Cases reported "Pulmonary Emphysema"

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1/46. Fragile lung in the marfan syndrome.

    Two cases of the marfan syndrome presented with spontaneous pneumothorax. Both had chest radiographs showing bilateral bullae in the upper lung zones and pulmonary function tests consistent with mild emphysema. There were dereases in forced expiratory flow rates at low lung volumes, carbon monoxide transfer factor, and lung elastic recoil. It is suggested that pneumothorax and bullous emphysema in this syndrome are caused by a weakness in the pulmonary connective tissue framework.
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keywords = volume
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2/46. Unilateral lung volume reduction in preparation for contralateral pneumonectomy.

    A case of staged trans-sternal unilateral lung volume reduction (LVR) on the right followed by contralateral pneumonectomy for a locally advanced left lung malignancy is presented. The predicted symptomatic and functional benefit offered by LVR was felt to be necessary before the removal of the left lung. The patient, a 50-year-old male, with a history of chronic air flow limitation secondary to bullous emphysema, underwent a left pneumonectomy six weeks following a right LVR procedure for poor pulmonary function secondary to generalized emphysema. On admission, forced expiratory volume in 1 s (FEV1) was 1.37 L, 47% of predicted with an FEV1/forced vital capacity of 56%. Five weeks after the unilateral LVR, the patient's FEV1 was 1.85 L, and one year postdischarge from hospital, FEV1 was 0.9 L. One year after discharge, the patient did not require oxygen support, and was active and free of malignant disease.
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ranking = 477.45337136441
keywords = forced expiratory volume, expiratory volume, capacity, volume
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3/46. A case of thoracoscopic bilateral lung volume reduction surgery in a supine position.

    We present a case of thoracoscopic bilateral lung volume reduction surgery performed with the patient in a supine position. By rotating the operative table, bilateral apical resection could be performed without difficulty. The duration of the operation was 160 minutes and the patient's forced expiratory volume in 1 second improved from 0.81 l to 2.49 l.
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ranking = 475.18790636166
keywords = forced expiratory volume, expiratory volume, volume
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4/46. Improved ventilatory function after combined operation for pulmonary emphysema and lung cancer.

    BACKGROUND: smoking is the leading cause of both lung cancer and emphysema. Therefore, some patients with stage I and II disease will present with contra-indications to resection including a predicted postoperative FEV1 of less than 0.81 or a VO2max of less than 10 ml/kg/min. Recently, lung volume reduction surgery (LVRS) has re-emerged in the management of emphysema with excellent results. methods AND patients: 2 patients are reported with lung cancer in the left lower lobe and emphysematous destruction in both upper lobes. They, respectively, had a predicted postoperative FEV1 of 0.9211 and 0.6851. No metastases were present. Pre-operatively, a COPD index of 0.9 and 0.7 was calculated. A left lower lobectomy together with volume reduction of the left upper lobe was performed through a standard posterolateral thoracotomy. RESULTS: Pathological examination showed, respectively, stage IIb and stage Ib disease. The postoperative course was uneventful and 3 months later a FEV1 of 1.441 for patient 1 and 1.041 for patient 2 were recorded. CONCLUSION: These findings suggest that pulmonary function criteria for pulmonary resection have to be revised when patients can undergo simultaneous lung cancer resection and LVRS. The pre-operatively calculated COPD index can be used to predict which patients may not have a decrease in ventilatory function.
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keywords = volume
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5/46. 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.
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keywords = volume
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6/46. Redo lung volume reduction surgery in a patient with alpha1-antitrypsin deficiency.

    Lung volume reduction surgery is a palliative procedure that improves dyspnea and pulmonary function in selected patients with advanced emphysema. Postoperative benefit is sustained for an individual period and depends on the emphysema morphology, the surgical technique, and other not yet well-defined factors. The question whether lung volume reduction surgery can be performed a second time on the same thoracic cavity is often raised but experience in this regard is lacking. We describe a patient who has undergone a successful redo operation 2 years after the initial lung volume reduction surgery.
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ranking = 7
keywords = volume
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7/46. Active management of a patient with endstage pulmonary emphysema using lung volume reduction surgery and intensive rehabilitation.

    INTRODUCTION: Lung volume reduction surgery (LVRS) and pulmonary rehabilitation are newer options available in the treatment of advanced emphysema. We describe the progress of our first local patient to have undergone these 2 new treatment modalities. CLINICAL PICTURE: A 65-year-old man with advanced emphysema, limited by crippling dyspnoea despite maximal medical therapy with inhaled bronchodilator therapy, methylxanthines and supplementary oxygen. TREATMENT: Physical reconditioning with a 4-week inpatient pulmonary rehabilitation programme, followed by LVRS and a further 6-week outpatient pulmonary rehabilitation. OUTCOME: Dramatic improvements in spirometric indices, arterial blood gases, exercise capacity and overall functional status. Improvements maintained at one-year follow up period. CONCLUSIONS: LVRS with pulmonary rehabilitation is an exciting new treatment option in a select group of patients with advanced emphysema. Their role in improving overall performance status and quality of life should be considered in patients otherwise considered to have reached the limits of medical therapy.
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ranking = 7.2654650027528
keywords = capacity, volume
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8/46. Intermediate alpha1-antitrypsin deficiency resulting from a null gene (M-phenotype).

    The presence of a null gene for alpha1-antitrypsin was detected in a family study by the inheritance of intermediate antitrypsin deficiency in association with a normal (PiM) phenotypic pattern. The proband, a 42-year-old man (M-phenotype), was a cigarette smoker and had physiologic evidence of pulmonary emphysema. Three female members of the family were receiving estrogenic medication but had deficient values for serum trypsin inhibitory capacity nevertheless, indicating an unresponsive gene. The mean serum trypsin inhibitory capacity for those with an M-phenotype was significantly lower than that found with an MZ phenotype, presumably due to the total noncontribution to serum antitrypsin activity by the null gene. A quantitative measurement of antitrypsin activity or concentration is necessary in an antitrypsin screening program, since phenotyping procedures alone cannot reveal the null gene.
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ranking = 4.5309300055056
keywords = capacity
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9/46. A surgical approach for patients with endstage emphysema.

    For patients with emphysema who experience deteriorating lung function and concomitant comorbidity, there has been little to offer apart from best supportive care and more recently pulmonary rehabilitation. The early promise of lung transplantation for these patients has failed to materialize--a shortage of donors has meant that younger patients are more likely to receive donor lungs. A renewed interest in lung volume reduction surgery (LVRS) appears to offer hope for selected patients. This article looks at the history of LVRS and illustrates its benefits with a case study. However, if LVRS is a clinically significant approach to the treatment of emphysemic patients, then it requires careful clinical trials so that its benefits and costs can be fully evaluated.
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ranking = 1
keywords = volume
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10/46. A case of idiopathic constrictive bronchiolitis in a middle-aged male smoker.

    When one sees a middle-aged male smoker who presents with progressive exertional dyspnoea and irreversible airflow obstruction, the most likely clinical diagnosis is pulmonary emphysema or chronic obstructive pulmonary disease (COPD). We report a 45-year-old male smoker who was initially suspected to have such a disease but was eventually diagnosed as having idiopathic constrictive bronchiolitis by lung biopsy, clinical history, and laboratory findings. A finding on lung computed tomography of diffuse hyperinflation but few low attenuation areas and relatively well-preserved diffusing capacity of carbon monoxide seems to be the key for suspecting this rare clinical entity. The pathological difference between this bronchiolitis and small airway disease observed in COPD will be also discussed.
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ranking = 2.2654650027528
keywords = capacity
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