1/34. lung cancer associated with pulmonary bulla. case report and review of literature.A few reports have suggested the possible association between lung cancer and bullous disease. We report a surgical case of lung adenocarcinoma located in close proximity to pulmonary bullae. A 48-year-old nonsmoker, asymptomatic male was found to have a pulmonary tumor mass and giant bulla in the right lung. thoracotomy identified a tumor arising from a firm, scarred and contracted area close to the bulla wall. Based on this report and review of other cases in the literature, we emphasize the need for physicians to be aware of the potential development of lung cancer in patients with pulmonary bulla. copyright copyright 1999 S. Karger AG, Basel- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/34. Development of a giant bulla after lung volume reduction surgery.lung volume reduction surgery (LVRS) is being evaluated in the treatment of emphysema. The proposed mechanisms of improvement are increased elastic recoil of the lung and improved mechanical efficiency of the muscles of respiration. We report a unique patient with emphysema who developed a giant bulla 3 years subsequent to LVRS. The patient underwent extensive evaluation, including measurements of lung mechanics. Bullectomy was performed, but it was unsuccessful. Although the mechanisms behind the development of giant bullous disease remain speculative, heterogeneous improvement in elastic recoil following LVRS may be one of the responsible mechanisms.- - - - - - - - - - ranking = 6keywords = giant (Clic here for more details about this article) |
3/34. Surgery for bullous emphysema.The present indications for surgery are mainly large or increasing bullae that result in compression of apparently good lung tissue, and the complications of bullous diseases such as pneumothorax. The results of local resection of localized giant bullae are dramatic. The resection of small bullae generally has little effect on lung function. Lobectomy should not be done until bullae have been removed locally and the remaining lung has been tested by positive ventilation. The indications for the resection of large bullae in the presence of diffuse emphysema require very careful individual study. Pulmonary function tests are mandatory but computed tomography is the single most useful method of assessing the extent of the bullous disease and the underlying lung disease. If the underlying lung is diffusely cystic then any surgical treatment is palliative only.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/34. Pulmonary giant bulla in Wegener's granulomatosis.The association of lung emphysema with severe systemic antineutrophil cytoplasm antibodies (ANCA)-positive vasculitis, such as Wegener's granulomatosis is unusual since only four cases have been described previously. We report the first case of a 30 year-old smoker man presenting with biopsy-proven Wegener's granulomatosis, who developed a bullous emphysema during severe active lung vasculitis, in association with positive ANCA disclosing an anti-myeloperoxydase pattern. alpha 1-antitrypsin deficiency, a known risk factor of lung emphysema recently found to be associated with anti-proteinase 3-positive vasculitis, was not present in this patient. Cigarette smoking, in association with severe lung vasculitis, might have contributed to the development of this emphysematous lesion.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
5/34. A case of localized persistent interstitial pulmonary emphysema.Interstitial pulmonary emphysema is a well-documented complication of assisted mechanical ventilation in premature infants with respiratory distress syndrome. Localized persistent interstitial pulmonary emphysema (LPIPE) confined to a single lobe was incidentally presented in a 4-day-old female infant. This patient was a normal full-term baby with no respiratory distress symptom and no experience of assisted mechanical ventilation. Chest radiograph showed radiolucent area in right lower lobe zone, which needed differential diagnosis from other congenital lesions such as congenital cystic adenomatoid malformation and congenital lobar emphysema. CT scan showed irregular-shaped air cystic spaces and pathologically, cystic walls primarily consisted of compressed lung parenchyma and loose connective tissue intermittently lined by multinucleated foreign body giant cells.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
6/34. New operative method for a giant bulla: sutureless and stapleless thoracoscopic surgery using the Ligasure system.Thoracoscopic bullectomy performed with staplers is the main treatment for giant bullae in many institutions. However, there are certain problems associated with the increasing use of stapling devices. In response, we have applied a new operative method in which we excised a bulla with an ultrasonic-driven scalpel and successfully sealed the cut ends using the LigaSure Vessel Sealing System, a new bipolar system developed by Valleylab Inc. Herein we describe our experience with this newly designed technique which could render possible 'sutureless and stapleless' thoracoscopic surgery in the future.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
7/34. Persistent pulmonary interstitial emphysema in an unventilated neonate.Persistent pulmonary interstitial emphysema (PPIE) is a chronic form of pulmonary interstitial emphysema. The disease is histologically distinguished by large cysts and giant cells. Our patient was a female twin who was born at 31 weeks of gestation with a birth weight of 1,450 g. A chest X-ray at 2 hr after delivery was normal. At 12 hr, respiratory distress developed, and nasal continuous positive airway pressure (CPAP) was initiated. A chest film revealed left-sided pneumothorax. A chest tube was inserted, and the baby continued on nasal CPAP for 5 days. Her chest X-ray on postnatal day 4 showed diffuse cystic changes in the left lung. Thoracic computed tomography revealed multiple thick-walled cysts, the largest measuring 3 cm in diameter. Our case confirms that localized PIE may occur in preterm infants who have been treated with nasal CPAP only. Since this method is being used increasingly to avoid mechanical ventilation and in the postextubation period, it is very important that clinicians be aware of its complications.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
8/34. Simultaneous surgical treatment of chronic post-traumatic aneurysm of the thoracic aorta, diaphragmatic hernia and giant emphysema bulla.Thoraco-abdominal blunt trauma can lead to multiple injuries of several organs. We report a case of a patient in whom, 10 years after a trauma, a chest X-ray showed visceral herniation into the left thorax. Angio computed tomographic scan (CTS) and magnetic resonance imaging (MRI) confirmed these lesions and also showed a saccular thoracic aortic aneurysm. During the surgical procedure a giant post-traumatic emphysema bulla of the left lower pulmonary lobe was discovered and repaired. In the presence of diaphragmatic injuries, CTS and MRI are mandatory for excluding other organ involvement, and during the surgical procedure, careful inspection of left thorax and abdomen should always be done to repair other possible injuries not seen before.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
9/34. The UPAO test in preoperative evaluation for major pulmonary resection: an operative case with markedly improved ventilatory function after radical pulmonary resection for lung cancer associated with pulmonary emphysema.A 65-year-old man was admitted to our hospital for treatment of a squamous cell carcinoma in his right lung. Respiratory function testing showed an extremely reduced forced expiratory volume in 1 second (FEV1) of 1.0 l (29.9% of predicted), and a reduced FEV1/FVC ratio of 24.1%. Arterial blood gases on room air showed a pH of 7.41, a PaCO(2) of 36.7 mmHg, and a PaO(2) of 79.3 mmHg. To assess the predictive postoperative cardiopulmonary function, unilateral pulmonary artery occlusion (UPAO) testing was performed. In the condition of right main PA occlusion, the mean pulmonary artery pressure (mPAP), cardiac index (CI) and total pulmonary vessel resistance index (TPVRI) was 18 mmHg, 3.2 l/min/m(2) and 443.37 dyne.sec.cm(-5)/m(2), respectively. He underwent a middle lobectomy with combined partial resection of both the upper and lower lobes. He also underwent simultaneous resection of a giant bulla arising from the right upper lobe as lung volume reduction surgery. At 80 days after the operation, his FEV1 rose to 1.88 l, and the PaO(2) on room air was improved to 88.9 mmHg. UPAO testing was suggested to be more useful than routine pulmonary function test to determine the accurate predictive postoperative cardiopulmonary function and to decide indication for a radical operation.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
10/34. titanium particles identified by energy-dispersive X-ray microanalysis within the lungs of a painter at autopsy.A 72-year-old male painter, who complained of his "lungs burning" for 2 weeks, died suddenly. autopsy examination revealed severe coronary atherosclerosis with plaque rupture as the cause of death. Examination of the lungs revealed emphysema, interstitial fibrosis, and multinucleated giant cells with intra- and extracellular brown-black, crystalline, polarizable foreign material. Energy-dispersive X-ray microanalysis showed the material to contain titanium, aluminum, silicon, and iron. An increased incidence of respiratory disease has been reported in professional painters. titanium is widely used as a pigment in the manufacturing of commercial paints. Cases of pneumoconiosis and alveolar proteinosis have been described in painters in which analysis of lung tissue revealed increased levels of titanium. This case is presented as an example of a rarely reported phenomenon, which may have clinical implications for evaluation and management of lung disease in painters.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
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