Effect of cannabis and tobacco on emphysema in patients with spontaneous pneumothorax

Purpose

To compare imaging findings on thoracic computed tomography (CT) examination in patients with primary spontaneous pneumothorax (SP), depending on their tobacco and/or cannabis consumption.

Bronchoscopic Lung Volume Reduction: A New Hope for Patients With Severe Emphysema and Air Trapping

Chronic obstructive pulmonary disease (COPD) is common and has significant morbidity and mortality as the fourth leading cause of death in the United States. In many patients, particularly those with emphysema, COPD is characterized by markedly increased residual volume contributing to exertional dyspnea. Current therapies have limited efficacy. Surgical resection of diseased areas of the lung to reduce residual volume was effective in identified subgroups but also had significant mortality in and suboptimal cost effectiveness. Lung-volume reduction, using bronchoscopic techniques, has shown substantial benefits in a broader patient population with less morbidity and mortality. This review is meant to spread the awareness about bronchoscopic lung-volume reduction and to promote its consideration and early referral for patients with advanced COPD and emphysema frequently encountered by both primary care physicians and specialists. A search was conducted on PubMed (MEDLINE), EMbase, and Cochrane library for original studies, using the following keywords: “lung-volume reduction.” “endobronchial valves,” “intrabronchial valves,” “bronchoscopic lung-volume reduction,” and “endoscopic lung-volume reduction.” We included reports from systematic reviews, narrative reviews, clinical trials, and observational studies. Two reviewers evaluated potential references. A total of 27 references were included in our review. Included studies report experience in the diagnosis and bronchoscopic treatment for emphysema; case reports and non-English or non-Spanish studies were excluded.     

Updated evaluation of the cost-effectiveness of lung volume reduction surgery

BACKGROUND: The National Emphysema Treatment Trial, a randomized clinical trial of lung volume reduction surgery (LVRS) vs medical therapy for severe emphysema, included a prospective economic analysis. We present an updated analysis of cost-effectiveness with 1-year additional follow-up data. METHODS: Following pulmonary rehabilitation, 1,218 patients at 17 medical centers were randomized to receive LVRS or continued medical treatment. The cost-effectiveness of LVRS vs medical therapy was calculated over the duration of the trial (January 1998 to December 2003) and estimated at 10 years using modeling based on observed trends in survival, cost, and quality of life. RESULTS: The cost-effectiveness of LVRS vs medical therapy was $140,000 per quality-adjusted life-year (QALY) gained (95% confidence interval, $40,155 to $239,359) at 5 years, and was projected to be $54,000 per QALY gained at 10 years. In subgroup analysis, the cost-effectiveness of LVRS in patients with upper-lobe emphysema and low exercise capacity was $77,000 per QALY gained at 5 years, and was projected to be $48,000 per QALY at 10 years. Compared to the initial results, the updated results are similar for the overall cohort but vary substantially for the subgroups. CONCLUSIONS: LVRS is costly relative to other health-care programs during the time horizon when costs and outcomes are known. The extended follow-up period offers more certainty regarding the long-term value and economic impact of this procedure.     

Quantification of emphysema: a composite physiologic index derived from CT estimation of disease extent

The combination of functional indices best reflecting the extent of emphysema is not known. High-resolution computed tomography (HRCT) studies of 106 patients with emphysema [men=71; median age=61 (range=26–86 years)] were reviewed and the extent of emphysema was quantified: (a) visually (emphysema_vis) and (b) by automated estimation (emphysema_auto). Functional-morphologic relationships were compared for the two scoring systems, and a composite physiologic index (CPI) (providing the best fit of functional indices against emphysema extent) was derived. Emphysema_vis and emphysema_auto were strongly correlated (r=0.90; p<0.0005), but the extent of emphysema_vis was consistently greater (p<0.00005). Emphysema_vis correlated most strongly with indices of gas transfer [percent predicted single-breath carbon monoxide diffusing capacity (Dl_co) and alveolar volume (K_co); r=−0.70, both p<0.0005]. The combination of physiologic indices most representative of emphysema extent on CT (using visual or automated methods) consisted of K_co and forced expiratory volume in 1 s (FEV₁) levels. The equation explanatory power was higher for visual scoring [emphysema_vis=96.8-(0.67×% predicted K_co)-(0.41×% predicted FEV₁); equation r ²=0.57] than automated estimation (equation r ²=0.48). Weighted combinations of K_co and FEV₁ levels provide a CPI best reflecting morphologic emphysema extent. CPI has the potential to refine the stratification of patients in epidemiological and therapeutic studies.     

螺旋CT在尘肺诊断中的价值

目的：评价螺旋CT在尘肺影像诊断中的价值。材料和方法：回顾性分析39例尘肺的胸片与螺旋CT的影像表现。结果：螺旋CT检查的39例中有23例出现散在的2—9mm圆形结节影，大于10mm的大结节有12例，29例患者有不同程度的肺气肿，35例显示胸膜病变，ll例分别患有新老肺结核灶，34例有不同组的淋巴结肿大或钙化。纠正胸片误诊的I期尘肺5例，Ⅱ期尘肺l例，发现胸片未能准确分期的Ⅱ期尘肺4例、Ⅲ期尘肺2例。结论：螺旋CT在显示尘肺的直接征象和间接征象上较常规胸片敏感，可以弥补x线平片的许多不足，有利于尘肺的正确诊断和鉴别诊断，特别有利于尘肺的早期诊断。     

接触水泥粉尘工人尸检病理研究

对21例接触水泥生产中各类粉尘的工人尸检表明肺内尘源性病变有:尘班、尘斑周肺气肿、有的尚伴有混合尘结节和大块纤维化。采用分析电镜及X 线衍射方法对肺内病灶中的粉尘作了定性、定量分析,证明了肺内粉尘与各自生前工作现场粉尘一致,从而证明了水泥生产中产生的各类粉尘都能致尘肺。     

血管生成因子修复肺气肿病变的实验研究

目的 观察碱性成纤维细胞生长因子（bFGF）和血管内皮生长因子（VEGF）对大鼠肺气肿模型动脉血气和肺组织病理学的影响,探讨bFGF、VEGF修复肺泡的机制及肺气肿新的发病机制。方法 Wistar大鼠24只,随机分为bFGF组、VEGF组、对照组和健康对照组4组。bFGF组、VEGF组、对照组大鼠气管内一次性注入猪胰弹性蛋白酶（PPE）（250U／kg）复制肺气肿模型,健康对照组以生理盐水对照,4周后模型制成,bFGF组、VEGF组气管内分别注入bFGF（400U／只）和VEGF（2μg/只）,对照组和健康对照组注人生理盐水,每周1次,连续3次。4周后对比大鼠动脉血气和肺泡形态学变化,免疫组化法检测CD34’细胞个数确定肺毛细血管增生情况。结果各组血气分析差异均无统计学意义;bFGF组、VEGF组平均肺泡数（MAN）分别为[（43±8）／视野、（44±9）／视野],均明显多于对照组[（30±6）／视野]（P〈0．01）;平均肺泡面积（MAA）分别为（9856±1864）μm^2、（9804±1929）μm^2,均明显小于对照组[（14525±3408）μm^2]（P〈0．01）;平均内衬间隔（MLI）分别为（196±38）μm、（194±38）μm,均明显小于对照组[（288±68）μm]（P〈0．01）;CD34’阳性细胞相对面积分别为3．7％±1．3％、2．6％±1．2％,均明显多于对照组（0．8％±0．7％）（P〈0．05）。结论 bFGF和VEGF能促进肺毛细血管再生,修复肺气肿的病变。肺毛细血管的损伤可能在肺气肿的发生发展中扮演了重要角色。     

Inter-scan repeatability of CT-based lung densitometry in the surveillance of emphysema in a lung cancer screening setting

Purpose

To investigate the inter-scan repeatability of CT-based lung densitometry protocols in the surveillance of emphysema in a lung cancer screening setting.

Materials and methods

Fifty-two healthy subjects who underwent low-dose chest CT and subsequent follow-up scan within a 16 month interval were retrospectively evaluated. Inter-scan repeatabilities were assessed for 9 different CT-based lung densitometry protocols with standard deviation (SD) of inter-scan differences. Susceptibility to inspiratory level was additionally assessed for each protocol, and volume adjustment (VA) was applied in order to evaluate the potential improvement of repeatability after compensating the influence of inspiratory level.

Results

A wide variation of inter-scan repeatability was observed among the evaluated protocols showing a difference of up to a factor of 9. Susceptibility of inspiratory level was found to be highly associated with the inter-scan repeatability of densitometric protocols. The application of VA could substantially reduce the influence of inspiratory level for all protocols, which results in an improvement of repeatability up to 51%.The order of repeatability among the protocols remained unchanged after VA. The resulting two best protocols in terms of inter-scan repeatability were RA970 and Perc1 which showed SD of 0.8% and 5.5 HU, respectively.

Conclusions

Lung densitometry protocols produce different levels of repeatability for an asymptomatic population, each being influenced by inspiratory level to a different degree. For surveillance of emphysema in a lung cancer screening setting, RA970 and Perc1 may be the most suitable protocols, in which the application of VA needs to be included as a critical part.     

113例老年慢性肺心病临床分析

目的：通过对113例肺心病临床分析，以探讨肺心病的特点及改进防治措施，方法：对1996年11月至2001年8月院病例临床表现，实验室检查及治疗措施进行分析。结果：肺心病病因以慢支肺气肿最常见，占77％；死因主要为心衰，呼衰；发热以低热中热度为主，中性粒细胞多增高，达78％，咳痰以白粘液为主，胸片以斑片状影多见，达83％，常合并电解质紊乱，肺心病并冠心病约占半数，但冠心病症状多不典型，常合并肝功能损害，上消化道病变。结论：老年肺心病是慢性病理过程的结果。常合并多脏器功能改变，除常规抗感染，止咳祛痰外，加强营养及中药制剂有助增强疗效。