Characterization of the interstitial lung diseases via density-based and texture-based analysis of computed tomography images of lung structure and function

RATIONALE AND OBJECTIVES: Efforts to establish a quantitative approach to the computed tomography (CT)-based character ization of the lung parenchyma in interstitial lung disease (including emphysema) has been sought. The accuracy of these tools must be site independent. Multi-detector row CT has remained the gold standard for imaging the lung, and it provides the ability to image both lung structure as well as lung function. MATERIAL AND METHODS: Imaging is via multi-detector row CT and protocols include careful control of lung volume during scanning. Characterization includes not only anatomic-based measures but also functional measures including regional parameters derived from measures of pulmonary blood flow and ventilation. Image processing includes the automated detection of the lungs, lobes, and airways. The airways provide the road map to the lung parenchyma. Software automatically detects the airways, the airway centerlines, and the branch points, and then automatically labels the airway tree segments with a standardized set of labels, allowing for intersubject as well intrasubject comparisons across time. By warping all lungs to a common atlas, the atlas provides the range of normality for the various parameters provided by CT imaging. RESULTS: Imaged density and textural changes mark underlying structural changes at the most peripheral regions of the lung. Additionally, texture-based alterations in the parameters of blood flow may provide early evidence of pathologic processes. Imaging of stable xenon gas provides a regional measure of ventilation which, when coupled with measures of flow, provide for a textural analysis regional of ventilation-perfusion matching. CONCLUSION: With the improved resolution and speed of CT imaging, the patchy nature of regional parenchymal pathology can be imaged as texture of structure and function. With careful control of imaging protocols and the use of objective image analysis methods it is possible to provide site-independent tools for the assessment of interstitial lung disease. There remains a need to validate these methods, which requires interdisciplinary and cross-institutional efforts to gather appropriate data bases of images along with a consensus on appropriate ground truths associated with the images. Furthermore, there is the growing need for scanner manufacturers to focus on not just visually pleasing images, but on quantitatifiably accurate images.     

A benign cause of surgical emphysema

Surgical emphysema affecting a limb is rare. A case is reported of subcutaneous emphysema involving the upper limb resulting from a trivial laceration 2 cm in size on the third interdigital space on the dorsum of the right hand. Gas can form in soft tissues from a wound infection with a gas-forming organism or from a variety of non-infectious causes. One mechanism involves the skin wound acting as a flap valve leading to air being trapped in soft tissues.Institute of origin, Whipps Cross University Hospital.     

The outcome of volume reduction surgery according to the underlying type of emphysema

Lung volume reduction surgery (VRS) is widely performed to improve symptoms in patients with severe pulmonary emphysema; however, it remains unclear whether or not the underlying type of emphysema affects the surgical results. A total of 58 patients with advanced symptomatic emphysema underwent thoracoscopic VRS of emphysematous lung tissue. The resected lung tissue was examined microscopically, and the patients were classified into two groups according to the predominant pathological findings, as having either centrilobular-type or panacinar-type emphysema. A predominant pathological type was identified in only 34 patients (59%), 19 of whom had centrilobular-type emphysema and 15, panacinar-type emphysema. Patients with predominately panacinar emphysema had more compromised total lung capacity and residual volume than those with centrilobular emphysema. Significant improvements in forced expiratory volume in 1 s were evident 3 months after surgery in the group with centrilobular emphysema (+515 ± 141 ml) compared with that in the group with panacinar-type emphysema (+109 ± 40 ml, P = 0.03). The results of lung VRS were found to depend on the underlying type of emphysema, as the benefits of surgery for panacinar emphysema were less marked than those for centrilobular emphysema. Received: February 25, 2000 / Accepted: March 6, 2001     

Intra-operative and post-operative hypercapnia leading to delayed respiratory failure associated with transanal endoscopic microsurgery under general anaesthesia

We present an unusual case of hypercapnia and surgical emphysemaduring transanal endoscopic microsurgery, which led to delayedpost-operative ventilatory failure. The hypercapnia and surgicalemphysema were secondary to rectal insufflation with carbondioxide used to facilitate visualization and resection of arectal tumour. Despite a return to wakefulness after surgery,the patient’s level of consciousness deteriorated in therecovery area as a result of hypercapnia. The Pa_CO2 rose to16.8 kPa because of absorption of carbon dioxide from the surgicalemphysema. On close examination, surgical emphysema was identifiedin unusual areas, including the anterior abdominal wall, bothloins, both groins and the left thigh. Reventilation was requireduntil these unusual carbon dioxide stores had dissipated. Wediscuss the need for prolonged post-operative vigilance in patientswith surgical emphysema secondary to carbon dioxide insufflation,and the risk of delayed ventilatory failure. Br J Anaesth 2001: 86; 586–9     

机器人辅助腹腔镜前列腺癌根治术(RALP)与开放性耻骨后前列腺癌根治术(RRP)的5年肿瘤学效果对比

 目的 分析机器人辅助腹腔镜前列腺癌根治术（robot-assisted laparoscopic radical prostatectomy，RALP）与开放性耻骨后前列腺癌根治术（open retropubic radical prostatectomy，RRP）治疗局限性前列腺癌的5年肿瘤学效果。方法 收集复旦大学附属华东医院泌尿外科2009年7月至2014年3月同期接受RALP或RRP并获得随访的95例患者临床资料，比较两种术式的手术时间、术中失血量及输血比例、术后病理、生化复发率等指标。结果 95例手术均获成功，RALP组无中转开放。RALP组与RRP组手术时间分别为212.3与166.8 min（P<0.05），术中失血量分别为237.3与557.3 mL（P<0.05）；术中输血比例分别为16.7%与78.7%（P<0.05）；手术切缘阳性率分别为22.0%与7.8%（P<0.05），1年尿控率分别为79.5%和84.7%，6个月、1年、2年、3年、4年、5年生化复发率分别为6.2%和4.3%、18.8%和6.4%、25.0%和14.9%、29.2%和21.3%、31.2%和21.3%、31.2%和23.4%。两组5年内的生化复发率差异无统计学意义。结论 RALP具有损伤小、出血少、输血少的优点，但手术时间长于RRP。两种术式的尿控、手术切缘阳性率及5年长期肿瘤学效果等相似。     

Chest radiographic findings following video-assisted thoracoscopic lung volume reduction surgery for emphysema

Surgical reduction of lung volume is being investigated as a promising alternative in the treatment of selected patients with severe debilitating emphysema. Following bilateral video-assisted thoracoscopic surgical resection (VATS) of emphysematous lung tissue, patients show improvements in exercise tolerance, dyspnoea, increases in oxygenation, decreased airway obstruction and enhanced quality of life. The postoperative findings in the first 24 patients who underwent bilateral VATS volume reduction are described. Pneumothoraces developed in all patients, often with unusual shapes related to the surgical sutures. Perihilar, pulmonary and paramediastinal pulmonary parenchymal opacities were seen in approximately half of the patients, representing areas of pulmonary contusion, atelectasis and/or haemorrhage associated with the staple lines. The purpose of the present study is to describe the immediate postoperative chest radiographic appearances and to familiarize radiologists with the surgical procedure.     

Pneumomediastinum and Subcutaneous Emphysema from Pacemaker Placement

Percutaneous insertion of permanent pacemaker leads through the subclavian vein is an alternative to the cephalic vein approach. A rare occurrence and successful conservative management of extensive pneumomediastinum and subcutaneous emphysema without concomitant pneumothorax resulting from permanent transvenous pacemaker insertion in an 80-year-old man with syncope and arrhythmia is reported.     

Elastase inhibitors

Two applications claim novel 1,4-bisphenyl-1,4-dihydropyridine derivatives; 2-hydroxy and 2-aminodihydropyridines, respectively. The compounds are claimed to be useful as neutrophil elastase inhibitors and also in the treatment of both chronic obstructive pulmonary disease and myocardial infarction. These compounds represent yet another use of the widely employed 1,4-dihydropyridine privileged structure.     

Traumatic Subperiostial Emphysema Caused by Hyperpneumatization of the Temporal and Occipital Bone

Hyperpneumatization of the temporal bone with extension into the occipital bone and even the parietal bones is a rare condition. We report a case in which the patient suffered periodically from a palpable mass in the parietal‐occipital region which originated from extensive occipital bone pneumatization. Computed tomography examination revealed extensive temporal and occipital pneumatization and subperiosteal pneumatoceles, which was corrected by surgery.