阻断剂干预组(简称吸烟+干预组,8只).对各组进行肺功能测定,同时测定小气道病理评分和平均肺泡线性间隔.结果 吸烟+干...     

Correlation between autopsy findings for chronic obstructive airways disease and in-life disability in South African gold miners

Objectives: In South Africa chronic obstructive airway disease (COAD), which could be due to working in a dusty atmosphere in scheduled mines or works, is a compensatable disease. Miners are compensated for in-life respiratory disability and for findings at autopsy of COAD, which includes emphysema, bronchitis assessed by mucus gland hyperplasia in the main bronchus, and bronchiolitis assessed by goblet cell metaplasia. The question arises as to whether the autopsy findings correlate with in-life impairment. The objectives of the study were: (1) to determine whether autopsy COAD outcomes relate to lung function and to respiratory symptoms and signs; and (2) to quantify the individual contributions of emphysema, bronchiolitis and bronchitis to lung function impairment. Methods: On 724 gold miners, pathological findings of COAD – emphysema, bronchitis and bronchiolitis – were related to lung function measurements and respiratory symptoms and signs observed within 5 years prior to death. Results: Emphysema diagnosed at autopsy was the main determinant of airflow impairment. The emphysema score categories 0–5, 5–35, 35–65 and >65 were associated with decreased forced expiratory volume in 1 s, expressed as percentage predicted (FEV₁%) as follows: 78.8%, 66.2%, 52.0% and 46.0%, respectively. The score was also associated with increasing frequency of dyspnoea. After adjustment for emphysema, the bronchitis and bronchiolitis were not related to significant lung function loss, and in subjects without emphysema, the presence of moderate or marked bronchitis was associated with a mild impairment only. Bronchitis at autopsy was associated with increased frequency of rhonchi, sputum and cough, whereas bronchiolitis was associated with increased sputum only. Silicosis found at autopsy was associated with some obstructive and restrictive lung function impairment. Tobacco smoking was associated with all the COAD outcomes. Received: 5 May 1999 / Accepted: 11 December 1999     

经支气管镜肺减容术初探

目的评价经支气管镜肺减容术治疗的有效性及安全性。方法通过支气管镜向目的支气管置入单向活瓣，观察并记录实验动物的耐受情况，2周后行CT检查和组织病理学检查。结果经支气管镜肺减容术临床操作简便，所有实验动物均能良好耐受，无动物死亡。CT检查和组织病理学检查提示支气管内置入活瓣可导致部分肺组织萎陷而达到减容的目的。结论经支气管镜肺减容术是一种简便、安全、有潜力的治疗方法，其临床应用有待于进一步研究。     

CT scores of emphysema and oxygen desaturation during low-grade exercise in patients with emphysema

Purpose: We evaluated the usefulness of CT for assessing oxygen desaturation during walking in patients with emphysema.Material and Methods: The study comprised 32 patients with emphysema (mean age 67±6 years). Serial CT images of 5 mm were obtained from the apex to the basal regions of the lung during deep inspiration. The severity of emphysema was scored by four physicians according to a visual method. A six-minute walking test and oxygen desaturation (pSO₂) measurements were performed.Results and Conclusion: The mean CT score of the four observers was signfiicantly correlated with the nadir pSO₂ and ΔpSO₂, but did not correlate with the total distance walked. These results suggest that CT may be used for the assessment of oxygen desaturation during low-grade exercise in patients with emphysema.     

离体肺气体容积和肺密度在肺气肿小鼠模型中的变化

目的研究以猪胰弹性蛋白酶(PPE)诱导小鼠肺气肿模型的离体肺气体容积(ELGV)和肺组织的密度变化规律,探讨ELGV和肺密度与肺气肿的相关性。方法30只雄性C57BL/6小鼠随机均分为对照组、PPE 3d组和PPE 7d组,气管内滴注PPE,建立肺气肿模型。以密度测量仪测量ELGV和肺组织密度,同时进行肺组织病理学观察及图像半定量分析。结果与对照组相比,PPE 3d组和PPE 7d组肺湿重的差异均无统计学意义(P值均>0.05)。对照组、PPE 3d组和PPE 7d组的ELGV分别为(0.217±0.011)、(0.271±0.016)和(0.420±0.034)cm~3,PPE 3d和PPE 7d组显著高于对照组(P值均<0.01),PPE 7d组又显著高于PPE 3d组(P<0.01)。对照组、PPE 3d组和PPE 7d组的肺组织密度分别为(0.606±0.016)、(0.541±0.033)和(0.368±0.032)g/cm~3,PPE 3d和PPE 7d组显著低于对照组(P值均<0.01),PPE 7d组又显著低于PPE 3d组(P<0.01)。结论ELGV和肺组织密度与肺气肿的形态学改变密切相关,可以作为监测和评价肺气肿形态学改变的可行性指标。